RESUMEN
PURPOSE: The aim of the present study was to analyze major and minor complications-including long-term impairment of intestinal, bladder, and sexual function-following surgery for deeply infiltrating endometriosis using anterior rectal resection. METHODS: Patients who had undergone anterior rectal resection due to endometriosis between 2001 and 2011 were included (n = 113). Clinical and surgical data, as well as minor and major complications, were recorded. A questionnaire was sent to the patients and also to a healthy control group (n = 100). RESULTS: Major complications occurred in 15.9% of cases and minor complications in 15%. Patients with postoperative ileostomies (n = 8) initially had ultralow anastomoses significantly more often. The questionnaire response rate was 77%, with a mean follow-up period of 85.9 months. Weak urinary flow was reported by 22.4% of the patients: a feeling of residual urine by 18.4%; more than one bowel movement/day by 57.5%; and insufficient lubrication during intercourse by 36.5%. These results differed significantly from the control group. Subgroup analysis showed no statistical associations between questionnaire responses and major or minor complications, ultralow anastomoses, bilateral dissection of the sacrouterine ligaments, or dissection of the vagina and rectovaginal space. CONCLUSIONS: The major complication rate was consistent with the literature, but there were fewer minor complications. Patients with bowel anastomoses below 6 cm (ultralow) should receive information postoperatively about the high risk of insufficiency and should be closely monitored. The high rate of bladder, bowel, and sexual function impairment, and inadequate data make further prospective studies on this topic necessary.
Asunto(s)
Endometriosis/cirugía , Complicaciones Posoperatorias/epidemiología , Recto/cirugía , Adulto , Defecación , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Femenino , Humanos , Retención Urinaria/epidemiologíaRESUMEN
BACKGROUND: Standardized methods to measure peritoneal cytokine production do not exist. This feasibility study examines the use of microdialysis to monitor perioperative peritoneal mediator production in patients following abdominal surgery for infective or non-infective conditions. MATERIALS AND METHODS: At the beginning of the operation, a microdialysis catheter was placed between the patient's parietal peritoneum and the muscular fascia of the abdominal wall in the connective tissue bed. The device was irrigated (18 microL/h, Ringer's solution/0.05% albumin) for up to 7 days. Samples of the dialysate were collected at least twice a day, and concentrations of interleukin (IL)-6 and monocyte chemoattractant protein (MCP)-1 were measured by an ELISA technique. Four of the nine patients included had proved intra-abdominal infections. RESULTS: In uninfected patients, IL-6 concentrations peaked 8 h after skin incision (mean +/- SEM): 1696 +/- 1292 pg/mL and dropped rapidly to significantly lower concentrations (less than 400 pg/mL) thereafter. MCP-1 concentrations also peaked at 8 h (12787 +/- 6893 pg/mL). In the following days, MCP-1 concentrations were variable between 1000 and 5000 pg/mL. In infected patients, early IL-6 production tended to be higher and that of MCP-1 tended to be lower than in uninfected patients. Catheters were removed between day four and day seven when the system failed or when the patients became mobile without any clinical symptoms of complications. CONCLUSION: The samples derived from microdialysis were suitable to measure sub-peritoneal mediator profiles during surgery and up to 7 days postoperatively. Microdialysis data should be validated for a potential correlation with the clinical course.
Asunto(s)
Citocinas/metabolismo , Neoplasias Gastrointestinales/cirugía , Microdiálisis/métodos , Peritoneo/metabolismo , Abdomen/cirugía , Adulto , Anciano , Quimiocina CCL2/análisis , Quimiocina CCL2/metabolismo , Citocinas/análisis , Ensayo de Inmunoadsorción Enzimática , Estudios de Factibilidad , Femenino , Humanos , Interleucina-6/análisis , Interleucina-6/metabolismo , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Atención Perioperativa , Proyectos Piloto , Complicaciones Posoperatorias/diagnóstico , Periodo Posoperatorio , Muestreo , Sensibilidad y EspecificidadRESUMEN
In injured patients, it has been shown that a polymorphism of the tumor necrosis factor-beta (TNFbeta) gene is related to the development of sepsis. We investigated the relation of TNFbeta gene polymorphism with the development of severe complications after elective major abdominal operations, and with production of TNFalpha perioperatively. In the present investigation, the Ncol polymorphism was studied in genomic DNA isolated from the blood of 172 patients. Preoperatively and postoperatively, lipopolysaccharide (LPS)-stimulated production of TNFalpha in the patients' whole blood was tested in vitro. Genotypes and TNFalpha production were related to the occurrence of severe complications. Postoperatively, 15% (n = 26) of the patients developed severe complications. The overall mortality was 2% (n = 3). The homozygous TNFB2 genotype was found in 54% of the patients, the homozygous TNFB1 genotype was found in 14% of the patients, and the heterozygous genotype was found in 32% of the patients. In patients with complications, the B2B2 genotype was much more frequent (21/26, 81%) than in those without complications (72/146, 49%; P < 0.003). The development of complications was associated with a lower capacity to produce TNFalpha 3 and 7 days after the operation. In patients without complications, the TNFbeta polymorphism was not related to different levels of TNFalpha production. These data indicate an association between TNFbeta polymorphism and postoperative complications and they suggest the B2/B2 genotype as a high risk factor for the development of sepsis after elective operative trauma.
Asunto(s)
Predisposición Genética a la Enfermedad , Polimorfismo Genético , Complicaciones Posoperatorias/etiología , Factor de Crecimiento Transformador beta/genética , Adulto , Anciano , Anciano de 80 o más Años , Esófago/cirugía , Femenino , Genotipo , Homocigoto , Humanos , Intestinos/cirugía , Lipopolisacáridos/farmacología , Masculino , Persona de Mediana Edad , Páncreas/cirugía , Riesgo , Sepsis/prevención & control , Estómago/cirugía , Factores de TiempoRESUMEN
The aim of the study was to compare peritoneal and systemic production of interleukin 6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) in uninfected patients and in patients with peritonitis. Peritoneum was excised at laparotomy for acute peritonitis (n = 22) or noninfectious reasons (n = 61), and was incubated with or without lipopolysaccharide (LPS). Mediator concentrations in the culture-supernatants, in the patients' serum, and in plasmasupernatants of LPS-stimulated whole blood were related to outcome. Spontaneous production of IL-6 by the peritoneum was increased in infected patients compared with uninfected patients. In contrast to IL-6, LPS-stimulated production of MCP-1 was significantly less in infected patients. Serum concentrations of both mediators were higher in infected patients and the highest concentrations of MCP-1 were in patients who died. LPS-stimulated production of IL-6 in whole blood was least, whereas that of MCP-1 was greatest in infected patients who died. These contrasting results for local and systemic production of mediators illustrate the compartmentalized immune response to intra-abdominal infection.