1,721,079 research outputs found
Malnutrition and postoperative complications in abdominal surgery
No full textWe read with great interest the article by Hennessey et al 1 who studied retrospectively the relationship between preoperative serum albumin and surgical site infection(SSI) in a heterogeneous population of 524 patients undergoing gastrointestinal surgery.A total of 105 patients developed SSI and among them hypoalbuminemia (>30 mg/dL) was significantly associated, both at univariate and multivariate analysis, with the development of SSI, deeper SSI and prolonged inpatient stay. It is well known that malnutrition is a significant risk factor of postoperative complications in major abdominal surgery. Disclosure: The authors declare that they have nothing to disclose. DOI: 10.1097/SLA.0b013e3182306457
However, in the last 3 decades we have assisted to an impressive improvement of anaesthetic and surgical techniques and in an amelioration of postoperative patient management that have led to a reduction of postoperative morbidity and mortality.
At the same time, some recent evidence suggests that being overweight and obesity, rather than malnutrition, are significant risk factors of postoperative complications in major abdominal surgery.
Indeed, in 2008 we published the results of a prospective study that evaluated the incidence of mortality and major and minor postoperative complications in patients who underwent surgery for gastric cancer between 2000 and 2006. In this study, we stratified patients according to the preoperative percentage weight loss (0%–5%, 5.1%–10%, >10%) and serumalbumin levels < 3.0 g/dL; 3.0–3.4 g/dL; ≥ 3.5 g/dL). Interestingly, the rate of major infectious, major non-infectious and minor infectious (as SSI) postoperative complications was similar in patients with serum albumin 8.1%, respectively); between 3.0 and 3.4 (8.8%, 13.3%, 17.7%, respectively) or ≥ 3.5 g/dL (10.5%, 7.9%, 8.7%, respectively). It is difficult to explain the difference between our study and that of Hennessey et al Indeed, the study of Hennessey et al was retrospective and it is unknown if the surgeons or the attending doctors who made the diagnosis of SSI in each case were blinded to the status of serum albumin. In addition, the population studied by Hennessey et al was extremely heterogeneous, including patients who underwent elective or urgent operations on the gastrointestinal tract including stomach, duodenum, gallbladder, small intestine and colon and rectum, whereas we studied only patients undergoing gastric surgery. It has been shown that malnutrition does not re-enter in the risk factors predictive of postoperative morbidity in surgery for malignant gastric tumors.
It seems that role of hypoalbuminemia in the development of SSI varies according to the type of disease, to the type of surgery and to the characteristics of patients
[Laparostomy in the treatment of pancreatic abscess. A case report]
No full textPancreatic abscess is a major cause of death from acute pancreatitis; its reported frequency is between 1.7 and 25 per cent of all patients presenting with acute pancreatitis. The mortality varies between 13 and 54 per cent. Despite apparently adequate initial surgical treatment, the recurrence rate is about 30 per cent. The key to survival in pancreatic abscess is adequate drainage of cavity. Proponents of open treatment claim that it allows better drainage of the viscid content of the pancreatic abscess which often cannot easily pass down a drain. In the present case, following laparotomy for severe intra-abdominal sepsis due to pancreatic abscess, the abdominal cavity was left open to heal by granulation. The procedure permitted early resolution of the septic process. Total parenteral nutritional support resulted in definitive wound healing. We regard laparostomy as a valuable technique in the management of pancreatic abscess; the successful of this technique hinges on expert nursing care and the capability of maintaining complication-free long term parenteral nutrition
Short-term antibiotic prophylaxis in open urologic surgery
No full textThe aim of the present study was to compare the efficacy of a single dose of ceftriaxone with a triple dose of gentamicin as prophylactic agents in patients undergoing open urologic surgery. Fifty-two patients were allocated into two groups which were well matched with respect to sex, age and surgical procedure: --24 were given single-dose ceftriaxone (2 g i.v.) at the time of anesthesia (ceftriaxone group); --28 received gentamicin (80 mg i.v.) at the time of anesthesia and two additional doses of the same antibiotic were subsequently administrated every 8 hours (gentamicin group). The incidence of urinary tract infection (UTI) was 3.5% in the gentamicin group and 0% in the ceftriaxone group (p = n.s.); postoperative fever (greater than 38 degrees C) occurred in 28.3% and 8.3% in the gentamicin and ceftriaxone groups respectively (p = n.s.). There was no clinical or hematological evidence of drug side effects in any patient. Results of the study show that short-term antibiotic regimens can improve UTI rates after open urologic surgery; moreover a single preoperative dose of ceftriaxone resulted to be as effective as three doses of gentamicin
[Role of lymphadenectomy in gastric carcinoma]
No full textControversy still surrounds the value of extensive regional lymphnode dissection in the treatment of gastric cancer. The aim of the present paper is to give this topic a contribution through the review of the literature and the analysis of personal results
ASO Author Reflections: Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery-What We Know and Future Perspectives
No full textN/
Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients
No full textTo compare extensive with limited lymph node dissection in the surgical treatment of gastric cancer, 320 patients undergoing gastric resection during 1981-1990 were divided into two groups. Although patients undergoing extended lymphadenectomy (n = 157) had a longer operating time (P = 0.0001) and a greater intraoperative blood transfusion requirement (P = 0.009) than those receiving limited dissection (n = 163), the incidence of postoperative complications (22.3 versus 28.2 per cent, P = 0.13) and the hospital mortality rate (3.8 versus 7.4 per cent, P = 0.12) were similar in the two groups. The 5-year survival rate after curative resection (117 and 121 patients after extensive and limited lymph node dissection respectively) was 65.4 versus 50.1 per cent (P = 0.01): 85.9 versus 82.2 per cent for stage I disease (P = 0.60), 66.1 versus 57.8 per cent for stage II (P = 0.82) and 48.7 versus 29.8 per cent for stage III (P = 0.02). Multivariate analysis using the Cox model showed that the extent of lymphadenectomy was an independent prognostic factor for survival (P = 0.01). The results support the value of extensive lymph node dissection in the surgical treatment of gastric carcinoma
Protein-sparing therapy after major abdominal surgery: lack of clinical effects. Protein-Sparing Therapy Study Group
No full textA prospective multicenter randomized trial was designed to evaluate the clinical efficacy of postoperative protein-sparing therapy
Validity of serum albumin, total lymphocyte count, and weight loss in predicting postoperative nutrition-associated complications
No full textNOT FOUN
- …
