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PubMedDate not supplied

Imaging of early postoperative complications after polypropylene mesh repair of inguinal hernia.

PURPOSE: We report our experience with the use of US and CT in postoperative complications of inguinal hernioplasty using a prosthetic polypropylene mesh. MATERIALS AND METHODS: This study was divided into two parts. In the first we evaluated the in-vitro sonographic and CT appearance of a fragment of prosthetic mesh. In the second, we retrospectively reviewed the imaging findings in 31 patients (aged 42 to 75 years) examined after inguinal hernia repair between December 2000 and December 2002. Seventeen hernias had been repaired with a laparoscopic approach, and the others with the anterior tension-free technique proposed by Lichtenstein (12 cases) and Trabucco (2 cases). Sonography was performed to assess suspected complications between the second and the fourth postoperative day. Both high-resolution 7.5-10 MHz linear transducers and a 3.5 MHz convex probe were employed to ensure complete evaluation of superficial and deep structures. Eight obese patients also underwent CT for confirmation of the US results. RESULTS: At sonography the prosthetic mesh appeared as a linear hyperechoic image measuring about 2 mm in thickness, with posterior acoustic shadow and a finely irregular surface. Only one of the 17 patients examined after laparoscopic inguinal hernioplasty had a seroma; in the other 14 repaired with the anterior tension-free technique we identified 2 abscesses, 3 seromas, 2 "foldings" of the prosthetic mesh, and 2 mesh displacements with associated recurrence of hernia. CT confirmed the US results as to the presence of fluid collections, and visualised the prosthetic mesh in only 2/8 cases. CONCLUSIONS: Sonography is a useful means of assessing postoperative changes in laparoscopic and in anterior tension-free hernia repair. It can differentiate these complications from recurrences of hernia. Colour-Doppler US can also correctly detect normal blood flow of the testes. Sonography is the only technique that can easily demonstrate the prosthetic mesh in the abdominal wall.

Abscess↗
PubMedDate not supplied

Iatrogenic metatarsal coalition: a postoperative complication of adjacent V-osteotomies.

The authors present a case report of iatrogenic metatarsal coalition, a postoperative complication of adjacent V-osteotomies. The paper also includes a discussion of surgical considerations of multiple adjacent osteotomies contributing to such a sequela, including adequate irrigation, instrumentation, anatomy, and the use of corticosteroids.

Adrenal Cortex Hormones↗
PubMed2006

Using a collaborative approach to reduce postoperative complications for hip-fracture patients: a three-year follow-up.

BACKGROUND: To reduce perioperative complications for hip fracture, (1) patients were assigned admitting service using a simple clinical algorithm, (2) evidence-based guidelines and order sets were implemented for perioperative care; (3) a nurse specialist facilitated adherence to evidence-based interventions and mobility goals; and (4) patients and families were given an educational brochure highlighting the daily hospital course. METHODS: A case series with pre/post intervention comparison was conducted for all patients with hip fracture (preintervention n = 97, postintervention n = 589) at 9 months before and 33 months after the intervention. RESULTS: The algorithm assigned approximately one-third of patients to each of the three general services, with few to subspecialty services. Miscellaneous complications were almost eliminated, and significant reductions were observed in the proportion of patients with iatrogenic complications and postprocedure hemorrhage and hematoma. The percentage of patients with any postoperative complication fell from almost 60% to less than 10% by the end of the study. CONCLUSIONS: This study provides preliminary data from which to investigate the effectiveness of collaborative approaches to management on the outcomes of care for medically complex and geriatric surgical patients.

Cooperative Behavior↗
PubMed1992

[Comparative study of postoperative complications in primary and secondary implantation of posterior chamber intraocular lens in cataract surgery for diabetic patients].

Postoperative complications of diabetic cataract cases with active stage diabetic retinopathy, which underwent simultaneous extracapsular lens extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation in 84 eyes, ECCE only in 38 eyes and secondary implantation of PC-IOL after ECCE in 23 eyes, were studied. In the eyes of the primary PC-IOL implantation group, fibrous response in 35 eyes (42%), posterior iris synechia in 10 eyes (12%), progression of diabetic retinopathy in 13 eyes (16%), after cataract in 11 eyes (13%), pupil capture in 4 eyes (5%) and decentration of lens optics in 3 eyes (4%) were appeared, while in the ECCE only group, fibrous response in 11 eyes (29%), posterior iris synechia in 4 eyes (11%), after cataract in 11 eyes (29%), progression of diabetic retinopathy in 6 eyes (16%) were observed. On the other hand, in the secondary PC-IOL implantation group, only fibrous response was appeared in 1 eye (4%), Although PC-IOL implantation has been so far considered contraindication in cases with cataract combined with active stage retinopathy, the present studies strongly suggest that secondary PC-IOL implantation would be good indication in these cases whose blood sugar was properly controlled and the retinopathy was burned out by panretinal photocoagulation soon after ECCE.

Aged↗
PubMed1976

Acute cholecystitis as a postoperative complication.

The clinical course and management of 40 patients who underwent operation for acute cholecystitis developing as a postoperative complication were reviewed. Of note was the mortality of 47%, the high incidence of gangrene, perforation, empyema, and cholangitis, and the atypical clinical presentation of acute cholecystitis under these conditions. Awareness of this possible complication, knowledge of its clinical features, and early surgical intervention are important facets of successful management.

Acute Disease↗
PubMed1994

[Postoperative complications in cataract surgery. Results of a prospective study of 3,429 operations with various wound sutures].

We analyzed the postoperative complications in a prospective study of 3,429 cataract operations: over 95% phacoemulsification and 4% ECCE. In more than half of the procedures, the no-stitch technique with implantation of a standard PMMA IOL was used. Postoperative wound-closure complications were more frequent in the group of corneoscleral incision with double running suture: hypotony (under 5 mmHg) in 5%, wound dehiscence with iris prolapse in 1.9%. In the series with the no-stitch technique, hypotony occurred in 1.8%. Other wound-closure complications were eliminated to a pro mille level. Intraocular inflammation with fibrin exudation was also reduced by the no-stitch technique (4.2 vs 7.4%).

Cataract Extraction↗
PubMed1992

[Prognostic analysis for postoperative complications of abdominal surgery in the elderly].

In order to evaluate the prognostic importance of the conditions before abdominal surgery for patients over 60 years of age. Multivariate analyses of postoperative complications were performed in 634 patients (comprising 525 cases of elective abdominal surgery and 109 cases of emergency abdominal surgery). The Mortality rate was significantly higher (p < 0.01) in the emergency group (11.9%) and relatively low among the elective abdominal surgery group (3.8%). In the emergency group, 13 patients died, and MOF (multiple organ failure) was found to be the direct cause of death in 11 (85%). Although, the majority (75%) of emergency operations were for benign disorders, the remainder (25%) had malignant tumors. It is noteworthy that among 25% of cases, obstructions and perforations due to large bowel cancers were found to be 59% and 19%, respectively. In the elective surgery group, postoperative pulmonary and cardiovascular complications were found in 11.6% and 9.6%, respectively. Death due to cardiovascular problems in rare (5%), however, postoperative pneumonia was the cause of death in 70% of all of postoperative death. Risk factors affecting postoperative pulmonary complications were malnutrition, advanced age, male sex, malignant disease, dementia, cerebrovascular disorders, impaired pulmonary function tests. Surprisingly, the risk factors were identical, except for impaired pulmonary function, for postoperative MRSA pneumonia. In our study, postoperative pulmonary death was not associated with impaired pulmonary function, and it appears to be rather affected by the presence of cerebrovascular disorders and malnutritional state. A poor nutritional states (< 40 according to Onodera's nutritional index) was present in over 50% of patients with cerbrovascular disorders and low ADL.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed2002

Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complications.

AIM: To determine whether the use of azathioprine/6-mercaptopurine before colectomy is associated with an increased rate of postoperative complications. METHODS: All patients who underwent colectomy with ileal pouch-anal anastomosis for ulcerative colitis between 1997 and 1999 were identified. Medical records were abstracted for demographics, extent and duration of disease, dose and duration of corticosteroids and azathioprine/6-mercaptopurine, albumin, and Truelove/Witts score. Early (30-day) and late (6-month) complications were identified. Noncorticosteroid immunosuppressive use was coded as none, azathioprine/6-mercaptopurine within 1 week of surgery, or therapy with other immunosuppressive agents within 1 month of surgery. A logistic regression analysis assessed the association between these variables and complications. RESULTS: Early complications occurred in 49 of 151 (32%) patients not treated with immunosuppressive agents, 12 of 46 (26%) azathioprine/6-mercaptopurine-treated patients, and 4 of 12 (33%) patients treated with other immunosuppressive agents (p = 0.71). Late complications occurred in 72 of 148 (49%), 20 of 46 (43%), and 8 of 12 (67%) patients in these same groups, respectively. Intravenous or oral steroids at doses of 40 mg/d or greater (p < 0.01) and severe or fulminant disease (p = 0.0094) were associated with greater early complication rates. CONCLUSION: Early complications after restorative proctocolectomy for ulcerative colitis are associated with high dose steroids and severe disease but not use of azathioprine/6-mercaptopurine.

Adolescent↗
PubMed2000

Postoperative complications of chronic subdural hematomas: prevention and treatment.

The treatment of chronic subdural hematoma seems simple and effective; however, postoperative complications like recurrence of hematoma, pneumocephalus brain collapse, and intracervical hemorrhage still occur in some patients, and these complications are dependent on surgical technique, patient's age, and preexisting morbidity.

Hematoma, Subdural, Chronic↗
PubMed1984

Postoperative complications in abdominal vascular surgery.

Two hundred patients who consecutively underwent abdominal vascular surgery were retrospectively studied with regard to early (less than 30 days) postoperative complications. The mortality was 4% after elective surgery and 30% after emergency surgery, which was chiefly for aortic aneurysm. The main causes of death were cardiac and renal diseases. Postoperative morbidity was mainly of cardiopulmonary or renal origin. Quantitatively, however (length of hospital stay), the foremost complications were local--haematoma, lymph fistula and necrosis in the incisions, especially in the groins. Against this background, the importance of scrupulous technique in vascular surgery is stressed.

Abdomen↗
PubMed1989

[A simple point score for definition of the risk of postoperative complications].

During a 5-year-period we recorded prospectively 5,823 patients who had undergone general surgery and documented the postoperative complications as wound infection, pneumonia, reoperations and death. A score including all these complications was developed to evaluate the risk of an operation more exactly than using the wound infection rate alone. This method seems to provide a continuous monitoring and the comparison of the complication risks of certain operations within a quality assurance program. For gastric and colon surgery we found a correlation between postoperative antibiotic use and score, but not between score and postoperative hospitalization time.

Anti-Bacterial Agents↗
PubMed2004

[Postoperative complications after orthotopic liver transplantation: clinical analysis of 18 cases].

OBJECTIVE: To investigate experience in diagnosis and treatment of postoperative complications in patients undergoing orthotopic liver transplantation (OLT). METHODS: Complications, treatment and management following liver transplantation in 16 cases were analyzed retrospectively. RESULTS: Of 16 patients, 5 patients had advanced liver cirrhosis, 7 primary liver carcinoma, 1 liver failure after hepatectomy for liver cancer, 1 Wilson's disease, 1 chronic renal failure and liver cirrhosis and 1 acute live failure. Twelve patients survived, the longest survival was 4 years. Complications following OLT included: intra-abdominal bleeding in 3 cases, intracerebral vascular lesions in 2, pulmonary infection in 6, adult respiratory distress syndrome in 2, suprahepatic inferior vena caval occlusion in 2, hepatic artery thrombus in 1 case, bile duct stone or sludge in 3, bile leakage in 1 case, acute rejection in 2, chronic rejection in 2, acute renal failure in 2. Six patients died during perioperative period, one patient died of intracerebral bleeding, one from adult respiratory distress syndrome, one of acute renal failure one of hepatic artery thrombus, one of acute rejection and one of liver failure. CONCLUSIONS: Proper prevention and treatment can effectively reduce complications following OLT during perioperative period. The timely diagnosis, treatment and prophylactics are necessary to prevent these complications.

Adult↗
PubMed1985

[Postoperative complications in colonic cancer patients].

The immediate results of radical surgery in 367 cases of colonic cancer were analysed. The rate of postoperative complications was found to be in correlation with the surgical procedure and certain indexes of homeostasis. Complications developed in 50.4% of cases, pyo-inflammatory ones--in 162 cases. 71.2% of cases of postoperative peritonitis were due to failure of intestinal anastomosis.

Abscess↗
PubMed1996

Pulmonary function and postoperative complications after wedge and flap reconstructions of the main bronchus.

Between 1980 and 1989, 8 wedge and 17 flap main bronchoplasties were done in 24 patients (4 carcinoid tumors, 4 benign lesions, 17 carcinomas). Bronchial anastomotic stenoses, pulmonary function, and survival were evaluated. Preoperative ventilation/perfusion scans with preoperative and postoperative spirometry were done in all patients except two who underwent a wedge bronchoplasty. Postoperative bronchoscopy was done in all patients. Follow-up was complete for the patients with carcinoma (N = 17). In the wedge group bronchial anastomotic stenoses occurred in three (38%) of eight patients. All three patients had serious postoperative complications (persistent atelectasis in one, prolonged ventilatory support in two); one patient died and the other two had impaired postoperative pulmonary function. Complete function recovery occurred in only three (38%) of eight patients who underwent wedge bronchoplasty. In the flap group, bronchostenosis occurred in 3 (18%) of 17 patients. The associated complications (mucus retention, minor atelectasis, partial lobar torsion) were mild. Complete pulmonary function recovery occurred in 13 (76%) of 17 patients who had flap bronchoplasty. Actuarial survival, for the patients with carcinoma, was 88%, 47%, and 41% after 1, 3, and 5 years, respectively. The local recurrence rate was 25% (4/16). In our series, flap main bronchoplasties were effective for the resection of bronchial tumors with local involvement of the adjacent main bronchus. Wedge main bronchoplasties, however, were associated with substantial postoperative complications.

Adult↗