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PubMedDate not supplied

[Postoperative complications and local recurrence of mid-lower rectal carcinoma treated with neoadjuvant chemoradiotherapy and surgery. Preliminary results].

In our study we evaluate postoperative complications and local recurrence in local advanced rectal cancer after preoperative chemoradiation plus surgery. We treated 24 patients, 15 males and 9 females; in all cases the cancer was at stage II or III. Down-staging was observed in 14 patients (58.3%), 2 patients (8.3%) had no residual disease. We performed 2 APR, 20 low anterior resections (10 of which laparoscopic) and 2 transanal local excisions. In postoperative period we observed 8 complications, 4 minor and 4 major ones, with an over-all morbidity of 33.3% and of 16.6% if considering major complications. At present no local recurrence was registered.

Adult↗
PubMed2006

Modified and bilateral retroperitoneal lymph node dissection for testicular cancer: peri- and postoperative complications and therapeutic outcome.

OBJECTIVE: To characterize surgical invasiveness and morbidity and to verify therapeutic efficacy, we reviewed perioperative and postoperative courses and therapeutic outcomes of patients who underwent retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancers. METHODS: The study included 31 patients who underwent retroperitoneal lymph node dissection. A modified template was used if retroperitoneal metastasis was limited to the areas below the level of the renal hilus and above the level of the inferior mesenteric artery (IMA). Perioperative and postoperative courses and complications were reviewed as well as therapeutic outcomes. RESULTS: Overall, 27 perioperative and postoperative complications were observed in 15 patients (48.4%). Superficial surgical site infection and paralytic ileus were seen most frequently. All of them were resolved without special additional treatments; however, patients who underwent retrocrural dissection had a tendency to have severe symptomatic complications such as chylothorax, phrenic nerve palsy and orthostatic hypotension. Antegrade ejaculation was preserved in 94.1% of patients with modified template dissection, whereas no patients with additional dissection below the level of the IMA had the function preserved. One patient (3.2%) developed a postoperative recurrent disease in the retroperitoneum, which was outside the dissection field, as well as in the mediastinum. CONCLUSIONS: Although RLND had high morbidity, most peri- and postoperative complications were manageable conservatively. Modified template dissection enabled patients to preserve antegrade ejaculation without compromising its therapeutic efficacy, if the disease extension allowed us to use the template.

Adolescent↗
PubMed1990

[Results of re-thoracotomy for the management of early postoperative complications after bronchoplastic operations].

We reviewed cases of re-thoracotomy performed for early complications after bronchoplastic procedures. One hundred and sixteen bronchoplasties were performed in our department over 20 years. The diseases for which bronchoplasty was undertaken were lung cancer in 102 patients (87.9%), tuberculous stenosis of the bronchus in eight, esophageal cancer in three, and trauma in three. The most frequent postoperative complication was difficulty of expectoration and atelectasis, which generally improved with conservative treatment. Re-thoracotomy was performed for early postoperative intrathoracic complications on 11 patients. The reasons for re-thoracotomy were bronchial anastomotic dehiscence in five cases, obstruction of bronchial anastomosis in two, atelectasis in two, and occlusion of anastomosis of pulmonary arterial angioplasty in two cases. All except two underwent re-thoracotomy within two weeks of the first operations. The operative procedures performed were completion pneumonectomy in six cases, re-bronchoplasty in three, suture of anastomotic dehiscence in two, patch closure of pericardial defect with aspiration of secretions in the atelectatic lobe in one, and partial decortication with suture closure of the alveolar fistula in one. Pedicled omental wrapping was applied to two patients with re-bronchoplasty and one with completion pneumonectomy. Post-operative complications after re-thoracotomy were anastomotic insufficiency in two cases, bronchopleural fistula in two, and pneumonia in one. Two patients underwent a third thoracotomy. There was no anastomotic dehiscence or bronchopleural fistula in the patients with pedicled omental wrapping. One patient died due to bronchopleural fistula within 30 days of re-thoracotomy. Six patients died of recurrence or pneumonia from 39 days to one year after re-thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchi↗
PubMed2002

[Initial empirical antimicrobial therapy with piperacillin/tazobactam in intra-abdominal infections due to perforation of the large intestine and rectum and in postoperative complications after resection of the large intestine and rectum].

One of the basic therapeutic procedures in surgical intraabdominal infections is early administration of antimicrobial drugs. The basic requirement for the selection of antimicrobial drugs is a broad-spectum bactericide action with low toxicity. Within the framework of a retrospective non-comparative investigation the action of the betalactam antibiotic piperacillin combined with the betalactamase inhibitor tazobactam was tested which was used in the initial empirical antimicrobial treatment of 33 patients with intraabdominal infectious complications caused by perforation of the large bowel or dehiscence of the anastomosis on the large intestine or rectum. Twenty-eight patients developed diffuse inflammation of the peritoneum (caused by perforation of a diverticulum in 17, by dehiscence of the anastomosis on the large intestine and rectum after resection on account of carcinoma in 7, by a penetrating injury of the large bowel and rectum in 3 and by postirradiation necrosis of the rectum in one female patient). Five patients developed an intraabdominal abscess as a complication of diverticulitis of the large intestine or as a postoperative infectious complication after resection of the large bowel and rectum. All patients were operated (resection of the large bowel according to Hartmann, or stoma above the site of injury or dehiscence of the intestinal anastomosis or drainage of the abscess). After surgery administration of piperacillin/tazobactam (4.5 g, subsequently after 8 hours). The period of administration was on average 8 days (5 to 11 days). After surgery the contents of the peritoneal cavity were collected for bacteriological examination incl. evaluation of the sensitivity of the isolated bacteria to piperacillin/tazebactam. From the isolated pathogens 58% were Gram-negative aerobic bacteria, in 24% anaerobic bacteria and in 18% enterococci. In 3 patients antimicrobial treatment was because of resistance of isolated bacteria to piperacillin/tazobactam (Klebsiella species, Pseudomonas aeruginosa) combined with aminoglycosides (amikacin, netilmicin). Postoperative complications developed in 9 patients (27%), incl. 3 who died (9%). In patients with intraabdominal infection caused by perforation of the large bowel and rectum or dehiscence of the anastomosis after resection of the large bowel and rectum piperacillin/tazobactam is the antibiotic of choice for the initial empirical antimicrobial treatment on account of its great efficacy against the majority of isolated bacteria, its safety and low toxicity.

Abdominal Abscess↗
PubMed1999

Relationship of protamine dosing with postoperative complications of carotid endarterectomy.

Protamine sulfate (PS) neutralization of heparin (HEP) given during carotid endarterectomy (CEA) has been previously associated with an increased postoperative stroke rate. Dosing regimens of PS have varied in previous studies. The accuracy of PS dosing and its effect on postoperative complications was analyzed. The medical records of all patients undergoing elective CEAs from January 1993 to June 1996 in our institution were reviewed. A hematoma was defined as either an event requiring return to the operating room or when repeatedly identified in the medical record. The accuracy of dosing PS was determined utilizing a formula calculating the logarithmic exponential decay of HEP, which determined the residual HEP at the time of PS dosing. An ideal PS dose was then calculated and compared to the dose given. Statistical analyses was performed using a Fisher's exact test as well as the Student's t-test. Four hundred-seven CEAs were performed in 365 patients. There were 10/407 (2.5%) postoperative strokes (STROKE) and 11/407 (2.7%) hematomas, 3 of which required reoperation. Results indicate that (1) the administration of PS significantly reduced the incidence of postoperative hematoma; (2) there appears to be an association between the administration of PS and STROKE; (3) the inaccuracy in dosing PS appears to be based on a decision to dose PS to the total HEP given rather than the residual HEP on board at the time of neutralization. The effect of PS overdosing is unclear, but it may play a role in STROKE.

Aged↗
PubMed1978

[Relationship of postoperative complications to the surgical approach in treating cancer of the proximal portion of the stomach].

The authors have analyzed the interrelationship between postoperative complications and surgical approach in the treatment of carcinoma of the proximal portion of the stomach. The radical operations were carried out upon 140 patients; in 93 of them the transperitoneal approach was applied and in 47-the transpleural one. It has been found that in the transpleural approach the insufficiency of anastomosis sutures and postoperative pancreatitis occur much more seldom, and bronchopulmonary complications rate the first. Such complications are not infrequent after the transperitoneal approach either. The disorders of bronchial permeability constitute the main cause in the occurrence of these complications.

Acute Disease↗
PubMed1999

[Strategy of the surgical treatment of postoperative complications in patients with obstructive ileus of the colon of tumorous etiology].

Under analysis were postoperative intraperitoneal complications and results of relaparotomies in 33 patients (13 women and 20 men) aged from 33 to 76 years with obturative ileus caused by stenosing cancer of different portions of the colon. High frequency of peritonitis in the general picture of postoperative complications was due to incompetent sutures of the colonic anastomoses applied during emergency and urgent operations in patients with sub- and decompensated forms of intestinal obstruction. The best variant of completion of radical operations in emergency surgery in this category of patients is the formation of a single- or double-trunk colostomy without a primary reestablishment of the continuity of the intestinal tube especially when stenosing cancer is localized in the left part of the colon.

Adult↗
PubMed1996

["Central islands"--an early postoperative complication after photorefractive keratectomy].

BACKGROUND: After myopic photorefractive keratectomy undercorrected zones in the center of the treated cornea (central islands (CI)) occur early postoperatively occasionally the reason for double-vision, halos and reduction of best corrected visual acuity. PATIENTS AND METHODS: Sixty-two eyes of 33 patients were treated with an 193 nm excimer laser for correction of myopia (range: -1.0 to -12.0 D) and an optical zone of 6.0 mm. The patients were selected consecutively regarding the follow-up examination which ranged from 1 month to 21 months after surgery. RESULTS: At 1 month after surgery the incidence of central islands was 72.6%. It rarely occurs after corrections of -3.0 D and less but may be detected in every case of correction of -6.0 D and more. The correlation between attempted correction and incidence of central islands is statistically significant (p < 0.005). Approximately 21% of the patients were steroid responders whose central islands appeared more marked. CONCLUSIONS: Central islands are an early postoperative complication with a not yet decided cause. Depending on attempted correction (D) and the follow-up the central islands disappear and/or did not result in reduction of visual acuity. In contrast, in patients with increased corticosteroid response the central islands persisted longer (15 months and more). Reoperations because of central islands should not be performed before 6 months after surgery. We describe a new form of central corneal iron deposit.

Adult↗
PubMed2004

Does mechanical bowel preparation have a role in preventing postoperative complications in elective colorectal surgery?

BACKGROUND: mechanical bowel preparation (MBP) consists of orthograde fluid preparation to clean the bowel. MBP is considered to prevent postoperative complications. METHODS: meta-analysis of prospective randomised clinical trials (RCT) evaluating MBP versus no MBP. RESULTS: following a medline search we retrieved 15 prospective trials of which only 5 where RCT comparing MBP versus no MBP in elective colorectal surgery. For the randomised studies, there were respectively 186, 179, 149, 267 and 380 patients, including all type of resections. The total number of patients in these 5 studies was 1144 (565 with MBP and 579 with no preparation). All patients received perioperative antibiotic prophylaxis. Only one of these RCT show a significant decrease in anastomotic leak (AL), but among all the patients enrolled, AL is significantly more frequent in the group with MBP (Odds Ratio 1.8). Wound infection, re-operation and intra-abdominal abscess rates were more frequent in the MBP group but the difference did not reach statistical significance and the odds ratios for a 95% confidence interval were extremely large. CONCLUSION: there is limited evidence in the literature to support the use of MBP in patient undergoing elective colorectal surgery. Available data tend to suggest that MBP could be harmful with respect to the incidence of anastomotic leak. Moreover, MBP does not reduce the incidence of other infectious complications. Further RCTs are needed to establish an evidence-based rationale for the use of MBP in elective colorectal surgery.

Anastomosis, Surgical↗
PubMed1985

[Malignant kidney tumors in old age--postoperative complications and mortality].

Surgery was performed on 38 patients over 70 years of age with malignant renal tumours. The mortality rate (29%) and the incidence of postoperative complications (18%) were relatively high. Various means of preventing these complications, taking the factor of old age into particular consideration, are discussed in this paper.

Age Factors↗
PubMed2005

[The early postoperative complications and cost-effectiveness analysis of non-penetrating trabecular surgery in patients with primary open angle glaucoma].

OBJECTIVE: To compare the early postoperative complications of non-penetrating trabecular surgery (NPTS) and modified trabeculectomy (MT) in patients with primary open angle glaucoma, and to analyze the cost-effectiveness of NPTS to prevent adverse events as well. METHODS: One hundred and forty seven consecutive cases (215 eyes) with primary open angle glaucoma from the glaucoma division, Zhongshan Ophthalmic Center, were involved. One hundred and four eyes underwent NPTS; while 111 eyes underwent MT. Visual acuity, intraocular pressure and complications occurred while staying in the hospital, were recorded. Number of need to treat (NNT) was used to analyze the cost-effective for NPTS. RESULTS: (1) Visual acuity decrease over 2 lines occurred in 25 eyes (24.0%) in NPTS group and 26 eyes (23.4%) in MT group. The difference of visual changes between these two groups was not statistically significant (P > 0.05). (2) One day after the operation, hypotension [IOP less or equal to 5 mm Hg (1 mm Hg = 0.133 kPa)] occurred in 39 eyes in NPTS group (38.2%), and 10 eyes in MT group (9.2%). The difference was significant (P < 0.01). On the day of discharge, the incidence of hypotension was 27.5% in NPTS group and 17.3% in MT group, respectively. The difference was still significant (P < 0.05). (3) Hyphema was found in 20 eyes (19.2%) in NPTS group and ten eyes (9.0%) in MT group. In either group, a surgical procedure was needed in two eyes to evacuate the blood. (4) Two eyes of grade II degrees and five eyes of grade I degrees shallow chamber were found in NPTS group. Five eyes of grade II degrees and five eyes of grade I shallow chamber were found in MT group. The difference of incidence of shallow chamber between these two groups was not statistically significant (P > 0.05). (5) Other complications: In the NPTS group, trabeculo-descemetic membrane rupture occurred in one eye, pupil dilated to 7 mm observed in six eyes; in the MT group, acute elevated IOP occurred in one eye, peripheral anterior synechia at inner incision occurred in one eye, hypotensive macular edema occurred in one eye. (6) The absolute risk ratio (ARR) of NPTS for adverse event was 3.0%, (NNT = 33.2), it costs additional RMB yen 116, 100 for preventing one adverse event. For serious adverse event, ARR = 1.8% (NNT = 55.5), and it costs additional RMB yen 194, 000 to prevent one serious adverse event. CONCLUSIONS: Although the NPTS may reduce the incidence of serious adverse event in comparing with MT, the cost of NPTS is very high, therefore, it is not an optimal procedure in China. Ophthalmologists in the general hospital should familiar with the MT procedure to save the medical expenses.

Adolescent↗
PubMed1989

[Ruptured aneurysm of the abdominal aorta. Successful treatment of potentially fatal postoperative complications].

Forty-four years old patient operated upon for rupture of abdominal aorta aneurysm is presented. His hospital stay was 73 days because of postoperative complications. 22 haemodialysis were attempted because of renal failure. 74 litres of blood was replaced because of massive haemorrhage from nose and gastric mucosa. Once was reanimated after cardiac arrest. Eight days was commatous. At end of hospital stay his physical and mental condition, and renal function is normal.

Acute Kidney Injury↗
PubMedDate not supplied

Preoperative state of mind among patients undergoing CABG: effect on length of stay and postoperative complications.

This study was undertaken to determine if a pessimistic self-assessment prior to an elective coronary artery bypass graft (CABG) was predictive of postoperative complications and increased length of stay (LOS). Subjects (n = 565), aged 65 and older and undergoing elective CABG, were stratified into 2 groups (optimistic, pessimistic) based on their mental health subscale scores prior to surgery. After adjusting for age, gender, and severity of disease, the average LOS for pessimistic patients was 1.3 days longer than for optimistic patients. Despite adjustment for previous CABG, renal failure, peripheral vascular disease, and gender, pessimism was associated with an increased risk of prolonged ventilation time and permanent stroke. Negative state of mind prior to a major cardiovascular intervention may be predictive of increased LOS, permanent stroke, and prolonged ventilation time.

Aged↗
PubMed2000

Postoperative complications of scleral buckling surgery.

The postoperative course of scleral buckling surgery can witness a host of untoward events, which may undo the anatomical success of retinal reattachment. Diligent preoperative identification of all retinal breaks and meticulous intraoperative technique will enhance the likelihood of a tranquil postoperative course.

Humans↗
PubMed1979

Late isolated left ventricular tamponade. Clinical, hemodynamic, and echocardiographic manifestations of a previously unreported postoperative complication.

A unique case of late postoperative left ventricular tamponade, hemodynamically indistinguishable from severe left ventricular failure, is reported in a patient 1 month after an apparently uncomplicated aortic valve replacement. An echo-free space behind the left ventricle led to surgical exploration and successful resolution of the disease process. To our knowledge, this is the first documented case of isolated left ventricular tamponade in the literature. The findings highlight the importance of postoperative echocardiography in the evaluation of the patient having cardiac surgery.

Aneurysm, Infected↗
PubMedDate not supplied

Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions.

The focus of this study was to document postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Data from 172 consecutive patients with newly diagnosed carcinoma of the vulva were studied. One hundred and one patients primarily treated with modified radical vulvectomy and complete inguinofemoral lymphadenectomy using separate groin incisions (n = 187) were included in this study. One or more complications were documented in 77 of the 101 (76%) patients. Complications after groin dissection were observed in 66% of the patients. The main complications were wound breakdown (17%) and/or infection (39%) of the groin, lymphocyst formation (40%), and lymphedema (28%). In 98 of 187 (52%) groin dissections, one or more complications were documented. The presence of lymph node metastases, postoperative radiation, age older than 65 years, and removal of the vena saphena magna were not significant risk factors for the occurrence of complications. The occurrence of early complications after groin dissection was significantly related to the late-complication lymphedema (P = 0.002). Our results confirm relatively high rates of wound breakdown, infection, lymphocyst formation, and lymphedema even with separate groin incisions. The occurrence of early complications was related to lymphedema. No other risk factors could be identified.

Age Distribution↗
PubMed2001

Esophageal resection in elderly esophageal carcinoma patients: improvement in postoperative complications.

BACKGROUND: Advanced age is considered to be a relative contraindication for radical esophagectomy with a three-field lymph node dissection. METHODS: Preoperative risks, postoperative morbidity and mortality, and long-term survival in 55 elderly patients (> or =70 years) who had undergone extensive esophagectomy for esophageal carcinoma were compared with those of 149 younger patients (<70 years). RESULTS: Elderly patients had worse preoperative cardiopulmonary function and had more frequent postoperative cardiopulmonary complications compared with younger patients (p < 0.05). The postoperative death rate was not statistically different between the elderly (10.9%) and younger groups (5.4%). When the study period was divided into an early and a late phase, the postoperative death rate dropped significantly (p < 0.05) in recent years (1.4%) when compared with the previous era (10.0%). The overall survival rates were not different between elderly and younger patients. CONCLUSIONS: Preoperative cardiopulmonary risk factors and postoperative complications after esophagectomy were more frequently noticed in elderly patients than in younger patients. A dramatic improvement in postoperative death was noticed in recent years. The long-term survival of elderly patients after extended esophagectomy was almost similar to that in younger patients.

Aged↗