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PubMed1992

[Tarsoconjunctival transposition. Causes, prevention and possibilities for correction of postoperative complications].

The Hughes' tarsoconjunctival flap technique has proved to be a reliable operative procedure for the treatment of large lower-lid defects for more than 55 years. The Hughes' procedure has maintained its importance despite the development of numerous other operations, two reasons for this being that there have now been several modifications to this technique and that the lids do not have to be closed as long. To help the surgeon avoid and eliminate problems and errors in the operative technique we provide details and some useful tricks we have learned over the years while treating over 50 patients. The causes, prophylaxis, and correction of postoperative complications are described for the following: lowering the lid margin; thinning of the lid in the area of the tarsal transposition; lymph edema of the transplant; lid margin defects, and dehiscence of the wound; corneal epithelial defects; trichiasis caused by lanugo hair; keratinization of the lid margin; ectropion of the conjunctiva; retraction of the upper lid, and entropion of the upper lid. If these details are taken into consideration, the Hughes' procedure is a simple operative technique that is free of serious complications and gives good results in the reconstruction of the lower lid.

Entropion↗
PubMed1991

[Gallbladder extirpation in The Netherlands; frequency, surgical mortality and postoperative complications (1987-1989)].

In view of the fast-growing popularity of laparoscopic cholecystectomy, a retrospective analysis was made of 'traditional' cholecystectomy in the Netherlands in the period 1987-1989 (data provided by the Health Care Information Centre Foundation), as compared with the period 1979-1981 (data provided by the Medical Registration Foundation). As regards frequency, the number of cholecystectomies had decreased by 25.5% compared with the period 1979-1981. The number of cholecystectomies with exploration of the choledochus had decreased by 43.8%. The surgical mortality in the period 1987-1989 amounted to 1.4%. Postoperative complications, including wound infections, were relatively infrequent, occurring in 4.3% and 1.5%, respectively, of the patients. Acute cholecystitis, age greater than 70 years and choledochus exploration proved to be risk factors with substantially higher surgical mortality and postoperative morbidity.

Aged↗
PubMed1983

[What determines the prognosis following cholecystectomy: anamnesis, surgical findings, postoperative complications?].

In 346 patients followed up 6, 12, 24 and 48 months after cholecystectomy the clinical results (VISICK and self-assessment) were very good in over 80%, 1% had symptoms due to organic disturbances and 15-20% had mostly mild symptoms (pain, fullness, food tolerance) without detectable causes. These functional disorders were found frequently in female patients with long preoperative history and frequent attacks of pain. Age of patient, character of pain, therapy before the operation, postoperative complications or change of body weight showed no correlation with later results. The results were almost always good in patients with acute pancreatitis or acute cholecystitis before the operation, or who underwent choledochotomy.

Age Factors↗
PubMed1989

[Use of pervomur solutions in the complex treatment of suppurative postoperative complications and local suppurative infection].

The author used 0.8 and 1.2% solutions of pervomur for complex treatment of purulent postoperative complications and local purulent infection by the method of washing drainage and application in 68 patients which made healing the wound quicker and shortened staying of the patients at the hospital. The authors recommend to widely use solutions of pervomur in complex treatment of purulent wounds especially infected by anaerobic infection.

Animals↗
PubMed1984

[Role of cross-infection in the development of postoperative complications].

The increased intensity and volume of surgical interventions in large surgical hospitals leads to a greater amount of postoperative complications. Intrahospital strains of infections are responsible for some of such complications. The complex investigations of the microbiological background allowed the range of prophylactic measures against gram-positive microflora to be enlarged.

Carrier State↗
PubMed1994

[Laser in the prevention of early postoperative complications in the surgical treatment of obesity].

The results of conduction of operative interventions in 37 patients with alimentary-costitutional obesity are adduced. In 22 of them having the obesity of III-IV stages the small stomach 100-150 ml in volume was constructed puuling in it too tight with a synthetic ribbon. In 1-1.5 years after the operation patient loses 70-80% of excessive body mass, and severe metabolic disturbances never occur. In 15 patients cutaneo-subcutaneous aprons on the abdomen were excised. Intravascular blood irradiation with the help of helium-neon laser for the prophylaxis of early postoperative complications occurrence was conducted. The stimulating action of laserotherapy on the cell and humoral immunity groups, alike central and peripheral hemodynamics improvement, moderate hypocoagulating and analgetic effect, lowering of the purulent-septical and thromboembolic complications in 1.5-2 times was noted.

Adult↗
PubMed1995

Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip.

We prospectively studied 367 patients who had a fracture of the hip, to determine the effect of an operative delay on postoperative complications and on the one-year mortality rate. All of the patients were at least sixty-five years old, cognitively intact, living at home, and able to walk before the fracture. An operative delay was defined as an interval of three calendar days or more between the time of admission to the hospital and the operation. The operation was performed within two calendar days after admission in 267 (73 per cent) of the patients. When the factors of the patient's age and sex and the number of pre-existing medical conditions were controlled, it was found that an operative delay beyond this period approximately doubled the risk of the patient dying before the end of the first postoperative year. When the patient's age and sex and the severity of pre-existing medical conditions were controlled, there was also an increase in mortality associated with an operative delay, although this was not significant. With the numbers studied, an operative delay beyond two calendar days did not have a significant effect on the prevalence of complications during hospitalization. We concluded that an operative delay of more than two calendar days after admission is an important predictor of mortality within one year for elderly patients who have a fracture of the hip and who are cognitively intact, able to walk, and living at home before the fracture. Optimally, such patients should have the operation within two calendar days after admission to the hospital.

Activities of Daily Living↗
PubMed1993

Indications and limitations for CT-guided stereotaxic surgery of hypertensive intracerebral haemorrhage, based on the analysis of postoperative complications and poor ability of daily living in 158 cases.

The authors have studied the indications and limitations for computerized tomography (CT)-guided stereotaxic surgery (CTGS Surgery) of hypertensive intracerebral haematomas (ICH), based on the analysis of 158 patients in our institutions. Of 158 patients, 120 had putaminal haemorrhage, 21 thalamic, 14 subcortical and 3 in other locations. The patients ranged in age from 37 to 82 years (average 60). Haematoma volume ranged from 8 to 140 ml (average 43). Eleven patients in the series worsened postoperatively because of rebleeding in 6 cases, cerebral infarction in 2, and unknown causes in the remaining 3 cases. Seven of the 11 patients pre-operatively had untreated hypertension and 3 had mild liver dysfunction without major haemorrhagic tendency. Most postoperative complications were seen in older patients and in those with severe neurological deficit or chronic disease. All these cases ended in poor outcome. From our study, we propose three indications for CTGS Surgery: absolute, aggressive and passive indications. The absolute indication is applied to those who would have been operated on by conventional open surgery. The aggressive indication is for those with mild neurological deficit so that early rehabilitation can be started to regain higher cerebral function. The passive indication is for elderly patients and those with severe neurological deficit or chronic disease. This indication must be decided carefully because poor outcome is likely.

Activities of Daily Living↗
PubMedDate not supplied

Effects of intraoperative blood transfusion on postoperative complications and survival after orthotopic liver transplantation.

BACKGROUND/AIMS: Massive blood transfusion related to the coagulation disorders occurring during the anhepatic and reperfusion phases, remains a serious problem during orthotopic liver transplantation. To analyze the influence of intraoperative blood transfusion on postoperative complications, and survival and to identify the preoperative variables associated with greater intraoperative bleeding, 100 orthotopic liver transplantations, carried out on adults, were reviewed in our center. METHODOLOGY: Patients were grouped into three categories according to intraoperative blood volume transfused; group A, 1.5 or less blood volumes transfused; group B, > 1.5 and < 3 volumes used and group C, 3 or more volumes given. RESULTS: Group C patients had a higher incidence of upper abdominal surgery (p < 0.01 between groups C and A. and p<0.05 between groups C and B); higher values of postoperative total bilirubin and SGOT, and lower prothrombin activity. Acute rejection and steroid-resistant episodes per patient occurred less commonly (p <0.01 between groups C and A) and so did chronic rejection (p <0.05 between groups C and B). Higher infection rate, and gastrointestinal and intraabdominal complication rates were also noticed in groups C and B (p < 0.01 and p < 0.05 respectively). Patient survival rates were lower in group C (p < 0.05 between groups C and A). CONCLUSIONS: It was concluded that previous upper abdominal surgery was the only preoperative factor associated with massive blood transfusion. Poor graft function during the first days after transplant, higher incidence of infections, higher incidence of gastrointestinal and intraabdominal complications, and lower rejection episodes and survival for patients receiving intraoperatively large amounts of blood can be expected.

Adult↗
PubMed1977

[Results of the Wertheim-Meigs hysterectomy with special regard to postoperative complications].

From 1965 to 1975, 232 radical hysterectomies (using the Wertheim-Meigs method) were performed in the Department of Obstetrics and Gynecology, University Hospital, Mannheim. Statistical evaluation showed that the average patient was 43,3 years old. In more than 50 percent of all cases the reason for admission to hospital was given as bleeding problems and contact bleeding, in 30 percent of the cases the readon was given as suspicious cervical os findings. 80 percent of all patients were operated on in stage Ia or Ib. An indwelling catherer was in place for an average of 14.96 days. Postoperative complications occurred in 194 (83.62%) patients. Of those, a majority (71.55%) was found to be an urological problem. Wound healing disturbances amounted to 12 percent of all cases. The mortality rate was 1.29 percent.

Abdominal Muscles↗
PubMed1999

[Postoperative complications of surgery for malignant tumors of the thyroid gland].

In order to assess the main complications following surgical treatment of thyroid neoplasms, a prospective-historical study was made in 145 patients operated between 1985 and 1997. Permanent hypocalcemia was encountered in 3.3% of our cases, and unilateral nerve injury in 2.2%, with 0.7% of fatal complications. The remain complications evaluated include: serohematoma, postoperative bleeding, and wound infection. To sum up, surgery of the thyroid neoplasms is a relatively safety procedure. The incidence of complications is similar to the surgical treatment of the remainder thyroid diseases.

Adolescent↗
PubMedDate not supplied

[Surgical experience with 50 transplantations of neoprene-occluded segmental pancreas. Technique and postoperative complications].

UNLABELLED: Since the beginning of our pancreas transplantation program in November, 1987, 50 patients have received a segmental intraperitoneal neoprene-occluded pancreas graft and a contralateral kidney graft. The aim of this study is to present our surgical technique and the postoperative complications encountered. Operation in the donor: subtotal pancreatectomy is performed. A venous patch is preserved at the end of the splenic vein. The splenic artery is removed with a patch taken from the end of the celiac trunk and the origin of the common hepatic artery, even in case of right (n = 1) or left (n = 4) hepatic artery. The canal is injected with neoprene (2 to 3 cc) ex vivo and the pancreatic parenchyma is recut after stappling. Operation in the recipient: the transplant is inserted in an extraperitoneal location, between the bladder and the pubic arch, then anastomosed to the external iliac vessels. RESULTS: All pancreas grafts functioned immediately. All patients but 3 are alive at present. Seven pancreas transplants were lost postoperatively due to venous thrombosis (n = 3), hemorrhage (n = 3) and death at D27 (n = 1). Many patients developed peripancreatic fluid collections and/or fistulae (the most frequent complication, probably due to the extraperitoneal site of transplantation). The actuarial survival rate of the patients, kidneys and pancreas after 2 years is 96%, 92% and 80%, respectively.

Actuarial Analysis↗
PubMed1997

[Use of immunochemical studies to predict the course of fibrous cavernous tuberculosis of lung and postoperative complications in patients on chemo and laser therapy].

A total of 103 patients with fibrocavernous tuberculosis of the lung were examined. They all received chemotherapy, including 3 - 4 antituberculous agents. Laser therapy was performed with a UZOR-2K low-energy semiconductor laser. In patients with profound changes in the serum level of protein, with high antigenemia and antibody production, the course of the disease was found to be poor; X-ray positive changes were achieved to a lesser extent, bacterial expellation stopped less frequently and more slowly. The decreases in the serum content of the proteins tested, in the level of antigenemia and antibody production which occur with drug and laser therapies are also an important factor of preoperative preparation, which is highly effective in preventing postoperative complications.

Adult↗
PubMed1981

[Basilar impression and malformation of Arnold-Chiari. Postoperative complications in 126 cases (author's transl)].

Within a period of ten years we operated on 126 cases of basilar impression and/or Arnold-Chiari malformation. Two surgical techniques were employed for decompression of the posterior fossa. In the group I (64 cases) the operation consisted of craniectomy and the dura mater was left open and was fixed to the lateral musculature. The technique of the group II (62 cases) consisted in endotracheal intubation without flexion of the head, position of the head without anterior flexion during the operation and plastic closure of the dura. The dural graft was employed to create more space at the craniocervical joint, to avoid cerebrospinal fluid fistula and to restore the integrity of the dura as a protection for the nervous structures of the posterior fossa. The frequency of postoperative complications and mortality observed in group II was definitely less than in the group I.

Arnold-Chiari Malformation↗
PubMed1990

Preventing postoperative complications in the adult cystic fibrosis patient.

Herein we report on a 27-year-old cystic fibrosis (CF) patient who developed bronchospasm, secretory plugging of the trachea, and pneumothorax following general endotracheal anesthesia for intranasal polypectomy and bilateral Caldwell-Luc procedures at an adult facility. Intranasal polypectomy and paranasal sinus procedures are the most common surgical procedures performed on cystic fibrosis patients, making the otolaryngologist a frequent member of the cystic fibrosis team [8]. As survival improves, the pediatric otolaryngologist will find himself following CF patients into their 20's and 30's. Adult care facilities may not be as familiar with these patients as the surgeon would like. The otolaryngologist's familiarity with the unique perioperative requirements of the CF patient can prove invaluable in such a setting. Preoperative assessment should identify any acute pulmonary changes, assess nutritional status, assure good control of blood glucose levels, and rule out clotting abnormalities. Good perioperative hydration and meticulous attention to pulmonary toilet are of foremost importance in the surgical care of the cystic fibrosis patient. Chest physiotherapy and suctioning of the tracheobronchial tree should precede arousal from anesthesia and extubation. By insisting on appropriate anesthetic and perioperative care, the knowledgeable otolaryngologist may circumvent potential postoperative complications in the cystic fibrosis patient.

Adult↗
PubMed1994

Surgery after radiochemotherapy for stage III lung cancer: postoperative complications and late results.

Fifty-seven stage III lung cancer patients underwent radiochemotherapy and subsequent surgery. Forty radical (R-), six non-radical, and eleven exploratory operations were performed. Pneumonia (five cases), pulmonary insufficiency (one case), bronchial fistula (one case) were the major non-fatal complications. Four deaths due to adult respiratory distress syndrome (ARDS) or pulmonary embolism occurred. Sixty percent of the 10 patients who had no viable tumor at operation survived 3 years, as well as 41% of those who achieved a complete remission by resection and 11% of those with residual disease (R+) after operation. However, the 1- and 2-year survival rates were similar. The main pattern of failure in R- and R+ patients was extra- and intra-RT-field progression, respectively. A slightly higher rate of postoperative complications, with respect to current practice, was observed. However, data lead to argument on the improvement of locoregional control and long-term survival following radical surgery.

Carcinoma↗
PubMed2004

[Preoperative evaluation, anesthetic management and postoperative complications of athetotic type cerebral palsy patients undergoing laminoplasty].

BACKGROUND: The patients with athetotic type cerebral palsy need to have their necks fixed for preventing worsening of their symptoms during surgery. Cervical fixation with a halo vest leads to difficult tracheal intubation and possibility of aspiration. Therefore careful perioperative management is necessary, especially for respiratory complications. However, since it is difficult on the patients with cerebral palsy to perform spirogram correctly, their preoperative respiratory functions are hard to be evaluated. METHODS: We evaluated the relationships between preoperative condition and postoperative complications in 50 athetotic type cerebral palsy patients who had undergone laminoplasty. In addition, we also compared them with non-cerebral palsy patients for laminoplasty without a halo vest. RESULTS: The patients with cerebral palsy showed lower preoperative ADL score, severer symptoms of myelopathy, and decreased %VC in spirogram. We found all of these were related to prolonged postoperative recovery of ADL and longer hospitalization. Two patients with cerebral palsy suffered from aspiration pneumonia after operation, whereas any non-cerebral palsy patients had no remarkable complications. CONCLUSIONS: Careful perioperative management is necessary for cerebral palsy patients undergoing laminoplasty, especially for prevention of aspiration pneumonia.

Adult↗