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At least 577 records · Page 32Linked to original sources
PubMed2001

The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy.

BACKGROUND: The benefit of preoperative biliary drainage in jaundiced patients undergoing pancreaticoduodenectomy for a suspected malignancy of the periampullary region is still under debate. This study evaluated preoperative biliary drainage in relation to postoperative outcomes. STUDY DESIGN: At the Academic Medical Center, Amsterdam, the Netherlands, a cohort of 311 patients undergoing pancreaticoduodenectomy from June 1992 up to and including December 1999 was studied. Of this cohort 21 patients with external or surgical biliary drainage were excluded and 232 patients who had received preoperative internal biliary drainage were divided into three groups corresponding with severity of jaundice according to preoperative plasma bilirubin levels: < 40 microM (n = 177), 40 to 100 microM (n = 32), and > 100 microM (n = 23) were designated as groups 1, 2, and 3, respectively. These groups were compared with patients who underwent immediate surgery (n = 58) without preoperative drainage. RESULTS: The median number of stent (re)placements was 2 (range 1 to 6) with a median drainage duration of 41 days (range 2 to 182 days) and a stent dysfunction rate of 33%. Although patients in group 1 were better drained than patients in groups 2 and 3 (median reduction of bilirubin levels 82%, 57%, and 37%, respectively, p < 0.01), there was no difference in overall morbidity among the drained groups (50%, 50%, and 52%, respectively). There was no significant difference in overall morbidity between patients with and without preoperative biliary drainage (50% and 55%, respectively). CONCLUSIONS: Preoperative biliary drainage did not influence the incidence of postoperative complications, and although it can be performed safely in jaundiced patients it should not be used routinely.

Adult↗
PubMed2002

Abdominal incisions: techniques and postoperative complications.

BACKGROUND AND AIMS: The choice of incision for laparotomy depends on the area that needs to be exposed, the elective or emergency nature of the operation and personal preference. Type of incision may however have its influence on the occurrence of postoperative wound complications. Techniques and features of various incisions are discussed, as well as the incidence of their postoperative complications. METHOD: A medline search was conducted identifying prospective randomised trials, as well as retrospective studies with sufficient follow-up, comparing midline, paramedian, transverse and oblique incisions. RESULTS: Significant differences in wound infection and wound dehiscence rates were not reported. Transverse, oblique and paramedian incisions caused significantly less incisional hernias than midline incisions. However, trials comparing transverse and midline incisions for larger laparotomies did not show significant differences. All four trials comparing lateral paramedian with midline incisions reported incisional hernia rates of 0% after the lateral paramedian incision. Differences with the midline incision were significant. CONCLUSION: Transverse or oblique incisions should be preferred for small unilateral operations. The paramedian incision should be used for major elective laparotomies. The use of the midline incision should be restricted to operations in which unlimited access to the abdominal cavity is useful or necessary.

Abdominal Wall↗
PubMed2004

Cauda equina syndrome as a postoperative complication of lumbar spine surgery.

OBJECT: The term "cauda equina syndrome" (CES) has been used to describe the signs and symptoms in patients with compressive neuropathy of multiple lumbar and sacral roots. This syndrome is well known as an indication for surgical intervention in treating lumbar spine disease, but relatively unknown as a postoperative complication following surgery for disease. In this study the author describes two cases of CES that occurred following uneventful lumbar spine procedures--one microdiscectomy and one decompressive laminectomy. METHODS: Preoperative, operative, and postoperative management is discussed and the relevant literature reviewed. One patient suffered perineal numbness and bowel and bladder difficulty following a decompressive laminectomy. Postoperative imaging studies were negative for residual lesion and the treatment goal pursued was partial long-term resolution of symptoms. The second patient had progressive numbness and weakness in the lower extremities. Results of urgent postoperative magnetic resonance imaging studies were inconclusive and repeated exploration was performed within hours of the initial procedure. The patient made a full recovery, although the intraoperative findings did not reveal a clear cause of the patient's symptoms. CONCLUSIONS: Postoperative symptoms of partial or complete CES represent a medical emergency, especially if they are progressive. It is necessary to perform urgent postoperative imaging in patients, but the results are not always helpful. Surgical exploration is warranted if a mass lesion is demonstrated on imaging studies or if symptoms progress and the disease origin is not clear based on available information.

Adult↗
PubMed1991

[Pancreatic ductal carcinoma. Intra- and postoperative complications in palliative and curative interventions].

During 1982 and 1989 we treated 95 patients with ductal pancreatic carcinoma. Of these, 32.6% (31/95) had resection. The operation lethality was 3% (1/31), the clinical lethality 12% (4/31). The median length of survival was 6,8 months. Almost half of the potential curatively operated patients showed complications. Remarkable, that patients, operated in stages III and IV have been involved over proportionally often. Complications are the intra- and postoperative bleeding, the pancreatic fistulae, the intra-abdominal abscess, the sepsis and cardiopulmonary insufficiencies. 33 Patients underwent palliative operation, where the complication rate was significantly lower. Indeed, 5 patients who got a biliodigestive anastomosis, subsequently developed a pyloric or duodenal stenosis and had to be reoperated. The 30-day-lethality of the palliatively operated patients was 13% (4/33), the clinical lethality was 15% (5/33) and the median length of survival was 5,6 months. 24 patients underwent exploratory laparotomy and 7 patients were inoperable. Due to the higher complication rate in the curatively operated patients and only little higher life expectancy, an extensive surgical treatment of pancreatic carcinoma should only be considered effective in selected cases and in an early stage of carcinoma.

Adult↗
PubMed1990

[Correction of immunological status of patients with cholelithiasis for the prevention of postoperative complications].

An investigation of immune status of patients with chronic calculous cholecystitis prior to operation and in the postoperative period has proved the development of a pronounced secondary immune deficiency involving T and B-systems of the immune control as well as factors of nonspecific resistance. These changes may be considered as risk factors of the development of infectious complications in the postoperative period. Prophylactics of the secondary immune deficiency by administration of Contrical is indicated which permitted the amount of postoperative complications and the period of stay at the hospital to be decreased.

Adjuvants, Immunologic↗
PubMed2006

Postoperative complications following gingival augmentation procedures.

BACKGROUND: Postoperative pain, swelling, and bleeding are the most common complications following soft tissue grafting procedures; however, detailed documentation is sparse in the literature. The aims of this prospective study were as follows: 1) to compare the frequency of complication occurrence after free soft tissue grafting (FSTG) or subepithelial connective tissue grafting (SCTG) procedures; 2) to evaluate the use of an acellular dermal matrix (ADM) as the donor tissue alternative to an FSTG or SCTG; and 3) to identify possible predictors for these complications. METHODS: Seventy-five FSTG and 256 SCTG procedures were performed in 228 patients by a single operator. In five free soft tissue and 84 bilaminar graft procedures, an ADM was used instead of autogenous tissue. Variables such as the duration and location of procedures, smoking history, gender, and age were recorded. Patients were asked to fill out a questionnaire 1 week after the surgeries regarding postoperative pain, swelling, and bleeding. Data were analyzed using the chi2 test and logistic regression analysis. Odds ratios were calculated for moderate and severe adverse outcomes grouped together. RESULTS: The duration of surgical procedures was highly correlated with pain or swelling post-surgically (P = 0.001). Current smokers were three times more likely to experience post-surgical swelling (P = 0.01). Patients who underwent FSTG procedures were three times more likely to develop post-surgical pain (P = 0.002) or bleeding (P = 0.03) compared to those who received SCTG procedures. When an ADM was applied instead of autogenous tissue, the probability of swelling or bleeding was significantly reduced (odds ratio [OR] = 0.46, P = 0.02 and OR = 0.3, P = 0.001, respectively). CONCLUSIONS: Long surgical procedures and smoking may increase the severity and frequency of certain post-surgical complications after gingival augmentation procedures. FSTG procedures incur a higher likelihood for postoperative pain or bleeding than SCTG procedures, whereas the application of an ADM may significantly reduce the probability of swelling and bleeding.

Adult↗
PubMedDate not supplied

[Prevention and treatment of postoperative complications of hepatic echinococcosis].

The paper presents the outcomes of surgical treatment in 117 patients with complicated liver echinococciasis in the past 9 years. Hepatic function and immunity, their pre- and postoperative changes in the combined use of essentiale and T-activin were studied. It has been found that the functional status of the liver, its detoxifying function in particular, largely impairs and immunosuppression develops in patients with complicated liver echinococciasis. The postoperative combined use of essentiale and T-activin led to the normalization of hepatic function and immunity. The combined treatment reduced the incidence of postoperative complications from 34.83 to 17.2%, such as acute hepatic failure, suppuration of a wound and a residual cavity, isolated abdominal abscesses, pleurisy, and pneumonia.

Abdominal Abscess↗
PubMed1987

Neuroleptic malignant syndrome as a possible postoperative complication: a case report.

Neuroleptic therapy for postoperative agitation in a mentally retarded schizophrenic patient is described. Clinical features consistent with neuroleptic malignant syndrome (NMS) developed. NMS is a dangerous, drug-induced complication of neuroleptic administrations that can be a differential diagnostic problem. Already often misdiagnosed, this syndrome is especially likely to be unrecognized in nonpsychiatric settings, and may occur postoperatively. Failure to recognize NMS may lead to reexposures to the offending agent, with potentially grave consequences.

Adult↗