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["Open palm" technique in Dupuytren's disease. Postoperative complications and results after more than 5 years].

From 1974 to 1988, 868 open palm and/or finger operations were carried out by a surgeon at the SOS Main emergent hand surgery unit in Strasbourg. Out of these, 107 patients making up 140 fingers were seen again after a period of more than 5 years. The essential advantage of the method is the low rate of postoperative complications relative to the other methods involving skin closure. All patients had an ambulatory treatment with regional anesthesia. The palm was opened in 85% of cases, and both the palm and the base of the fingers in 14%. The average healing time was 26 days, with an average sick leave of 28 days. Postoperative pain was noted in 20% of cases, requiring medication in 10% for an average of 3 days. Postoperative bleeding requiring new dressing occurred in one case, after the patient had already been discharged (0.7%), while 3.5% of all patients had anticoagulants. No hematoma and no flap necrosis were noted, and temporary dysesthesia was noted in 4.6% of cases, nerve involvement in 3.1%, and neurovascular dystrophy in 7%, including 4 only with a functional deficit (2.8%). On the other hand, results after 5-6 years are similar to those of selective aponeurectomies published in the literature, with frequent recurrence (40.6%, including 23% severe enough to require second surgery). Extension was noted in 39% of all cases, and the total activity of the disease was present in 55% of all studied hands.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature.

Carpal Tunnel Syndrome (CTS) has been referred to as the most common peripheral entrapment neuropathy. As Mirza and colleagues note, its incidence continues to increase. Einhorn and Leddy cite Palmer's estimated incidence of 1% in the general population and 5% or more of workers in certain industries which require repetitive use of the hands and wrists. Conservative treatment of CTS includes splinting and modification of activities. However, surgical release of the transverse carpal ligament or the flexor retinaculum is an extremely common procedure. The open surgical technique has been used since 1924 and is still considered by many to be the gold standard. In 1989 Oksuto introduced the endoscopic carpal tunnel release (ECTR) with the rationale of potentially decreasing the prevalence of complications. In the ensuing years, endoscopic results have generated a tremendous amount of study and controversy. Berger reported that many "passionate arguments both for and against the use of ECTR" exist. This paper briefly reviews the literature generated by this debate, focusing on one potential postoperative complication: pillar pain. Various definitions of pillar pain are noted, and suggested etiologies are grouped into four categories. This is followed by a brief discussion of the treatment approaches and issues.

Carpal Tunnel Syndrome↗

[Immunological tests in the prognostication of postoperative complications in patients with chronic diseases of the lungs].

The authors examined 50 patients with chronic diseases of the lungs in the pre- and post-operative period. Immunological indices, neutrophil phagocytic activity in the first place, in combination with the laboratory severity index make it possible to conduct effective control of preoperative management and the patients condition in the postoperative period.

Adolescent↗

Delayed gastric emptying after pylorus-preserving pancreatoduodenectomy is strongly related to other postoperative complications.

Patients undergoing pylorus-preserving pancreatoduodenenectomy (PPPD) have a risk of up to 50% for developing delayed gastric emptying (DGE) in the early postoperative course. From 1994 to August 2002, a total of 204 patients underwent PPPD for pancreatic or periampullary cancer (50%), chronic pancreatitis (42%), and other indications (8%). Retrocolic end-to-side duodenojejunostomy was performed below the mesocolon. DGE was defined by the inability to tolerate a regular diet after day 10 (DGE10) or day 14 (DGE14) postoperatively, as well as the need for a nasogastric tube at or beyond day 10 (DGE10GT). Postoperative morbidity was 38%, 30-day mortality was 2.9%, and median postoperative length of stay was 15 days. DGE occurred in 14.7% (DGE10), 5.9% (DGE14), and 6.4% (DGE10GT), respectively. After further exclusion of 21 patients (10.3%) with major complications and no possible oral intake (because of death, reoperation, or mechanical ventilation), the frequencies of DGE10, DGE14, and DGE10GT in the remaining group of 183 patients were 9%, 2%, and 2%, respectively. Multivariate analysis revealed postoperative complications (P<0.001), the presence of portalvenous hypertension (P<0.01), and tumors as indications for surgery (P<0.01) as independent risk factors for DGE10. The overall incidence of DGE was low after PPPD. In those patients experiencing DGE, however, other postoperative complications were the most important factor associated with its occurrence.

Adult↗

Endoscopic sphincterotomy in the management of postoperative complications of hepatic hydatid disease.

The results obtained using endoscopic sphincterotomy (EST) in the management of postoperative biliary complications of hepatic hydatid disease are presented. The outcome was favourable in all eight patients treated with no associated morbidity or mortality. In three patients the clinical manifestations of cholangitis resolved, and in five of six patients the external bile fistula previously present for 26 to 68 days closed within 3 to 15 days. In one patient with a long-standing fistula (5 years) the bile outflow was reduced from 600cc to 50-100cc per day. No complications due to EST were encountered. The results show that EST can be considered the treatment of choice for biliary fistulae following surgery for hepatic hydatid disease and for drainage of bile in patients with cholangitis due to hydatid disease.

Biliary Fistula↗

A comparative investigation of the bowel wall in gastroschisis and omphalocele: relation to postoperative complications.

In gastroschisis the protruding bowel is generally covered by a fibrous coating as a result of prolonged exposure to amniotic fluid but no such coating is found on the exposed bowel loops in a ruptured omphalocele. In patients with gastroschisis, the postoperative course is often complicated by periods of hypoperistalsis. Based on studies of animal models of gastroschisis, various authors have suggested that the postoperative complications might be due to structural defects of the bowel wall. In our own experimental investigation of gastroschisis using chick embryos, we found no evidence of a structural defect of the bowel wall. With a view to clinical substantiation of our experimental findings, we conducted a comparative investigation of patients material, involving 10 cases of gastroschisis, 5 cases of ruptured omphalocele, and 9 cases of intact omphalocele. The investigation revealed an entirely normal structure of the bowel wall in all 10 cases of gastroschisis. On the serosa we noted an inflammation infiltrate rich in collagen fibers, frequently containing squamous cells (vernix) and lanugo. In the cases of ruptured omphalocele, the bowel wall specimens revealed a subacute inflammatory reaction. No major abnormalities were found in the bowel wall of patients with an intact omphalocele. Normal development of the autonomic nervous system was found in all patient material. Severe ischemic changes of the bowel wall were found in 4 of the gastroschisis cases and these were the 4 patients who suffered from postoperative hypoperistalsis. Thus the complications occurring during the postoperative phase of gastroschisis are most probably due to ischemic bowel damage.

Abdominal Muscles↗

Preoperative staging and early postoperative complications in radical prostatectomy. Experiences in 35 cases.

It is already a textbook item that in patients with prostatic cancer stage T1-T2 N0M0 radical prostatectomy is the only curative treatment. Radical prostatectomy is indicated also for patients in stage T3 N0M0 who underwent antiandrogenic (Fugerel) treatment for 3 months with the aim of reducing tumour volume. In the following 35 cases will be scrutinized, with special regard to preoperative staging and early postoperative complications.

Humans↗

Use of the omental J-flap for prevention of postoperative complications following radical abdominal hysterectomy: report of 140 cases and literature review.

Over a 7-year period from 1989 to 1996, 140 patients had an omental J-flap placed following type III radical abdominal hysterectomy. There were no complications as a result of omentopexy, and postoperatively no patient developed urinary fistula, pelvic infection or abscess, or intestinal obstruction even in the 35 patients who received whole pelvic radiation therapy postoperatively. The omental J-flap is a rapid, effective means of minimizing surgical morbidity following radical abdominal hysterectomy and merits consideration for routine placement at the conclusion of radical abdominal hysterectomy.

Adenocarcinoma↗

Comparison of postoperative complications after Küstner and Pfannenstiel transverse suprapubic incisions.

We compared postoperative morbidity with the Küstner (n = 53) and Pfannenstiel (n = 131) incisions in a consecutive series of women undergoing surgery for benign gynecological conditions. The incidence of febrile morbidity (15.1% vs 23.7%, chi 2(1) = 1.19, P = 0.28) and wound infection (5.7% vs 9.2%, P = 0.56, Fisher's exact test) were higher in the Pfannenstiel then in the Küstner group, but neither difference was statistically significant. One suprafascial hematoma was observed after a Küstner incison compared with eight subfascial hematomas after a Pfannenstiel incision (1.9% vs 6.1%, P = 0.45, Fisher's exact test). The postoperative hospital stay was statistically significantly lower in the Küstner than in the Pfannenstiel group (6.3 +/- 1.4 vs 7.1 +/- 1.2 days, P < 0.01, Student's t test). The Küstner incision warrants further evaluation and usage.

Adnexa Uteri↗