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Role of octreotide in the prevention of postoperative complications following pancreatic resection.

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. We conducted a randomized, double-blind, placebo-controlled, multicenter trial in 246 patients undergoing major elective pancreatic surgery. Patients were stratified into a high-risk stratum (limited to patients with pancreatic and periampullary tumors) or low-risk stratum (patients with chronic pancreatitis). Patients received octreotide (3 x 100 micrograms) or placebo subcutaneously for 7 days perioperatively. Eleven complications were defined: death, leakage of anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency, and postoperative pancreatitis. Two hundred patients underwent pancreatic head resection, 31 patients underwent left resection, and 15 patients had other procedures. The overall mortality rate within 90 days was 4.5%, with 3.2% in the octreotide group and 5.8% in the placebo group. The complication rate was 32% in the patients receiving octreotide (40 of 125 patients) and 55% in patients receiving placebo (67 of 121 patients) (p less than 0.005). In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.

Double-Blind Method↗

MR imaging of coarctation of the aorta and its postoperative complications in adults: assessment with spin-echo and cine-MR imaging.

To evaluate the ability of ECG-gated spin-echo (SE)-MR imaging vs. cine-MR imaging to assess coarctation of the aorta, 11 patients aged 15-45 years, with known or suspected coarctation of the aorta, and five patients suspected of re-stenosis or postoperative false-aneurysms after coarctation repair were examined by multisection SE-MR imaging and single-section multiphase cine-MR imaging on a 1.0 Tesla device. Aortography was performed in 15, and surgery in 14 of these 16 patients. Qualitatively, the location, severity, and length of the coarctation were shown in all cases with MR imaging, as well as the relationship with the arteries arising from the aortic arch. The respective sensitivities and specificities in the assessment of severity of stenoses were 86% and 100% for SE MR images, and 100% and 100% for cine-MR images. Cine-MR imaging was superior to SE imaging in stenosis diameter assessment with contrast angiography as reference, as well as to identify the site of leakage in cases of postoperative pseudoaneurysm. Pre-stenotic dilation or post-stenotic aneurysm, collateral channels, and associated malformations were better identified on SE images. Quantitatively, a better stenosis diameter correlation was found between cine-MR images and angiography than between SE-MR images and angiography (r=0.99 vs. r=0.78; p=0.001 vs. p=0.004), related to overestimation of stenoses with SE-MR imaging. The use of a combination of spin-echo and cine-MR imaging correlates well with conventional angiographic findings in this small series of patients with coarctation of aorta or postoperative pseudoaneurysmal complications. Cine-MRI can provide anatomic information that is equivalent to angiography for surgical planning.

Adolescent↗

Short-term pre-operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial.

BACKGROUND: Smokers have a higher risk of complicated tissue and wound healing after surgery than nonsmokers. We tested the hypothesis that short-term pre-operative cessation of smoking in colorectal surgery decreases the incidence of postoperative tissue and wound complications. METHODS: From February 1998 to March 2001, 60 patients, who smoked daily, undergoing colorectal resection were randomly assigned 2-3 weeks before scheduled surgery to either abstinence from smoking, counselling and nicotine replacement therapy or maintenance of daily smoking habits. Postoperative tissue and wound complications necessitating surgical or medical treatment were evaluated at discharge and 30 days after surgery by blinded outcome assessment. RESULTS: In the pre-operative period of 15 days (8-24) (median, interquartile range (IQR)), 89% of the patients in the intervention group vs. 13% in the control group abstained from smoking or reduced by more than half (P < 0.05). In the postoperative period of 11 days (10-13), the corresponding figures were 92% and 50%, respectively (P < 0.05). Postoperative tissue and wound complications occurred in 33% (9 of 27) of the patients in the intervention group compared to 27% (8 of 30) in the control group (NS). Likewise, no difference in overall postoperative complication rate was found between the groups. CONCLUSION: Short-term cessation of smoking does not reduce the risk of complicated tissue and wound healing or other complications in colorectal surgery.

Adult↗

Enterogastric intussusception: a rare postoperative complication.

The authors present a case of postoperative enterogastric intussusception after previous Billroth II-gastrectomy, associated with a Braun's W-anastomosis of the efferent small bowel loop. Loss of viability of the incarcerated jejunal loop required segmental small bowel resection. Total recovery was obtained. Literature is reviewed concerning diagnosis and treatment of adult intestinal intussusception.

Abdominal Pain↗

[Intraoperative and postoperative complications of splenectomy].

Spleen is being surgically removed because of trauma, in diagnostic and-or therapeutical purposes because of the benignant and malignant diseases. The percentage of morbidity during and after splenectomy is relatively low. During surgery might occur bleeding, trauma of the pancreatic tail, stomach, lineal flexure of the colon, left hemidiafragm, left suprarenal gland and upper pole of the left kidney, which must be correspondingly reclaimed during the same intervention. In the early postoperative period, postoperative bleeding, subfrenic abscess, pulmonal atelectasis, bronchopneumonia and left pleural extravasations might occur. Especially is important notification of these events in due time and adequate conservative and surgical treatment. After splenectomy, there is an increase of the number of trombocytes, which might lead to the tromboembolic complications. In the prevention of these complications in the postoperative period prolonged antiagregation therapy is suggested. Postsplenectomy sepsis is very late, general complication of splenectomy, which occurs because of the lower immunity in the child age. To prevent these complications, partial splenectomies, reimplantations of the spleen, prolonged application of the penicillin medicines after splenectomy and antipneumococcal vaccine are performed.

Humans↗

[Early diagnosis of central respiratory disorders in infants to avoid postoperative complications].

Infants with a higher incidence of frequent and prolonged apneas during sleep (sleep apnea syndrome) as a consequence of a delayed maturation of respiratory control, have an increased risk for respiratory problems after anesthesia. In 12 babies (one to five months old) showing visible apneas with cyanosis up to 12 hours after herniotomies, the respiratory pattern was examined by impedance pneumography during spontaneous sleep. The mean apnea duration (M.A. value) amounted to 8,6 +/- 5,96 sec/min, whereas the M.A. value of a comparable control group was significantly lower (2,97 +/- 2,13 sec/min) Aminophylline prophylaxis of risk infants diminished significantly the frequency of postoperative respiratory complications.

Aminophylline↗