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PubMedDate not supplied

Postoperative complications following vitrectomy for proliferative diabetic retinopathy with sew-on and noncontact wide-angle viewing lenses.

BACKGROUND AND OBJECTIVE: To compare the occurrence of vitreous hemorrhages and retinal detachments following vitrectomy surgery with sew-on lenses to a noncontact wide-angle lens system. PATIENTS AND METHODS: Retrospective review of 180 patients who underwent primary vitrectomy for proliferative diabetic retinopathy. The occurrence of persistent and recurrent vitreous hemorrhages as well as postoperative retinal detachments in the two groups was determined. RESULTS: There was no statistically significant difference in the occurrence of persistent vitreous hemorrhages between the sew-on (55%) and the wide-angle (42%) lens systems (P = 0.099). Likewise, recurrent vitreous hemorrhages were similar in both the sew-on (15%) and the wide-angle (17%) lens systems (P = 0.838). However, postoperative detachments were more frequent in the sew-on group (9%) than in the wide-angle (1%) group (P = 0.046). CONCLUSION: In patients with proliferative diabetic retinopathy, using a wide-angle noncontact lens system significantly reduced the incidence of postoperative retinal detachments, but not persistent or recurrent vitreous hemorrhages.

Diabetic Retinopathy↗
PubMed1984

[Postoperative complications of the radiation-exposed intestine].

Intestinal complications after radiotherapy cannot be avoided. Side effects of radiotherapy should be differentiated from injuries following correct application of radiation. Acute changes are usually transient. There is only a small incidence of major intestinal radiation injuries, amounting to less than 3%. Exact preoperative diagnostics is advisable in planning corrective operative procedures. The postoperative mortality rate is about 30%, operative procedures must be individualized, staged procedures are recommended.

Humans↗
PubMed1993

Postoperative complications of capsulorhexis.

Capsulorhexis has become the preferred method of anterior capsulotomy, and untoward effects have not been frequently noted. Nevertheless, distinct complications of continuous tear anterior capsulotomy are now recognized. These include capsular bag hyperdistention, shrinkage of the anterior capsule opening with visual loss and/or intraocular lens decentration, and lens epithelial cell hyperproliferation on the posterior lens capsule. The latter has not been reported and may be associated wit reduction or closure of laser posterior capsulotomies in the form of a "string of pearls" around the capsule opening. Current styles of capsular surgery and intraocular lens implantation in which the anterior capsule edge overlaps the lens may be responsible for these phenomena. Although altering the surgical methods may obscure these complications, eliminating the anterior subcapsular and equatorial lens epithelial cells is necessary to prevent capsule contraction and lens epithelial cell hyperproliferation.

Cataract Extraction↗
PubMed2004

Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery.

OBJECTIVES: (1) To show that total thyroidectomy (TT) can be performed in multinodular goiter (MG) by surgeons with experience in endocrine surgery with a definitive complication rate of 1% or less; and (2) to analyze the risk factors for complications in these patients. SUMMARY BACKGROUND DATA: There is current controversy over the role of TT in the treatment of MG; although there are potential benefits, high rates of complications are not acceptable in surgery for a benign pathology. PATIENTS AND METHOD: A prospective study was conducted on 301 MGs meeting the following criteria: (1) bilateral MG; (2) no prior cervical surgery; (3) operation by surgeons with experience in endocrine surgery; (4) no associated parathyroid pathology; (5) no initial thoracic approach; and (6) minimum follow-up of 1 year. Age, sex, time of evolution, symptoms, cervical goiter grade, intrathoracic component, thyroid weight, and presence of associated carcinoma were analyzed as risk factors for complications. The chi test and a logistic regression analysis were applied. RESULTS: Complications were presented by 62 patients (21%), corresponding to 29 hypoparathyroidisms, 26 recurrent laryngeal nerve injuries, 4 lesions of the superior laryngeal nerve, 3 cervical hematomas, and 1 infection of the cervicotomy. The variables associated with the presence of these complications were hyperthyroidism (P = 0.0033), compressive symptoms (P = 0.0455), intrathoracic component (P = 0.0366), goiter grade (P = 0.0195), and weight of excised specimen (P = 0.0302); hyperthyroidism (relative risk [RR] 2.5) and intrathoracic component (RR 1.5) persisted as independent risk factors. Definitive complications appeared in 3 patients (1%), corresponding to 2 hypoparathyroidisms and 1 recurrent laryngeal nerve injury. Two cases corresponded to a toxic goiter, and the third to an intrathoracic goiter with compressive symptoms. CONCLUSION: In endocrine surgery units, TT can be performed for MG with a definitive complication rate of around 1%; the main independent risk factors for the development of complications are hyperthyroidism and goiter size.

Clinical Competence↗
PubMed1998

Early postoperative complications after coronary artery bypass grafting at the Cardiovascular Center of Puerto Rico and the Caribbean.

OBJECTIVES: This study describes the preoperative cardiovascular characteristics, intraoperative data, in-hospital complications and factors associated to procedural-related complications in patients undergoing coronary artery bypass grafting (CABG). BACKGROUND: There is a growing body of evidence of CABG safety and efficacy; however, limited data is available regarding the value of this surgical procedure in the Puerto Rican population. METHODS: We retrospectively reviewed the medical records of 200 consecutive patients submitted to CABG at the Cardiovascular Center of Puerto Rico and the Caribbean over a three-month period in 1997. Bivariate and multivariate analyses were performed to determine factors associated with the occurrence of complications. RESULTS: The most frequent cardiac risk factor was hypertension (77%); stable angina (60.5%) was the predominant cardiac clinical diagnosis. Three vessel disease with proximal left anterior descending coronary artery stenosis (42.1%) was the most common anatomical lesion. The rate of major complications such as death (3%), perioperative myocardial infarction (2%), reoperation to control bleeding (1.5%), pulmonary embolism (1%), and stroke (1%) was low and similar to the rate reported elsewhere. Multivariate analysis showed that non-use of LIMA graft, extended hospital stay, prolonged cardiopulmonary bypass time, and left ventricular dysfunction were significantly associated with the occurrence of complications (p < 0.05); on the other hand, there was a trend for older age to be associated with the occurrence of complications (p = 0.057). CONCLUSIONS: CABG is being performed with an acceptably low complication rate in this institution.

Adult↗
PubMed2005

[Diagnostic imaging in liver transplantation. Preoperative evaluation and postoperative complications].

Complimentary to orthotopic liver transplantation (OLT), living donor liver transplantation (LDLT) is increasingly considered a therapeutic option in the therapy of end-stage liver disease. Accurate pre- and postoperative imaging is crucial for the transplantation success and represents an established part of the current evaluation algorithms. This article summarizes the most important requirements and the current imaging standards. Preoperative imaging is important for exclusion of transplantation contraindications in the recipient and for reliable assessment of anatomical variants in the donor. The main purpose of postoperative imaging is the early detection and characterization of complications. In both instances, multislice CT currently represents the most versatile and reliable imaging modality, still superior to MRI. For postoperative follow-up, the imaging modality of first choice is still bedside ultrasound; however, unclear findings usually need to be further assessed by CT.

Angiography, Digital Subtraction↗
PubMed1979

Cardiac pacemaker insertion: a study of the anaesthetic and postoperative complications.

One hundred and three patients undergoing pacing procedures have been studied, the majority requiring the insertion of an epicardial system under general anaesthesia. The main findings were of an elderly group of patients with a high incidence of associated disease, who suffered predominantly from pulmonary and renal complications. Methods of reducing these complications, particularly in relation to general anaesthesia are discussed.

Adolescent↗
PubMedDate not supplied

[Intermediate resection and distal pancreatectomy for benign neoplasms of the pancreas: comparison of postoperative complications and costs].

The middle pancreatic resection for benign pathology of the pancreas has been proposed as an advantageous alternative to the distal pancreatectomy, even though the risk of complications is greater. The purpose of the present study is to compare the cost and intra and perioperative impact for the 2 procedures. All patients with benign neoplasia of the body and tail of the pancreas operated on from 1990-1999 were selected from our computer archives, 21 patients underwent an intermediate resection and 64 a distal pancreatectomy. Operative time, units transfused, perioperative complications, post-operative stay and cost were compared. Statistical analysis revealed that the 2 operations are not significantly different in the intra-operative period. Comparing serious complications, the percentage of pancreatic fistulas (33% vs. 11%; P < 0.03) and average hospital stay (21.2 +/- 11.7 days vs. 15.5 +/- 7.1 days; p = 0.009) are greater for the middle than distal resection, respectively. In cases with post-operative complications the hospital stay is even more significant (middle 31.8 +/- 10.3 days vs. 19.1 +/- 7.6 days; p = 0.0002). The economic margin of residual costs, calculated by using the difference of DRG (no 192) and average post-operative costs, is similar for the 2 procedures in cases with normal post-operative courses, (intermediate Euro 2890.02; distal Euro 3181.9), while in cases with complications (DRG no 191), the difference increases (intermediate Euro 8670.11; distal Euro 12788.94). The middle pancreatic resection in respect to the distal pancreatectomy presents a greater technical difficulty when you take into account the longer post-operative course, the increased difficulty in treating complications and the increased costs.

Adolescent↗
PubMedDate not supplied

[Middle fossa vestibular neurectomy: postoperative complications].

The middle fossa approach is frequently used for vestibular neurectomy in patients with Ménière's disease. Middle fossa vestibular neurectomy has been criticized for its surgical complications, especially transient facial paralysis. The complication rate of 198 middle fossa vestibular neurectomies performed between 1968 and 1992 is reported. Facial paralysis, wound infection, suture dehiscence, CSF leak, meningitis, subdural hematoma, dead ears, average hospitalization time and death were evaluated. The overall complication rate was 29.3%. The acceptable incidence of complications makes middle fossa vestibular neurectomy one of the most adequate surgical treatments for Ménière's disease.

Adult↗
PubMed2000

[Immediate postoperative complications after a laparoscopic partial posterior fundoplication. Early laparoscopic reoperation].

AIM OF THE STUDY: The immediate postoperative course of laparoscopic partial posterior fundoplication can be complicated by severe dysphagia or paraesophageal hernia. The aim of this study was to describe the technical causes of these complications. PATIENTS AND METHOD: Four patients, operated for gastroesophageal reflux disease by laparoscopic partial posterior fundoplication, developed severe dysphagia (n = 2) or paraesophageal hernia (n = 2) during the immediate postoperative period. A barium swallow examination visualized the complication in both cases of dysphagia and in 1 case of paraesophageal hernia. The correct diagnosis was established by CT scan in the other case of paraesophageal hernia. Reoperations were performed by laparoscopy, 3 days (n = 2) or 6 days (n = 2) postoperatively. RESULTS: Dysphagia was due to compression of the esophagus against the hiatus by the fundoplication. A new and looser fundoplication was easily performed. Dysphagia was no longer present postoperatively. The two patients were symptom-free after 6 and 12 months of follow-up, respectively. In the cases of paraesophageal hernia, the bottoms of the crura were torn. In the patient reoperated 3 days postoperatively, the procedure was easily performed, the postoperative course was uneventful and the patient was symptom-free after a follow-up of 20 months. In the patient reoperated 6 days postoperatively, the upper part of the stomach had moved into the left pleural cavity, the procedure was difficult due to inflammation and thickening of the gastric wall, and the postoperative course was uneventful, but reflux recurred 18 months later. CONCLUSION: When severe dysphagia or paraesophageal hernia occurs during the immediate postoperative course of laparoscopic partial posterior fundoplication, reoperation, possibly by laparoscopy, identifies and cures the technical defects. Based on our experience, we suggest that surgical cure of paraesophageal hernia is easier when performed during the immediate postoperative period.

Adult↗
PubMed1987

Orthotopic liver transplantation: postoperative complications and their management.

The Birmingham liver transplant programme started in 1982. Forty-six patients have been transplanted with a follow-up of 3 months or longer. Twenty-seven patients are still alive, of whom sixteen have lived for more than one year. The 30 day hospital mortality was 30.4 per cent and the actuarial predicted one year survival 55.5 per cent. Four patients have been regrafted for chronic rejection and graft failure. Thirteen patients have required surgery in the postoperative period for: bleeding (two), removal of abdominal packs (four), biliary leaks and obstruction (five), duodenal perforation (one) and small bowel obstruction (one). Acute rejection was common, occurring in 30 patients and progressing to chronic rejection in 4. Ten patients developed renal failure with an 80 per cent mortality and eleven patients developed grand mal fits. Severe bleeding (greater than 70 units) was associated with previous abdominal surgery and a high mortality (88.9 per cent). Opportunistic fungal infection carried a 100 per cent mortality. Although more than half of all transplanted patients will survive for more than one year, the postoperative period is still one of high morbidity and mortality.

Acute Kidney Injury↗