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At least 19 recordsLinked to original sources
PubMed2006

Resection and primary anastomosis in acute complicated diverticulitis, a systematic review of the literature.

OBJECTIVE: To determine the safety and feasibility of primary resection and anastomosis with or without a diverting stoma, as compared to Hartmann's procedure, for patients with acute complicated sigmoid diverticulitis. SEARCH STRATEGY: MEDLINE was searched for studies and trials conducted between 1966 and December 2003. This search revealed trials comparing primary resection and anastomosis to Hartmann's procedure. The term "diverticulitis, colonic" with the sub-heading "surgery" was used and the search was limited to human studies and clinical trials. Additional studies were found using the MeSH terms: "surgical procedures, operative", "surgical anastomosis", and "Hartmann procedure", combined with the term "diverticulitis, colonic". The author also searched EMBASE and the Cochrane database for clinical trials using similar terminology. No language restrictions were applied. RESULTS: Eighteen studies met the inclusion criteria and reported 884 patients with acute complicated diverticulitis. None of these studies were randomised; it is likely that there was a significant degree of selection bias. No significant differences were found between primary resection with anastomosis and Hartmann's procedure with respect to mortality, morbidity, sepsis, wound complications and duration of procedure and anti-biotic treatment. Some studies found that primary anastomosis and a protecting stoma, with or without intra-operative colonic lavage, have more favourable results than Hartmann's procedure. CONCLUSIONS: This review suggests that surgical resection and primary anastomosis in acute diverticulitis with peritonitis compares favourably with Hartmann's procedure in terms of peri-operative complications. The need for revision of Hartmann's procedure could be subsequently avoided. Some articles showed that patients with severe peritonitis, who had a diverting stoma, in the setting of resection and primary anastomosis, had the lowest complication rate. However, the quality of these studies was poor with the presence of selection bias.

Acute Disease↗
PubMed1983

The application of real-time ultrasound imaging during surgical procedures.

Operative ultrasound using real-time high resolution B-mode ultrasound scanning is a practical and useful diagnostic aid. At operations upon the biliary tract, pancreas and blood vessels, ultrasound had a favorable impact upon surgical management. When similar operative roentgenographic studies were available, operative ultrasound compared favorably with both operative cholangiography and arteriography. Problems with the lack of familiarity of the surgeon with the performance and interpretation of imaging ultrasound and lack of specifically dedicated ultrasound instruments need to be resolved to increase and improve the use of this potentially helpful aid to surgical diagnosis during operation.

Angiography↗
PubMed1991

Blood contacts during surgical procedures.

Operating room personnel are at risk for infection with blood-borne pathogens through blood contact. To describe the nature and frequency of blood contact and its risk factors, trained observers monitored a sample of operations performed by six surgical services at Grady Memorial Hospital, Atlanta, Ga, for 6 months. In 62 (30.1%) of 206 operations, at least one blood contact was observed. Of 1828 operating room person-procedures observed, 96 (5.3%) had 147 blood contacts (133 skin contacts [90%], 10 percutaneous injuries [7%], and four eye splashes [3%]). The mean number of blood contacts per 100 person-procedures was highest for surgeons (18.6). The frequency of percutaneous injury was similar among surgeons and scrub staff (mean, 1.2 per 100 worker-procedures for each group). Risk factors for surgeons' blood contacts were (1) performing a trauma, burn, or orthopedic emergency procedure (odds ratio [OR], 4.1; 95% confidence interval [CI], 2.0 to 8.7); (2) patient blood loss exceeding 250mL (OR, 2.1; 95% CI, 1.2 to 3.7); and (3) being in the operating room longer than 1 hour (OR, 3.3; 95% CI, 1.6 to 7.1). Of 110 blood contacts among surgeons, 81 (74%) were potentially preventable by additional barrier precautions, such as face shields and fluid-resistant gowns. Twenty-one (84%) of 25 blood contacts among surgeons in procedures in which all three risk factors were present were potentially preventable by additional barriers. Of 29 blood contacts among anesthesia and circulating personnel, 20 (69%) would have been prevented by glove use. For surgical procedures in which operating room personnel are at increased risk of blood contact, reevaluation of surgical technique, use of appropriate barrier precautions, and development of puncture-resistant glove materials are indicated.

Accidents, Occupational↗
PubMed1990

Environmental concerns in surgery in the 1990s.

1. The surgical environment is the sum of the physical and the functional milieu in which surgical operative procedures are carried out in the course of patient care. 2. Although we acknowledge advances in surgical technology that have made possible a whole array of new procedures, we must be concerned with their effects on the surgical environment of the 1990s. These concerns include control of the spread of blood borne diseases and the lagging field of infectious and hazardous waste disposal. 3. The needs are clear for better departmental and institutional master planning, better systems analysis, better inservice training of personnel, and more precise and functional programming and planning. All must be accomplished within a framework of safety, efficiency, and economy.

Environment, Controlled↗
PubMed2004

[IKOP-Infection control in the operating theatreConsensus on the theme "Barrier measures during operations and invasive procedures"].

Postoperative surgical site infections remain frequent despite intensive control programs. With rising numbers of operations and invasive procedures in the outpatient setting and in immunocompromised patients, the prevention of wound infections presents a rapidly growing challenge to the medical community. Barrier measures including drapes and surgical gowns to prevent wound contamination, have clearly reduced the rate of wound infections. The optimal material characteristics for operating gowns and drapes are well defined, but there is still a long running controversy on the use of single-use versus reusable materials. We review the efficacy and ecological impacts of these different approaches. Currently no superiority of any of these approaches with regard to either efficacy or ecological impact can be found. The European Union has recently published a series of mandatory standards to specify material characteristics of barrier materials used in operating theatres (EN 13795). Their scope include production standards of these materials as well as specific processes in auditing their characteristics. The implementation of these norms will clearly present a challenge to European hospitals but will lead to better material characteristics in the end.

Europe↗
PubMed1977

[Combined surgical procedures in operations of stomach, duodenum and biliary system (author's transl)].

In a period of 4 years in the Clinic of Abdominal- and Transplantation Surgery of the Medical School Hannover in 52 patients with operations of the biliary system 56 combined surgical procedures and in 48 patients with operations of stomach and duodenum 51 combined surgical procedures were performed. In comparison with groups of patients, treated with similar operations as single procedures, the increase of risk was studied. It was found, that combined procedures of medium-sized trauma, which mostly depended on simultaneous injuries of both organs, caused an elevation of operation stress as well as an increase of complications. Small combined procedures indicated no elevation of risk. In accordance with our results, we postulate a very careful reflection on indication of combined surgical procedures together with operations of stomach, duodenum or biliary system.

Age Factors↗
PubMed2000

Surgery in the nineties.

The population of the United States is aging, and by 2020 it is estimated that 16 per cent of U.S. citizens will be over 65 years of age. Little has been published about the results of surgery in nonagenarians but mortality rates of 45 per cent are reported. Given recent improvements in perioperative care we reviewed the experience with major general surgical operative procedures in nonagenarians. We reviewed the charts of patients greater than or equal to 90 years of age who underwent general surgical procedures at UCLA Medical Center since 1986. No patients were excluded. Thirty-two patients were identified. Most (87.5%) patients had significant premorbid conditions. The most common diagnoses were cancer (12), incarcerated hernia (seven), trauma (three), colonic volvulus (two), and cholecystitis (two). Overall perioperative mortality was 9.4 per cent (3 of 32). Twenty-two surgeries (69%) were performed on an emergency basis, and all three deaths were in this group (13.6%). Overall morbidity rate was 57 per cent. Mean intensive care unit stay was 4.8 days. Most patients were discharged home. Our findings support the perioperative safety of elective general surgery in nonagenarians (0% mortality and 20% morbidity). We also found an acceptable risk (13.6% mortality and 68% morbidity) for emergency procedures despite significant comorbid conditions. Most of the patients had acceptable functional outcomes.

Aged↗
PubMed1986

Role of preoperative hemodynamic monitoring in intraoperative fluid management.

In this study the hemodynamic factors which contribute to postoperative mortality and morbidity were evaluated in 41 patients. Preoperative data were prospectively collected over a 5-year period. The patients underwent vascular and general surgical operative procedures. Among them, 23 patients had minor or no postoperative complications (group 1) and 18 patients suffered serious complications or died (group 2). Preoperative cardiac function was better in group 1, but both groups achieved their best cardiac index (CI) with fluids or pharmacologic manipulation preoperatively. Group 2 patients had longer operations, more blood loss, and were significantly hypovolemic postoperatively as indicated by lower pulmonary arterial wedge pressure (PAWP) and CI in comparison to the best preoperative values. When postoperative PAWP was higher than or within 3 mm Hg of the best preoperative level, complication rate was 14 per cent (3 of 21). In 15 of the 19 or 79 per cent of the patients, postoperative complications developed when PAWP decreased by 4 mm Hg or more. The difference in complications was significant (P less than 0.01). However, commonly measured parameters such as the amount of fluid infused, urine output, immediate postoperative heart rate, blood pressure, central venous pressure, and hemoglobin failed to reveal hemodynamically significant hypovolemia or lacticacidemia in group 2. The authors were unable to demonstrate a reduction in mortality or morbidity in group 2 patients in whom serious technical operative difficulties were also encountered.

Aged↗
PubMed1999

[Pilot experience with radio-knife "Surgitron"].

A new radiosurgical knife Surgitron is described in terms of its application in ENT operations. Surgical procedures, indications, operative regimes are detailed. Advantages and disadvantages of the device design are outlined. The device is functionally and cosmetically effective. Thus, it holds promise in surgery.

Endoscopy↗
PubMed1991

Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System.

To perform a valid comparison of rates among surgeons, among hospitals, or across time, surgical wound infection (SWI) rates must account for the variation in patients' underlying severity of illness and other important risk factors. From January 1987 through December 1990, 44 National Nosocomial Infections Surveillance System hospitals reported data collected under the detailed option of the surgical patient surveillance component protocol, which includes definitions of eligible patients, operations, and nosocomial infections. Pooled mean SWI rates (number of infections per 100 operations) within each of the categories of the traditional wound classification system were 2.1, 3.3, 6.4, and 7.1, respectively. A risk index was developed to predict a surgical patient's risk of acquiring an SWI. The risk index score, ranging from 0 to 3, is the number of risk factors present among the following: (1) a patient with an American Society of Anesthesiologists preoperative assessment score of 3, 4, or 5, (2) an operation classified as contaminated or dirty-infected, and (3) an operation lasting over T hours, where T depends upon the operative procedure being performed. The SWI rates for patients with scores of 0, 1, 2, and 3 were 1.5, 2.9, 6.8, and 13.0, respectively. The risk index is a significantly better predictor of SWI risk than the traditional wound classification system and performs well across a broad range of operative procedures.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

[Choice of surgical procedure in operations for chronic pancreatitis--personal experience].

The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 187 operated patients one patient with decompensated diabetes died postoperatively. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.

Chronic Disease↗
PubMed1994

Intestinal operations during surgical procedures for epithelial ovarian cancer.

Fifty-two intestinal operations were performed during 45 laparatomies in 43 non-obstructed ovarian cancer patients. The histology of the tumor was serous in 29/43 cases (67.5%). The gross postoperative morbidity rate was 15.5% and postoperative mortality rate 6.9%. The 5-year survival was 28.3%, and was not affected by the time of intestinal surgery (during the first or following laparotomies). As a result, intestinal surgery in advanced ovarian cancer patients is feasible without an undue increase in morbidity. However, it must be carefully tailored because, though contributing to the quality of life of these patients, it does not seem to affect their survival, at least in this retrospective series.

Journal Article↗
PubMed1977

[Risk of combined surgical procedures in operations of colon and rectum (author's transl)].

In a period of 4 years in the Clinic of Abdominal- and Transplantationsurgery of the Medical School Hannover 63 combined surgical procedures were performed in 56 patients with operations of colon and rectum. In comparison with a group of patients, who were treated with similar operations as a single procedure, the increase of risk was studied. Small combined procedures like appendectomia, herniotomia, exstirpation of cysts or removal of diverticula indicate no elevation of the operative risk. Cholecystectomy or prostatectomy, though increasing the entire trauma of operation, did not elevate the rate of complications significantly. In accordance with our results outlines regarding the performance and indication of operations in combination with colon- and rectum surgery are discribed.

Adult↗
PubMedDate not supplied

Operative ultrasonography during hepatobiliary and pancreatic surgery.

On the basis of our experience with operative ultrasonography during hepatobiliary and pancreatic surgery, its indications, benefits, and disadvantages are summarized. High-resolution operative ultrasound scanning of the liver, biliary tract, and pancreas was performed during 357, 735, and 242 operations, respectively. The benefits of operative ultrasonography were categorized as acquisition of diagnostic information otherwise not available, replacement for or complement to operative radiography, and guidance of surgical procedures. Operative ultrasonography provided beneficial information during 73 of 82 hepatic operations (89.0%), 57 of 69 noncalculous biliary operations (82.6%), and 177 of 242 pancreatic operations (73.1%). Operative ultrasonography was significantly superior (sensitivity 93.3%) to other screening tests for diagnosing liver metastasis from colorectal carcinoma evaluated in 189 patients, and it detected previously unrecognized metastatic tumors in 18 patients (9.5%). For screening common bile duct calculi during 666 operations, operative ultrasonography and operative cholangiography were comparable in all indices of accuracy except for a higher predictability of a positive test of operative ultrasonography (94.8% versus 71.7%). For diagnosing portal vein invasion of pancreatic carcinoma, operative ultrasonography provided better overall accuracy than preoperative studies (89.7% versus 64.1%). On the basis of operative ultrasound findings, previously planned surgical procedures were altered in 32 of 82 hepatic operations (39.0%) and 24 of 145 pancreatic operations for chronic pancreatitis (16.6%). Operative ultrasound guidance of various surgical procedures was performed during 88 hepatic and 84 pancreatic operations, including 40 ultrasound-guided hepatectomies and 42 pancreatotomies. Operative ultrasonography has a number of advantages, such as safety and speed in performance, wide application, high diagnostic accuracy, and ability of guiding procedures. Its disadvantages are the limitation of the fields of view in certain applications, the need for special equipment, and a slow learning curve.

Biliary Tract↗
PubMed2005

Combination of osteotomy of the first metatarsal according to Frejka with McBride operation procedure in surgical therapy of extreme hallux valgus.

Hallux valgus is to be perceived as a complex of deformities of the first ray of the foot, often accompanied by deformity of forefoot. Although, this deformity can be treated with as many as 200 surgical procedures, the authors would like to demonstrate the effect of their own approach. The authors evaluate the results of hallux valgus surgery combining the operation according to McBride and wedge osteotomy of the first metatarsal (MT) basis in 21 patients (37 surgeries) with post-surgical follow-up lasting from 29 to 45 months (i.e. 3 years in average). Pre-operative mean intermetatarsal 1-2 angle revealed by radiographs was surgically corrected from 21.7 degrees at the baseline to the mean degree of 8.8. The pre-surgical average 45.9-degree of great toe valgosity proved by radiographs was surgically improved to the mean of 13.5 degrees. 87% of patients expressed their personal satisfaction with their surgical results. The authors consider the combination of wedge osteotomy of the first metatarsal basis with the operation according to McBride to be suitable in the therapy of extreme valgosity of great toes with increased metatarsal angle between first and 2nd metatarsal in young patients with minimum of changes in the metatarsophalangeal joint developed due to arthrosis (Tab. 2, Fig. 6, Ref. 7).

Female↗
PubMed2000

[The peroneal or fibular free flaps. Surgical anatomy, operative procedures and indications].

The microsurgical story of the fibula began 25 years ago. The author reports on the vascular anatomy of the fibular free flaps, particularly the osseous, cutaneous and muscular branches of the fibular artery and their variations. This surgical anatomy explains the various osseous and composite flaps that can be harvested on the fibular vessels. The fibular flaps harvested on the anterior tibial vessels are used less often. The surgical procedure is explained about the typical osteocutaneous peroneal flap and the many other variations. The indications and results are discussed according to the international literature and the author's experience: 42 mandibular, 12 tibial, ten femoral, three radial, two humeral and one nasomaxillary reconstructions. The aetiological and topographical particularities, various abilities of the fibular donor site, preoperative strategy, bone implantation and contention, vascular anastomosis and delays of consolidation are analysed for each recipient site. The advantages and disadvantages of these fibular flaps are then discussed. Finally, the present and future associated procedures are evoked.

Bone Transplantation↗