Kjaergaard J

Risk Factors for Tissue and Wound Complications in Gastrointestinal Surgery

Background:Surgical site infections and disruption of sutured tissue are frequent complications following surgery. We aimed to assess risk factors predictive of tissue and wound complications in open gastrointestinal surgery. Methods:Data from 4855 unselected patients undergoing open gastrointestinal surgery from 1995 through 1998 were recorded in a clinical database and validated. The database embraced variables related to patient history, preoperative clinical condition, operative findings and severity, and the surgeons training. Variables predictive of surgical site infection and dehiscence of sutured tissue within 30 days after surgery were assessed by multiple logistic regression analysis. Results:Following elective operation, the incidence of tissue and wound complications was 6% compared with 16% in emergency surgery (P < 0.001). These complications resulted in prolonged hospitalization in 50% of the patients and a 3-fold higher risk of reoperation but not increased mortality. Factors associated with complications following elective operations were smoking, comorbidity, and perioperative blood loss. Following emergency operations, male gender, peritonitis, and multiple operations were predictors of complications. Irrespective of elective or emergency surgery, the type of operation was a predictor of complications. Conclusion:Factors known to affect the process of tissue and wound healing are independently associated with tissue and wound complications following gastrointestinal surgery.

Smoking is a risk factor for recurrence of groin hernia.

Studies of connective tissue from patients with inguinal hernia have shown that smoking may be associated with hernia formation due to a defective connective tissue metabolism. Whether smoking is a risk factor for recurrence, too, was examined in this study. From December 1990 through December 1995, 649 patients underwent hernia repair as open sutured repair (Cooper ligament or abdominal ring repair) or as open mesh repair. Five hundred forty-four eligible patients were evaluated for recurrence 2 years postoperatively. Association between recurrence and 17 patient-, disease-, and intraoperative variables were analyzed by multiple logistic regression. The results showed that smoking was significantly and independently associated with recurrence compared to nonsmoking [odds ratio (OR = 2.22; 95% confidence interval (95% CI) = 1.19–4.15)]. Open sutured repair compared to open mesh repair was the most significant predictor for recurrence (OR = 7.23; 95% CI = 3.01–17.37). Surprisingly, local anesthesia was associated with a higher risk of recurrence compared to general anesthesia (OR = 2.44; 95% CI = 1.19–5.09). Potential confounders and other risk factors for hernia recurrence such as age, alcohol consumption, previous surgery, and anatomical characteristics of the hernia were adjusted for in the analysis. In conclusion, smoking is an important risk factor for recurrence of groin hernia, presumably due to an abnormal connective tissue metabolism in smokers.

Evaluation of Symptoms and Signs of Gallstone Disease in Patients Admitted with Upper Abdominal Pain

We present a prospective evaluation of the diagnostic value of 37 symptoms and signs of gallstones in 192 patients admitted with upper abdominal pain. The study was carried out independently of the examination and treatment by the staff. The routine investigations showed 49 patients with gallstones. Univariate analysis showed that old age, previous similar attacks of pain, previous intolerance to fatty foods, severe (that is, requiring analgetic injections) and radiating pain, and tenderness in the upper right quadrant were significantly more frequent in patients with gallstone disease than in those without. The evaluation showed that the classical signs and symptoms are relatively poor in establishing the diagnosis of gallstone disease, but their absence is a relatively good indicator for excluding the diagnosis. The multivariate analysis showed that the diagnosis of gallstone disease than in those without. The evaluation showed that the classical signs and and symptoms are relatively poor in establishing the diagnosis of gallstone disease, but their absence is a relatively good indicator for excluding the diagnosis. The multivariate analysis showed that the diagnosis of gallstone disease depends, in the main, on intolerance to fatty foods, severe pain, and tenderness in the upper right quadrant. The other classical signs and symptoms depend on and vary mutually with these three.

Rectal anastomosis with application of luminal fibrin adhesive in the rectum of dogs: An experimental study

By performing a colorectal anastomosis, the risk of a serious clinical leakage is about 10 percent. On the basis of this, the current study describes a combined fibrin adhesive-sutured anastomosis in the rectum performed with interrupted seromuscular sutures externally and fibrin adhesive in the mucosa-mucosa cleft internally. Ten dogs having combined anastomosis were compared with ten dogs having a two-layer sutured anastomosis in the rectum as a control. The median bursting strength in the rectum seven days after the operation was 280 mm Hg (range, 180 to 340 mm Hg) for the combined anastomosis and 260 mm Hg (range, 170 to 405 mm Hg) for the sutured anastomosis in the control group. Two anastomoses with two-layer sutured anastomosis had a leak demonstrated radiographically, while no leakage was demonstrated in the ten dogs with combined anastomosis. In conclusion, intraluminal applied fibrin adhesive may contribute to the security of the sutured rectum-anastomosis.

Omeprazole 20 mg three days a week and 10 mg daily in prevention of duodenal ulcer relapse

In a double-blind, parallel-group clinical trial of 195 patients with duodenal ulcers who after a short-term study had relief of pain and healed ulcers proved endoscopically, 65 were randomized to receive 20 mg omeprazole 3 days a week (once in the morning from Friday to Sunday), 64 to receive 10 mg omeprazole once daily in the morning, and 66 to receive placebo for up to 6 months. The patients underwent repeat endoscopy with biopsy of the gastric fundic mucosa (qualitative assessment of argyrophilic cell population), assessment of symptoms, and laboratory screening with measurement of basal serum gastrin concentrations at 3 and 6 months or more often if indicated by recurrence of symptoms. At 3 months, endoscopically proved ulcer relapse occurred in 16% receiving 20 mg omeprazole 3 days a week; 21% receiving 10 mg omeprazole daily; and 50% receiving placebo. At 6 months, corresponding rates were 23%, 27%, and 67% with 95% confidence intervals of difference between the placebo group and omeprazole groups of 28%-60% and 24%-56% (P less than 0.00001), respectively, and between omeprazole groups of -19%-11% (NS). No major clinical or laboratory side effects were noted. Thus both omeprazole regimens are effective and safe in preventing duodenal ulcer relapse.

Failure in Prophylactic Management of Thromboembolic Disease in Colorectal Surgery

The operative courses of 294 elective consecutive colorectal resections were reviewed in order to evaluate the morbidity and mortality of postoperative thromboembolic complications. All patients received low-dose heparin prophylaxis. Fifty-seven patients were screened for deep venous thrombosis with the fibrinogen uptake test, and treatment of thromboembolism was started if the diagnosis was established by venography and/or pulmonary scintigraphy. Neither the morbidity nor mortality from clinical thromboembolic complications was lowered in the group of patients who were screened. Rectal surgery seems to carry a higher risk of postoperative thromboembolic complications than colon surgery, and thromboembolic complications are responsible for about half of the postoperative deaths following elective colorectal surgery.

Dihydroergotamine in postoperative ileus

The effects of dihydroergotamine (DHE) on postoperative ileus after major abdominal surgery were studied. Forty‐one patients received 0.5 mg DHE subcutaneously twice a day from the day of surgery to the seventh postoperative day. Thirty‐three patients served as controls. There were no significant differences in the time to the first postoperative passage of flatus or delivery of stools nor in the quantity of laxatives given. It is concluded that DHE does not reduce the duration of postoperative ileus.

Colostomy irrigation with prostaglandin F2α

Prostaglandin F2α applied directly in quantities up to 400 μ g had no clinical effect on the emptying time of the colon in patients undergoing colostomy irrigation.

Convalescence after inguinal herniorrhaphy.

BACKGROUND The aim of this investigation was to evaluate factors influencing the length of convalescence after ambulant inguinal hernia repair. METHODS One hundred and twenty-three patients were followed up to assess when they returned to work, considered that they had regained full working capacity, and resumed leisure time activities. The length of sick leave was recommended on the basis of the load of the occupation. RESULTS Half of the patients had a longer sick leave than recommended by the surgeon. Active and heavy work showed an independent significant positive correlation to the length of sick leave. Median sick leave among these patients was 42 days, which was the time they considered that they had regained full working capacity and 1 week after they had resumed their leisure time activities. Median sick leave among patients with sedentary or moderately active work was 9 days before regaining full working capacity and 12 days before resuming leisure time activities. CONCLUSIONS Other factors than load of work and surgeons advice seem to play a role in the patients decision about when to resume normal activities on the job.

Inadequately reduced acid secretion after vagotomy for duodenal ulcer. A follow-up study three to nine years after surgery.

In a study of 545 patients who underwent vagotomies for repair of duodenal ulcers, 62 patients (11%) were found to have inadequately reduced pentapeptide and/or insulinstimulated acid secretions three months after operation. The ulcers recurred in 14 patients within three to nine years (mean: four years) (23%, 95% confidence limits: 13–35). Postoperative acid production and acid reduction were equal in patients with and without ulcer recurrence. The patients who did not develop recurrent ulcers had significantly lower preoperative pentapeptide peak acid outputs and significantly shorter preoperative histories of ulcers than patients whose ulcers recurred.