. The Pattern and Outcome of Surgical Acute Abdomen at (original) (raw)

Provisional chapter Open Abdomen : The Surgeons ’ Challenge

2019

An open abdomen is defined as purposely foregoing fascial closure of the abdomen after the cavity is opened. Management of complex abdominal problems with the open abdomen and temporary abdominal closure techniques has become a common and valuable tool in surgery. Several challenging clinical situations can necessitate leaving the abdominal cavity open after surgery, resulting in an open abdomen. The indications for open abdomen are as follows: Damage control for life-threatening intraabdominal bleeding, severe acute pancreatitis, severe abdominal sepsis, and prevention and treatment of the abdominal compartment syndrome. Damage control surgery is based on a rapid control of bleeding and focuses on reversing physiologic exhaustion in a critically ill or injured patient. In severe abdominal sepsis, the intervention should be abbreviated due to suboptimal local conditions for healing and global susceptibility to spiraling organ failure. Abdominal compartment syndrome (ACS) is commonly...

IROA: International Register of Open Abdomen, preliminary results

World Journal of Emergency Surgery, 2017

Background: No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). Methods: A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. Results: Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). Afterclosure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p= 0.016).

IROA: the International Register of Open Abdomen

World Journal of Emergency Surgery, 2015

Actually the most common indications for Open Abdomen (OA) are trauma, abdominal sepsis, severe acute pancreatitis and more in general all those situations in which an intra-abdominal hypertension condition is present, in order to prevent the development of an abdominal compartment syndrome. The mortality and morbidity rate in patients undergone to OA procedures is still high. At present many studies have been published about the OA management and the progresses in survival rate of critically ill trauma and septic surgical patients. However several issues are still unclear and need more extensive studies. The definitions of indications, applications and methods to close the OA are still matter of debate. To overcome this lack of high level of evidence data about the OA indications, management, definitive closure and follow-up, the World Society of Emergency Surgery (WSES) promoted the International Register of Open Abdomen (IROA). The register will be held on a web platform (Clinical Registers®) through a dedicated web site: www.clinicalregisters.org. This will allow to all surgeons and physicians to participate from all around the world only by having a computer and a web connection. The IROA protocol has been approved by the coordinating center Ethical Committee (Papa Giovanni XXIII hospital, Bergamo, Italy). IROA has also been registered to ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT02382770).

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Canadian Journal of Surgery

Background: Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). Methods: Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization. Results: Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. Conclusion: Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed. Contexte : La chirurgie abdominale d'urgence à risque élevé est associée à un fort taux de mortalité, à des complications postopératoires multiples et à des hospitalisations prolongées. Il est donc nécessaire d'élaborer de nouvelles stratégies pour améliorer le rétablissement après ce type de chirurgie. La présente étude visait à décrire le fonctionnement physique et les obstacles aux déplacements autonomes chez les patients ayant subi une chirurgie de ce type (jours postopératoires 1 à 7). Méthodes : Nous avons recruté successivement les patients subissant une chirurgie abdominale d'urgence à risque élevé dans un hôpital universitaire du Danemark. Durant la première semaine postopératoire, tous les patients ont subi quotidiennement une évaluation visant à vérifier leur fonctionnement physique. Nous nous sommes servis du Cumulated Ambulation Score (CAS; de 0 à 6 points) pour évaluer la mobilité de base et du moniteur activPAL pour évaluer le niveau d'activé physique 24 heures par jour. Nous avons noté les obstacles aux déplacements autonomes. Résultats : Cinquante patients (âge moyen : 61,4 ans ± 17,2) ont été retenus. Sept sont décédés durant la première semaine postopératoire, et 15 des 43 patients restants (35 %) ne se déplaçaient pas encore de façon autonome (CAS < 6) le septième jour, une situation associée à l'apparition de complications pulmonaires (53 % c. 14 % de ceux qui avaient un CAS de 6, p = 0,012). Les patients étaient couchés ou assis pendant une durée mé diane de 23,4 heures par jour durant la première semaine postopératoire, et les principaux obstacles aux déplacements autonomes étaient la fatigue et la douleur abdominale.

The role of open abdomen in non-trauma patient: WSES Consensus Paper

World journal of emergency surgery : WJES, 2017

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions ...

Medical management of the surgical abdomen

Oxford Handbook of Humanitarian Medicine

This chapter provides essential management guidance for medical providers in low-resource environments when surgical services are not readily available. ‘Medical management of the surgical abdomen’ provides practical advice for the non-surgeon on medical management options for an acute abdomen when definitive surgical care is not available.

Predictors of morbidity and mortality post emergency abdominal surgery: A national study

Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 2018

Emergency surgeries have increased in Saudi Arabia. This study examines these surgeries and associated complications. This was a prospective multicenter cohort study of patients undergoing emergency intraperitoneal surgery from the eight health sectors of Saudi Arabia. Patients' data were collected over 14 days. In total, 283 patients were included (163 men [54.06%]). The majority of cases were open surgery (204 vs. 79). The 24 h and 30-day mortality rates for the cohort were 0.7 and 2.47%, respectively. Twenty-nine patients (10.24%) required re-intervention, while 19 (8.12%) needed critical care admission. The median length of hospital stay was 3 days. Multivariate analysis showed American Society of Anesthesiologist (ASA) classification score (P = 0.0003), diagnosis (P < 0.0001), stoma formation (P = 0.0123), and anastomotic leak (P = 0.0015) to correlate significantly with 30-day mortality. American Society of Anesthesiologist score, diagnosis, stoma formation and anastomo...

A comparative study of pre-operative with operative diagnosis in acute abdomen

Kathmandu University medical journal (KUMJ)

In this observational study (from August 2000 to January 2001) 102 patients of all age group with non-traumatic acute abdomen were studied to see the negative laparotomy rate and the diagnostic accuracy and predictive values of different investigations in acute abdomen. The disease was most common in the age group 20-29 years with male predominance. More than half of the acute abdomen was due to the acute appendicitis. Neutrophil leucocyte count had the highest sensitivity (91.5%) while Plain X-ray abdomen showed the highest specificity (88.8%) and positive predictive value (88.6%) in diagnosing acute abdomen. Urinalysis showed the highest negative predictive value (93.3%). Overall diagnostic accuracy was 78.4%, which was statistically significant (p<0.05). Diagnostic accuracy was highest in bowel obstruction (82.4%) and lowest in peritonitis due to viscus perforation (69.0%). Negative laparotomy rate was 17.6% in the study, which was statistically significant (p<0.05). It was...

Open Abdomen: The Surgeons’ Challenge

Wound Healing - Current Perspectives, 2019

. The Pattern and Outcome of Surgical Acute Abdomen at (original) (raw)

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