Outcome of emergency abdominal surgery in elderly patients

The outcome of emergency abdominal surgery in elderly patients [above 60 years old] remains unsatisfactory. Factors contributing to this outcome were studied; particularly in those aged 80 years and older. 44 patients aged 80 years or more [group A] and 152 patients aged 60-79 years [group B] who underwent emergency abdominal surgery between 1998 and 2003 in El-Minia University hospital and Al Haram hospital. Complications were significantly higher in group A than in group B. Respiratory failure was the most common postoperative complication. The mortality rate within 30 days after operation was also higher in group A[23%] than in group B [4.5%]. Morbidity and mortality did not differ significantly between those with and without preexisting concomitant disease in group A. Group B showed significant difference in morbidity and mortality among those Patients with or without preexisting concomitant disease Systemic Inflammatory Respouse Syndrome [SIRS]was noted in 26 patients [59%]in group A and in 71 patients [47%]in group B. Severe complications occurred in 22 patients [50%] of group A with Preoperative SIRS. The mortality rate in those with SIRS was significantly higher than that in patients without. So SIRS is considered a predictor of poor outcome in elderly patients who have emergency abdominal surgery. We concluded that Patients with SIRS should initially receive minimal treatment whenever possible, rather' than be over treated, until their condition stabilizes

Postoperative transient hypoparathyroidism in graves' disease

Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a deficiency in calcium and Vitamin D concomitant with transient hypoparathyroidism induced by surgery. In this study, we try to predict the risk factors for this observation by referring to serum 25-hydroxyvitamin D and alkaline phosphatase. The serum level of intact parathyroid hormone, calcium, other electrolytes, and 25-hydroxyvitamin D were measured preoperatively in 59 female patients with Graves' disease who underwent Subtotal thyroidectomy. A systematic accurate identification and preservation of parathyroid glands were always performed. Of the 59 female patients, 5 [8.4%] developed tetany. From analysis of different possible risk factors, the results showed that two were statistically significant: serum 25-hydroxyvitamin D [25 [OH] D] and alkaline Phosphatase [ALP] levels. The incidence of tetany according to the serum levels of 25 [OH] D and ALP was 20% [3/15] in patients with 25 [OH] D l55U/L, 9.09% [1/11] in those with 25 [OH] D 10 ngm/ml and ALP> 155u/L, and 0% [0/17] in those with 25 [OH] D> 10 ngm/ml and ALP >/= 155 u/L. Patients with Graves disease who have vitamin D deficiency and high serum alkaline phophatase levels is the highest risk group for postoperative tetany, so, serum 25 [OH] D and ALP should be monitired in patients with Graves' disease and preventive prescription of vitamin D and Calcium is recommended

Removal of huge spleen: a surgical risk? its morbidity and mortality

Reports vary about whether risks are greater for removal of huge [>1500g] spleens than for smaller [<1500g] spleens. Splenectomy was performed on 196 patients presented with massive splenomegaly [n=83] and smaller splenomegaly [n=113]. Patients with huge spleens are no more likely to have postoperative complications [relative risk [RR] 2.2 95% confidence interval [Cl] 1.5 to3.1; p=0.7] and death [RR, 4, 3; 95% Cl, 1.4 to 12.2; p=0.3]. When the investigation is restricted to comparable diagnoses [congestive splenomegaly], patients with huge spleens do not differ from those with smaller spleens regarding complications [RR 1.3; 95% Cl 0.9 to 2.8; p=0.2] and death [RR2.1; Cl 0.9 to 8.2; p=0.3]. Multivariate analysis accused age as a critical risk of complications and death. This series concluded that increased age and underlying illness are the predominant factors associated with morbidity and mortality following splenectomy for congestive and hematological massive splenomegally. Adjusting for age and diagnosis, spleen size is not a hazard

Repair of large paraesophageal hiatus hernia with polypropylene prosthesis

Posterior Cruroplasty repair of a large paraesophageal hiatus has a higher than desirable rate of recurrence attributable to the inexorable cyclic negative intrathoracic pressure of respiration and positive intrabdominal pressure produced by straining, physical exertion and coughing. To reduce the risk of recurrence, we have used posterior cruroplasty reinforced with an onlay polypropylene mesh prosthesis. Thirty consecutive patients with paraesophageal hiatus hernia had transabdominal posterior cruroplasty and onlay polypropylene mesh prosthesis applied to the crura and adjacent diaphragm to reinforce the hiatal defect with Nissen fundoplication to control associated reflux which was present in 80% of the patients. As regards to pre-and postoperative clinical manifestations, contrast radiography and upper gastrointestinal endoscopy, the results of the operation were excellent in 22 patients [73%], good in 6 patients [7%] Postoperative course was sound in most patients [23 from 30 patients]. After a period of follow up [from 18 to 48 months] there was neither cases of recurrence, nor complications related to the mesh. We conclude that mesh reinforcement of the esophageal hiatus hernia repair is effective, have a low clinical recurrence rate, and devoid of any complications related to the used polypropylene mesh. Concomitant antireflux procedure [we used Nissen fundoplication] is recommended in all operations for paraesophageal hiatus hernia especially if reflux can not be excluded before operation, or retroesophageal dissection is needed