Temporary abdominal closure in the critically ill patients with an open abdomen

The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags [Bogot? bag]. The study population comprised of 11 [57.9%] male and 8 [42.1%] female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 [57.9%] patients, subjective judgment that the fascia closure is too tight in 6 [31.6%] patient's damage control surgery in one patient [5.3%] and development of abdominal compartment surgery in one patient [5.3%]. Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 [47.4%] patients, post operative intestinal fistula in 4 [21.1%] patients, post traumatic intra abdominal bleeding in 3 [15.8%] patients and intestinal obstructions in 3 [15.8%] patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one [10.0%] patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 [%21.1] early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 [26.3%] late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 [range 2-54] months. Currently 10 patients [52.6%] are alive at a follow up of 45 [range 1-94] months. Only one [10.0%] patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogot? bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage

unusual case of recurrent gastric cancer long after the first gastrectomy due to adenocarcinoma

The postgastrectomy recurrence rate is as high as 30-65%, with 5-year overall survival rates of <20%. Local recurrence is very common which occurs in 38-45% of cases. The most common sites of locoregional recurrence are the gastric remnant at the anastomosis, the gastric bed, and the regional nodes. The recurrence may occur as early and late events after gastrectomy. Most recurrences are early, within three years of surgery. Numerous studies reported the late recurrences, but most of them having a survival time of less than ten years. This report elucidates a case of recurrent gastric cancer after 24 years postoperatively