Complication rates in managing hepatic trauma: a cross-sectional study stratifying their outcomes

Background: Liver trauma is the most commonly observed injured organ in abdominal trauma. The objectives of this study was to determine and evaluate the rates of complication in the management of liver traumaMethods: This cross-sectional observational study using non-probability convenient sampling technique was done at surgical unit of Liaquat University of Medical and Health Sciences, Jamshoro, for 06 months. After ethical approval from Institute’s Institutional Review Board (IRB), patients presenting to surgical emergency of the hospital between ages 16 to 60 years having blunt or penetrating liver trauma within 04 hours of incident, either road traffic accident, sustaining a fall, sporting injury, knife or stab wound were include while patients of liver trauma conservatively managed or had severe co-morbid, not fit for anesthesia, with multiple organs lesions (polytrauma) and all hepatic injury patients that were hemo-dynamically stable were excluded. SPSS version 23 was used for data analysis keeping p-value <0.05 as significant.Results: Among 136 patients with mean age 32.33±11.23 years, 120(88.2%) were males. 122(89.7%) of the patients were admitted due to liver trauma of blunt variety while 14(10%) with penetrating liver injury. Overall mean duration of hospital stay was 13.1±4.58 days. 41(30%) patients reported intra-abdominal sepsis, followed by recurrent hemorrhage in 33(24%) of patients while in 22(16%) of patients, biliary leakage was observed. An insignificant difference persisted in either surgical intervention in terms of the complication rates.Conclusions: Higher complication rates were observed in patients with peri-hepatic packing, however outcome of both surgical techniques in terms of complication rates were found to be insignificant. Further studies are needed to shed light upon the findings or this study.

Outcomes of surgical management of liver trauma at LUMHS Jamshoro

Background: Mortality from liver trauma remains high despite surgical advancements. The objective of this study was to determine the outcomes of surgical management of liver trauma at LUMHS Jamshoro.Methods: A cross-sectional observational study using non-probability convenient sampling technique was done at department of surgery LUMHS Jamshoro for 18 months. Patients between 14 to 50 years with blunt hepatic trauma presenting to the E.R. within 04 hours of incident were included and hepatic trauma patients managed conservatively, having multiple trauma and hemo-dynamically stable were excluded. SPSS version 20 was used for data analysis with mean and SD reported for qualitative and frequency and percentages for quantitative variables. Chi-square test was applied keeping p-value of < 0.05 as statistically significant.Results: From 136 patients with mean age of 32.33±1.23 years, 120 (88%) were male. 122 (89.7%) were admitted due to blunt trauma and 14 (10.3%) due to penetrating trauma. Peri-hepatic packing was performed in 116 (85.2%) and suture hepatorrhaphy in 20 (14.8%). Intra-abdominal sepsis was seen in 41 (30%) of patients followed by recurrent hemorrhage in 33 (24%) while 30 (22%) of patients died. Substantial differences (p < 0.001) were observed in terms of surgical technique and each of the complication i.e. sepsis, bile leak and recurrent hemorrhage among alive patientsConclusions: The most common post-operative complication was intra-abdominal sepsis followed by recurrent haemorrhage and bile leak. Significant mortality was observed in between type of complication as well as surgical technique.

Estudio de pacientes ingresados por peritonitis en el Centro Nacional de Cirugía de Mínimo Acceso / Study of patients with peritonitis admitted to the National Center for Minimal Access Surgery

Introducción: La peritonitis postoperatoria es una de las complicaciones más frecuentes que se presenta tras procederes laparoscópicos. Objetivo: Caracterizar la evolución de los pacientes complicados con peritonitis después de un proceder laparoscópico. Material y método: Se realizó un estudio observacional descriptivo de los pacientes con peritonitis ingresados en la terapia intensiva, del Centro Nacional de Cirugía de Mínimo Acceso, desde septiembre de 2010 hasta diciembre de 2015. Se analizaron algunas variables demográficas, procederes laparoscópicos que se complicaron con este diagnóstico, complicaciones clínicas, antibioticoterapia utilizada, tipo de nutrición y la escala de evaluación fisiológica APACHE II como predictor de pronóstico. La información se obtuvo de las historias clínicas. Las variables cualitativas se resumieron utilizando frecuencias absolutas y porcentajes. Para las cuantitativas se utilizó la media y la desviación estándar. Resultados: Se complicaron con peritonitis 26 de 298 pacientes ingresados en el período (8,7 ), la edad media fue de 60 años, predominó el sexo femenino (57,7 por ciento). Se complicaron más con este diagnóstico los pacientes perforados postcolonoscopia (50 por ciento). El disbalance hidroelectrolítico (73,1 por ciento) fue la complicación asociada más frecuente. Se usó precozmente la nutrición enteral en 57,7 por ciento y los antibióticos más utilizados fueron ceftriaxone, amikacina y metronidazol. Predominó la evolución favorable a pesar que el score APACHE II se mantuvo en valores elevados. Conclusiones: Las perforaciones intestinales después de una colonoscopía tienen un alto riesgo de sufrir peritonitis secundaria, pero si se realiza un diagnóstico y tratamiento precoz su evolución es favorable(AU)

Introduction: Endoscopic dilatation is the first therapeutic option to eliminate benign esophageal stenosis and improve the symptoms and the quality of life of those patients who suffer from it. Objective:To describe the results of endoscopic dilatation in patients with benign esophageal stenosis treated in the National Center for Endoscopic Surgery from January 2015 to December 2016. Material and Methods:A case series longitudinal observational study was conducted in 59 patients with benign esophageal stenosis. Dilatations were done with Savary-Gilliard bougie and balloons. Results:The mean age was 52,5 years, and the condition predominated in 37 male patients (62,7 percent). Post-surgical, peptic, and caustic were the most frequent etiologies with 25, 14, and 6 cases, respectively. Short stenosis predominated in 51 cases. Bougies were used in 48 patients for a total of 149 dilatations, corresponding to a mean of 3,1 dilatations/ patients. Correction of the stenosis was made in 1-3 sessions in 47 percent of patients; 11 cases were dilated with balloon, corresponding to a mean of 1- 3 dilatations/ patients. Four patients from the group that were dilated with Savary-Gilliard bougies showed refractoriness. A perforation, and two bleedings occurred. After the dilatations, dysphagia improved or disappeared in 93,2 percent of patients. Conclusions:Endoscopic therapy through dilatation of benign esophageal stenosis indicated to be a good alternative method in achieving corrections in a few dilatation sessions, with a low number of complications, and an improvement of the dysphagia(AU)

Combined use of early enteral nutrition, growth hormone and fibrin glue improves healing of intestinal anastomosis in intra-abdominal sepsis rats / 肠外与肠内营养

Objective: To investigate the effects of combined use of early enteral nutrition, growth hormone and fibrin glue on early healing of intestinal anastomosis in intra-abdominal sepsis rats. Methods: Male Wistar rats were randomized into 3 groups. In Control group, antimesenteric transverse enterotomy of 4mm was performed, a second laparotomy was subsequently performed after 24 hours, 6cm of the intestine in the middle of the fistula segment was resected. An end-to-end single layer anastomosis was constructed using 8 interrupted 6-0 polypropylene sutures; In EN group, anastomosis was constructed using 4 interrupted sutures and sprayed fibrin glue, enteral nutrition was given on the second postoperative day for 12 days; In EN/GH group, the animals were treated as EN group, and growth hormone(3.0 U/kg/d) was injected subcutaneously every 24 hours for 14 days. The anastomotic bursting pressure and breaking strength, hydroxyproline content and histology were measured as indicators of wound healing. Results: Anastomotic bursting pressure, anastomotic breaking strength and hydroxyproline content in EN+GH group were higher than that in control and EN groups. Conclusions: Combined use of early enteral nutrition , growth hormone and fibrin glue improves early healing of intestinal anastomosis in intra-abdominal sepsis rats.

Healing mechanism of intestinal anastomosis in intra-abdominal sepsis rats / 医学研究生学报

Objective: To investigate the mechanism of intestinal anastomosis in a rat model of intra-abdominal sepsis.Methods:Male Wistar rats were randomized into 2 groups.Control rats underwent intestinal anastomosis.Sepsis group underwent intestinal anastomosis after intestinal fistula operation.fibronectin(FN),?-smooth muscle actin(?-SMA),vascular endorthelial growth factor(VEGF) and apoqtosis in anastomoses were measured.Results:FN,?-SMA,VEGF in control group were higher than sepsis group and apoptosis were lower than the other.Conclusion:It is indicated that the repair of tissue was out of balance after infection,and the organization repair was retarded.The collagenoblast and the epithelial cell migration were slowed down,and the blood capillary regeneration was slowly.Not only the granulation organization was reduced,but also apoptosis was prematurely appeared.

Enteral fish oil immunonutrition prevents pulmonary dysfunction during intra-abdominal sepsis and hypertension in rats / 肠外与肠内营养

Objective:To investigate whether an enteral fish oil immunonutrition during intra-abdominal sepsis and hypertension dose improve pulmonary function.Methods: We divided 25 rats into three groups.The rats were supplemented by gavage with:(Ⅰ)normal saline as control group(9);(Ⅱ)fish oil(0.3%,8) and(III)fish oil(0.6%,8).The cytokine levels were analyzed.The lungs were harvested,stained with hematoxylin-eosin,and analyzed. Results:Intra-abdominal sepsis and hypertension induced thickening of alveolar walls and inflammatory reaction.Fish oil decreased expression of pro-inflammatory cytokines(TNF-? and IL-1?),inhibitted infiltration of MPO positive cells,and protected pulmonary structure.Conclusion: The lung may be protected by an enteral fish oil nutrition through attenuating inflammatory reaction.

Fish oil ameliorates the intra-abdominal sepsis and hypertension-induced ileus / 肠外与肠内营养

Objective:To investigate whether the fish oil improves intestinal motility function during intra-abdominal sepsis and hypertension.Methods: 25 rats were divided into three groups.The rats were supplemented by gavage with: ①normal saline as control group(n=9);②fish oil(0.3%,n=8)and ③fish oil(0.6%,n=8)for 4 weeks before operation.The rats were killed on the 24th hour after operation.In vitro ileual smooth muscle contractions were recorded.Ileum sections were assessed pathologically.Immunopositivity of c-kit as markers of ICC-MY by confocal microscopy were evaluated.Results: In the bowel segment with NS,muscles showed a significant reduction in the frequency of contraction compared to that with FO.This change was associated with the changes of ICC-MY network.Conclusion:The intestinal motility may be protected by an enteral fish oil nutrition through attenuating injury of ICC-MY network.

Healing mechanism of growth hormone and fibrin glue on intestinal anastomosi in intra-abdominal sepsis rats / 肠外与肠内营养

Objective: To investigate the mechanism of combined growth hormone and fibrin glue on early healing of intestinal anastomosis in intra-abdominal sepsis rats.Methods: Male Wistar rats of abdominal sepsis were randomized into 3 groups.Control rats were given intestinal anastomosis after intestinal fistula operation.Glue group was given intestinal anastomosis and fibrin glue after intestinal fistula.GH group was given intestinal anastomosis and fibrin glue and growth hormone after intestinal fistula.FN,?-SMA,VEGF,and apoptosis in anastomoses were measured.Results: Expression of intestinal FN,?-SMA,and VEGF in GH group were higher than those in other groups and apoptosis were lower than others.Conclusion: It is indicated that combined growth hormone and fibrin glue ameliorates healing of intestinal anastomosis in intra-abdominal sepsis rats.