Early intraabdominal complications after laparoscopic appendectomy: the status quo and the prospects for prevention

Acute appendicitis (AA) is the most common cause of acute surgical abdominal pain in patients all over the world. Appendectomy (AE) is still associated with relatively high risk of surgical site infection (SSI), regardless of surgical technique and approach, de-spite decades of practice. The incidence of SSI is 7% overall, ranging from 0 to 37.4%. According to various authors, SSI risk factors can be: conversion, experience of the surgeon, the type of inflammation of the process and the timing of the disease, the severity of systemic inflammation, operations at night, some signs according to CT, the features of surgical technique, and even COVID-19. But neither of authors point the laparoscopic approach as an independent risk factor for SSI, however, some of them was hypothesized that carboxyperitoneum and thermal exposure of surgical energy can damage the mesothelium and promote the translocation of microorganisms. Modern methods for diagnosing and assessing SSI after AE are also considered in this re-view: computed and magnetic-resonance imaging, as well as ultrasound diagnostics also with elastography. Thoroughly adher-ence to international guidelines for the prevention of SSI can reduce it incidence, however world experience shows that the list of measures to reduce the risk of SSI development is not limited to this. The surgical community is off to develop clear guidelines for the prevention of early SSI after AE. © 2022, Media Sphera Publishing Group. All rights reserved.

[Computed tomography and endovascular occlusion in diagnosis and treatment of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19]. / Komp'yuternaya tomografiya i rentgenendovaskulyarnaya okklyuziya v diagnostike i lechenii spontannykh krovotechenii v myagkie tkani bryushnoi, grudnoi stenok i zabryushinnogo prostranstva u bol'nykh COVID-19.

OBJECTIVE: To investigate the results of therapeutic and prophylactic endovascular hemostasis of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19. MATERIAL AND METHODS: We retrospectively studied 35 patients with COVID-19 complicated by spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space. According to CT data, the volume of hematoma was 1193.4±706.1 ml. In all patients, CT signs of ongoing bleeding were detected. Moreover, contrast agent extravasation in all phases of examination was established in 15 patients. In other ones, extravasation was detected in late phases or study phase was not identified. All patients underwent angiography. Ongoing bleeding was detected in 12 (34.3%) patients (group 1). They underwent embolization of the target vessel. In 23 patients, bleeding was not established during angiography. Of these, 13 ones underwent prophylactic embolization (group 2). No embolization was carried out in 10 patients (group 3). All groups differed in hematoma localization and COVID-19 severity. RESULTS: Fourteen (40%) patients died in postoperative period. Mortality was similar in all groups. The most common cause of death was progressive respiratory failure following pneumonia. The last one was established by autopsy in 10 (71.4%) patients. CONCLUSION: Angiography confirmed MR signs of contrast agent extravasation in 34.3% of patients. In case of extravasation in all CT phases, ongoing bleeding was confirmed in 66.7% of patients. Endovascular embolization is effective for arterial bleeding into soft tissues. However, large-scale studies are needed to assess the effect of this technique on survival.