Is prompt exploratory laparotomy the best attitude for mesenteric ischemia after cardiac surgery?

Mesenteric ischemia following cardiac surgery is a life-threatening complication. Early identification of patients may help optimizing management and improving outcome. Between January 2000 and July 2007, surgical exploration was realized when mesenteric ischemia was suspected after coronary-artery bypass grafts (CABG). Patients were divided in two groups according to diagnosis confirmation upon laparotomy. Peri-operative predictors of complication and death were analyzed. Of 1634 consecutive patients, 13 (0.8%) developed acute abdomen with suspicion of mesenteric ischemia. Seven (0.4%) underwent resection for ischemic lesions (group 1), of whom two were during a second look laparotomy. The other six patients had normal bowel (group 2). Both groups were comparable according to preoperative status, clinical signs, biological and radiological findings. Delays to laparotomy were 13.7+/-19.0 and 51.4+/-29.0 h in group 1 and 2, respectively (P=0.02). Mortality rates were 46.1% (6/13) overall, 42.8% for group 1 and 50% for group 2. All deaths occurred within the first nine postoperative days. Mesenteric ischemia following CABG is a fatal complication in almost half the cases. Diagnostic tools and timely laparotomy still need to be optimized. Low threshold-based strategy for prompt surgical intervention is efficient for both diagnosis and treatment.

[Two-year follow-up study of postoperative rehabilitation, return to work, and athletic activities of 111 Lebanese patients after coronary bypass]. / Rééducation postopératoire, réinsertion socio-professionnelle et reprise du sport chez 111 patients libanais opérés de pontage aorto-coronarien suivis pendant 2 ans.

The goal of this paper is to study the progress of the first phase of rehabilitation of a Lebanese population treated by coronary artery bypass surgery, as well as to follow long-term socioprofessional reinsertion and resumption of physical activity in these patients. 111 patients operated in our hospital of coronary artery bypass in 1997 have been studied retrospectively two years after the surgery. The analyzed parameters are socioprofessional demographic data, physical and sports activities before and after the bypass surgery as well as the applied rehabilitation program. Among the studied patients (mean age = 64 years, 77% of men), 30% only had a professional activity before the surgery. The majority of these patients returned to work in a mean delay of 45 days. 76% of the patients have regular physical activity two years after the surgery versus 50% before. On the 63 smoking patients before the bypass surgery, 41 continue to smoke 2 years later. The behavior of the Lebanese patients after a coronary artery bypass surgery is particular and different from what is reported in the literature: 1) The resumption of the initial work is more frequent and more precocious. 2) The patients start regular physical activity without surveillance or previous codification of the frequency and the intensity of the effort. 3) The majority of the smoking patients continue to smoke after surgery. 4) The functional rehabilitation is limited to the phase I.