ABSTRACT
BACKGROUND: Patterns of white blood cells differential count with low lymphocyte number have been associated with poor outcome following sepsis, burns and trauma. Lymphocytopenia, measured preoperatively or in response to surgical stress, may affect complications after bowel resection. METHODS: Clinical characteristics and white blood cells differential count values, measured both pre- and post-operatively of a cohort of patients submitted to intestinal resection and anastomosis from June 2014 to June 2017 in our General Surgery Division, were retrospectively analyzed. Multivariate logistic regression was used to determine the dependence of mortality and postoperative complications from the clinical characteristics of patients and white blood cells differential count values. RESULTS: A total of 301 consecutive patients were studied; 165 (54.8%) were male; mean age was 70 years. Overall, the rate of in-hospital 30-day mortality was 4%. Post-operative morbidity was observed in 124 (41.2%). On multivariate analysis, age adjusted Charlson Comorbidity Index, low preoperatively lymphocyte count, high preoperative monocyte count, high postoperative neutrophil count and anastomotic leak were independently associated with increased in-hospital mortality. Preoperative lymphocytopenia and rectal resection were independently associated with high morbidity rate, while low postoperative lymphocyte count was associated with an increased risk of anastomotic leak. CONCLUSIONS: Perioperative lymphocytopenia is associated with 30-days mortality, severe complications and anastomotic leak after bowel resection surgery. These routinely available laboratory data could help to identify patients at high-risk for developing complications.
ABSTRACT
BACKGROUND: The aim of this prospective study was to evaluate the results of combined rectal and urogynecologic surgery in women with associated obstructed defecation, urinary incontinence, or genital prolapse. METHODS: One hundred forty-two selected patients with obstructed defecation in isolation or associated with urinary incontinence, enterocele, or genital prolapse were consecutively operated on by stapled transanal rectal resection alone or associated with transobturator tape, vaginal repair of the enterocele, or vaginal hysterectomy, respectively, and followed up by clinical controls and defecography. RESULTS: At 2 years, all symptom, quality-of-life, and defecographic parameters had significantly improved in all groups (P < .001). The association with hysterectomy showed higher risk for severe complications, longer operative time, hospital stay, and time of inability (P < .001). Recurrence of urinary incontinence was observed in 3 of 24 patients, while 2 of 21 showed residual vaginal prolapse. CONCLUSION: The combination of rectal and urogynecologic surgery is effective, with higher morbidity in the association with vaginal hysterectomy. Randomized trials comparing surgery in 1 and more stages and longer follow-up are necessary for a definitive conclusion.
