Reduced preoperative serum choline esterase levels and fecal peritoneal contamination as potential predictors for the leakage of intestinal sutures after source control in secondary peritonitis.

BACKGROUND: The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons' choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. METHODS: Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. RESULTS: Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy. CONCLUSIONS: A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting.

Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK).

Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.

cagA and vacA status and influence of Helicobacter pylori infection on serum oxidative DNA damage in Iranian patients with peptic ulcer disease.

BACKGROUND: Infection with Helicobacter pylori strains may result in different pathological manifestations and increased oxidative stress leading to a strong inflammatory response in gastric mucosa. AIMS: The prevalence of cagA and vacA genes, proteins and the association of serum levels of 8-hydroxy-2-deoxyguanosine (8-OHdG) with oxidative DNA damage were determined. METHODS: The presence of cagA gene and vacA alleles and IgG antibodies against CagA and VacA proteins were determined. Oxidative DNA damage status was determined using serum levels of 8-OHdG. RESULTS: Helicobacter pylori-positive, cagA-positive, and vacA alleles (s1 and m2) were predominant in all clinical outcomes. There was no significant association between prevalence of CagA and VacA status and clinical outcomes. The serum levels of 8-OHdG was at a higher level in H. pylori-positive patients. CONCLUSIONS: These virulence factors are not associated with the development of PUD in Iranian patients. H. pylori infection may be associated with increased serum 8-OHdG.