Subject(s)
Cholecystectomy, Laparoscopic , Gallstones/surgery , Pleural Diseases/etiology , Postoperative Complications/etiology , Subphrenic Abscess/etiology , Aged , Humans , Male , Peritoneum , Pleural Diseases/therapy , Postoperative Complications/therapy , Subcutaneous Tissue , Subphrenic Abscess/therapyABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Subphrenic Abscess/etiology , Cholecystectomy, Laparoscopic/adverse effects , Drainage/methods , Cholecystitis/surgeryABSTRACT
PURPOSE: To evaluate the incidence of intra-abdominal adherences after open and laparoscopic cholecystectomy, on the basis of an experimental study in pigs. MATERIALS AND METHODS: A total of 40 female pigs, mean weight 25 kg, underwent open cholecystectomy by right subcostal laparotomy (group A, n = 22) or laparoscopic cholecystectomy using a Storz laparoscope (group B, n = 18). After surgery, the abdominal wall was closed with polydioxanone suture and staples (group A) or with staples only (group B). One month later, the pigs underwent medial laparotomy to assess whether intra-abdominal adherences had developed. Incidences were compared between groups by the chi-square test with Yates correction. RESULTS: Five pigs in group A and one pig in group B died within 24 hours of surgery, leaving 17 pigs in each group. Mean operative time was similar for both groups (24.7 minutes in group A, 25.3 minutes in group B). In group A, 16 pigs (94%) developed intra-abdominal adherences, in all cases multiple; in group B, only 9 pigs (53%) developed adherences, and in 8 of these pigs only a single adherence was present (P < 0.03). CONCLUSIONS: The results of this study indicate that the incidence of intra-abdominal adherences is statistical lower after laparoscopic cholecystectomy than after open cholecystectomy.
Subject(s)
Cholecystectomy, Laparoscopic , Cholecystectomy/methods , Postoperative Complications/epidemiology , Tissue Adhesions/epidemiology , Animals , Chi-Square Distribution , Female , Incidence , SwineABSTRACT
Because of the extraperitoneal location, generally used for renal grafting, intraperitoneal urine leaks are a rare complication after transplantation. We report a patient on peritoneal dialysis who developed ascites, abdominal pain, anuria and shock suddenly after renal transplantation. The patient was immediately taken back to the operating room. An abnormal implantation of ureter into the peritoneum overlying the bladder when carrying out an unstented parallel incision extravesical ureterone-ocystostomy was identified. After correcting ureter implantation the patient had immediate diuresis, renal function rapidly improved, with no further complications. Contributing causes were poor exposure, thickened peritoneum secondary to recurrent peritonitis, and the presence of residual peritoneal dialysis fluid.
Subject(s)
Kidney Transplantation/adverse effects , Peritoneum/surgery , Ureter/surgery , Adult , Female , HumansABSTRACT
En el trasplante renal la fuga de orina intraperitoneal es una complicación rara, debido a la implantación habitual en retroperitoneo. Informamos del caso de un paciente en diálisis peritoneal que inmediatamente al trasplante presenta ascitis, dolor abdominal, anuria y shock. Con rapidez es llevado de nuevo a quirófano. Se identificó una implantación del uréter en peritoneo y no en vejiga, en el curso de una ureteroneocistostomía extravesical no tutorizada. Después de corregir la implantación ureteral el paciente recuperó la diuresis, mejoró rápidamente su función renal, sin más complicaciones. Fueron factores contribuyentes la limitada exposición, el engrosamiento peritoneal secundario a peritonitis recurrente y la presencia de fluido de diálisis peritoneal residual (AU)
Subject(s)
Adult , Female , Humans , Ureter , Kidney Transplantation , PeritoneumABSTRACT
BACKGROUND: Case description of a patient who developed erysipelas of the surgical wound following appendectomy for acute appendicitis, and literature review of invasive group B streptococcal infections. METHODS: A 65-year-old man with perforated appendicitis underwent urgent appendectomy and drainage. Antibiotic prophylaxis with tobramycin (100 mg) and metronidazole (500 mg) was administered. At surgery, a phlegmon was identified with free perforation of the appendix and purulent peritoneal fluid. Appendectomy, irrigation with 0.9% NaCl solution, and drainage with a Silastic closed-suction drain was performed. A literature search in all languages was performed using MEDLINE, using the search terms surgical site infection, wound infection, group B streptococcus, Streptococcus agalactiae, necrotizing fasciitis, and postoperative infection. RESULTS: Erysipelas of the surgical wound developed on the fourth postoperative day. Intravenous penicillin and amoxicillin/clavulanic acid were administered empirically. Culture of the wound drainage identified Streptococcus agalactiae and a few colonies of Escherichia coli. The broad-spectrum antibiotic was discontinued, and a 10-day course of penicillin was completed. CONCLUSIONS: Erysipelas of the surgical wound is unusual, and infection with group B streptococci is rare compared with infection by group A streptococci. Streptococcus agalactiae is recognized to be increasingly virulent, with an increasing predilection for bacteremic infections in healthy hosts. Although Streptococcus agalactiae remains highly susceptible to antimicrobial agents effective against gram-positive cocci, the changing epidemiology and potentially invasive nature of these infections should have clinicians alert to the possibility of infection caused by group B streptococci.
Subject(s)
Appendectomy/adverse effects , Erysipelas/microbiology , Streptococcus agalactiae , Surgical Wound Infection/microbiology , Aged , Erysipelas/therapy , Humans , Male , Surgical Wound Infection/therapyABSTRACT
Over the last decade kidney transplantation has become a common therapeutic procedure for patients with end-stage renal diseases. Between 1988 and 1998 donors rate per million population has dramatically increased in our environment, thus providing us with more chances to offer kidney transplantation to a larger number of patients. The technico-surgical difficulties that have to be faced however, are increasingly frequent and require a search for new approaches and innovative changes to the usual surgical techniques for our patient's benefit.
Subject(s)
Arteriovenous Shunt, Surgical , Kidney Transplantation/methods , Female , Femoral Artery/surgery , Femoral Vein/surgery , Humans , ReoperationABSTRACT
El trasplante renal se ha convertido en la última década en una forma de tratamiento habitual para los pacientes con enfermedades renales terminales. Entre 1988 y 1998 la tasa de donantes por millón de habitantes ha aumentado espectacularmente en nuestro medio, ello implica que cada vez es posible ofrecer un trasplante renal a un número mayor de pacientes, de modo que las dificultades técnico-quirúrgicas con las que debemos enfrentarnos son cada vez más frecuentes, siendo preciso buscar e incorporar nuevos enfoques y modificaciones imaginativas de la técnica quirúrgica en beneficio de nuestros pacientes. (AU)
