ABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Thyroidectomy/adverse effects , Esophagus/injuries , Iatrogenic Disease , Intraoperative ComplicationsSubject(s)
Esophagus/injuries , Esophagus/surgery , Intraoperative Complications/surgery , Thyroidectomy , Female , Humans , Middle AgedABSTRACT
INTRODUCTION: Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply. MATERIAL AND METHOD: Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation. RESULTS: The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery >180 min (p<0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem. CONCLUSIONS: Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process.
Subject(s)
Hernia, Abdominal/surgery , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/surgery , Surgical Mesh/adverse effects , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Risk Factors , Time FactorsABSTRACT
Introducción: la infección de la prótesis es una complicación infrecuente pero importante en la cirugía de la pared abdominal. El objetivo de este estudio es valorar la incidencia y los factores de riesgo influyentes en la infección de la prótesis tras la reparación herniaria, así como el tratamiento a aplicar. Material y método: entre enero de 2002 y diciembre de 2006, se realizaron en total 1.055 reparaciones protésicas herniarias: 761 hernias inguinocrurales (72,1%), 74 hernias umbilicales (7%) y 220 eventroplastias (20,9%). Se analizaron de forma prospectiva variables preoperatorias, intraoperatorias y postoperatorias, así como la incidencia de infección de herida quirúrgica y de prótesis. Se utilizó la clasificación ASA para la valoración preoperatoria anestésica. Resultados: el porcentaje de infección del biomaterial en general fue del 1,3%. Observamos infección en 11 reparaciones con prótesis de polipropileno (PPL), en 4 con PTFE-e y 1 caso en prótesis combinada. Fueron factores de riesgo en la infección del biomaterial: la obesidad (p=0,002), la diabetes mellitus (p=0,020), el tipo de reparación (p=0,047), la intervención de urgencia (p=0,001), el tipo y el tamaño de la prótesis (p=0,003 y p=0,007) y el tiempo quirúrgico >180min (p<0,001). De 11 pacientes con infección de prótesis de PPL, 7 respondieron al tratamiento con curas, mientras que todos los casos con infección de PTFE-e o prótesis mixta necesitaron de su extirpación para resolver el problema. Conclusiones: existen numerosos factores de riesgo influyentes en la tasa de infección del biomaterial. Mientras que la terapia antibiótica adecuada y el drenaje quirúrgico de la infección pueden ser suficientes en la mayoría de las infecciones de prótesis de PPL, las de PTFE-e requieren extirpación precoz para acabar con el proceso infectivo (AU)
Introduction: Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply. Material and method: Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation. Results: The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery >180min (p<0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem. Conclusions: Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/surgery , Surgical Mesh/adverse effects , Hernia, Abdominal/surgery , Prospective Studies , Risk Factors , Time Factors , IncidenceABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Liver Abscess/complications , Liver Abscess/diagnosis , Liver Abscess/surgery , Abdominal Cavity/surgery , Cholecystectomy, Laparoscopic/methods , Calculi/complications , Calculi/surgery , Tomography, Emission-Computed/methods , Bile Duct Diseases/complications , Bile Duct Diseases , Gallstones/complications , Gallstones/surgerySubject(s)
Fasciitis, Necrotizing/etiology , Fasciitis, Necrotizing/surgery , Streptococcal Infections/etiology , Streptococcal Infections/surgery , Streptococcus pyogenes/isolation & purification , Adult , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/diagnostic imaging , Fasciitis, Necrotizing/microbiology , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Physical Exertion , Sports , Time Factors , Treatment Outcome , UltrasonographyABSTRACT
No disponible
Subject(s)
Male , Adult , Humans , Fasciitis, Necrotizing , Disease-Free Survival , Physical Exertion , Debridement/methods , Fasciitis, Necrotizing/surgeryABSTRACT
INTRODUCTION: The aim of this study was to assess the influence of age in laparoscopic cholecystectomy (LC) for the treatment of acute cholecystitis by determining the benefits and postoperative complications in patients older than 65 years. MATERIAL AND METHOD: Between January 2003 and March 2006, we performed 134 urgent LC for acute cholecystitis: 58 patients older than 65 years (group 1) were compared with 76 patients younger than 65 years (group 2). Preoperative, intraoperative and postoperative variables were compared between groups 1 and 2. ASA score was used in the preoperative anesthetic evaluation. RESULTS: A total of 31.2% of patients in group 1 had high surgical risk (24% ASA III and 9.2% ASA IV). The conversion rate was 24.1% in group 1 versus 11.3% in group 2 (p = 0.04), due to difficulty in surgical dissection and advanced cholecystitis. The mean length of postoperative hospital stay was 4.7 +/- 3.2 days in group 1 versus 3.3 +/- 2.4 days in group 2 (p = 0.001). The overall rate of postoperative complications was 33.1% and 18.7% respectively, with a predominance of infectious complications. CONCLUSIONS: Although age should not be an exclusion factor for LC, the conversion rate, postoperative complications and length of hospital stay are increased in the elderly. Higher morbidity due to the underlying disease and longer disease duration with more advanced cholecystitis complicate the laparoscopic approach in these patients.
Subject(s)
Cholecystectomy, Laparoscopic/methods , Cholecystitis, Acute/surgery , Aged , Female , Humans , Male , Middle AgedABSTRACT
Introducción. El objetivo de este estudio es valorar la influencia de la edad en la colecistectomía laparoscópica (CL) para el tratamiento de la colecistitis aguda (CTTA), determinando los beneficios y complicaciones postoperatorias en los pacientes mayores de 65 años. Material y método. Entre enero de 2003 y marzo de 2006, se practicó un total de 134 CL por CTTA en el área de urgencias: 58 pacientes tenían edades superiores a 65 años (grupo 1) y se los comparó con 76 pacientes más jovenes (grupo 2). Se analiza las variables preoperatorias, intraoperatorias y postoperatorias en el grupo 1 y se las compara con el resto de la serie. Se utilizó la clasificación ASA para valoración preoperatoria anestésica. Resultados. El grupo 1 presentó en un 31,2% alto riesgo quirúrgico (un 24%, ASA III y el 9,2%, ASA IV). La tasa de conversión a colecistectomía abierta fue del 24,1%, frente al 11,3% en el grupo 2 (p = 0,04), debido a dificultad en la disección quirúrgica y hallazgo de vesícula colecistítica muy evolucionada. La estancia media postoperatoria fue de 4,7 ± 3,2 días en el grupo 1 y de 3,3 ± 2,4 días en el grupo 2 (p = 0,001). La tasa general de complicaciones postoperatorias fue del 33,1 y el 18,7%, respectivamente, y prevalecieron las de tipo infeccioso. Conclusiones. Aunque la edad no debe ser un factor excluyente para la CL, la tasa de conversión, las complicaciones postoperatorias y la estancia hospitalaria son mayores en estos pacientes que en el resto de la población. Son características la mayor morbilidad por la enfermedad de base, y una evolución más larga del cuadro con hallazgos más frecuentes de colecistitis evolucionada, que complican el abordaje laparoscópico en estos pacientes (AU)
Introduction. The aim of this study was to assess the influence of age in laparoscopic cholecystectomy (LC) for the treatment of acute cholecystitis by determining the benefits and postoperative complications in patients older than 65 years. Material and method. Between January 2003 and March 2006, we performed 134 urgent LC for acute cholecystitis: 58 patients older than 65 years (group 1) were compared with 76 patients younger than 65 years (group 2). Preoperative, intraoperative and postoperative variables were compared between groups 1 and 2. ASA score was used in the preoperative anesthetic evaluation. Results. A total of 31.2% of patients in group 1 had high surgical risk (24% ASA III and 9.2% ASA IV). The conversion rate was 24.1% in group 1 versus 11.3% in group 2 (p = 0.04), due to difficulty in surgical dissection and advanced cholecystitis. The mean length of postoperative hospital stay was 4.7 ± 3.2 days in group 1 versus 3.3 ± 2.4 days in group 2 (p = 0.001). The overall rate of postoperative complications was 33.1% and 18.7% respectively, with a predominance of infectious complications. Conclusions. Although age should not be an exclusion factor for LC, the conversion rate, postoperative complications and length of hospital stay are increased in the elderly. Higher morbidity due to the underlying disease and longer disease duration with more advanced cholecystitis complicate the laparoscopic approach in these patients (AU)
