Transanal drainage tube reduces rate and severity of anastomotic leakage in patients with colorectal anastomosis: A case controlled study.

BACKGROUND AND AIMS: The aim of this study was to investigate the clinical usefulness of the placement of a transanal drainage tube to prevent anastomotic leakage in colorectal anastomoses. MATERIAL AND METHODS: This single-center retrospective trial included all patients treated with surgery for benign or malign colorectal disease between January 2009 and December 2012. The transanal drainage tube was immediately placed after colorectal anastomosis until day five and was routinely used since 2010. Patients treated with a transanal drainage tube were compared with the control group. Statistical analysis was performed using Fisher's exact or Chi-square tests for group comparison and a linear regression model for multivariate analysis. RESULTS: This study included 242 patients (46% female; median age 63 years; range 18-93); 34% of the patients underwent a laparoscopic procedure, and 57% of the patients received a placement of a transanal drainage tube. Anastomotic leakage occurred in 19 patients (7.9%). Univariate analysis showed a higher rate of anastomotic leakage in patients with an ASA score 4 (p = 0.02) and a lower rate in patients with transanal drainage placement (3.6% vs. 13.6%; p = 0.007). The grading of the complication of anastomotic leakage was reduced with transanal drainage (e.g., Dindo â‰§ 3b: 20.0% vs. 92.9%; p = 0.006), and the hospital stay was shortened (17.6 ± 12.5 vs. 22.1 ± 17.6 days; p = 0.02). Multivariate analysis revealed that transanal drainage was the only significant factor (HR = -2.90; -0.168 to -0.032; p = 0.007) affecting anastomotic leakage. CONCLUSIONS: Placement of a transanal drainage tube in patients with colorectal anastomoses is a safe and simple technique to perform and reduces anastomotic leakage, the severity of the complication and hospital stay.

Incisional hernia rate after open abdomen treatment with negative pressure and delayed primary fascia closure.

PURPOSE: Various techniques for delayed primary fascia closure have been published in patients treated with open abdomen (OA) and application of negative pressure, but to date, no data are available on incisional hernia (IH) rate. The aim of this retrospective analysis was to investigate the long-term outcome of this patient population with special interest in IH development. METHODS: Two hundred and nine consecutive patients, 90(43 %) female, were treated at our institution for various abdominal emergencies involving OA from June 2006 to June 2011. Mean age was 63(16-92) years. The indication was abdominal sepsis in 155(74 %) patients, ischemia in 24(12 %) and other reasons in 30(14 %). Hospital mortality was 21 %(n = 44); and planned ventral hernia was 7 %(n = 15); and mortality until follow-up was 16 %(n = 25), and 9 %(n = 13) patients were lost to follow-up, leaving 112 patients for evaluation of IH development. RESULTS: The rate of IH for patients with OA and delayed primary fascia closure was overall 35 % at a median (range) follow-up time of 26(12-81) months. Mean time for development of a ventral hernia was 11 months; 21(57 %) patients underwent surgery for symptomatic hernia (2 emergency operations for incarceration). Kaplan-Meier estimate for 5 years gave a 66 % IH rate. BMI, small bowel as source of infection and rapid adsorbable interrupted suture were identified risk factors. CONCLUSION: The rate of IH after open abdomen treatment with delayed primary fascia closure is high with a running suture with slow absorbable suture material showing the best results.

A 1-year Aspergillus terreus surveillance study at the University Hospital of Innsbruck: molecular typing of environmental and clinical isolates.

Aspergillus terreus appears to have become an increasingly frequent cause of opportunistic infections in the University Hospital of Innsbruck (UHI) and is of serious concern because of in vivo and in vitro resistance to amphotericin B. In order to determine the possible relationship between environmental contamination by A. terreus and the occurrence of invasive aspergillosis, a 1-year prospective study (2004-2005) was carried out in the UHI. Isolates obtained from air samples of various high-risk settings and those from surveillance cultures of proven and probable aspergillosis (EORTC/MSG criteria) were examined by genotyping. Within 1 year, 34 and 15 A. terreus isolates were collected from the environment and from patients, respectively. Genotypic analysis with rapid amplification of polymorphic DNA (RAPD) PCR and the combination of three different primers (R108, CII, P4) revealed 46 distinct genotypic profiles (types 1-46). No strain similarity was detected among and within the patients and environmental areas, indicating a great genomic diversity in A. terreus, which is common in the environment of Innsbruck and a source of invasive infections in immunosuppressed patients. Genotypical diversity was found in clinical and environmental A. terreus isolates.

Videobronchoscopic guidance makes percutaneous dilational tracheostomy safer.

BACKGROUND: Percutaneous dilational tracheostomy (PDT) can be performed under either conventional bronchoscopic or videobronchoscopic guidance. Only the latter procedure provides the surgeon with direct visual information. This study prospectively assessed procedural parameters and complications of PDT guided by conventional bronchoscopy (CB) or videobronchoscopy (VB). METHODS: Consecutive intensive care unit (ICU) patients who underwent PDT were enrolled in this study. Videobronchoscopy was available in two ICUs, whereas CB was available in three ICUs. Demographic data, procedural variables, and complications were recorded. RESULTS: In this study, 36 patients underwent PDT guided by VB (group V), and 38 patients underwent PDT guided by CB (group C). The two groups were well matched in terms of gender, anatomic aspects, and positioning of the patient. Operating time, procedural difficulty, and extent of tracheal bleeding were not different between the two groups. Group V showed a tendency to younger age (p = 0.055). Surgeons significantly more often considered PTD to be "completely safe" in group V (92% vs 61% in group C). The skin incisions were smaller (p = 0.003), and the extent of stomal bleeding was less (p = 0.001). Complications were tendentiously less frequent in group V (5.5%) than in group C (23.7%; p = 0.062). CONCLUSIONS: The surgeon performing PDT guided by VB has a higher degree of safety, resulting in less bleeding than with PDT guided by CB.

[Transperineal sonography in anorectal disorders]. / Transperineale Sonographie bei rektoanalen Erkrankungen.

AIM: Magnetic resonance imaging, computed tomography, endorectal and endoanal sonography are used for imaging of inflammatory and neoplastic conditions of the lower rectum, the anus and the perineum. These methods, however, have their limitations regarding accuracy, cost-effectiveness, and availability in the acute setting. Pain may be a limiting factor when introducing a probe into the anus. Percutaneous transperineal sonography is an acknowledged method for diagnosing anorectal malformations in children and infants and for diagnosis of prostatic disease. Until today, only limited reports regarding the value of transperineal sonography for evaluation of diseases of the lower rectum, the anus and the perianal region in adults are available. PATIENTS AND METHODS: Between 1997 and 2000 a total of 44 patients underwent transperineal sonography including B-mode and colour Doppler sonography for imaging anorectal structures using 3.5 MHz sector arrays and 7 MHz linear arrays. The lesions were also investigated using colour Doppler imaging. During examination the patient is positioned on his side. Orientation landmarks are the pubic symphysis and the prostate gland in men and the vagina in women. RESULTS: The spectrum of diseases of the current study population (44) included perianal fistulas (10), pararectal abscesses (7), fistulas with abscess (7), perianal inflammation without abscess (1), rectal (6) and anal carcinomas (3) and metastasis of a leiomyosarcoma (1). In 10 cases digital examination of the anus and rectum was not possible because of intense pain. In 34 patients (85 %) sonographic findings were confirmed by intraoperative diagnosis. CONCLUSION: Transperineal sonography proved to be an inexpensive, easily available diagnostic tool that may help in detecting a variety of pathological conditions of the lower rectum, the anus, and the perianal region.