Major Postoperative Complications (major + postoperative_complications)

Distribution by Scientific Domains

Selected Abstracts

Early and late outcome of cardiac surgery in patients with liver cirrhosis

Farzan Filsoufi
Liver cirrhosis is a major risk factor in general surgery. Few studies have reported on the outcome of cardiac surgery in these patients. Herein we report our recent experience in this high-risk patient population according to the Child-Turcotte-Pugh classification and Model for End-Stage Liver Disease (MELD) score. Between January 1998 and December 2004, 27 patients (mean age 58 10 yr, 20 male) with cirrhosis who underwent cardiac surgery were identified. Patients were in Child-Turcotte-Pugh class A (n = 10), B (n = 11), and C (n = 6) and mean MELD score was 14.2 4.2. Operative mortality was 26% (n = 7). Stratified mortality according to Child-Turcotte-Pugh class was 11%, 18%, and 67% for class A, B, and C, respectively. No mortality occurred in patients who had revascularization without the use of cardiopulmonary bypass (n = 5). The 1-yr survival was 80%, 45%, and 16% for Child-Turcotte-Pugh class A, B, and C, respectively (P = 0.02). Major postoperative complications occurred in 22%, 56%, and 100% for Child-Turcotte-Pugh class A, B, and C, respectively. Child-Turcotte-Pugh classification was a better predictor of hospital mortality (P = 0.02) compared to MELD score (P = 0.065). In conclusion, our results suggest that cardiac surgery can be performed safely in patients with Child-Turcotte-Pugh class A and selected patients with class B. Operative mortality remains high in class C patients. Careful patient selection is critical in order to improve surgical outcome in patients with cirrhosis. Liver Transpl, 2007. 2007 AASLD. [source]

Functional impairment after latissimus dorsi flap

Cherry E. Koh
Abstract Background:, Available published reports suggest that loss of latissimus dorsi muscle following latissimus myocutaneous flap does not lead to functional impairment. However, significant functional impairment has been observed in clinical practice, prompting this study to evaluate the functional deficit in patients who had undergone reconstruction using latissimus dorsi muscle. Methods:, A retrospective review was undertaken between 1998 and 2003. Patients were identified from the audit of the plastic surgery unit at St Vincent's Hospital and recruited by direct telephone contact. They were assessed using the Disability of Arm, Shoulder and Hand questionnaire. Results:, There were 25 participants. Eighteen completed their questionnaires. Six of 18 patients reported scores of 30 or more, which corresponded to a global moderate functional deficit. These patients were severely limited in their ability to carry out housework. Major postoperative complications were associated with high Disability of Arm, Shoulder and Hand scores (P = 0.028). Three of five patients involved with sports reported impaired performance in sports. The subgroup of four patients who underwent bilateral latissimus dorsi flaps also experienced significant morbidity with all four reporting moderate to severe impairment in their ability to return to gardening and/or sports. Conclusion:, Patients undergoing this procedure should be fully informed of potential sequelae. Athletic patients and patients undergoing bilateral latissimus dorsi flaps should also be warned of possible reduced performance in sports. Alternatively, perforator cutaneous flaps, which preserve the latissimus muscle, should be chosen when feasible. [source]

Early Surgical Morbidity and Mortality in Adults with Congenital Heart Disease: The University of Michigan Experience

Ginnie L. Abarbanell MD
ABSTRACT Objectives., To review early surgical outcomes in a contemporary series of adults with congenital heart disease (CHD) undergoing cardiac operations at the University of Michigan, and to investigate possible preoperative and intraoperative risk factors for morbidity and mortality. Methods., A retrospective medical record review was performed for all patients ,18 years of age who underwent open heart operations by a pediatric cardiothoracic surgeon at the University of Michigan Congenital Heart Center between January 1, 1998 and December 31, 2004. Records from a cohort of pediatric patients ages 1,17 years were matched to a subset of the adult patients by surgical procedure and date of operation. Results., In total, 243 cardiac surgical operations were performed in 234 adult patients with CHD. Overall mortality was 4.7% (11/234). The incidence of major postoperative complications was 10% (23/234) with a 19% (45/23) minor complication rate. The most common postoperative complication was atrial arrhythmias in 10.8% (25/234). The presence of preoperative lung or liver disease, prolonged cardiopulmonary bypass and aortic cross clamp times, and postoperative elevated inotropic score and serum lactates were significant predictors of mortality in adults. There was no difference between the adult and pediatric cohorts in terms of mortality and morbidity. Conclusions., The postoperative course in adults following surgery for CHD is generally uncomplicated and early survival should be expected. Certain risk factors for increased mortality in this patient population may include preoperative presence of chronic lung or liver dysfunction, prolonged cardiopulmonary bypass and aortic cross-clamp times, and postoperative elevated inotropic score and serum lactate levels. [source]

Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases

G. Jiang
SUMMARY Esophageal leiomyoma is the most common benign esophageal tumor. Thoracoscopic enucleation is currently a preferred approach to most of these lesions. We present our experiences of enucleation of these tumors using thoracoscopic approach. A retrospective review of 40 patients who underwent enucleation of esophageal leiomyoma from 1997 to 2007 in our institute was conducted. Presenting symptoms, operative approach, tumor size, tumor shape, outcomes, and indication for this approach were analyzed. Forty patients were identified. Postoperative histopathology confirmed the leiomyoma in all patients. The thoracoscopic enucleation was completed in 34 cases, and the operation was converted to open procedure in six cases. Reasons for conversion included too small tumors to be visualized in two cases, thoracic cavity adhesion in one case, and the too large tumors in three cases. The median operating time was 70 min (50 to 210 min). Mean tumor size was 3.7 cm (0.5,10 cm). There were no major postoperative complications. Symptoms especially dysphasia were relieved postoperatively. Short- and long-term follow-up was satisfactory with none of the patients having tumor recurrences or other problems. Thoracoscopic enucleation of esophageal leiomyoma is technically safe and effective. It is currently the best choice for management of esophageal leiomyoma 1 to 5 cm in diameter. It can also be tried on a tumor larger than 5 cm, although the possibility of conversion to thoracotomy increases along with tumor growing and surrounding the esophagus. [source]

Evaluation of the efficacy and safety of laparoscopic nephrectomy

Kazuhiro Yoshimura
AbstractPurpose: To evaluate the efficacy and safety of laparoscopic nephrectomy. Methods: From June 1994 to November 1999, 10 patients underwent laparoscopic nephrectomy at Osaka University Medical Hospital and Osaka Rosai Hospital. Laparoscopic nephrectomy was performed either via transperitoneal or retroperitoneal approach under general anesthesia. These 10 cases were reviewed in respect of primary disease of the kidney, operative time, complications and postoperative convalescence. Results: Of the 10 patients, five were preoperatively diagnosed as having a non-functioning kidney with hydronephrosis, two patients were diagnosed as having an atrophic kidney, two had renal cell carcinoma and one had renal pelvic tumor. The average operative time was 374 min (range 270,675 min). The mean blood loss was 330 mL (range 60,800 mL). One patient required transfusion due to postoperative oozing. The average hospital stay after operation was 7 days. No major postoperative complications were observed. Conclusion: Laparoscopic nephrectomy is an option in surgically managing renal disorders, including malignancies, although it has a longer operative time compared to conventional open surgery. [source]

Rhinophyma: Carbon dioxide laser with computerized scanner is still an outstanding treatment

Shueh-Wei Lim
ABSTRACT The cosmetic deformity produced by rhinophyma is characterized by nodular hypertrophy of the nasal skin. A retrospective review and analysis of nine consecutive patients with moderate and major rhinophyma treated with scanned carbon dioxide laser was performed. A particular method of continuous scanner use is described. This report demonstrates excellent cosmetic results and no major postoperative complications or recurrence of the condition after 1 year of follow up for seven patients. Two more patients had been followed up for 1 month at the time this paper was written. Scanned carbon dioxide laser is safe and highly effective treatment for rhinophyma. [source]

Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse

A. D'Hoore
Background: Postoperative constipation is a common problem with most mesh suspension techniques used to correct rectal prolapse. Autonomic denervation of the rectum subsequent to its complete mobilization has been suggested as a contributory factor. The aim of this study was to assess the long-term outcome of patients who underwent a novel, autonomic nerve-sparing, laparoscopic technique for rectal prolapse. Methods: Between 1995 and 1999, 42 patients had laparoscopic ventral rectopexy for total rectal prolapse. The long-term results after a median follow-up of 61 (range 29,98) months were analysed. Results: There were no major postoperative complications. Late recurrence occurred in two patients. In 28 of 31 patients with incontinence there was a significant improvement in continence. Symptoms of obstructed defaecation resolved in 16 of 19 patients. During follow-up, new onset of mild obstructed defaecation was noted in only two patients. Symptoms suggestive of slow-transit colonic obstipation were not induced. Conclusion: Laparoscopic ventral rectopexy is an effective technique for the correction of rectal prolapse and appears to avoid severe postoperative constipation. The ventral position of the prosthesis may explain the beneficial effect on symptoms of obstructed defaecation. Copyright 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Laparoscopic splenectomy: a suitable technique for children and adults

T. J. Wheatley
Aims: Splenectomy retains an important role in the management of certain haematological conditions that fail to respond to conventional medical therapy, and has traditionally been performed through a midline or left subcostal incision with patients requiring 5,7 days in hospital. The well recognized benefits of laparoscopic surgery should also apply to splenectomy. This study aimed to develop a safe and effective technique suitable for all age ranges and without the requirement for expensive stapling devices. Methods: An operative technique evolved over the 5-year period from 1994, from an initial six-port approach with the patient supine, to a four-port approach in a modified right lateral position, with locking surgical clips applied down a 5-mm port to vessels in the hilum, and removal of the spleen within a retrieval bag through a 4,6-cm Pfannanstiel incision. Data were collected prospectively for all patients undergoing laparoscopic splenectomy at Leicester Royal Infirmary, including demographic details, indication for surgery, duration of surgery, length of inpatient stay, transfusion requirement, postoperative complications and the response of the original condition to surgical intervention. Results: A total of 40 patients underwent laparoscopic splenectomy (14 children, 26 adults) for a variety of conditions (idiopathic thrombocytopenia (ITP) (n = 24), haemolytic anaemia (n = 9) or malignancy (n = 7)) with a median operating time of 180 min for the first 20 patients and 100 min for the second 20 (P < 00001), and median inpatient stay of 3 days for the first 20 patients and 2 days for the second 20 (P < 00003). None of the operations was converted to open surgery, five patients required blood and/or platelet transfusion perioperatively, none of the patients had major postoperative complications, 23 of the 24 patients with ITP developed normal platelet counts after operation, and all nine patients with haemolytic anaemia maintained a normal haemoglobin concentration after operation. Conclusions: Laparoscopic splenectomy can be performed safely and effectively in adults and children without the need for stapling devices. 2000 British Journal of Surgery Society Ltd [source]