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Postoperative Complications (postoperative + complications)
Kinds of Postoperative Complications Selected AbstractsSurgical Treatment of Chronic Gluteal Hidradenitis Suppurativa: Reused Skin Graft TechniqueDERMATOLOGIC SURGERY, Issue 2 2003Hung-wen Kuo MD BACKGROUND The treatment of chronic lesions in hidradenitis suppurativa (HS) remains a challenge for dermatologists. In most cases, wide surgical excision of the affected skin reduces the recurrence rate to a minimum. Split-thickness skin grafts have usually been applied to resurface large postoperative defects. OBJECTIVE The aim of this study is to introduce an alternative method of skin grafting, called "reused" or "recycled" skin graft, for the reconstruction of the large skin defect with chronic gluteal HS. METHODS The study consisted of six patients (two females and four males) with gluteal HS. After a wide en bloc excision, the wound was immediately recovered with meshed-skin graft, made from the resected skin itself. Thus, the sacrifice of the skin donor is spared. The drum dermatome (Padgett-Hood) is suitable to take the split-skin graft from the resected skin of the affected buttock. The thickness of grafts was set between 12/1,000 and 20/1,000 inches, and all grafts were meshed with 1.5 times the expansion. The skin grafts were secured in place on the wound and a tie-over dressing was applied. RESULTS Postoperative complications were usually minor ones, such as hematoma, discharge, and small areas of graft skin necrosis (less than 1 cm2), although one patient developed a 3×4 cm2 graft necrosis and wound infection. The follow-up period after surgery ranged from 8 to 36 months. No patient experienced any functional disabilities or recurrence during follow-up years. CONCLUSION When the epidermal involvement remains mild to moderate, this reused skin graft technique is an alternative choice to resurface the surgical defect of gluteal HS. It is superior to the conventional procedure, which requires fresh skin donor site. [source] Resection surgery with neoadjuvant chemoradiotherapy improves outcomes of patients with T4 esophageal carcinomaDISEASES OF THE ESOPHAGUS, Issue 2 2003T. Noguchi SUMMARY The prognosis of patients with T4 esophageal carcinoma is poor, and thus an effective treatment needs to be established. The present study assessed the effect of chemoradiotherapy (CRT), postoperative morbidity and mortality, and survival time in 41 patients with T4 esophageal carcinoma. Of these, 24 received CRT followed by surgery (group A) and the remaining 17 were treated with CRT alone (group B). Postoperative complications in group A were compared with 251 patients (group C) who underwent surgery without CRT during the same period. Postoperative complications were more frequent in group A than group C (29.2%vs 8.4%, P < 0.05). The overall median survival of group A was statistically longer than that of group B (13.8 months and 3.3 months respectively, P < 0.001). Complete histologic response (grade 3) was documented in 4 group A patients (16.7%). The overall median survival of grade 3 patients was statistically longer than the rest of group A (38.9 months vs 8.8 months, P < 0.05). The data confirm that chemoradiotherapy creates tumor regression in some patients and allows resection surgery in T4 esophageal carcinoma. Moreover, surgery with CRT confers a survival advantage in T4 esophageal carcinoma. [source] Hemispheric Surgery in Children with Refractory Epilepsy: Seizure Outcome, Complications, and Adaptive FunctionEPILEPSIA, Issue 1 2007Sheikh Nigel Basheer Summary:,Purpose: To describe seizure control, complications, adaptive function and language skills following hemispheric surgery for epilepsy. Methods: Retrospective chart review of patients who underwent hemispheric surgery from July 1993 to June 2004 with a minimum follow-up of 12 months. Results: The study population comprised 24 children, median age at seizure onset six months and median age at surgery 41 months. Etiology included malformations of cortical development (7), infarction (7), Sturge-Weber Syndrome (6), and Rasmussen's encephalitis (4). The most frequent complication was intraoperative bleeding (17 transfused). Age <2 yr, weight <11 kg, and hemidecortication were risk factors for transfusion. Postoperative complications included aseptic meningitis (6), and hydrocephalus (3). At median follow-up of 7 yr, 79% of patients are seizure free. Children with malformations of cortical development and Rasmussen's encephalitis were more likely to have ongoing seizures. Overall adaptive function scores were low, but relative strengths in verbal abilities were observed. Shorter duration of epilepsy prior to surgery was related significantly to better adaptive functioning. Conclusions: Hemispheric surgery is an effective therapy for refractory epilepsy in children. The most common complication was bleeding. Duration of epilepsy prior to surgery is an important factor in determining adaptive outcome. [source] Reconstruction after resection of hypopharyngeal carcinoma: Comparison of the postoperative complications and oncologic results of different methods,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2005Pen-Yuan Chu MD Abstract Background. Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. Methods. We retrospectively reviewed the records of 91 patients who underwent radical surgery and reconstruction. Postoperative complications and oncologic results of the different reconstructive methods were compared. Results. Reconstruction with gastric pull-up had the lowest pharyngocutaneous (PC) fistula (0%) and pharyngoesophageal (PE) stenosis rates (0%). However, the overall postoperative complication rate was high (64%). Laryngotracheal flap (LTF) reconstruction had relatively lower rates of PC fistula (3%), PE stenosis (10%), and overall complications (22%). The introduction of the LTF technique significantly decreased postoperative complications from 71% to 30% (p = .0001), with similar tumor control and survival. Conclusions. Hypopharyngeal reconstruction with an LTF is a simple and effective method. The chance of using a complex flap is decreased. The postoperative complications are reduced, and the oncologic results are satisfactory. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Complications of craniofacial resection for malignant tumors of the skull base: Report of an International Collaborative Study,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2005Ian Ganly MD Abstract Background. Advances in imaging, surgical technique, and perioperative care have made craniofacial resection (CFR) an effective and safe option for treating malignant tumors involving the skull base. The procedure does, however, have complications. Because of the relative rarity of these tumors, most existing data on postoperative complications come from individual reports of relatively small series of patients. This international collaborative report examines a large cohort of patients accumulated from multiple institutions with the aim of identifying patient-related and tumor-related predictors of postoperative morbidity and mortality and set a benchmark for future studies. Methods. One thousand one hundred ninety-three patients from 17 institutions were analyzed for postoperative mortality and complications. Postoperative complications were classified into systemic, wound, central nervous system (CNS), and orbit. Statistical analyses were carried out in relation to patient characteristics, extent of disease, prior radiation treatment, and type of reconstruction to determine factors that predicted mortality or complications. Results. Postoperative mortality occurred in 56 patients (4.7%). The presence of medical comorbidity was the only independent predictor of mortality. Postoperative complications occurred in 433 patients (36.3%). Wound complications occurred in 237 (19.8%), CNS-related complications in 193 (16.2%), orbital complications in 20 (1.7%), and systemic complications in 57 (4.8%) patients. Medical comorbidity, prior radiation therapy, and the extent of intracranial tumour involvement were independent predictors of postoperative complications. Conclusions. CFR is a safe surgical treatment for malignant tumors of the skull base, with an overall mortality of 4.7% and complication rate of 36.3%. The impact of medical comorbidity and intracranial tumor extent should be carefully considered when planning therapy for patients whose tumors are amenable to CFR. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Laparoscopic pyeloplasty for ureteropelvic junction obstruction: Outcome of initial 12 proceduresINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2004MASATSUGU IWAMURA Abstract Background:, Open pyeloplasty has been the gold standard for surgical treatment of ureteropelvic junction (UPJ) obstruction, enjoying a long-term success rate exceeding 90%. Unfortunately, this procedure requires a muscle incision that entails some degree of morbidity. We have, therefore, investigated the feasibility of laparoscopic pyeloplasty for UPJ obstruction and report here the outcomes of our early cases. The median follow up is 25 months (range, 12,42 months). Methods:, Between March 1999 and September 2001 we performed laparoscopic pyeloplasty on 12 ureters in 11 patients presenting with symptomatic hydronephrosis, secondary to a short stenosis of the UPJ or to ventrally crossing vessels; bilateral pyeloplasty was performed as a single procedure in one patient. We performed dismembered Anderson,Hynes pyeloplasty, Fenger plasty and Y-V plasty in eight, two and two ureters, respectively. All procedures were carried out transperitoneally. Results:, The procedure was completed successfully in all cases. Crossing vessels were noted in six of 12 ureters (50.0%). Mean operative time and blood loss in 11 patients (including one bilateral case) were 272.8 min (range, 175,480 min) and 96.4 mL (range, 20,340 mL), respectively. Postoperative complications were noted in two patients (18.2%): one instance of prolonged urine leakage and one anastomotic re-stricture. Eleven of 12 ureters (91.6%) demonstrated a patent UPJ on excretory urography and/or improvement of renal function on diuretic renography at a minimum follow up of 12 months. Conclusion:, Although the procedure requires advanced laparoscopic skills, it can be safely and successfully completed as frequently as the conventional open procedure. Laparoscopic pyeloplasty seems to be a valuable alternative to open pyeloplasty for UPJ obstruction. [source] A Xiphoid Approach for Minimally Invasive Coronary Artery Bypass SurgeryJOURNAL OF CARDIAC SURGERY, Issue 4 2000Federico Benetti M.D. However, opening the pleura has been a limitation of using these approaches. Aim: We used the xiphoid approach as an alternative to opening the pleura and to minimize pain after minimally invasive coronary artery bypass surgery. Methods: We review our surgical experience in 55 patients who underwent minimally invasive direct coronary artery bypass (MIDCAB) surgery through a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 ± 10 years and 65% were men. The mean Parsonnet score was 23 ± 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and saphenous vein graft from the LIMA to the right coronary artery (n = 1), and LIMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1). Results: Postoperative complications included atrial fibrillation (12%), acute noninfectious pericarditis (12%), and acute renal failure (5%). Mean postoperative length of stay was 4 ± 2 days. Angiography was performed in 16 patients and demonstrated excellent patency of the anastomoses. There was no operative mortality. Actuarial survival was 98% in a mean follow-up period of 11 ± 5 months. Conclusions: Minimally invasive coronary artery bypass can be performed safely through a xiphoid approach with low morbidity, mortality, and a relatively short hospital stay. [source] Pneumonectomy: four case studies and a comparative reviewJOURNAL OF SMALL ANIMAL PRACTICE, Issue 9 2004J. M. Liptak Pneumonectomy is the resection of all lung lobes in either the left right lung field. The surgical technique and postoperative results pneumonectomy for clinical disease have not been reported in companion animals. Pneumonectomy was performed in three dogs and one cat to treat pulmonary or pleural disease, and the postoperative outcome compared with the complications and results reported in the human literature. One dog died immediately postoperatively due to suspected respiratory insufficiency and the remaining three animals survived the perioperative period. Postoperative complications were reported in two animals. Cardiac complications occurred in the cat, with perioperative arrhythmias and progressive congestive heart failure. Gastrointestinal complications were diagnosed in one dog, with mediastinal shift oesophageal dysfunction. Left- and right-sided pneumonectomy is feasible in companion animals, and the postoperative outcome and complications encountered in this series were similar to those reported in humans. [source] Urethropexy for the management of urethral sphincter mechanism incompetence in the bitchJOURNAL OF SMALL ANIMAL PRACTICE, Issue 10 2001R. N. White Urethropexy was performed on 100 bitches for the management of urethral sphincter mechanism incompetence (SMI). The dogs ranged in age from 12 months to nine years (mean 4,5 years). Diagnosis of the condition was based upon clinical, laboratory and contrast radiographic examinations, and clinical response to medical management. In all bitches, incontinence developed in the adult individual and in the majority (89 bitches) after spaying. Radiographic findings were unremarkable in 22 bitches, apart from the presence of an intrapelvic bladder neck. Follow-up periods ranged from 12 months to seven years (mean 2,9 years). Fifty-six bitches were completely cured by surgery, 27 became less incontinent and 17 either failed to respond (nine animals) or showed an initial improvement in urinary function, but then relapsed (eight animals). Nine of these 17 animals underwent a second urethropexy procedure, resulting in a cure in six and an improvement in three cases (follow-up 12 to 41 months, mean 22-2 months). A deterioration in the response rate was observed over time. Postoperative complications were seen in 21 bitches and included an increased frequency of micturition (14 bitches), dysuria (six bitches) and anuria (three bitches). [source] Assessment of open versus laparoscopy-assisted gastrectomy in lymph node-positive early gastric cancer: A retrospective cohort analysisJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2010Ji Yeong An MD Abstract Background Laparoscopy-assisted gastrectomy (LAG) is still limited for early gastric cancer (EGC) with low possibility of lymph node (LN) metastasis, due to the concern for incomplete LN dissection and controversial long-term outcomes. We assessed oncological outcomes of laparoscopy-assisted versus open gastrectomy (OG) for patients with LN positive EGC. Methods Between 2003 and 2007, 204 patients underwent surgery for LN positive EGC. We evaluated adequacy of LN dissection and early and long-term outcomes after OG (n,=,162) and LAG (n,=,42). Results Operative time was longer but hospital stay was shorter for LAG than OG. Postoperative complications occurred in 14 patients (8.6%) after OG and 1 patient (2.4%) after LAG (P,=,0.316). Mean number of retrieved LNs and number of retrieved and metastatic LNs for each station did not differ between the two groups. During median 35 months of follow-up, 14 patients (8.6%) developed recurrence after OG, compared with 4 patients (9.5%) after LAG (P,=,0.769). Overall 5-year disease-free survival was 89.9% and 89.7% after OG and LAG. Status of LN metastasis was the only independent prognostic factor for disease-free survival. Conclusions LAG is an oncologically safe procedure even for LN positive EGC. Adequate LN dissection and comparable long-term outcomes to OG can be achieved by LAG. J. Surg. Oncol. J. Surg. Oncol. 2010;102:77,81. © 2010 Wiley-Liss, Inc. [source] Retrospective Study: Surgical intervention in the management of severe acute pancreatitis in cats: 8 cases (2003,2007)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2010Tolina T. Son DVM Abstract Objective , To evaluate clinical characteristics and outcomes of cats undergoing surgical intervention in the course of treatment for severe acute pancreatitis. Design , Retrospective observational study from 2003 to 2007 with a median follow-up period of 2.2 years (range 11 d,5.4 y) postoperatively. Setting , Private referral veterinary center. Animals , Eight cats. Interventions , None. Measurements and Main Results , Quantitative data included preoperative physical and clinicopathologic values. Qualitative parameters included preoperative ultrasonographic interpretation, perioperative and intraoperative feeding tube placement, presence of free abdominal fluid, intraoperative closed suction abdominal drain placement, postoperative complications, microbiological culture, and histopathology. Common presenting clinical signs included lethargy, anorexia, and vomiting. Leukocytosis and hyponatremia were present in 5 of 8 cats. Hypokalemia, increased total bilirubin, and hyperglycemia were present in 6 of 8 cats. Elevated alanine aminotransferase and aspartate transferase were present in all cats. Surgery for extrahepatic biliary obstruction was performed in 6 cats, pancreatic abscess in 3 cats, and pancreatic necrosis in 1 cat. Six of the 8 cats survived. Five of the 6 cats that underwent surgery for extrahepatic biliary obstruction and 1 cat that underwent pancreatic necrosectomy survived. All 5 of the cats with extrahepatic biliary obstruction secondary to pancreatitis survived. The 2 nonsurvivors included a cat with a pancreatic abscess and a cat with severe pancreatitis and extrahepatic biliary obstruction secondary to a mass at the gastroduodenal junction. Postoperative complications included progression of diabetes mellitus, septic peritonitis, local gastrostomy tube stoma inflammation, local gastrostomy tube stoma infection, and mild dermal suture reaction. Conclusion , Cats with severe acute pancreatitis and concomitant extrahepatic biliary obstruction, pancreatic necrosis, or pancreatic abscesses may benefit from surgical intervention. Cats with extrahepatic biliary obstruction secondary to severe acute pancreatitis may have a good prognosis. [source] The small remnant liver after major liver resection: How common and how relevant?LIVER TRANSPLANTATION, Issue 9 2003Cengizhan Yigitler The maximum extent of hepatic resection compatible with a safe postoperative outcome is unknown. The study goal was to determine the incidence and impact of a small remnant liver volume after major liver resection in patients with normal liver parenchyma. Among 265 major hepatectomies performed at our institution (1998 to 2000), 138 patients with normal liver and a remnant liver volume (RLV) systematically calculated from the ratio of RLV to functional liver volume (FLV) were studied. Patients were divided into five groups based on RLV-FLV ratio from ,30% to ,60%. Kinetics of postoperative liver function tests were correlated with RLV. Postoperative complications were stratified by RLV-FLV ratios. Ninety patients (65%) underwent resection of up to four Couinaud segments. The RLV-FLV ratio was ,60% in 94 patients (68%) including only 13 (9%) with RLV-FLV ,30%. There was no linear correlation between the number of resected segments and the RLV-FLV. Postoperative serum bilirubin but not prothrombin time correlated with extent of resection. The incidence of complications including liver failure was not different among groups. Analysis of the four groups with a RLV-FLV ratio <60% showed a trend toward more complications and a longer intensive care unit stay in patients with the smallest RLVs. After major hepatectomy in patients with normal livers, the proportion of patients with a small remnant liver is low and not directly related to the number of segments resected. Although the rate of postoperative complications, including liver failure, did not directly correlate with the volume of remaining liver, the postoperative course was more difficult for patients with smaller remnants. Therefore preoperative portal vein embolization should be considered in patients who will undergo extended liver resection who have (1) injured liver or (2) normal liver when the planned procedure will be complex or when the anticipated RLV-FLV will be <30%. (Liver Transpl 2003;9:S18-S25.) [source] Cardiac Pacing: Memories of a Bygone EraPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2008HARRY G. MOND M.D. The first cardiac pacemaker implants occurred in the late 1950s and involved insertion of epicardial or epimyocardial leads and abdominal pulse generators. By the mid 1960s, cardiologists were making attempts to insert transvenous leads into the right ventricle. These early unipolar leads had large, polished, high polarization electrodes, no fixation device, and no lumen in which to place a stylet for lead positioning. The lead implantation procedures were usually long and the irradiation to both patient and operator excessive. Pulse generators were powered by zinc-mercury cells, which were large, unreliable, and prone to sudden output failure. Postoperative complications such as lead dislodgement, exit block, and premature power source failure were very common with most patients requiring further surgery within a year. Little has been written of this period and in particular the experiences of the operators, such that today's pacemaker implanters have virtually no knowledge of this bygone era. This historical report by four Australian cardiologists details the operative procedures and follow-up management of those original pacemaker recipients. [source] Sexual Function and Tunica Albuginea Wound Healing Following Penile Fracture: An 18-year Follow-Up Study of 352 Patients from Kermanshah, IranTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2009Javaad Zargooshi MD ABSTRACT Introduction., We present a study on the experiences of penile fracture in an Iranian population. Aim., To determine the long-term outcome of penile fracture. Methods., Between April 1990 and May 2008, 373 patients presented with clinical features suggestive of penile fracture. Of these, 11 declined surgery. The remaining 362 were operated upon using a degloving incision. Ten patients had venous injury and 352 had penile fracture. At follow-up visits, in addition to answering our questionnaire, the patients completed the International Index of Erectile Function (IIEF), Erection Hardness Grading Scale (EHGS), and global self-assessment of potency (GSAP). To enhance documentation and to promote transparency, with the patients' permission, their full name and hospital chart number was sent to the journal. Main Outcome Measures., Clinical findings and IIEF and EHGS scores. Results., Mean patients' age was 29.6 years. Mean duration of follow-up was 93.6 months. Diagnosis was solely clinical. At presentation, 278 (78.9%) reported no pain. Cavernosography, ultrasonography, or magnetic resonance imaging was not used in any of the patients. Penile fracture was due to taqaandan in 269 patients (76.4%). Patients were treated with surgical exploration and repair within 24 hours of admission, regardless of delay in presentation. A nodule was found at follow-up in 330 patients (93.7%). The painless, mostly proximal nodule was palpated at the floor of the corpora cavernosa, in a deep midline position above the corpus spongiosum. The non-expansive nodule was not associated with erectile dysfunction (ED) or Peyronie's disease. Postoperative complications included mild penile pain in cold weather (two patients), transient wound edema (one patient), mild chordee (four patients), and occasional instability of the erect penis (one patient). Postoperatively, of the 217 patients who had partners, 214 (98.6%) were potent. Mean IIEF ED domain score was 29.8 ± 1.1. The EHGS score was 4 in 203 and 3 in 11. The GSAP score was 0 in 204, 1 in 8, and 2 in 2. ED in the remaining three could not be explained by penile fracture. Of 10 nonoperated patients, eight (80%) developed ED. Conclusion., Pain is rare in penile fracture. Postoperatively, almost all patients develop a permanent, inconsequential, fibrotic nodule. Our time-tested approach provided excellent long-term sexual function. Zargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran. J Sex Med **;**:**,**. [source] Postoperative complications after extracapsular dissection of benign parotid lesions with particular reference to facial nerve functionTHE LARYNGOSCOPE, Issue 3 2010Nils Klintworth MD Abstract Objectives/Hypothesis: The desirable extent of surgical intervention for benign parotid tumors remains a matter of controversy. Superficial or total parotidectomy as a standard procedure is often said to be the gold standard; however, with it the risk of intraoperative damage to the facial nerve cannot be ignored. For some time now, extracapsular dissection without exposure of the main trunk of the facial nerve has been favored as an alternative for the treatment of discrete parotid tumors. Data on the incidence of facial nerve lesions and other acute postoperative complications of extracapsular dissection have been lacking until now. Study Design: Retrospective analysis. Methods: We performed a retrospective analysis of the data from patients in whom extracapsular dissection of a benign parotid tumor had been performed under facial nerve monitoring and as a primary intervention in our department between 2000 and 2008. Results: A total of 934 patients were operated on for a newly diagnosed benign tumor of the parotid gland. Three hundred seventy-seven patients (40%) underwent extracapsular dissection as a primary intervention. The most common postoperative complication was hypoesthesia of the cheek or the earlobe, as reported by 38 patients (10%). Eighteen patients (5%) developed a seroma and 13 patients (3%) a hematoma. A salivary fistula formed in eight patients (2%). Secondary bleeding occurred in three patients (0.8%). In 346 patients (92%) facial nerve function was normal (House-Brackmann grade I) in the immediate postoperative period, whereas 23 patients (6%) showed temporary facial nerve paresis (House-Brackmann grade II or III) and eight patients (2%) developed permanent facial nerve paresis (seven patients House-Brackmann grade II, one patient House-Brackmann grade III). Conclusions: Extracapsular dissection of benign parotid tumors is associated with a low rate of postoperative complications, a fact that is confirmed by the available literature. We therefore recommend that use of this technique always be considered as a means of treating benign parotid tumors as conservatively, that is, as uninvasively, as possible. Laryngoscope, 2010 [source] Cartilage tympanoplasty: Indications, techniques, and outcomes in A 1,000-patient seriesTHE LARYNGOSCOPE, Issue 11 2003John Dornhoffer MD Abstract Objectives/Hypothesis: The purpose of this study was to analyze the anatomical and audiologic results in more than 1,000 cartilage tympanoplasties that utilized a logical application of several techniques for the management of the difficult ear (cholesteatoma, recurrent perforation, atelectasis). Our hypothesis was that pathology and status of the ossicular chain should dictate the technique used to achieve optimal outcome. Study Design: Retrospective clinical study of patients undergoing cartilage tympanoplasty between July 1994 and July 2001. A computerized otologic database and patient charts were used to obtain the necessary data. Methods: A modification of the perichondrium/cartilage island flap was utilized for tympanic membrane reconstruction in cases of the atelectatic ear, for high-risk perforation in the presence of an intact ossicular chain, and in association with ossiculoplasty when the malleus was absent. A modification of the palisade technique was utilized for TM reconstruction in cases of cholesteatoma and in association with ossiculoplasty when the malleus was present. Hearing results were reported using a four-frequency (500, 1,000, 2,000, 3,000 Hz) pure-tone average air-bone gap (PTA-ABG). The Student t test was used for statistical comparison. Postoperative complications were recorded. Results: During the study period, cartilage was used for TM reconstruction in more than 1,000 patients, of which 712 had sufficient data available for inclusion. Of these, 636 were available for outcomes analysis. In 220 cholesteatoma cases, the average pre- and postoperative PTA-ABGs were 26.5 ± 12.6 dB and 14.6 ± 8.8 dB, respectively (P < .05). Recurrence was seen in 8 cases (3.6%), conductive HL requiring revision in 4 (1.8%), perforation in 3 (1.4%), and postand intraoperative tube insertion in 11 (5.0%) and 18 ears (8.2%), respectively. In 215 cases of high-risk perforation, the average pre- and postoperative PTA-ABGs were 21.7 ± 13.5 dB and 11.9 ± 9.3 dB, respectively (P < .05). Complications included recurrent perforation in 9 ears (4.2%), conductive HL requiring revision in 4 (1.9%), postoperative and intraoperative tube insertion in 4 (1.9%) and 6 ears (2.8%), respectively. In 98 cases of atelectasis, the average pre- and postoperative PTA-ABGs were 20.2 ± 10.9 dB and 14.2 ± 10.2 dB, respectively (P < .05). Complications included 1 perforation (1.0%), conductive loss requiring revision in 2 cases (2.0%), and post- and intraoperative tube insertion in 7 (7.1%) and 12 ears (12%), respectively. In 103 cases to improve hearing (audiologic), the average pre- and postoperative PTA-ABGs were 33.6 ± 9.6 dB and 14.6 ± 10.1 dB, respectively (P < .05). Complications included 1 perforation (1.0%), conductive loss requiring revision in 11 (11%), and post- and intraoperative tube insertion in 6 (5.8%) and 2 (1.9%), respectively. Conclusions: Cartilage tympanoplasty achieves good anatomical and audiologic results when pathology and status of the ossicular chain dictate the technique utilized. Significant hearing improvement was realized in each pathological group. In the atelectatic ear, cartilage allowed us to reconstruct the TM with good anatomic results compared to traditional reconstructions, which have shown high rates of retraction and failure. In cholesteatoma, cartilage tympanoplasty using the palisade technique resulted in precise reconstruction of the TM and helped reduce recurrence. In cases of high-risk perforation, reconstruction with cartilage yielded anatomical and functional results that compared favorably to primary tympanoplasty using traditional techniques. We believe the indications for cartilage tympanoplasty (atelectatic ear, cholesteatoma, high-risk perforation) were validated by these results. [source] Surgical Excision of Acoustic Neuroma: Patient Outcome and Provider CaseloadTHE LARYNGOSCOPE, Issue 8 2003Fred G. Barker II Abstract Objectives/Hypothesis For many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume,outcome relationship for surgical excision of acoustic neuromas. Study Design Retrospective cohort study. Methods The Nationwide Inpatient Sample (1996 to 2000) was used. Multivariate regression analyses were adjusted for age, sex, race, payer, geographic region, procedure timing, admission type and source, medical comorbidities, and neurofibromatosis status. Results At 265 hospitals, 2643 operations were performed by 352 identified primary surgeons. Outcome was measured on a four-level scale at hospital discharge: death (0.5%) and discharge to long-term care (1.2%), to short-term rehabilitation (4.4%), and directly to home (94%). Outcomes were significantly better after surgery at higher-volume hospitals (OR 0.47 for fivefold-larger caseload, P <.001) or by higher-volume surgeons (OR 0.46, P <.001). Of patients who had surgery at lowest-volume-quartile hospitals, 12.3% were not discharged directly home, compared with 4.1% at highest-volume-quartile hospitals. There was a trend toward lower mortality for higher-volume hospitals (P = .1) and surgeons (P = .06). Of patients who had surgery at lowest-caseload-quartile hospitals, 1.1% died, compared with 0.6% at highest-volume-quartile hospitals. Postoperative complications (including neurological complications, mechanical ventilation, facial palsy, and transfusion) were less likely with high-volume hospitals and surgeons. Length of stay was significantly shorter with high-volume hospitals (P = .01) and surgeons (P = .009). Hospital charges were lower for high-volume hospitals (by 6% [P = .006]) and surgeons (by 6% [P = .09]). Conclusion For acoustic neuroma excision, higher-volume hospitals and surgeons provided superior short-term outcomes with shorter lengths of stay and lower charges. [source] Implementation of a Clinical Pathway in Management of the Postoperative Vestibular Schwannoma Patient,THE LARYNGOSCOPE, Issue 11 2001Katrina R. Stidham MD Abstract Objective The purpose of the study was to evaluate the effectiveness of a new clinical pathway in management of patients with postoperative vestibular schwannoma. The impact on duration of hospitalization and quality of care was evaluated. Study Design The study was a retrospective review of 59 consecutive patients undergoing surgical intervention for vestibular schwannoma between January 1995 and July 1999. Methods A new clinical pathway for management of postoperative vestibular schwannoma patients was implemented at The California Ear Institute at Stanford (Palo Alto, CA) in January 1995. All patients undergoing surgical intervention subsequent to initiation of the pathway were included in the study. Data including surgical approach, patient age, sex, and tumor size were included. Duration of hospitalization and postoperative complications were recorded. During the same time period, data for patients undergoing radiation therapy for vestibular schwannomas were evaluated for length of hospital stay and in-hospital complications. Data were compared with norms recorded in the literature for duration of hospitalization and complications following surgical intervention. Results Fifty-nine patients underwent 35 middle fossa approaches and 24 translabyrinthine approaches to their tumors. The average patient age was 53 years; there were 34 female and 25 male patients. The average length of hospital stay was 3.83 days (SD = 1.4 days) with a range from 2 to 10 days. Postoperative complications were observed in 19% of patients, including eight (13%) cerebrospinal fluid (CSF) leaks, two requiring lumbar drains (3.4%); one hematoma (1.6%), one postoperative fever (1.6%), and one dural tear with associated hyponatremia (1.6%). These results compared favorably with previously recorded average hospital stays of 5.95 to 9.5 days 1,5,7 and CSF leak complication rates of 7% to 15%. 9,10 Conclusions Implementation of a clinical pathway for management of the patient with postoperative vestibular schwannoma improves efficiency of patient care, allowing decreased duration of hospitalization. This goal is achieved without increasing complication rates and, in our experience, actually improving the quality of clinical care. The cost-effectiveness of clinical pathways may become increasingly important in a managed care,driven environment. [source] Minimally invasive straight laparoscopic total proctocolectomy for ulcerative colitisASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010H. Ozawa Abstract Introduction: We have performed straight laparoscopic total proctocolectomy for ulcerative colitis, in which all procedures, including transection of the rectum and anastomosis, were performed in the abdominal cavity. The primary objective of this study was to evaluate whether straight laparoscopic total proctocolectomy is technically feasible and safe. Methods: A retrospective database identified 22 consecutive patients who underwent straight laparoscopic total proctocolectomy for ulcerative colitis between March 1998 and September 2007. Patients were excluded if they required emergency surgery. First, to create a stoma site, a mini-laparotomy to insert a 15 mm trocar was performed. Seven other trocars, 5 mm in diameter, were then inserted. Mobilization and dissection of the colorectum and anastmosis were performed completely intracorporeally under laparoscopic guidance. Anastomosis of an ileal J-pouch to the anal canal was performed using the double-stapling technique. Results: Nineteen patients were underwent ileal pouch anal canal anastomosis; two underwent ileorectal anastomosis; and one underwent abdominoperineal resection. The median operation time was 355 min (range 255,605); the median blood loss was 50 g (range 0,800); and the median postoperative hospital stay was 24.5 d. Postoperative complications occurred in eight patients, including three (13.6%) with bowel obstruction, two (9.1%) with portal vein thrombosis, one (4.5%) with anastomotic leakage, and one (4.5%) with postoperative hemorrhage. The morbidity rate was 36.4%. There were no intraoperative complications or conversions to conventional surgery. Conclusion: In the context of this study, we have shown that straight laparoscopic total proctocolectomy is technically feasible and safe in patients with ulcerative colitis. [source] Surgical treatment of uterine torsion using a ventral midline laparotomy in 19 maresAUSTRALIAN VETERINARY JOURNAL, Issue 7 2008C Jung Objective ,To report on the outcome of surgical treatment of uterine torsion in preterm mares. Design ,Retrospective case series of pregnant mares with uterine torsion presented to the Clinic for Obstetrics, Gynaecology and Andrology of Large and Small Animals. Methods ,Hospital records of all pregnant mares that underwent ventral midline laparotomy for uterine torsion between 1998 and 2004 were reviewed. The signalment, history, clinical signs, results of diagnostic procedures, direction and degree of the uterine twist, treatment and outcome were retrieved from each case record. Results ,This study comprised 19 mares between months 5 and 11 of pregnancy (8.7 ± 1.9) and suffering from uterine torsion. In all cases ventromedian laparotomy was carried out under general anaesthesia. Gastrointestinal disorders were also present in 52.6% of horses. Postoperative complications included subcutaneous seromas (five mares), peritonitis (one mare) and abortion (two mares). In four mares (21%) the operation was unsuccessful (i.e. these mares had to be euthanased intra- or postoperatively). Of the surviving 15 mares, 13 (86.6%) gave birth to viable foals at full term. The foals developed normally. Only two mares aborted. Conclusions ,Because of its versatility the ventral midline approach should be considered for correction of uterine torsion. The approach has many advantages, including rapid and clear access to the abdominal cavity, safety, visual assessment of uterine wall viability, correction of concomitant gastrointestinal tract problems, and performance of hysterotomy or hysterectomy, if indicated. In this study, managing uterine torsion in this way resulted in a high percentage of cases (86.6%) in which pregnancy was maintained, with the birth of a viable, mature foal. [source] Malignant risk and surgical outcomes of presacral tailgut cysts,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2010K. L. Mathis Background: Presacral tailgut cysts are uncommon and few data exist on the outcomes following surgery. Methods: Patients undergoing tailgut cyst resection at the Mayo Clinic between 1985 and 2008 were analysed retrospectively. Demographic data, clinicopathological features, operative details, postoperative complications and recurrence were reviewed. Results: Thirty-one patients were identified (28 women), with a median age of 52 years. Seventeen patients were symptomatic and 28 had a palpable mass on digital rectal examination. Median cyst diameter was 4·4 cm. Four patients had a fistula to the rectum. Complete cyst excision was achieved in all patients; eight underwent distal sacral resection or coccygectomy. Postoperative complications occurred in eight patients but without 30-day mortality. Malignant transformation was present in four patients: adenocarcinoma in three and carcinoid in one. The cyst recurred in one patient after surgery for a benign lesion. Conclusion: Presacral tailgut cysts should be removed due to the risk of malignant transformation. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Haemoglobin A1c as a predictor of postoperative hyperglycaemia and complications after major colorectal surgery,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2009U. O. Gustafsson Background: Hyperglycaemia following major surgery increases morbidity, but may be improved by use of enhanced-recovery protocols. It is not known whether preoperative haemoglobin (Hb) A1c could predict hyperglycaemia and/or adverse outcome after colorectal surgery. Methods: Some 120 patients without known diabetes underwent major colorectal surgery within an enhanced-recovery protocol. HbA1c was measured at admission and 4 weeks after surgery. All patients received an oral diet beginning 4 h after operation. Plasma glucose was monitored five times daily. Patients were stratified according to preoperative levels of HbA1c (within normal range of 4·5,6·0 per cent, or higher). Results: Thirty-one patients (25·8 per cent) had a preoperative HbA1c level over 6·0 per cent. These had higher mean(s.d.) postoperative glucose (9·3(1·5) versus 8·0(1·5) mmol/l; P < 0·001) and C-reactive protein (137(65) versus 101(52) mg/l; P = 0·008) levels than patients with a normal HbA1c level. Postoperative complications were more common in patients with a high HbA1c level (odds ratio 2·9 (95 per cent confidence interval 1·1 to 7·9)). Conclusion: Postoperative hyperglycaemia is common among patients with no history of diabetes, even within an enhanced-recovery protocol. Preoperative measurement of HbA1c may identify patients at higher risk of poor glycaemic control and postoperative complications. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Advantages of laparoscopic stented choledochorrhaphy over T-tube placementBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2004A. M. Isla Background: Postoperative complications after laparoscopic choledochotomy are mainly related to the tube. Both laparoscopic endobiliary stent placement with primary closure of the common bile duct (CBD) and primary closure of the CBD without drainage have been proposed as safe and effective alternatives to -tube placement. Methods: This was a retrospective analysis of data collected prospectively on 53 consecutive patients suffering from proven choledocholithiasis who underwent laparoscopic CBD exploration through a choledochotomy between January 1999 and January 2003. In the early period a -tube was placed at the end of the procedure (n = 32). Biliary stent placement and primary CBD closure was performed from June 2001 (n = 21). Results: There were no significant differences in epidemiological characteristics, preoperative factors or intraoperative findings between the groups. Seven patients developed complications, six in the -tube group and one in the stent group. Univariate analysis revealed a significantly lower morbidity rate and shorter postoperative hospital stay in the stent group. Conclusion: Placement of a biliary endoprosthesis after laparoscopic choledochotomy achieves biliary decompression, and avoids the complications of a tube, leading to a shorter postoperative hospital stay. The method is a safe and effective alternative method of CBD drainage after laparoscopic choledochotomy. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2003C. Wullstein Background: Although laparoscopy may be associated with fewer intra-abdominal adhesions and quicker recovery of bowel function, it remains unclear whether patients with acute small bowel obstruction (SBO) might benefit from laparoscopic techniques. Method: The results of patients with acute SBO treated laparoscopically (LAP; n = 52) and conventionally (CONV; n = 52) were compared in a retrospective matched-pair analysis. Conversions were included in the laparoscopic group. Results: Complete laparoscopic treatment was performed in 25 patients (48·1 per cent). Major intraoperative complications occurred in 15 patients in the LAP group and eight in the CONV group (P = 0·156). Intraoperative perforations were more frequent in patients who had undergone more than one previous laparotomy (P = 0·066). Postoperative complications occurred in ten patients (19·2 per cent) in the LAP group and in 21 patients (40·4 per cent) who had conventional surgery (P = 0·032). Bowel movements started 3·5 days after operation in the LAP group and 4·4 days after conventional operation (P = 0·001). The length of hospital stay was 11·3 and 18·1 days respectively (P < 0·001). Conclusion: Laparoscopic treatment of acute SBO was feasible in about half of these patients. Postoperative recovery was improved after laparoscopic procedures but the risk of intraoperative complications increased. A laparoscopic approach seems justified in a subset of patients. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2002W. W. Vrijland Background: The optimum method for inguinal hernia repair has not yet been determined. The recurrence rate for non-mesh methods varies between 0·2 and 33 per cent. The value of tension-free repair with prosthetic mesh remains to be confirmed. The aim of this study was to compare mesh and non-mesh suture repair of primary inguinal hernias with respect to clinical outcome, quality of life and cost in a multicentre randomized trial in general hospitals. Methods: Between September 1993 and January 1996, all patients scheduled for repair of a unilateral primary inguinal hernia were randomized to non-mesh or mesh repair. The patients were followed up at 1 week and at 1, 6, 12, 18, 24 and 36 months. Clinical outcome, quality of life and costs were registered. Results: Three hundred patients were randomized of whom 11 were excluded. Three-year recurrence rates differed significantly: 7 per cent for non-mesh repair (n = 143) and 1 per cent for mesh repair (n = 146) (P = 0·009). There were no differences in clinical variables, quality of life and costs. Conclusion: Mesh repair of primary inguinal hernia repair is superior to non-mesh repair with regard to hernia recurrence and is cost-effective. Postoperative complications, pain and quality of life did not differ between groups. © 2002 British Journal of Surgery Society Ltd [source] Craniofacial surgery for malignant skull base tumorsCANCER, Issue 6 2003Report of an International Collaborative Study Abstract BACKGROUND Malignant tumors of the skull base are rare. Therefore, no single center treats enough patients to accumulate significant numbers for meaningful analysis of outcomes after craniofacial surgery (CFS). The current report was based on a large cohort that was analyzed retrospectively by an International Collaborative Study Group. METHODS One thousand three hundred seven patients who underwent CFS in 17 institutions were analyzable for outcome. The median age was 54 years (range, 1,98 years). Definitive treatment prior to CFS had been administered in 59% of patients and included radiotherapy in 367 patients (28%), chemotherapy in 151 patients (12%), and surgery in 523 patients (40%). The majority of tumors (87%) involved the anterior cranial fossa. Squamous cell carcinoma (29%) and adenocarcinoma (16%) were the most common histologic types. The margins of surgical resection were reported close/positive in 412 patients (32%). Adjuvant postoperative radiotherapy was received by 510 patients (39%), and chemotherapy was received by 57 patients (4%). RESULTS Postoperative complications were reported in 433 patients (33%), with local wound complications the most common (18%). The postoperative mortality rate was 4%. With a median follow-up of 25 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 54%, 60%, and 53%, respectively. The histology of the primary tumor, its intracranial extent, and the status of surgical margins were independent predictors of overall, disease-specific, and recurrence-free survival on multivariate analysis. CONCLUSIONS CFS is a safe and effective treatment option for patients with malignant tumors of the skull base. The histology of the primary tumor, its intracranial extent, and the status of surgical margins are independent determinants of outcome. Cancer 2003;98:1179,87. © 2003 American Cancer Society. DOI 10.1002/cncr.11630 [source] Longterm results after phacovitrectomy and foldable intraocular lens implantationACTA OPHTHALMOLOGICA, Issue 8 2009Wensheng Li Abstract. Purpose:, This study aimed to evaluate the longterm results of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co-existing vitreoretinal diseases. Methods:, We carried out a retrospective study of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity (VA), preoperative data, and intraoperative and postoperative complications. Results:, The most common indications for surgery were non-diabetic vitreous haemorrhage and proliferative diabetic retinopathy. Preoperative vision ranged from 0.6 to light perception; postoperative vision ranged from 1.2 to no light perception. Postoperatively, in 162 eyes (87.1%) VA improved by , 3 lines on the decimal chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased by the last follow-up. Postoperative complications included elevated intraocular pressure and posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis, neovascular glaucoma. Conclusions:, Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities co-existing with cataract. Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract. [source] Autologous blood injection for marked overfiltration early after trabeculectomy with mitomycin CACTA OPHTHALMOLOGICA, Issue 3 2001Koji Okada ABSTRACT. Purpose: After trabeculectomy with mitomycin C, extremely low intraocular pressure (IOP) with excess filtration may cause hypotonous maculopathy in the early postoperative period. We evaluated the effect of injecting autologous blood on reversing early postoperative marked hypotony after trabeculectomy with mitomycin C. Methods: Trabeculectomy with mitomycin C was performed in 258 eyes between 1994 and 1998. Peribleb autologous blood injection was performed in five eyes in which pressure patches were ineffective in reversing excess filtration. Approximately 0.1 to 0.3 ml of whole unclotted blood was slowly injected at least 3 mm from the edge of the flap using a sterile 27-gauge needle. Results: None of these eyes developed hypotonous maculopathy after injection. After a mean 31-month follow-up, all eyes had well-controlled IOP and visual acuity in three eyes was much improved. Postoperative complications included mild IOP elevation in one eye treated with laser suturelysis, and fibrinous pupillary membrane in one eye. Conclusion: In the early postoperative period, autologous blood injection is effective in reversing excess filtration. [source] Patient-centered outcome of immediately loaded implants in the rehabilitation of fully edentulous jawsCLINICAL ORAL IMPLANTS RESEARCH, Issue 10 2009Melissa Dierens Abstract Introduction: Edentulism often involves functional, esthetic, phonetic and psychological problems. Objectives: To evaluate patient-centered outcomes of full-arch screw-retained rehabilitation on immediately loaded implants. Material and methods: Fifty patients treated with Astra TechÔ implants answered self-administered questionnaires on a visual analogue scale (VAS) 100 mm scale or with multiple-choice or open questions: at baseline, 1 week, 3 or 6 months and 1 year. Changes of VAS in time were analyzed using mixed models for repeated measures, adjusting for gender, age and jaw; comparison of cross-sectional parameters between jaws was performed with the Mann,Whitney U- or ,2 -test, all at the 0.05 significance level. Results: The median calculated general satisfaction score increased from 40.25 (mean=40.9; SD=23.82; range=0,95) at baseline to 98.25 (mean=95.3; SD=6.68; range=74,100) after 1 year. Overall comfort, eating comfort, speaking comfort and perceived esthetics improved significantly within 1 week after surgery and immediate provisionalization. This did not change significantly until the final bridge was installed after 3 months (mandible) or 6 months (maxilla), when a further significant improvement was demonstrated. The most common postoperative complication was swelling, especially in the maxilla. The importance of one-stage surgery and immediate loading was rated very high by patients before treatment, especially in the mandible. The main reason for choosing fixed prosthetics was eating comfort. Phonetics and esthetics were more important in the maxilla than in the mandible. Conclusion: Immediate full-arch rehabilitation yeilds an instant significant improvement in general patient satisfaction and self-perceived factors related to comfort, function and esthetics. Eating comfort is the main concern for the patient and shows the highest improvement. Postoperative complications are limited and patients considered immediate loading important. [source] The impact of pre- or postoperative radiochemotherapy on complication following anterior resection with en bloc excision of female genitalia for T4 rectal cancerCOLORECTAL DISEASE, Issue 4 2009B. Szynglarewicz Abstract Objective, The aim of the study was to assess the mortality and morbidity following extended anterior resection with excision of internal female genitalia combined with pre- or postoperative chemoradiotherapy in women with extensive rectal cancer. Method, The study included a consecutive series of 21 women with T4 adenocarcinoma of the rectum infiltrating the reproductive organs treated with curative intent between 1997 and 2003. All patients had an extended anterior sphincter preserving resection of the rectum (total mesorectal excision) and hysterectomy with or without posterior vaginal wall excision. In all patients, surgery was combined with adjuvant radiochemotherapy. Ten patients received preoperative radiotherapy (50.4 Gy) concurrently with two courses of chemotherapy [fluorouracil with folinic acid (FA)] followed by surgery within 6,8 weeks and subsequently four courses of postoperative chemotherapy. Eleven received postoperative chemoradiotherapy (50.4 Gy plus fluorouracil with FA). Results, There was no postoperative mortality. Postoperative complications were observed in 57% patients (early in 14% and late in 52%). These included: anterior resection syndrome with anorectal dysfunction in 52% (requiring proximal diversion in 5%), urinary complications in 24% (complete incontinence requiring a permanent catheter in 5%). In addition, postoperative acute bleeding requiring relaparotomy, delayed wound healing caused by superficial infection, anastomotic leakage, prolonged bowel paralysis, benign rectovaginal fistula and anastomotic stricture occurred (5% each). The risk of postoperative morbidity (52%) was similar for patients with or without preoperative radiochemotherapy. Conclusion, Despite this aggressive therapeutic approach, most postoperative complications were transient or could be treated. Preoperative radiochemotherapy did not increase the risk of morbidity. [source] | |||||||||||||||||||||||||||||||||||||