Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Affinity of Staphylococcus epidermidis to various prosthetic graft materials

yerdel, mehmet ali/0000-0002-4044-076XWOS: 000169838100010PubMed: 11421606Background. Abdominal wall hernias have always been a major problem for general surgeons. The techniques of repairing primacy, recurrent, and incisional hernias have evolved throughout the years at an accelerating trend, especially after production of prosthetic graft materials. Although looked upon with suspicion due to infection, fistula formation, and foreign body reaction, prosthetic graft materials are used deliberately in primary and recurrent hernias. The present study was,designed to evaluate bacterial adherence to frequently used prosthetic graft materials. Materials and methods. The study was carried out in five different groups with each group consisting of 10 identical samples of the same kind of prosthetic graft material. The prosthetic graft materials used in the study were polypropylene, polyglactin 910, polyester fibers, steel, and polytetrafluoroethylene (PTFE). These prosthetic graft materials were incubated in vitro with a Staphylococcus epidermidis strain which was ++++ adhesion positive. The degree of adhesion of S. epidermidis to prosthetic graft materials was assessed by the ELISA. method. Results. Vicryl grafts showed significantly minimal bacterial adhesion whereas PTFE grafts tended to have more adhesion but this did not reach a statistical significance. Other graft materials did not show any difference for bacterial adhesion (Table 3). Conclusion. These results suggest that in vitro S. epidermidis adhesion to Vicryl grafts is less than other types of prosthetic graft materials (P 2001 Academic press

Chronic illness and emotional distress in adolescence.

OBJECTIVE: The purpose of this study was to investigate emotional distress and suicidal ideation among adolescents with and without chronic illness. METHODS: Two groups were compared from the Barcelona Adolescent Health Survey (3,129 students aged 14-19 years) data base. The index group included 162 adolescents with chronic conditions (100 females and 62 males) including those with asthma, diabetes, seizures, or cancer. No differences in prevalence of emotional distress or suicidal ideation were found among the four categories of disease. The control group included 865 subjects (383 females and 482 males). No age differences were evident between the index and control groups. Chi-square and Student's t-test were used for intergroup comparisons, with the criterion value set at p < .01 to reduce the probability of type I error. Analyses were conducted separately by gender. RESULTS: Compared with controls, a significantly greater proportion of females with chronic illness reported emotional problems, feeling in a bad mood, feeling sad, believing nothing amused them, having suicidal thoughts, expressing depressive symptomatology, and having personal problems needing professional help. In contrast, no significant group differences were found for males. No gender differences were found regarding recent contact with a mental health specialist. CONCLUSIONS: Chronic illnesses were associated with substantive emotional distress and suicide ideation in females but not in males. Females with chronic conditions did not, however, seek mental health services more often than their non-chronically ill counterparts. This suggests serious shortcomings in identification of "at-risk" youth and effective outreach to this population

Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant

Background: Incisional hernia in aged patients represents a challenge even for experienced surgeons. Besides increased risk of complications due to comorbidities, mesh fixation and assuring a sufficient mesh overlap of the defect are the main issues in carrying out the repair. Aims: In order to assure broader coverage of the abdominal wall and a tension- and fixation-free repair, a specifically designed prosthesis was developed for the surgical treatment of incisional hernias. The results of a fixation-free incisional hernia repair carried out in elderly patients using a tentacle-shaped implant are reported herewith. Methods: A tentacle-shaped flat mesh with a large central body and integrated arms was used to repair incisional hernia in 23 elderly patients. The mesh was placed fixation-free and secured in place through the friction exerted by the tentacles. All tentacle straps were positioned with a special passer needle. Implant placement was preperitoneal in 18 patients and retromuscular sublay in five. Results: In a follow-up of 18 to 59 months (mean 36 months), four seromas occurred. Postoperative fast track helped avoid the typical complications affecting this patient subset. No infection, hematoma, chronic pain, mesh dislocation or recurrence have been reported to date. Discussion: The tentacle strap system allowed for reduced skin incision thus minimizing surgical trauma and ensuring easier and faster implant placement. Conclusion: The tentacle arms of the implant ensured mesh stability and broad defect overlap. Besides a very low complication rate, none of the typical postoperative complications of aged patients occurred