Urgent Abdominal Re-Explorations

BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs) and factors that affect mortality. METHODS: Demographic characteristics; initial diagnoses; information from and complications of the first surgery received; durations and outcomes of UAR(s) performed in patients who received early RLs because of complicated abdominal surgeries in our clinic between 01.01.2000 and 31.12.2004 were investigated retrospectively. Statistical analyses were done using the chi-square and Fisher exact tests. RESULTS: Early UAR was performed in 81 out of 4410 cases (1.8%). Average patient age was 50.46 (13–81) years with a male-to-female ratio of 60/21. Fifty one (62.96%) patients had infection, 41 (50.61%) of them had an accompanying serious disease, 24 (29.62%) of them had various tumors and 57 (70.37%) patients were operated under emergency conditions during first operation. Causes of urgent abdominal re-explorations were as follows: leakage from intestinal repair site or from anostomosis (n:34; 41.97%); hemorrhage (n:15; 18.51%); intestinal perforation (n:8; 9.87%); intraabdominal infection or abscess (n:8; 9.87%); progressive intestinal necrosis (n:7; 8.64%); stomal complications (n:5; 6.17%); and postoperative ileus (n:4; 4.93%). Two or more UARs were performed in 18 (22.22%) cases, and overall mortality was 34.97% (n:30). Interval between the first laparotomy and UAR averaged as 6.95 (1–20) days, and average hospitalization period was 27.1 (3–78) days. Mortality rate was found to be higher among the patients who received multiple UARs. The most common (55.5%) cause of mortality was sepsis/multiple organ failure (MOF). The rates for common mortality and sepsis/MOF-dependent mortality that occured following UAR were significantly higher in patients who received GIS surgery than in those who received other types of surgeries (p:0.000 and 0.010, respectively). CONCLUSION: UARs that are performed following complicated abdominal surgeries have high mortality rates. In particular, UARs have higher mortality rates following GIS surgeries or when infectious complications occur. The possibility of efficiently lowering these high rates depends on the success of the first operations that the patient had received

Thick-needle vacuum-assisted biopsy technique for inflammatory breast carcinoma diagnosis Técnica de biópsia aspirativa por agulha de grosso calibre para o diagnóstico do carcinoma inflamatório da mama

PURPOSE: Inflammatory breast carcinoma (IBC) is a rare clinicopathological cancer type with unique clinical features and a poor prognosis. In this disease, there is generally no palpable mass in the breast. IBC can be mistakenly diagnosed as mastitis and patients may receive a delayed diagnosis and treatment, since these two disorders cause similar pathological appearences on the breast. Clinical suspicion of the disease followed by histopathological observation of occluded dermal lympthatics by tumor emboli leads to definitive diagnosis of IBC. METHODS: Here, we report our experiences in diagnosing IBC using Thick-Needle Aspiration Biopsy (TNAB). RESULTS: Eight patients having clinically suspected IBC, received TNAB. IBC was definitively diagnosed upon observation in histopathological examination of occluded dermal lymphatics by tumor emboli since TNAB allowed adequate tissue sampling. CONCLUSION: In this study, we showed that IBC can be reliably diagnosed using TNAB.<br>OBJETIVO: O carcinoma inflamatório da mama (CIM) é um raro tipo histopatológico do câncer mamário, com características clínicas especiais e prognóstico reservado. Nesta doença, geralmente não se palpa nódulos mamários. O CIM pode equivocadamente ser diagnosticado como mastite e gerando um retardo no diagnóstico e tratamento, visto que ambas as doenças tem apresentação semelhante. A suspeita clínica da doença seguida da observação histopatológica de embolia tumoral com oclusão dos linfáticos da derme conduz ao diagnóstico definitivo de CIM. MÉTODOS: Relata-se o procedimento no diagnóstico de CIM utilizando a biópsia de aspiração por agulha de grosso calibre (BAAGC). RESULTADOS: Oito pacientes com suspeita clínica CIM foram submetidos a BAAGC. Todos os casos receberam diagnóstico definitivo de CIM após caracterização histopatológica da biópsia. BAAGC permitiu a amostragem adequada do tecido. CONCLUSÃO: O CIM pode ser diagnosticado utilizando BAAGC

Percutaneous cholecystostomy for delayed laparoscopic cholecystectomy in patients with acute cholecystitis: analysis of a single-centre experience and literature review

Introduction : Percutaneous cholecystostomy (PC) has been used as a relatively safe and efficient temporising measure in the treatment of acute cholecystitis (AC) in high-risk patients with serious co-morbidity and in elderly patients. Aim : To assess the effectiveness, possible advantages, and complication of delayed laparoscopic cholecystectomy (LC) following PC in patients with AC. Material and methods : A total of 52 LC for AC were divided into two groups: the first group consisted of patients who had PC followed by LC (PCLC group, n = 12), and the second group consisted of patients who had conservative treatment followed by LC (non-PCLC group, n = 40). Eight of these patients were males and four were female. The groups were statistically compared regarding their demographic, comorbidity, hospital stay, conservation, and complication rates. PC was performed via the transhepatic route under ultrasound guidance using local anaesthesia. Results : Percutaneous cholecystostomy was technically successful in 12 patients with no attributable mortality or major complications. Upon the regression of cholecystitis and the decrease in APACHE-II scores, the PC catheter was unplugged and elective LC was scheduled for after 8 weeks. Ninety-two percent had complete resolution of symptoms within 48 h of intervention while 8% had partial resolution. All of the patients in PCLC and non-PCLC groups recovered well from cholecystectomy. Conclusions : This study suggests that PCLC would not significantly improve the outcome of LC as assessed by conversion and morbidity rate and hospital stay compared with non-PCLC. Percutaneous cholecystostomy is a valid alternative for patients with acute cholecystitis. And our study shows that the laparoscopic cholecystectomy is a good option in high-risk patients who have been treated by percutaneous cholecystostomy for acute cholecystitis

Flapless Conventional Thyroidectomy: A Prospective, Randomized Study

Purpose. Conventional thyroid surgery is one of the most common operations performed worldwide. The conventional technique involves placement of small or large cutaneous flaps. However, the published data regarding flap use for thyroidectomy are contradictory. This study presents the results using a flapless conventional thyroidectomy and the efficacy of this approach in a thyroidectomy. In addition, the study determined whether there are any advantages associated with the use of this approach in comparison to conventional thyroid surgery