Peculiarities of the formation of polyorganic dysfunction syndrome in experimental abdominal sepsis: kidney dysfunction

Introduction: A steady increase in the incidence of the abdominal sepsis puts it into the top priority in terms of both medical and socio-economic significance. Multiple organ failure/dysfunction syndrome is one of the most important components of the pathogenesis of abdominal sepsis, determining the severity of the course, features of the clinical picture, mortality and outcome. The aim of the study is to determine the dynamics of changes in the functional state of the excretory system under the conditions of modeling of the AS in the acute experiment. Material and methods: The study included acute experiment on 38 white rats with abdominal sepsis modeled by intraabdominal injection of a patented mixture of both aerobic and anaerobic conditionally pathogenic microorganisms' suspension and adjuvant substances influencing local host resistance. This study conforms to international and national standards of bioethics. Kidneys' functional state was evaluated by determining a set of 46 functional markers. Results: All renal function parameters were significantly influenced by abdominal sepsis formation. At the beginning of the formation of the abdominal sepsis, the disruption of the transport of sodium ions is concentrated mainly in the area of the distal tubules. Subsequently, the zone of functional disorders also covers the proximal nephron. Conclusions: Formation of abdominal sepsis is characterized by a complex of physiological changes in the functional state of the kidneys, both adaptive- compensatory and pathological. Renal function undergoes phase changes under abdominal sepsis with predominantly adaptive and compensatory mechanisms dominating at the beginning with further involvement of kidneys' components and formation of renal dysfunction

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study : a WSES observational study

BackgroundTiming and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted.MethodsThis worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018.ResultsA total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate >= 22 breaths/min, systolic blood pressure 4mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8.ConclusionsThe simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.Peer reviewe

The effectiveness of the application of nanomaterial polymer technologies in a comprehensive approach to surgical treatment of soft tissue wounds

Treatment of purulent wounds remains one of the most important problems of surgery, both theoretically and practically. The aim was to study the effect of biodegradable polymer film "biodep-nano" and hydrated fullerene C60 on the healing of soft tissue wounds and prevention of their infection. We observed 124 patients with purulent-inflammatory soft tissue complications. Scientific group 53 (42.7%) patients who, in addition to complex treatment, performed the proposed therapy. The control group consisted of 71 (57.2%) patients who were treated according to conventional methods. The results showed that the temperature of the study area in the main group returned to normal on the 3rd day (2.8 ± 0.2 days), and in the group where traditionally used wipes on the 5-7th (5.9 ± 0, 4) the day where (p <0.05). Note that the average time of postoperative wound cleansing in patients of the control group was 14.1 ± 0.8 days, the appearance of granulation tissue - 15.6 ± 0.9 days, and the beginning of the marginal epithelialization - 18.4 ± 1.0 days The length of stay of patients in this group on an inpatient bed was 34.3 ± 2.8 days. Thus, from a surgical point of view, a new promising alternative is a combination of surgical treatment of wounds and the use of nano-containing biodegradable polymeric material, which not only destroys pathogenic wound flora, but also can prevent re-infection and purulent-inflammatory recurrence

ІМПЛЕМЕНТАЦІЯ ПРОТОКОЛІВ ПРИСКОРЕНОГО ПІСЛЯОПЕРАЦІЙНОГО ВІДНОВЛЕННЯ (ERAS) У ПАЦІЄНТІВ З КОЛОРЕКТАЛЬНИМ РАКОМ ТА СУПУТНІМ МЕТАБОЛІЧНИМ СИНДРОМОМ

Introduction. Implementation of enhanced recovery after surgery protocol (ERAS) is becoming more and more widespread due to their effectiveness and safety. At the same time, there is a rather limited number of studies focusing on the opportunities of ERAS in the context of its association with metabolic syndrome in patients with colorectal cancer. This study represents the results of our early experience implementing elements of the ERAS program in the perioperative management of patients with colorectal cancer associated with metabolic syndrome. The aim. To conduct a comparative analysis and evaluate the results of surgical treatment using the enhanced recovery after surgery protocol in patients with colorectal cancer and accompanying metabolic syndrome. Materials and methods. This study included 106 patients with colorectal cancer and accompanying metabolic syndrome, divided into two groups: the first group with the use of elements of the ERAS protocol in colorectal surgery from 2018 – 56 patients, and the second group in which the principles of ERAS were not used (50 patients). Results. In the first group, with a statistically significant difference, a less severe pain syndrome was observed according to VAS (p<0.001), as well as a lower necessity for prescribing opioid analgesics in the postoperative period. Activation of patients, restoration of enteral nutrition and peristalsis occurred earlier in first group (p<0.001). Mean hospital stay in the first group was 5.7±1.5 days, and in second group – 7.7±1.7 days (p<0.001). In the 2nd group, the percentage of complications such as: postoperative wound seroma, abdominal organ eventration, and anastomotic leaks in the 30-day postoperative period were higher than in the group with ERAS elements included. Conclusion. The implementation of elements from the Enhanced Recovery After Surgery (ERAS) protocol for the treatment of patients with colorectal cancer and concomitant metabolic syndrome is effective and safe. It is associated with a decreased duration of hospitalization, less postoperative pain, earlier return to enteral nutrition, quicker patient mobilization, and restoration of peristalsis. Additionally, it reduces the frequency of postoperative complications and readmission rates.Вступ: Імплементація протоколів прискореного післяопераційного відновлення (ERAS) набуває дедалі більшого поширення завдяки їх ефективності та безпечності використання. При цьому існує досить обмежена кількість праць, що акцентують увагу на темі можливостей застосування ERAS в контексті асоціації метаболічного синдрому у пацієнтів з колоректальним раком. В цьому дослідженні представлено результати нашого раннього досвіду впровадження елементів програми ERAS у периопераційному веденні пацієнтів з колоректальним раком асоційованого з метаболічним синдромом. Мета: Провести порівняльний аналіз та оцінити результати хірургічного лікування з використанням протоколів прискореного післяопераційного відновлення у пацієнтів з колоректальним раком та супутнім метаболічним синдромом. Матеріали та методи: В дослідження увійшло 106 пацієнтів з колоректальним раком та супутнім метаболічним синдромом, розділених на дві групи: 1 група із застосуванням елементів протоколу ERAS в колоректальній хірургії від 2018 року – 56 пацієнтів, та 2 група у веденні яких принципи ERAS не використовувались (50 пацієнтів). Результати: В 1 групі зі статистично достовірною різницею спостерігався менш виражений больовий синдром за ВАШ (р<0,001), та менша потреба у призначенні опіоїдних анальгетиків у післяопераційному періоді. Активізація пацієнтів, відновлення ентерального харчування та відновлення перистальтики відбувалася раніше в 1 групі (р<0,001). Середня тривалість перебування пацієнтів в стаціонарі у 1 групі становила 5,7±1,5 днів, а в 2 групі – 7,7±1,7 днів (р<0,001). У 2 групі дослідження в 30-денний термін післяопераційного періоду відсоток ускладнень у вигляді сероми післяопераційної рани, евентерації та неспроможності кишкових анастомозів був вищим, ніж у групі із застосуванням елементів ERAS. Висновки: Впровадження в хірургічну практику елементів протоколу прискореного післяопераційного відновлення (ERAS) у програму лікування пацієнтів з колоректальним раком та супутнім метаболічним синдромом є ефективним і безпечним, та асоційовано зі зниженням тривалості госпіталізації, меншим больовим синдромом в післяопераційному періоді, раннім відновленням ентерального харчування, ранньою активізацією пацієнтів та відновленням перистальтики, а також зменшенням частоти післяопераційних ускладнень та повторних хірургічних втручань

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

BACKGROUND: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. CONCLUSIONS: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands