Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined.To assess whether use of 80% oxygen reduces the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery.The PROXI trial, a patient- and observer-blinded randomized clinical trial conducted in 14 Danish hospitals between October 2006 and October 2008 among 1400 patients undergoing acute or elective laparotomy.Patients were randomly assigned to receive either 80% or 30% oxygen during and for 2 hours after surgery.Surgical site infection within 14 days, defined according to the Centers for Disease Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality.Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory failure in 38 (5.5%) vs 31 (4.4%) (OR, 1.27; 95% CI, 0.78-2.07; P = .34), and mortality within 30 days in 30 (4.4%) vs 20 (2.9%) (OR, 1.56; 95% CI, 0.88-2.77; P = .13).Administration of 80% oxygen compared with 30% oxygen did not result in a difference in risk of surgical site infection after abdominal surgery.clinicaltrials.gov Identifier: NCT00364741.
Received: Revised: Accepted: March 14, 2013 September 20, 2013 January 17, 2014 Rectal tears are relatively common in horses after rectal examinations for diagnosis of gastrointestinal disorders or reproduction. We present the case of a mare that was freely bred and started with colic 8 hrs later. A rectal tear was produced by accidental rectal penetration of the stallion penis with a secondary septic peritonitis. Conservative medical treatment was made. Four days after the accident, the mare presented repetitive colic episodes that were associated with a huge hematoma that almost close the rectum lumen and caused feces retention.
INTRODUCTION Most blood loss in hepatic resections occurs during transection of the liver. To reduce this blood loss and avoid blood transfusions, initial experience with radiofrequency based dissecting devices are presented. Curative liver surgery requires combinations of classical resections and tumorablations. MATERIALS AND METHODS Retrospective analysis of 22 patients who underwent various hepatic resections for colorectal liver metastases. Two commercially available devices were used for transection, either the TissueLink or the Habib Sealer. RESULTS Mortality was zero and morbidity low. No blood transfusions were needed following the use of the Habib Sealer, whereas four patients received blood after TissueLink. 27% of the patients needed a combination of resection and tumorablation. CONCLUSION Liver surgery and transection of the liver can be performed safely with radiofrequency based dissecting devices. Theoretical advantage could be more candidates to curative surgery.
The aim of the present study was to compare gallbladder emptying, gastric emptying and release of cholecystokinin (CCK), gastrin and secretin after intragastric administration of fish oil and trioleate. After intravenous injection of 99mTc-HIDA, 30 ml of a lipid labelled with 111In was administered through a gastric tube. Using dual scintigraphy with two markers, gallbladder and gastric emptying were measured simultaneously for 120 min. Plasma concentrations of gastrin, secretin and CCK, were determined throughout the period. The emptying of the gallbladder was reduced by 27% and the release of CCK by 85% after fish oil as compared with trioleate. Gastric emptying as well as the release of gastrin and secretin were similar after the two types of fat. The results suggest that the reduced gallbladder emptying after fish oil may be due to a smaller release of CCK.
A series of 377 consecutive patients were operated upon with low anterior resection for rectal cancer in the nine Danish departments of surgical gastroenterology during 1992-1993. A retrospective analysis was carried out to calculate the frequency of anastomotic leakage and to evaluate factors of potential influence on the development of leakage according to the literature. Sixty-three patients (17%) developed leakage, which was followed by an increased mortality within the first three postoperative months. Only two variables significantly influenced the leakage rate: male gender was associated with a higher leakage rate (p = 0.02), whereas departments with a low number of rectal cancer surgeons had a low rate of anastomotic leakage (p = 0.02). In conclusion, the rather high frequency of anastomotic leakage calls for further clinical and pathogenetic research in this field. Until then, we recommend the routine use of a peroperative leakage test and selective use of prophylactic ostomy in cases of unsatisfactory anastomosis. Furthermore, it is recommended that low anterior resection for rectal cancer is limited to few surgeons in each department in order to ensure a uniform quality and hopefully also thereby reduce the rate of anastomotic leakage.
Background: The frequency of intestinal obstruction varies in the literature (0.2–10.7%) and requires evaluation in a proper design. Methods: From 1978 to 1985, 1951 patients underwent appendectomy; 58 patients were excluded because of appendectomy per occasionem, 156 because of previous laparotomy, and 190 because of simultaneous major surgery. Three foreigners were lost to follow-up. The cohort was linked to the Danish National Inpatient Register for identification of cases, defined by intestinal obstruction requiring surgical intervention. Results: The follow-up period was long (median, 3563 days; range, 2–5113). Twenty-one patients developed intestinal obstruction. The cumulated incidence was 0.33% after 30 days, 0.79% after 1 year, and 1.51% after 14 years. Female sex as compared with male sex (RR = 3.91; 95% confidence limits (CL), 1.28–12.0) and removal of a normal appendix as compared with an inflamed appendix (RR = 4.0; 95% CL, 1.28–12.5) carried a significantly higher risk of intestinal obstruction. Conclusion: Intestinal obstruction after open appendectomy is rare.
Abstract Thromboembolism is a serious complication oi surgery and prophylaxis is therefore recommended. This study examines a new aspect of the problem, the incidence of thromboembolism after day-case surgery. From 1982 to 1992, 2281 patients underwent day-case repair for inguinal hernia management. Hospital admission for thromboembolism within the first 30 days after surgery was identified by computer linkage to the National In-Patient Register, which contains details of all hospital admissions in Denmark. One patient developed non-fatal pulmonary embolism. No other patients were admitted to hospital with venous thromboembolism within 30 days of herniorrhaphy. It is concluded that there is no need for routine prophylaxis for thromboembolism in day-case hernia surgery.
