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The actual incidence of gossypiboma is difficult to determine possibly due to reluctance to report occurrence arising from fear of legal repercussion, but retained surgical sponge is reported to occur one in every 3000-5000 abdominal operations and is most frequently discovered in abdomen. Here, we report a case of 69-year-old male patient who suffered from severe irritative voiding symptoms with abdominal wall fistula at the incision site due to accidently left surgical sponge in bladder following suprapubic cystolithotomy surgery for bladder stone at some other hospital.

Background: Failure of laparotomy closure develops after up to 20% of abdominal operations. Suture tension has an influence on the quality of tissue regeneration. No sensors are available to register suture tension dynamics in vivo. Methods: In a series of animal experiments, the effect of suture tension on the ultrastructure of the healing incision was examined. Surgeons’ ability to suture with target tension was tested. An implantable sensor and data logger were developed and tested experimentally in sutures closing midline laparotomies in pigs both under normal and elevated intra-abdominal pressure. Results: High suture tension has a negative influence on the regeneration of laparotomy incisions. Running sutures for laparotomy closure lose 45% of their initial tension over periods of 23 h. Intermittent elevation of intra-abdominal pressure to 30 mm Hg leads to a near total loss of suture tension after 23 h. Conclusion: Surgeons are not able to control and reproduce suture tension. Suture tension dynamics can be measured in vivo by the sensor developed. Further research is needed to define a tissue-specific suture tension optimum to reduce the incidence of complications after laparotomy. Techniques for laparotomy closure need to be modified.

Currently, there is an increased interest in the minimally invasive surgical approach. A pancreatectomy is among the most complex and challenging of abdominal operations where laparoscopy has important limitations, especially for major pancreatectomies performed in only a few centres (1,2).

Background Patients with previous history of abdominal operations are sometimes excluded from consideration for peritoneal dialysis because of concerns for increased risk of complications during the implantation procedure and inadequate dialysis due to reduced peritoneal surface area. Employing a laparoscopic approach, we compared the outcome of peritoneal dialysis catheters in 2 groups of patients with and without intra-abdominal adhesions. Methods All data in this report were recorded prospectively. Revision-free and overall survival of catheters, the incidence of mechanical and infectious complication, and surgical revision rates were compared between the 2 groups. Results In 217 successful catheter implantations, there was a history of previous abdominal surgery in 42.9% of procedures; only 26.9% of them had intraperitoneal adhesions; 2.8% of patients without history of previous abdominal surgery had intraperitoneal adhesions. There were no significant differences between the 2 groups for 1- and 2-year revision-free and overall catheter survival, mechanical dysfunction, infectious complications, or surgical revision rates. Conclusion History of previous abdominal surgery should not be used to judge the eligibility of patients for peritoneal dialysis. Laparoscopic placement is the best way to ensure optimal catheter outcomes equivalent to patients without previous abdominal surgery.

In natural orifice translumenal endoscopic surgery (NOTES) intentional puncture of one of the viscera (e.g., stomach, rectum, vagina, and urinary bladder) is made and an endoscope is used to access the abdominal cavity and perform an intra-abdominal operation. Early studies focused on feasibility, including such accomplishments as pure transgastric splenectomy and gastrojejunostomy. Contemporary studies are investigating the infectious and immunologic implications of NOTES and honing the tools and techniques required for complex abdominal operations. Today NOTES has entered the clinical arena in quite a few cases: The first clinical series of transgastric peritoneoscopy has recently been published; many groups are accumulating patients in studies of NOTES cholecystectomy, either via the transgastric or transvaginal route; and a series of transgastric appendectomies has been well publicized, yet they remains unpublished. Although clinically NOTES is gaining momentum, the field should remain in check while rigorous studies are performed and clinical trials are undertaken. The zeal for NOTES should not take precedence over the welfare of the patient.

Sonography is a comparatively cheap, convenient, and noninvasive testing on diagnosing fatty liver disease and with satisfied sensitivity and specificity. The sonographic diagnosis of fatty liver is usually made by radiologists who have few opportunities to observe the macroscopic changes on fatty liver. Having observed some obvious macroscopic changes of simple fatty liver in abdominal operations, we wanted to know how many morphological changes of the simple fatty liver there were in the end and what is the corresponding relationship between sonographic diagnosis and morphologic changes of the fatty liver. So, we designed this study for these destinations by using the intuitive and minimally invasive advantages of laparoscopy.For this study, we chose patients with benign cholecystic disease and simple fatty liver diagnosed by sonography. In the laparoscopic operations, the surface and periphery of the liver were observed and videotaped simultaneously. Liver biopsies were performed during the operations, and the specimen was analyzed by experienced pathologists postoperatively. The videos, histologic results, and the sonographic examinations on fatty liver were compared and tried to find some potential correlation among them.In this study, we found some common macroscopic changes of the fatty liver under laparoscopy, such as hepatomegaly, the dullness of the liver edge, the fatty infiltration of the liver surface, the texture of the liver changing from softness to tenacity, and the blood vessels of the liver surface becoming more fuzzy. According to the histologic results, the characteristics of different gradings of fatty liver under laparoscopy could be confimed. The statistical analysis revealed a higher consistency between sonographic diagnosis and laparoscopic macroscopic changes of the fatty liver.There are some typical features of the simple fatty liver under laparoscopy. These characteristics correspond to the sonographic diagnosis on the fatty liver. There is a high consistency between sonographic diagnosis and laparoscopic findings on the fatty liver. According to the macroscopic changes of the liver under laparoscopy, the extent of simple fatty liver could be evaluated under laparoscopy.

Object Ventriculoperitoneal shunts (VPSs) are commonly placed into the peritoneal cavity via a small laparotomy or blindly by using a split trocar. Larger patients require larger incisions, and placement is made more difficult by previous abdominal operations and obesity. For general surgeons, laparoscopy has become the first-choice approach for abdominal procedures, using 1 or several very small incisions. The authors discuss their pediatric series of patients in whom laparoscopy was used to place distal shunt catheters. Methods The authors reviewed the medical records accrued over a 9-year period, noting VPS operations performed using laparoscopy. Complications, morbidity, and alterations of planned management were noted. Results One hundred thirty-seven VPS operations in 126 patients were identified, 92 performed by the senior author (M.H.H.) alone and 45 conducted with the assistance of a general surgeon. A second port was placed for lysis of adhesions or retrieval of old catheters in 7 cases. There were no immediate complications. The infection rate was 6.6%, comparable with the institutional norm (6.3%) over an 8-year period. There were 3 early failures due to abdominal malabsorption without infection. Five catheters later broke at the level where they were introduced into the abdomen due to shearing by the abdominal trocar. Conclusions Laparoscopic placement of distal VPS catheters is relatively safe and allows insertion via inconspicuous incisions. It can allow for inspection or lysis of adhesions and removal of foreign bodies, help determine if and where the abdomen can absorb shunt fluid, and make VPS surgery in the obese patient easier.

Venous thrombolism (VTE) is a significant cause of morbidity for surgical patients. Comparative risk across major procedures is unknown.Retrospective analysis of the Nationwide Inpatient Sample (2001-2005) was conducted. Eight surgeries were identified: bariatric surgery, colorectal surgery, esophagectomy, gastrectomy, hepatectomy, nephrectomy, pancreatectomy, splenectomy. Age18, patients with multiple major surgeries, and those admitted for treatment of VTE were excluded. Primary outcome was occurrence of VTE. Independent variables included age, gender, race, Charlson score, hospital teaching status, elective procedures, cancer/metastasis, trauma, and year.Patients, 375,748, were identified, 5,773 (1.54%) with VTE. Overall death rate was 3.97%, but 13.34% after VTE. Unadjusted rate (0.35%) and adjusted risk for VTE were lowest among bariatric patients. On multivariate analysis, highest risk for VTE was splenectomy (odds ratio 2.69, 95% CI 2.03-3.56). Odds ratio of in-hospital mortality following VTE was 1.84 (1.65-2.05), associated with excess stay of 10.88days and $9,612 excess charges, translating into $55 million/year nationwide.Highest risk for VTE was associated with splenectomy, lowest risk with bariatric surgery. Since bariatric patients are known to have greater risk for this complication, these findings may reflect better awareness/prophylaxis. Further studies are necessary to quantify effect of best-practice guidelines on prevention of this costly complication.

An 404 Patienten, die sich in einem Krankenhaus der Regelversorgung gastrointestinalen Karzinomresektionen oder groseren Eingriffen in der Bauchhohle, zum Teil mit kompliziertem Verlauf, unterziehen musten, wurden zur perioperativen hochkalorischen parenteralen Ernahrung 500 Cava-Katheter in die V. subclavia eingelegt. Der Grosteil der Katheter lag zwischen 6 und 20 Tagen. Die langste Liegedauer betrug 44 Tage. Die Katheterinsertion gelang in 97,8 %. Fehllagen der Katheterspitze traten in 4,4 % auf, wobei in 2,8 % eine Korrektur unter dem Bildwandler moglich war. 92,2 % der Katheter blieben komplikationslos. In 1,4 % kam es zum Pneumothorax, in 0,4 % zur zentralen Thrombose. Eine Kathetersepsis trat in 6,2 % auf. Peri-operative high-calorie nutrition was administered, through a total of 500 catheters introduced into the superior vena cava via the subclavian vein, to 404 patients admitted to hospital for gastro-intestinal cancer resection or other major abdominal operations, some of them taking a complicated course. Most of the catheters remained in situ for 6-20 days; the longest period was 44 days. Catheter insertion was successful in 97.8 %. Faulty position of the catheter occurred in 4.4 %; in 2.8 % it was rectified under fluoroscopic control. In 92.2 % there were no complications ascribable to the catheter. A pneumothorax resulted in 1.4 % of patients, central thrombosis in 0.4 %. Catheterrelated sepsis was noted in 6.2 %.

OBJECTIVE To compare occlusive hydrocolloid dressing (OHD; Karayahesive) and gauze dressing (GD) with regard to the cost and incidence of wound infection after abdominal surgery. METHODS A total of 134 patients who underwent incisions were randomized to have their wounds dressed with either OHD or GD. OHD was left on until the sutures were removed, and GD was changed everyday postoperatively. The cost calculations represent the number of dressings required for each treatment group as determined by the frequency of required dressing changes and cost per dressing. RESULTS There were no differences between the groups regarding the need for dressings to be changed or the incidence of infection. OHD was less expensive and complicated than GD, which needed to be changed everyday ( p CONCLUSION The results suggest that OHD is less expensive to use than GD, and the risk of wound infection is not increased compared to GD.

Natural orifice translumenal endoscopic surgery (NOTES) involves the intentional puncture of one of the viscera (e.g., stomach, rectum, vagina, urinary bladder) with an endoscope to access the abdominal cavity and perform an intraabdominal operation. Early laboratory work focused on feasibility studies, including such accomplishments as pure transgastric splenectomy and gastrojejunostomy. Contemporary laboratory work is investigating the infectious and immunologic implications of NOTES and honing the tools and techniques required for complex abdominal operations. Today NOTES has entered the clinical arena in a few cases: the first clinical series of transgastric peritoneoscopy has recently been published; multiple groups are accumulating patients in studies of NOTES cholecystectomy, either via the transgastric or transvaginal route; and a series of transgastric appendectomies has been well publicized, yet it remains unpublished. Although clinical NOTES is gaining momentum, the field should remain in check while rigorous laboratory work is performed and cogent clinical trials are undertaken. The zeal for NOTES should not take precedence over the welfare of the patient.

Natural orifice translumenal endoscopic surgery (NOTES) has gained much interest by minimal invasive surgeons and gastroenterologists. Performing abdominal operations without any abdominal wall incisions may offer all the advantages of minimally invasive surgery (MIS) and eliminate the complications associated with these wounds. The NOTES technique is rapidly being developed, but one of the major issues involved in the procedure that has to be addressed prior to implementation is in obtaining adequate spatial orientation.The aim of this study was to combine the standard laparoscopic vision together with the endoscopic surgery procedure in order to acquire an independent satisfactory vision source.The hybrid technique was performed in 6 porcine animal models. Among the procedures performed were tubal ligation, liver biopsies, oophorectomy, and cholecystectomy. All procedures were performed under general anesthesia, and all animals were euthanized at the termination of the procedure.The laparoscopic vision offers substantial advantages over the endoscopic vision. Spatial orientation is achieved in the same manner and quality as in MIS, and furthermore, the laparoscopic vision increases the safety of the NOTES procedure.The hybrid technique offers a superior vision source independent to the working endoscope. It may be an interim technique for developing NOTES until a novel imaging device will be available, or serve as the final solution for acquiring an adequate vision for this approach.

Two different approaches can be distinguished in the surgical treatment of rectal prolapse, i. e. the transabdominal route and the perineal procedures. The following article deals with both operative options with a detailed discussion of the Delorme's operation and the perineal rectosigmoidectomy, also known as the Altemeier procedure for the perineal techniques. Regarding abdominal operations simple rectopexy is compared with operations including bowel resection including minimally invasive approaches. In general, perineal procedures for full-thickness rectal prolapse cause less morbidity compared with abdominal operations. They are especially indicated in the elderly and /or high-risk patients. Recurrences, on the other hand, are usually encountered more often following local techniques as compared with abdominal operations. It can be concluded that perineal as well as abdominal procedures remain important options in the surgical treatment of rectal prolapse and should be part of the armamentarium of colorectal surgeons.

Pancreatic redo procedures belong to the most difficult abdominal operations because of altered anatomy, significant adhesions, and the potential of recurrent disease. We report on our experience with 15 redo procedures among a series of 350 consecutive pancreatic operations.From January 1, 2004 to May 31, 2006 a total of 350 patients underwent pancreatic surgery in our department. There were 15 patients identified who had pancreatic redo surgery for benign (14) or malignant (1) disease. Perioperative parameters and outcome of 15 patients undergoing redo surgery after pancreatic resections were evaluated.Operative procedures included revision and redo of the pancreaticojejunostomy after resection of the pancreatic margin (6), completion pancreatectomy (3), conversion from duodenum-preserving pancreatic head resection to pylorus-preserving pancreaticoduodenectomy (3), classic pancreaticoduodenectomy after nonresective pancreatic surgery (1), redo of left-sided pancreatectomy (1), and classic pancreaticoduodenectomy after left-sided pancreatectomy (1). Histology revealed chronic pancreatitis in 14 and a mucinous adenocarcinoma of the pancreas in 1 patient. Median operative time was 335 min (235-615 min) and median intraoperative blood loss was 600 ml (300-2,800 ml). Median postoperative ICU stay was 20 h (4-113 h) and median postoperative hospital stay was 15 days (7-30 days). There was no perioperative mortality and morbidity was 33%.Pancreatic redo surgery can be performed with low morbidity and mortality. Redo surgery has a defined spectrum of indications, but to achieve good results surgery may be performed at high-volume centers.

Background Postoperative bowel obstruction (PBO) plagues patients of all ages after intraabdominal surgery. We examined the incidence, risk factors, and the need for operative intervention of PBO. Methods We reviewed all children who underwent a laparotomy or laparoscopy. Parameters included age, diagnosis, type and number of procedures, complications, time interval to PBO, treatment of PBO, morbidity, and mortality. Results From 2001 to 2005, 2187 abdominal operations were performed. Overall, 61 patients (2.8%) developed a PBO; 43 (70.5%) required reoperation. Postoperative bowel obstruction was more common in patients younger than 1 year (28/601, 4.7%) compared with older children (33/1586, 2.1%; P = .01, β = .80). In infants, PBO was not influenced by initial diagnosis ( P = .26) or whether the initial operation was clean/clean-contaminated or contaminated/dirty ( P = .12). In children older than 1 year, nonoperative treatment was more likely to be successful if PBO occurred within 12 weeks of initial operation (12/16 vs 3/14; P = .01). In contrast, all but one infant (16/17) with early PBO required reoperation. Conclusion The incidence of PBO is significantly higher in newborns and infants than in older children (who have rates comparable to those reported in adults). Infants are significantly more likely to require operative intervention, particularly if PBO occurs early after the initial operation.

Emergency services have an increasingly high profile: they are the acute contact zone between the NHS and the population it serves. Furthermore, emergencies represent an increasingly high percentage of all surgical admissions and account for almost half of all abdominal operations. Despite these well-recognised statistics, no actual policy directive other than the Department of Health (DoH) and The Royal College of Surgeons of England guidelines has been issued to deal with the problems inherent in the delivery of emergency general surgical services.

Fistulae can result from diverticulitis-associated abscesses perforating into surrounding structures. Diverticular ureterocolic fistulae are rare, with only nine previous cases reported.1 They are usually related to previous operations and affect the left ureter due to its proximity to the sigmoid colon.2 In the absence of a non-functioning infected kidney, it is recommended to resect the diseased colon with no manipulation of the urinary system (eg, nephroureterectomy).2 Our case is the first to report a spontaneous right ureterocolic fistula secondary to diverticular disease in a patient with no previous abdominal operations. A 68-year-old man presented with …

Endoscopic surgery is one of minimally invasive medical treatments, which reduces both physical and mental burdens of a patient than conventional abdominal operations. At present, a variety of training environments for endoscopic surgery, such as a dry box, a virtual reality (VR) simulator, and an animal experiment have been prepared to cultivate certifying physicians of endoscopic surgery. Even now, more effective training environments have been requested from the surgeons. Thus, this study proposes an application of augmented reality to establish a novel training environment of endoscopic surgery. We focused on one of Japanese learning styles in writing, in which children repeatedly trace the letters written on a sheet in order to learn how to use a pencil to write neatly without concerning the meanings of the letters. This study applies this learning style to our training system by using a dry box and augmented reality (AR). In our training system, AR Toolkit is utilized to describe a target trajectory which is displayed on a monitor and is refereed by a trainee. And we originally develops the devices which detect the motions of endoscopic forceps while training. This paper introduces the basic constitution of our training system and discusses about the training effects obtained from the experimental results with beginner subjects.

Intestinal brids are most common cause of postoperative ileus although there are various cause of ileus after abdominal operation. On the other hand internal herniation is a rare cause of ileus after abdominal operations. Diagnosis of this hernias are important because of strangulation and necrosis of its content due to circulatory disturbance. In this case report, we publish a patient with ileus due to a greft which has been used in a previous abdominal surgery for abdominal aort aneurysm.

Background: The aim of the present study was to evaluate the effect of gallstone disease (GD) and laparoscopic cholecystectomy on gastric electrical activity of slow waves, which was recorded via transcutaneous electrogastrography (EGG). Methods: Twenty-one consecutive patients (M/F: 12/9, 52.7 ± 15 years old) with GD and no previous history of abdominal operations or known disease affecting gastrointestinal motility were studied. The EGG was performed for 30 min prior to and 90 min after a standard meal, during a 4–6 month period prior to and after laparoscopic cholecystectomy. The percentile proportion of the three spectra of gastric slow waves frequency was studied, defined as follows: bradygastria, 1–2.1 cycles per min (c.p.m.); normogastria, 2.2–3.9 c.p.m.; and tachygastria, 4–9 c.p.m. The findings were compared to those of nine healthy subjects (M/F: 5/4, 49.5 ± 14.8 years old). Results: No statistically significant difference was found in percentile distribution of bradygastria, normogastria and tachygastria, pre- or post-prandially, neither before or after laparoscopic cholecystectomy, nor between patients and controls. Conclusions: Patients with GD do not exhibit differences in gastric electrical activity of slow waves in comparison to normal subjects and laparoscopic cholecystectomy does not alter gastric electrical activity. These findings suggest that cholelithiasis does not seem to cause dyspeptic symptoms due to gastric dysrythmias.

But: Comparer les effets des pansements occlusifs (Comfeel) et des pansements classiques (Mepore) sur la cicatrisation des incisions cutanees apres chirurgie abdominale. Type d'etude : Prospective randomisee. Provenance: Laboratoire et hopital universitaires, Danemark. Patients: Soixante treize patients ayant eu une chirurgie abdominale propre par une incision de plus de 5 cm de long entre Aout 1993 et Aout 1995 dont le pansement a ete fait apres tirage au sort soit avec du Comfeel soit avec du Mepore. Methodes : Le Comfeel a ete laisse en place jusqu'a l'ablation des fils, et le Mepore a ete retire a J2 postoperatoire. Principaux criteres de jugement: La survenu d'infections, d'accolements, d'ecoulements et l'aspect esthetiqua 3 mois plus tard. Resultats : Le choix entre Comfeel et Mepore a ete fait fait par tirage au sort. Vingt neuf patients n'ont pas ete analyses (20 ont eu du Mepore et 9 du Comfeel) 26 et 17 patients ayant ete respectivement retenus pour l'analyse des resultats. Il y a eu un abces de paroi dans le groupe Comfeel et 5 dans le groupe Mepore (p = 0,2). Il n'y avait pas de difference entre les deux groupes en ce qui concerne la necessite de changer le pansement, l'incidence des ecoulements, ou l'incidence de decollement du pansement de la peau. Le Comfeel adherait bien a la peau et restait plus ou moins transparent jusqu'au moment de l'ablation des fils. Chez 23 patients (64%) le pansement est reste completement transparent, et chez aucun des patients il est devenu totalement opaque. Du point de vue esthetique il n'y avait pas de difference a trois mois. Nous avons eu l'impression que les patients qui avaient du Comfeel etaient plus confortables et accomplissaient leurs activitees quotidiennes plus facilement. Conclusions: Les pansements occlusifs tiennent bien en place et restent transparents, et ils n'augmentent pas le risque d'infection. Ils pourraient meme etre plus confortables. Ils representent une alternative raisonnable aux pansements traditionels.

But: Evaluer les effets des lavements preoperatoires sur la reprise du transit apres une intervention digestive n'interessant pas le colon. Type d'etude : Essai prospectif, randomise. Provenance: Centre universitaire et ses hopitaux dependants, Suisse. Patients: Cent seize patients (âges de plus de 16 ans) programmes pour une intervention de chirurgie digestive n'interessant pas le colon. Methodes: Apres randomisation, les patients ont eu un lavement d'un litre d'eau et de glycerine le jour precedent leur intervention (n = 53) ou aucune preparation intestinale preoperatoire (n=53 ). Principaux criteres de jugement: La reprise du transit apres l'intervention, evaluee par l'auscultation abdominale et le moment des premieres selles. Tous les patients ont ete suivis quotidiennement pendant 10 jours ou jusqu'a leur sortie par le meme examinateur. Resultats: Un consentement eclaire a ete donne par 110 patients, 6 ont refuse de participer a l'etude, et 4 ont du etre exclus apres randomisation, faisant ainsi porter l'analyse sur 106 cas. La reapparition des bruits intestinaux et le moment de la premiere selle ont ete significativement plus precoces chez les patients qui n'avaient pas eu de lavement preoperatoire (p=0,02 et p=0,01 respectivement). Aucun sous groupe de patients n'a beneficie des lavements. Conclusions: Les lavements preoperatoires retardent plutot qu'ils n'ameliorent la reprise du transit apres chirurgie. Selon nous, cette habitude devrait etre abandonnee.

To assess the utility of advanced tests performed before surgery on patients who needed emergent abdominal operations, and to assess the outcomes of these patients relative to their diagnoses.Patients with a potential abdominal catastrophe may have various presentations, contributing to the difficulty of the decision about whether an operation is indicated. Advanced tests can be valuable, but the use of these adjuncts should be appropriate to the clinical status of the patient so that treatment is not delayed. The role of these tools in the evaluation of the patient who may need an emergent abdominal operation is less well defined.Data were reviewed on adult patients undergoing emergent abdominal operations. Entrance criteria included patients who had an emergent abdominal operation, defined as one performed for presumed gastrointestinal perforation, infarction, or hemorrhage within 6 hours of admission or surgical consultation. Advanced tests were those that were time-consuming or invasive or required scheduling with other departments so that the risk/benefit ratio of these tests could be questioned. A useful test was one that provided information that contributed to a change in the patient's management.During a 5-year period, 300 consecutive adult patients (158 perforations, 66 hemorrhage, 53 ischemia/infarction, and 23 "other") underwent emergent nontrauma celiotomies. Overall, the death rate was 20%. Advanced preoperative tests were performed in 135 (45%) of the 300 patients, and 40 of these patients had delayed treatments. Preoperative localization of bleeding sites was accomplished in 77% of patients with upper gastrointestinal bleeding and 86% of patients with lower gastrointestinal bleeding.Most patients in need of emergent abdominal operations should not undergo advanced tests. The primary role of advanced tests in these patients is in the localization of a bleeding site. With the exception of patients who present with hemorrhage, advanced tests frequently cause a delay in treatment.

PURPOSE OF REVIEW The scope of this article is to provide an updated review examining the role of early feeding in the postoperative period. RECENT FINDINGS Guidelines for postoperative care after abdominal surgery have historically outlined the dogma of 'nil by mouth' until bowel movement returns, but they are currently questioned. This change in mindset, especially after colorectal surgery, was initiated with fast-track or enhanced recovery after surgery programs, which particularly led to an opioid-sparing strategy. Many randomized trials and meta-analyses suggested an absence of benefit in keeping patients 'nil by mouth'. Conversely, in elective abdominal surgery, improvement in comfort without increased morbidity is now demonstrated with a liberal strategy, and a recent meta-analysis even demonstrated a decrease in mortality. Early caloric hydration and chewing gum are the most acceptable actions with a high level of proof. After emergency surgery, few data are available but a similar strategy should probably be chosen with no obvious benefit from maintenance of fasting. SUMMARY Early oral intake is possible after elective abdominal surgery and should be moderate and progressive to be well tolerated. Any sign of nausea may mean intestinal or gastric disturbance and is a caution not to pursue this policy. The strategy in emergency abdominal surgery still requires adequately powered, randomized controlled trials.

A review of the current literature is presented regarding the surgical management of full thickness rectal prolapse, comparing laparoscopic rectopexy with open abdominal operations and perineal procedures. Outcome measures include length of stay, short- and long-term outcomes and financial burdens. Current evidence suggests that laparoscopic rectopexy as treatment for full thickness rectal prolapse is a safe alternative to the other options.

To compare a new technique of radical hemorrhoidectomy using an electrothermal device originally devised to seal vessels in abdominal operations, with the conventional open Milligan-Morgan procedure performed with diathermy.Hemorrhoidectomy is one of the most commonly performed anorectal operations. Two well-established methods, the "open" Milligan-Morgan excision and the "closed" Ferguson technique, both carry risks of postoperative bleeding, urinary retention, and late anal stenosis. The convalescence is similarly long and difficult after both operations. The quest for an improved technique of radical excision of hemorrhoids is justified.In this case-control study, two groups of patients were alternatively allocated into study and control groups. In the study group (n = 40), an electrothermal system was used. The tissue fusion produced by this device consists of melting of collagen and elastin. This technique essentially achieves a sutureless closed hemorrhoidectomy. The operative time, postoperative complications, and time off work were compared with the group undergoing conventional Milligan-Morgan hemorrhoidectomy (control group, n = 40).The operative time and time off work were significantly shorter in the study group. There were also fewer postoperative complications in this group.The "tissue-welding" properties of this device and the shape of the electrode handpiece may be successfully applied to the performance of an operation most appropriately described as a "modified sutureless closed hemorrhoidectomy." This pilot study shows that this new technique is simple and safe, significantly shortens the operation, and is followed by a significantly easier and shorter recovery.

It was with great interest that we read the manuscript entitled ‘Postoperative Outcomes in Vedolizumab-treated Patients Undergoing Abdominal Operations for Inflammatory Bowel Diseases’, recently published in this journal, by Lightner et al .1 In this retrospective study, 94 patients with previous exposure to vedolizumab [VEDO] within 12 weeks before abdominal operations were compared with two control groups, [preoperative infliximab [IFX] and conventional therapy] to check differences in postoperative complications. Patients with previous VEDO had more overall complications and surgical site infections [SSIs] than patients with previous IFX or no biologics [ p < 0.001]. In multivariate …

Previous abdominal operations might cause severe intraperitoneal adhesions (IPA), which can complicate caesarean section (CS) procedures. When selecting the mode and timing of delivery, obstetricians are also curious about uterine scar healing if the previous operation was a CS. Uterine scar thickness is an indicator of uterine scar healing. We aimed to evaluate the possible predictive value of striae gravidarum (SG) on IPA formation and uterine scar thickness (UST).Fifty-five women with a previous CS history were evaluated for SG Davey Score. They were investigated for IPAs and lower segment uterine scar thickness during the current CS operation.Out of the patients with no SG (n = 11), mild SG (n = 10) and severe SG (n = 34), 1 (9.1%), 3 (30%) and 17 (50%) had IPA, respectively (p = 0.044). The mean uterine scar thicknesses in the no SG, mild SG and severe SG groups were 3.82 ± 4.04, 5.20 ± 4.13 and 5.18 ± 3.52, respectively (p = 0.561).To the best of our knowledge, this was the first study to investigate the relationship between SG and IPA and uterine scar thickness. The SG status of a patient with a previous delivery and abdominal operation history might help predict IPA status before planning a new operation.

Among the surgical procedures with abdominal approach (Burch colposuspension, Marshall-Marchetti-Krantz operation, Richardson paravaginal repair) used to correct genuine stress incontinence (GSI), the Burch colposuspension is both easy to perform and very effective. The purpose of the operation is to reposition the cervicourethral complex in a fixed retropubic space. Since anterior replacement of the vaginal axis may cause iatrogenic enterocele or increase a posterior cystocele or a previous rectocele, other complementary operations (Douglas obliteration, anterior or posterior vaginal repair) are necessary. The authors report that in 256 patients with type I and II genuine stress incontinence, the recovery rate after Burch colposuspension associated with gynecological procedures has been 81.25% in a 1 to 5-year follow-up.

Ventral hernia repair is one of the most common abdominal operations. Recurrence rate remains high despite all preventive measures. "Tension-free" repair has been postulated as the surgical method of choice. A laparoscopic approach to ventral hernia repair has been described recently. Theoretical advantages of a laparoscopic repair include faster recovery, less postoperative pain, less morbidity, and a better cosmetic result. However, the approach requires advanced laparoscopic skills and familiarity with its technique. An animal model of ventral hernia, suitable for laparoscopic repair, was developed to be used for educational and experimental purposes. The model is simple, reliable, and reproducible in any minimally invasive surgery facility. We conclude that the pig can be used as an excellent model to learn the technique and evaluate a variety of endpoints for laparoscopic ventral hernia repair.

PURPOSE: The study contained herein used the database of the American Board of Colon and Rectal Surgery to demonstrate trends in colorectal practice from 1989 to 1996 and to compare the one-year technical experience of a colorectal resident with the five-year totals of a general surgery resident. METHODS: Complete case lists from applicants for the American Board of Colon and Rectal Surgery's qualifying examination have been entered into a database. Similar data have been compiled from the Residency Review Committee for Surgery. RESULTS: From 1989 through 1996, 446,082 procedures have been listed by 417 colorectal residents, an average of 1,060 cases per resident. When contrasted with the operative experience of a general surgery resident, the colorectal resident performs substantially more anorectal operations, more endoscopic procedures, and more index abdominal operations in one year than the average general surgery resident performs in five years. CONCLUSIONS: When added to the required general surgery experience, one year of training in colorectal surgery trains a true subspecialist with unique expertise in the treatment of disorders of the colon, rectum, and anus.

Adequate exposure enables an operation to be performed safely and with precision. In most of the upper abdominal operations, good retraction of the abdominal wall as well as the upper abdominal viscera is necessary. A simple but effective and inexpensive method of liver retraction is introduced.

Hysterectomy is the most common non-pregnancy-related surgical procedure performed in the USA. The ratio of abdominal operations to vaginal operations is 3:1, which probably reflects surgeon's experience and practice styles, the absence of clear guidelines for selecting a surgical route, lack of patient knowledge about the options, and inappropriate decision-making. With the trend toward evidence-based and outcome-based practice, the indications and contraindications for abdominal, vaginal, and laparoscopically-assisted hysterectomy must be examined critically. In the author's extensive experience the rates of abdominal, vaginal, and laparoscopically-assisted procedures are 1.9, 88.7, and 9.4%, respectively. Techniques useful in vaginal hysterectomy with or without simultaneous oophorectomy, the pros and cons of simultaneous incidental appendectomy, and methods of protecting the ureter are discussed.

Postoperative intestinal obstruction is a relatively common complication among those after abdominal operations, and adhesions in the intestine cause the intestinal obstruction two times in the postoperative course following an appendectomy for appendicitis is reported. At first time, adhesions in the intestinal obstruction, and a rare entity of jejuno-jejunal intussusception caused the second intestinal obstruction. It is etiologically thought that tha jejuno-jejunal intussusception might be caused by a bent portion of intestine due to fibrous adhesion between the same small vowel serosae as the head of the intussusception.

Natural orifice transluminal endoscopic surgery (NOTES) (Halim and Tavakkolizadeh, Int J Surg 6:273–276, 2008) is an surgical technique whereby “scarless” abdominal operations can be performed with an endoscope passed through a natural orifice (mouth, urethra, anus, etc.) then through an internal incision in the stomach, vagina, bladder (Lima et al., J Urol 176:802–805, 2006) or colon, thus avoiding any external incisions or scars (Baron, Br J Surg 94:1–2, 2007).

The objective of this study was to develop a method for analyzing differences in the performance of hospitals with respect to outcome by separating patient factors from procedural factors. The setting included a prospective follow-up of a sample of 5571 patients undergoing all types of surgical procedures in general surgery departments of 11 hospitals (20 surgical departments) across Israel. Of these, 769 underwent surgery involving the opening of the bowel, and they are the subjects of this report. Our method consisted of a prospective follow-up by a nurse epidemiologist, including detailed clinical data from the day of admission to hospital discharge. Analysis was directed at identifying reasons for the observed variability in wound infections among departments. Observed rates were compared with “expected” rates calculated from a logistic model pooled over departments. An attempt was made to separate patient-inherent characteristics, such as age, sex, and diagnosis, from procedural factors, depicting the patient's experience during his hospitalization. Results indicated that the marked interdepartmental differences in the observed infection rates were not accounted for by differences in the “case mix” among departments. Procedural risk factors in this data set played the main role in explaining the observed variability among surgical departments. We conclude that the simple method presented here used the data pooled over departments to define the main risk determinants for infection in this data set. It separated intrinsic patient factors from procedural characteristics, and could be used in studies where the main interest is to compare institutions, and point at reasons behind the differences in outcomes.

Backgrounds/Aims: We aimed to to evaluate the feasibility of laparoscopic common bile duct exploration (LCBDE) in patients with previous upper abdominal surgery. Methods: Retrospective analysis was performed on data from the attempted laparoscopic common bile duct exploration in 44 patients. Among them, 5 patients with previous lower abdominal operation were excluded. 39 patients were divided into two groups according to presence of previous upper abdominal operation; Group A: patients without history of abdominal operation. (n=27), Group B: patients with history of upper abdominal operation. Both groups (n=12) were compared to each other, with respect to clinical characteristics, operation time, postoperative hospital stay, open conversion rate, postoperative complication, duct clearance and mortality. Results: All of the 39 patients received laparoscopic common bile duct exploration and choledochotomy with T-tube drainage (n=38 [97.4%]) or with primary closure (n=1). These two groups were not statistically different in gender, mean age and presence of co-morbidity, mean operation time (164.5±63.1 min in group A and 134.8±45.2 min in group B, ρ=0.18) and postoperative hospital stay (12.6±5.7 days in group A and 9.8±2.9 days in group B, ρ=0.158). Duct clearance and complication rates were comparable (ρ＞0.05). 4 cases were converted to open in group A and 1 case in group B respectively. In group A (4 of 27 (14.8%) and 1 of 12 (8.3%) in group B, ρ=0.312) Trocar or Veress needle related complication did not occur in either group. Conclusions: LCBDE appears to be a safe and effective treatment even in the patients with previous upper abdominal operation if performed by experienced laparoscopic surgeon, and it can be the best alternative to failed endoscopic retrograde cholangiopancreatography for difficult cholelithiasis. (Korean J Hepatobiliary Pancreat Surg 2012;16:154-159)

Total laparoscopic pancreaticoduodenectomy (TLP) represents perhaps one of the most challenging abdominal operations. This procedure is gaining popularity in recent years, mostly due to the numerous reports underling its safety and feasibility in the setting of several benign and malignant pancreatic pathologies. Minimal-invasive pancreatic surgery is rapidly becoming a reality in many centers around the globe and its benefits, compared to the traditional open approach, have been extensively proven in the setting of distal pancreatic resection. The many advantages of a laparoscopic approach, such as the improved visual magnification, the theoretical improved tissue exposure, and the potential for a more delicate manipulation of tissues are reasonably expected to be applicable to other pancreatic procedures including TLP. Herein we describe a technique for a TLP; we provide some suggestions on patient selection, pre-operative preparation, equipment, postoperative management, and finally discuss some of the most common pitfalls encountered during the procedure.