Showing posts with label obstuction. Show all posts
Showing posts with label obstuction. Show all posts
Saturday, November 12, 2011
Monday, May 23, 2011
Adhesiolysis in Repeat Caesarean Delivery Common, Costly
Adhesiolysis in Repeat Caesarean Delivery Common, Costly
Alice Goodman
May 20, 2011 (Washington, DC) — Adhesions from previous Caesarean deliveries severe enough to require adhesiolysis during repeat Caesarean delivery have clinical and economic implications, according to a retrospective review of a large database with discharge data from 60 hospitals in the United States. The data were reported here at the American Congress of Obstetricians and Gynecologists 59th Annual Clinical Meeting.
The matched cohort study found that for patients who required adhesiolysis, the cost per patient was $300 more, operative length was longer, hospital stay was longer, and postoperative complications were more frequent.
"Adhesions are a significant complication of surgery. C-sections are increasingly common in the United States, and anywhere from 30% to 50% of patients have adhesions," explained Michael Broder, MD, from the University of California at Los Angeles School of Medicine. He estimated that treating complications of adhesions related to Caesarean deliveries that are severe enough for adhesiolysis costs $25 million to $30 million per year.
Read The Rest
Alice Goodman
May 20, 2011 (Washington, DC) — Adhesions from previous Caesarean deliveries severe enough to require adhesiolysis during repeat Caesarean delivery have clinical and economic implications, according to a retrospective review of a large database with discharge data from 60 hospitals in the United States. The data were reported here at the American Congress of Obstetricians and Gynecologists 59th Annual Clinical Meeting.
The matched cohort study found that for patients who required adhesiolysis, the cost per patient was $300 more, operative length was longer, hospital stay was longer, and postoperative complications were more frequent.
"Adhesions are a significant complication of surgery. C-sections are increasingly common in the United States, and anywhere from 30% to 50% of patients have adhesions," explained Michael Broder, MD, from the University of California at Los Angeles School of Medicine. He estimated that treating complications of adhesions related to Caesarean deliveries that are severe enough for adhesiolysis costs $25 million to $30 million per year.
Read The Rest
Thursday, February 24, 2011
Hyperosmolar water-soluble contrast medium in the management of adhesive small-intestine obstruction.
J Int Med Res. 2010;38(6):2126-34.
Hyperosmolar water-soluble contrast medium in the management of adhesive small-intestine obstruction.
Atahan K, Aladağli I, Cökmez A, Gür S, Tarcan E.
First Surgical Department, İzmir Atatürk Training and Research Hospital, İzmir, Turkey. kemalatahan@yahoo.com.tr
Abstract
This prospective study investigated the value of the hyperosmolar water-soluble contrast medium Urografin(®) in choosing which patients with small-intestine obstruction, caused by post-operative adhesions, to treat conservatively. Thirty-seven patients with adhesive intestinal obstruction received Urografin(®) via a nasogastric tube. Direct abdominal radiographs were taken after 2, 4 and 8 h. Twenty-four patients (64.9%) had Urografin(®) in the right colon within 8 h and were considered to have partial obstruction. These patients commenced oral feeding even though abdominal radiographs revealed gas-fluid levels. In the remaining 13 patients (35.1%), Urografin(®) was not observed in the right colon within 8 h: three of the 13 patients (23.1%) were successfully treated conservatively; 10 of the 13 patients (76.9%) developed toxic signs and underwent surgery, with obstruction resulting from adhesive bands being confirmed at operation. Conservative treatment can be recommended for patients in whom contrast medium is observed in the right colon within 8 h following administration, regardless of the presence of obstruction signs. Absence of contrast medium in the right colon within 8 h cannot, however, be considered an indication for surgery.
PMID: 21227018 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/21227018
Hyperosmolar water-soluble contrast medium in the management of adhesive small-intestine obstruction.
Atahan K, Aladağli I, Cökmez A, Gür S, Tarcan E.
First Surgical Department, İzmir Atatürk Training and Research Hospital, İzmir, Turkey. kemalatahan@yahoo.com.tr
Abstract
This prospective study investigated the value of the hyperosmolar water-soluble contrast medium Urografin(®) in choosing which patients with small-intestine obstruction, caused by post-operative adhesions, to treat conservatively. Thirty-seven patients with adhesive intestinal obstruction received Urografin(®) via a nasogastric tube. Direct abdominal radiographs were taken after 2, 4 and 8 h. Twenty-four patients (64.9%) had Urografin(®) in the right colon within 8 h and were considered to have partial obstruction. These patients commenced oral feeding even though abdominal radiographs revealed gas-fluid levels. In the remaining 13 patients (35.1%), Urografin(®) was not observed in the right colon within 8 h: three of the 13 patients (23.1%) were successfully treated conservatively; 10 of the 13 patients (76.9%) developed toxic signs and underwent surgery, with obstruction resulting from adhesive bands being confirmed at operation. Conservative treatment can be recommended for patients in whom contrast medium is observed in the right colon within 8 h following administration, regardless of the presence of obstruction signs. Absence of contrast medium in the right colon within 8 h cannot, however, be considered an indication for surgery.
PMID: 21227018 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/21227018
Saturday, February 19, 2011
Friday, February 11, 2011
Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction
(ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery
There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial.
Open surgery or laparoscopy are used without standardized indications.
Methods: A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus.Recommendations: In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, vascularisedbowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted.
These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution.
WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours.
After 72 hours of NOM without resolution surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions.
WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment.Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In highly selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique.
Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band.
A low threshold for open conversion should be maintained.Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions.
Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.
Author: Fausto CatenaSalomone Di SaverioMichael KellyWalter BifflLuca AnsaloniVincenzo MandalaGeorge VelmahosMassimo SartelliGregorio TugnoliMassimo LupoStefano MandalaAntonio PinnaPaul SugarbakerHarry Van GoorErnest MooreJohannes Jeekel
Credits/Source
There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial.
Open surgery or laparoscopy are used without standardized indications.
Methods: A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus.Recommendations: In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, vascularisedbowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted.
These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution.
WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours.
After 72 hours of NOM without resolution surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions.
WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment.Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In highly selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique.
Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band.
A low threshold for open conversion should be maintained.Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions.
Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.
Author: Fausto CatenaSalomone Di SaverioMichael KellyWalter BifflLuca AnsaloniVincenzo MandalaGeorge VelmahosMassimo SartelliGregorio TugnoliMassimo LupoStefano MandalaAntonio PinnaPaul SugarbakerHarry Van GoorErnest MooreJohannes Jeekel
Credits/Source
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