1
|
Quint E, Kukeev I, Hazan I, Grupel D, Dukhno O, Osyntsov A, Sebbag G, Guetta O, Czeiger D. Clinical characteristics of SARS-CoV-2 vaccine-related acute appendicitis. Can J Surg 2023; 66:E304-E309. [PMID: 37225246 DOI: 10.1503/cjs.009322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND In a large nationwide mass vaccination setting, the SARS-CoV-2 vaccine was recently linked to myocarditis, lymphadenopathy, herpes zoster infection and appendicitis. We aimed to examine the characteristics and management of SARS-CoV-2 vaccine-related acute appendicitis. METHODS We performed a retrospective cohort study in a large tertiary medical centre in Israel. All patients presenting with acute appendicitis within 21 days of receiving their SARS-CoV-2 vaccination (PCVAA group) were compared with patients who presented with acute appendicitis not related to the vaccination (N-PCVAA group). RESULTS We reviewed the records of 421 patients with acute appendicitis from December 2020 to September 2021; 38 (9%) patients presented with acute appendicitis within 21 days of receiving their SARS-CoV-2 vaccination. Patients in the PCVAA group were older than those in the N-PCVAA group (mean 41 ± 19 yr v. 33 ± 15 yr, respectively, p = 0.008), with male predominance. More patients were managed nonsurgically during the pandemic than before the pandemic (24% v. 18%, p = 0.03). CONCLUSION With the exception of older age, the clinical characteristics of patients presenting with acute appendicitis within 21 days of receiving the SARS-CoV-2 vaccination did not differ from those of patients who presented with acute appendicitis not related to the vaccination. This finding suggests that vaccine-related acute appendicitis is similar to "classic" acute appendicitis.
Collapse
Affiliation(s)
- Elchanan Quint
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| | - Ivan Kukeev
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| | - Itai Hazan
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| | - Daniel Grupel
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| | - Oleg Dukhno
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| | - Anton Osyntsov
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| | - Ohad Guetta
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| | - David Czeiger
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel (Quint, Kukeev, Dukhno, Osyntsov, Sebbag, Guetta, Czeiger); Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Hazan); Internal Medicine B, Soroka University Medical Center, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel (Grupel)
| |
Collapse
|
2
|
Sibilla MG, Cremonini C, Portinari M, Carcoforo P, Tartaglia D, Cicuttin E, Musetti S, Strambi S, Sartelli M, Radica MK, Catena F, Chiarugi M, Coccolini F, Salvetti F, Negoi I, Zese M, Occhionorelli S, Shlyapnikov S, Sugrue M, Demetrashvili Z, Dondossola D, Ioannidis O, Novelli G, Frattini C, Nacoti M, Khor D, Inaba K, Demetriades D, Kaussen T, Jusoh AC, Ghannam W, Sakakushev B, Guetta O, Dogjani A, Costa S, Singh S, Damaskos D, Isik A, Yuan KC, Trotta F, Rausei S, Martinez-Perez A, Bellanova G, Fonseca VC, Hernández F, Marinis A, Fernandes W, Quiodettis M, Bala M, Vereczkei A, Curado R, Fraga GP, Pereira BM, Gachabayov M, Chagerben GP, Arellano ML, Ozyazici S, Costa G, Tezcaner T, Porta M, Li Y, Karateke F, Manatakis D, Mariani F, Lora F, Sahderov I, Atanasov B, Zegarra S, Fattori L, Ivatury R, Xiao J, Ben-Ishay O, Zharikov A, Dubuisson V. Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA). World J Surg 2023; 47:142-151. [PMID: 36326921 PMCID: PMC9726668 DOI: 10.1007/s00268-022-06733-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents. MATERIAL AND METHODS A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA). TRIAL REGISTRATION NCT02382770. RESULTS 1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49-74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.001). Definitive abdominal closure was achieved in 82.3% of cases in America (fascial closure in 90.2% of cases) and in 56.4% of cases in Asia (p < 0.001). Prosthesis were mostly used in Europe (17.3%, p < 0.001). The overall entero-atmospheric fistula rate 2.5%. Median open abdomen duration was 4 days (IQR 2-7). The overall intensive care unit and hospital length-of-stay were, respectively, 8 and 11 days (no differences between continents). The overall morbidity and mortality rates for America, Europe, and Asia were, respectively, 75.8%, 75.3%, 91.8% (p = 0.001) and 31.9%, 51.6%, 56.9% (p < 0.001). CONCLUSION There is no uniformity in OA management in the different continents. Heterogeneous adherence to international guidelines application is evident. Different temporary abdominal closure techniques in relation to indications led to different outcomes across the continents. Adherence to guidelines, combined with more consistent data, will ultimately allow to improving knowledge and outcome.
Collapse
Affiliation(s)
- Maria Grazia Sibilla
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Camilla Cremonini
- General Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia,1, 56124 Pisa, Italy
| | - Mattia Portinari
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Dario Tartaglia
- General Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia,1, 56124 Pisa, Italy
| | - Enrico Cicuttin
- General Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia,1, 56124 Pisa, Italy
| | - Serena Musetti
- General Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia,1, 56124 Pisa, Italy
| | - Silvia Strambi
- General Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia,1, 56124 Pisa, Italy
| | | | - Margherita Koleva Radica
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Fausto Catena
- Emergency Surgery, Parma University Hospital, Parma, Italy
| | - Massimo Chiarugi
- General Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia,1, 56124 Pisa, Italy
| | - Federico Coccolini
- General Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia,1, 56124, Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Guetta O, Osyntsov A, Rahamimov R, Tobar A, Israeli M, Masarwa Y, Gurevich M, Tennak V, Mezhybovsky V, Gravetz A, Eisner S, Nesher E. The Role of Early Sequential Biopsies in Delayed Renal Graft Function of Transplanted Kidney Is Reduced in Modern Immunosuppression Era. Nephron Clin Pract 2022; 147:127-133. [PMID: 35908545 PMCID: PMC10137296 DOI: 10.1159/000525912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Delayed graft function (DGF) immediately after kidney transplantation is considered a risk factor for acute rejection. According to clinical guidelines, a weekly allograft biopsy should be performed until DGF resolves. Based on clinical evidence, the first biopsy is considered appropriate. However, the recommendation for further biopsies is based on sparse evidence from era of earlier immunosuppression protocols, and the benefit of the second and further biopsies remains uncertain. The aim of this study was to reevaluate this policy. METHODS The database of a transplant medical center was retrospectively reviewed for all patients who underwent kidney transplantation in 2011-2020. Those with DGF who performed two or more graft biopsies within the first 60 days after transplantation were identified. Clinical data were collected from the medical files. The rates of diagnosis of acute rejection at the second and subsequent biopsies were analyzed relative to the previous ones. RESULTS Kidney transplantation was performed in 1,722 patients during the study period, of whom 225 (13.07%) underwent a total of 351 graft biopsies within 60 days after transplantation, mostly due to DGF. A second biopsy was performed in 32 patients (14.2%), and a third biopsy in 8, at weekly intervals. In 2 patients (6.25%), the diagnosis changed from the first biopsy (acute tubular necrosis or toxic damage) to acute rejection in the second biopsy. In both, the rejection was borderline. Third and fourth biopsies did not add information to the previous diagnosis. CONCLUSIONS The common practice of performing sequential biopsies during a postoperative course of DGF seems to be of low benefit and should be considered on a case-by-case basis.
Collapse
Affiliation(s)
- Ohad Guetta
- Department of Organ Transplantation, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anton Osyntsov
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ruth Rahamimov
- Institute of Nephrology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Tobar
- Department of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Moshe Israeli
- Tissue Typing Laboratory, Rabin Medical Center - Beilinson Hospital, Petach Tikva, affiliated to Zefat Academic College, Zefat, Israel
| | - Yasmin Masarwa
- Tissue Typing Laboratory, Rabin Medical Center - Beilinson Hospital, Petach Tikva, affiliated to Zefat Academic College, Zefat, Israel
| | - Michael Gurevich
- Department of Organ Transplantation, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Tennak
- Department of Organ Transplantation, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vadym Mezhybovsky
- Department of Organ Transplantation, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Gravetz
- Department of Organ Transplantation, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Eisner
- Department of Organ Transplantation, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eviatar Nesher
- Department of Organ Transplantation, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Guetta O, Brotfain E, Shaked G, Sebbag G, Klein M, Czeiger D. Intra-abdominal pressure may be elevated in patients with open abdomen after emergent laparotomy. Langenbecks Arch Surg 2020; 405:91-96. [PMID: 31955259 DOI: 10.1007/s00423-020-01854-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/09/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To estimate the change in intra-abdominal pressure (IAP) among critically ill patient who were left with open abdomen and temporary abdominal closure after laparotomy, during the first 48 h after admission. METHODS A cohort study in a single ICU in a tertiary care hospital. All adult patients admitted to the ICU after emergent laparotomy for acute abdomen or trauma, who were left with temporary abdominal closure (TAC), were included. Patients were followed up to 48 h. IAP was routinely measured at 0, 6, 12, 24, and 48 h after admission to ICU. RESULTS Thirty-nine patients were included, 34 were operated due to acute abdomen and 5 due to abdominal trauma. Seventeen patients were treated with skin closure, 13 with Bogota bag, and 9 with negative pressure wound therapy (NPWT). Eleven patients (28.2%) had IAP of 15 mmHg or above at time 0, (mean pressure 19.0 ± 3.0 mmHg), and it dropped to 12 ± 4 mmHg within 48 h (p < 0.01). Reduction in lactate level (2.4 ± 1.0 to 1.2 ± 0.2 mmol/L, p < 0.01) and increase in PaO2/FiO2 ratio (163 ± 34 to 231 ± 83, p = 0.03) were observed as well after 48 h. CONCLUSIONS This is the first large report of IAP in open abdomen. Elevated IAP may be measured in open abdomen and may subsequently relieve after 48 h.
Collapse
Affiliation(s)
- Ohad Guetta
- Department General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Be'er Sheva, Israel.
| | - Evgeni Brotfain
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Gad Shaked
- Head of Trauma Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Gilbert Sebbag
- Department General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Be'er Sheva, Israel
| | - Moti Klein
- Head of Critical Care Department, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - David Czeiger
- Department General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Be'er Sheva, Israel
| |
Collapse
|
5
|
Guetta O, Vakhrushev A, Dukhno O, Ovnat A, Sebbag G. New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients. World J Diabetes 2019; 10:78-86. [PMID: 30788045 PMCID: PMC6379729 DOI: 10.4239/wjd.v10.i2.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/08/2019] [Accepted: 01/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It has been established that bariatric surgery, including laparoscopic sleeve gastrectomy (LSG), has a positive impact on type 2 diabetes mellitus (T2DM). However, less frequently T2DM is reported as a risk factor for complications with this type of surgery.
AIM To evaluate the safety of LSG in T2DM.
METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015. Data was collected through digitized records. Any deviation from normal postoperative care within the first 60 d was defined as an early complication, and further categorized into mild or severe.
RESULTS Nine hundred eighty-four patients underwent LSG, among these 143 (14.5%) were diagnosed with T2DM. There were 19 complications in the T2DM group (13.3%) compared to 59 cases in the non-T2DM (7.0%). Out of 19 complications in the T2DM group, 12 were mild (8.4%) and 7 were severe (4.9%). Compared to the non-T2DM group, patients had a higher risk for mild complications (Odds-ratio 2.316, CI: 1.163-4.611, P = 0.017), but not for severe ones (P = 0.615). An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications (P = 0.013, CI: 1.074-1.843) but not for mild ones.
CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM. Whether pre-operative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.
Collapse
Affiliation(s)
- Ohad Guetta
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Alex Vakhrushev
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Oleg Dukhno
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Amnon Ovnat
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Gilbert Sebbag
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| |
Collapse
|
6
|
Vaynshtein J, Guetta O, Replyansky I. Abdominal Pain in Pregnancy. JAMA Surg 2019; 154:176-177. [PMID: 30383119 DOI: 10.1001/jamasurg.2018.3860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Julie Vaynshtein
- General Surgery B, Soroka University Medical Center, Be'er Sheva, Israel
| | - Ohad Guetta
- General Surgery B, Soroka University Medical Center, Be'er Sheva, Israel
| | - Ilya Replyansky
- General Surgery B, Soroka University Medical Center, Be'er Sheva, Israel
| |
Collapse
|
7
|
Coccolini F, Ceresoli M, Kluger Y, Kirkpatrick A, Montori G, Salvetti F, Fugazzola P, Tomasoni M, Sartelli M, Ansaloni L, Catena F, Negoi I, Zese M, Occhionorelli S, Shlyapnikov S, Galatioto C, Chiarugi M, Demetrashvili Z, Dondossola D, Ioannidis O, Novelli G, Nacoti M, Khor D, Inaba K, Demetriades D, Kaussen T, Jusoh AC, Ghannam W, Sakakushev B, Guetta O, Dogjani A, Costa S, Singh S, Damaskos D, Isik A, Yuan KC, Trotta F, Rausei S, Martinez-Perez A, Bellanova G, Fonseca V, Hernández F, Marinis A, Fernandes W, Quiodettis M, Bala M, Vereczkei A, Curado R, Fraga GP, Pereira BM, Gachabayov M, Chagerben GP, Arellano ML, Ozyazici S, Costa G, Tezcaner T, Porta M, Li Y, Karateke F, Manatakis D, Mariani F, Lora F, Sahderov I, Atanasov B, Zegarra S, Gianotti L, Fattori L, Ivatury R. Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA). Injury 2019; 50:160-166. [PMID: 30274755 DOI: 10.1016/j.injury.2018.09.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/26/2018] [Accepted: 09/20/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question. MATERIAL AND METHODS A prospective analysis of adult patients enrolled in the IROA. RESULTS Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogotà-bag (21.9%). Mean OA days were 7.9 ± 18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p = 0.018), days of OA (p = 0.003) and time to provision-of-nutrition (p = 0.016) with EAF occurrence. CONCLUSION Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment.
Collapse
Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Marco Ceresoli
- General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy.
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus Haifa, Israel.
| | | | - Giulia Montori
- General Surgery, San Giovanni Bianco Hospital, Bergamo, Italy.
| | - Fracensco Salvetti
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Paola Fugazzola
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Matteo Tomasoni
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy.
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Fausto Catena
- Emergency Surgery dept., Parma University Hospital, Parma, Italy.
| | - Ionut Negoi
- Emergency Surgery Hospital, Bucharest, Romania
| | - Monica Zese
- Emergency Surgery dept. Ferrara University Hospital, Ferrara, Italy
| | | | | | | | | | | | - Daniele Dondossola
- HPB Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Orestis Ioannidis
- Fourth Surgical dept. Hospital George Papanikolau, Aristotle University, Thessaloniki, Greece
| | | | - Mirco Nacoti
- Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Kenji Inaba
- LAS+USC Medical Centre, Los Angeles, California
| | | | - Torsten Kaussen
- Pediatric Intensive Care Unit, Hannover University Hospital, Hannover, Germany
| | | | | | | | | | | | - Stefano Costa
- Emergency and General Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Arda Isik
- Erzincan University Faculty Of Medicine MengucekGazi Training Research Hospital Erzincan, Turkey
| | | | | | - Stefano Rausei
- Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | | | | | | | | | | | | | | | - Miklosh Bala
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | | | | | | | | | - Sefa Ozyazici
- Adana Numune Training and Research Hospital, Department of Surgery, Adana, Turkey
| | - Gianluca Costa
- Ospedale Sant'Andrea University Hospital Sapienza, Rome, Italy
| | | | - Matteo Porta
- General Surgery, IRCCS Policlinico San Donato, Milano, Italy
| | - Yousheng Li
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Faruk Karateke
- Numune Training and Research Hospital, Department of Surgery, Numune, Turkey
| | | | - Federico Mariani
- General Surgery, Santa Maria alleScotteUniversitary Hospital Siena, Italy
| | - Federic Lora
- General Surgery, Cittàdella Salute e dellascienza, Torino, Italy
| | - Ivan Sahderov
- General Surgery, Krasnoyarsk Regional Hospital, Krasnoyarsk, Russia
| | | | | | - Luca Gianotti
- General and Emergency Surgery, Milano-Bicocca University School of Medicine and surgery, Monza, Italy
| | - Luca Fattori
- General and Emergency Surgery, Milano-Bicocca University School of Medicine and surgery, Monza, Italy
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
8
|
Vaynshtein J, Guetta O, Replyansky I, Vakhrushev A, Czeiger D, Ovnat A, Sebbag G. Wandering Spleen: Three Subsequent Cases in Young Women. Isr Med Assoc J 2018; 20:656-657. [PMID: 30324789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Julie Vaynshtein
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ohad Guetta
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilya Replyansky
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Vakhrushev
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Czeiger
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amnon Ovnat
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
9
|
Guetta O, Shaked G, Greenberg G, Sebbag G, Czeiger D. Blunt abdominal aortic injury – A hybrid approach to combined injuries. JEVTM 2018. [DOI: 10.26676/jevtm.v2i2.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Blunt abdominal aortic injury (BAAI) is a relatively rare pathology, usually the result of a seat belt injury in motor vehicle accidents (MVA), mostly combined with other injuries. Time is a crucial factor for the successful early management of these cases. Hybrid operating theaters, which support the integration of surgical treatment and interventional radiology, provide opportunities to reduce the time-to-surgery for life threatening conditions. We report a case of a 24-year-old female who was involved in a high-kinematics MVA. On presentation she was hemodynamically stable but had a prominent seat belt sign and peritoneal signs. A computerized tomography (CT) scan revealed an intimal flap of the infra-renal aorta and a peri-aortic hematoma together with a suspected laceration of the small bowel. The patient was operated in a hybrid approach; emergent endovascular repair of the aortic injury with stent deployment immediately followed by an explorative laparotomy for the intestinal injury. Her postoperative course was uneventful. The hybrid staged approach allowed a clean and efficient repair of a potentially lethal aortic injury and addressing a contaminated injury in the same compartment, hence preventing redundant morbidity. With the advances and growing availability of endovascular techniques, the hybrid approach has to be an important component of trauma management in the modern era.
Collapse
|
10
|
Guetta O, Ovnat A, Czeiger D, Vakhrushev A, Tsaban G, Sebbag G. The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity. Obes Surg 2017; 27:2785-2791. [DOI: 10.1007/s11695-017-2721-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Coccolini F, Montori G, Ceresoli M, Catena F, Ivatury R, Sugrue M, Sartelli M, Fugazzola P, Corbella D, Salvetti F, Negoi I, Zese M, Occhionorelli S, Maccatrozzo S, Shlyapnikov S, Galatioto C, Chiarugi M, Demetrashvili Z, Dondossola D, Yovtchev Y, Ioannidis O, Novelli G, Nacoti M, Khor D, Inaba K, Demetriades D, Kaussen T, Jusoh AC, Ghannam W, Sakakushev B, Guetta O, Dogjani A, Costa S, Singh S, Damaskos D, Isik A, Yuan KC, Trotta F, Rausei S, Martinez-Perez A, Bellanova G, Fonseca VC, Hernández F, Marinis A, Fernandes W, Quiodettis M, Bala M, Vereczkei A, Curado RL, Fraga GP, Pereira BM, Gachabayov M, Chagerben GP, Arellano ML, Ozyazici S, Costa G, Tezcaner T, Ansaloni L. Erratum to: IROA: International Register of Open Abdomen, preliminary results. World J Emerg Surg 2017; 12:13. [PMID: 28286545 PMCID: PMC5343596 DOI: 10.1186/s13017-017-0127-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 02/08/2023] Open
Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Giulia Montori
- General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Marco Ceresoli
- General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | | | - Massimo Sartelli
- General and Emergency Surgery Department, Macerata Hospital, Macerata,, Italy
| | - Paola Fugazzola
- General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Davide Corbella
- Neuro Intensive Care Unit Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Salvetti
- General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Ionut Negoi
- Emergency Surgery Hospital, Bucharest, Romania
| | - Monica Zese
- Emergency Surgery Department, Ferrara University Hospital, Ferrara, Italy
| | | | | | | | | | | | | | - Daniele Dondossola
- HPB Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Yovcho Yovtchev
- University Hospital "Prof Stoian Kirkovich" AD, Stara Zagora, Bulgaria
| | - Orestis Ioannidis
- Fourth Surgical Department, Hospital George Papanikolau, Aristotle University, Thessaloniki, Greece
| | | | - Mirco Nacoti
- Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Desmond Khor
- LAS + USC Medical Centre, Los Angeles, California USA
| | - Kenji Inaba
- LAS + USC Medical Centre, Los Angeles, California USA
| | | | - Torsten Kaussen
- Pediatric Intensive Care Unit, Hannover University Hospital, Hannover, Germany
| | | | | | | | | | | | - Stefano Costa
- Emergency and General Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Arda Isik
- Erzincan University Faculty of Medicine Mengucek Gazi Training Research Hospital Erzincan, Erzincan, Turkey
| | | | | | - Stefano Rausei
- Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | | | | | | | | | | | | | | | - Miklosh Bala
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Andras Vereczkei
- Department of Surgery, Medical School University Pécs, Pécs, Hungary
| | | | | | | | - Mahir Gachabayov
- Vladimir City Clinical Hospital of Emergency Medicine, Vladimir City, Russia
| | | | | | - Sefa Ozyazici
- Adana Numune Training and Research Hospital, Department of Surgery, Adana, Turkey
| | - Gianluca Costa
- Ospedale Sant' Andrea University Hospital Sapienza, Rome, Italy
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| |
Collapse
|
12
|
Coccolini F, Montori G, Ceresoli M, Catena F, Ivatury R, Sugrue M, Sartelli M, Fugazzola P, Corbella D, Salvetti F, Negoi I, Zese M, Occhionorelli S, Maccatrozzo S, Shlyapnikov S, Galatioto C, Chiarugi M, Demetrashvili Z, Dondossola D, Yovtchev Y, Ioannidis O, Novelli G, Nacoti M, Khor D, Inaba K, Demetriades D, Kaussen T, Jusoh AC, Ghannam W, Sakakushev B, Guetta O, Dogjani A, Costa S, Singh S, Damaskos D, Isik A, Yuan KC, Trotta F, Rausei S, Martinez-Perez A, Bellanova G, Fonseca VC, Hernández F, Marinis A, Fernandes W, Quiodettis M, Bala M, Vereczkei A, Curado RL, Fraga GP, Pereira BM, Gachabayov M, Chagerben GP, Arellano ML, Ozyazici S, Costa G, Tezcaner T, Ansaloni L. IROA: International Register of Open Abdomen, preliminary results. World J Emerg Surg 2017; 12:10. [PMID: 28239409 PMCID: PMC5320725 DOI: 10.1186/s13017-017-0123-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/14/2017] [Indexed: 02/08/2023] Open
Abstract
Background No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). Methods A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. Results Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p= 0.016). Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days. Conclusion Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results. Trial registration ClinicalTrials.gov NCT02382770
Collapse
|
13
|
Abstract
The chemical structure of a polysaccharide named Fucogel was characterized and the position of acetylation was identified by NMR. A conformational analysis was performed on this 3-sugar repeating unit. From this, the persistence length, characterizing the stiffness of the polysaccharide, was determined and the role of the presence of acetyl group, reducing the stiffness, was pointed out. The helical conformations were also predicted, one of these being in agreement with X-ray data obtained on a similar polysaccharide. Experimental characterization of the native and deacetylated polysaccharides was developed. SEC experiments allowed us to determine the molar mass and the persistence length on the deacetylated polysaccharide. The value is in good agreement with that predicted from the molecular modeling. Microcalorimetry, rheology, and fluorescence spectroscopy demonstrated respectively that no helical conformation exists in solution but that loose interchain interactions due to the acetyl substituents exist in dilute solutions.
Collapse
Affiliation(s)
- O Guetta
- Centre de Recherche sur les Macromolécules Végétales, CNRS, associated with Université Joseph Fourier, BP 53, 38041 Grenoble Cedex 9, France
| | | | | | | | | |
Collapse
|
14
|
Abstract
The chemical structure and the rheological behavior of the Klebsiella polysaccharide ATCC 12657 was studied and compared with data described in the literature and obtained for similar polysaccharides. The acetylated polysaccharide presents in solution a normal viscoelastic behavior with no evidence of an ordered conformation whatever the experimental conditions are. The deacetylated form can induce the formation of physical gels, in the presence of salt excess or ethanol. Microcalorimetry, optical rotation, and rheology experiments demonstrate that a thermally reversible and highly cooperative conformational transition occurs at the same temperature than a sol-gel transition. The melting of the gel and the conformational transition temperatures are dependent on the nature of cations and ionic concentration, whereas the gel strength is only influenced by polymer concentration.
Collapse
Affiliation(s)
- O Guetta
- Centre de Recherche sur les Macromolécules Végétales, CNRS, associated with Joseph Fourier University, BP 53, 38041 Grenoble Cedex 9, France
| | | | | |
Collapse
|
15
|
Buhler E, Guetta O, Rinaudo M. Characterization of Semiflexible Polyelectrolyte Solutions in the Presence of Excess Salt: From Dilute to Semidilute Regime. International Journal of Polymer Analysis and Characterization 2001. [DOI: 10.1080/10236660008034656] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|