Primary or Redo Posterior Sagittal Anorectoplasty without a Stoma: To Feed or Not to Feed?

2017 ◽  
Vol 29 (02) ◽  
pp. 150-152 ◽  
Author(s):  
Clare Skerrit ◽  
Alexander Dingemans ◽  
Victoria Lane ◽  
Alejandra Sanchez ◽  
Laura Weaver ◽  
...  
Keyword(s):  
Breast Milk ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Wound Complication ◽  
Wound Complications ◽  
Age At Surgery ◽  
Significant Difference ◽  
Male Patients ◽  
The Mean ◽  
Picc Line

Introduction Repair of anorectal malformations (ARMs), primarily or with a reoperation, may be performed in certain circumstances without a diverting stoma. Postoperatively, the passage of bulky stool can cause wound dehiscence and anastomotic disruption. To avoid this, some surgeons keep patients NPO (nothing by mouth) for a prolonged period. Here, we report the results of a change to our routine from NPO for 7 days to clear fluids or breast milk. Materials and Methods After primary or redo ARM surgery, patients given clear liquids were compared to those who were kept strictly NPO. Age, indication for surgery, incision type, use of a peripherally inserted central catheter (PICC) line, and wound complications were recorded. Results There were 52 patients, including 15 primary and 37 redo cases. Group 1 comprised 11 female and 15 male patients. The mean age at surgery was 4.9 years (standard deviation [SD]: 2.3). There were 8 primary cases and 18 redo cases. Twelve (46.6%) received a PICC line. The average start of clear liquids was on day 5.3 (SD: 2.2) after examination of the wound, and the diet advanced as tolerated. The first stool passage was recorded on average on day 2.3 (SD: 1.3). Four minor wound complications and no major wound complications occurred.Group 2 comprised 14 females and 12 male patients. The mean age at surgery was 3.5 (SD: 2.4) years. There were 7 primary and 19 redo cases. One (3.8%) patient required a PICC line. A clear liquid diet was started within 24 hours after surgery. A regular diet was started on average on day 5.8 (SD: 1.3). The first stool passage was recorded on an average of day 1.6 (SD: 0.9). Three minor wound complications occurred; however, there was no significant difference between the two groups (SD: 0.71). One major wound complication occurred. However, there was no significant difference in major wound complications between the groups (SD: 0.33). Conclusion No increase in wound problems was noted in children receiving clear liquids or breast milk compared with the strict NPO group, and PICC line use was reduced. We believe this change in practice simplifies postoperative care without increasing the risk of wound complications.

scholarly journals Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Mackenzie N. Abraham ◽  
Steven L. Raymond ◽  
Russell B. Hawkins ◽  
Atif Iqbal ◽  
Shawn D. Larson ◽  
...  
Keyword(s):  
Young Adults ◽  
Older Patients ◽  
Pilonidal Disease ◽  
Wound Complication ◽  
Wound Complications ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Significant Difference ◽  
Secondary Healing ◽  
Age And Sex

Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults.Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease.Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497).Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.

scholarly journals Parastomal hernia repair with onlay mesh remains a safe and effective approach

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marie Shella De Robles ◽  
Christopher J. Young
Keyword(s):  
Mesh Repair ◽  
Parastomal Hernia ◽  
Loop Ileostomy ◽  
Wound Complication ◽  
Loop Colostomy ◽  
Wound Complications ◽  
Parastomal Hernia Repair ◽  
Significant Difference ◽  
Onlay Mesh ◽  
Midline Approach

Abstract Background Parastomal hernia (PSH) management poses difficulties due to significant rates of recurrence and morbidity after repair. This study aims to describe a practical approach for PSH, particularly with onlay mesh repair using a lateral peristomal incision. Methods This is a retrospective review of consecutive patients who underwent PSH repair between 2001 and 2018. Results Seventy-six consecutive PSH with a mean follow-up of 93.1 months were reviewed. Repair was carried out for end colostomy (40%), end ileostomy (25%), ileal conduit (21%), loop colostomy (6.5%) end-loop colostomy (5%) and loop ileostomy (2.5%). The repair was performed either with a lateral peristomal incision (59%) or a midline incision (41%). Polypropylene mesh (86%), biologic mesh (8%) and composite mesh (6%) were used. Stoma relocation was done in 9 patients (12%). Eight patients (11%) developed postoperative wound complications. Recurrence occurred in 16 patients (21%) with a mean time to recurrence at 29.4 months. No significant difference in wound complication and recurrence was observed based on the type of stoma, incision used, type of mesh used, and whether or not the stoma was repaired on the same site or relocated. Conclusion Onlay mesh repair of PSH remains a practical and safe approach and could be an advantageous technique for high-risk patients. It can be performed using a lateral peristomal incision with low morbidity and an acceptable recurrence rate. However, for patients with significant adhesions and very large PSH, a midline approach with stoma relocation may also be considered.

scholarly journals Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0036
Author(s):  
Julie Neumann ◽  
Maxwell Weinberg ◽  
Chong Zhang ◽  
Charles Saltzman ◽  
Alexej Barg
Keyword(s):  
Wound Complication ◽  
Ankle Arthrodesis ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Wound Complications ◽  
Complication Rates ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Tibiotalar Arthrodesis ◽  
End Stage

Category: Ankle Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. To date, it is unclear whether concurrent distal tibio-fibular joint arthrodesis affects this nonunion rate as there have been no studies directly comparing patients with and without arthrodesis of the distal tibio-fibular joint. The purpose of this clinical study is to compare the rate of nonunion in patients with a distal tibio-fibular fusion to those without a distal tibio-fibular fusion in the setting of a primary, open ankle arthrodesis. The hypothesis of this study was that the addition of a distal tibio-fibular fusion would decrease the nonunion rate in patients undergoing open ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. 366 ankles from 354 unique patients met inclusion criteria. All patients underwent primary, open tibiotalar arthrodesis. 250 patients underwent open tibiotalar arthrodesis with a distal tibio-fibular fusion and 116 patients underwent open tibiotalar arthrodesis without a distal tibio-fibular fusion. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was nonunion rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, and rate of development of post-operative deep vein thrombosis (DVT)/Pulmonary embolism (PE). Results: Average age of the patients was 56.2 +/- 14.2 years. Mean follow-up time was 33.8 months. Unions were assessed on routine post-operative radiographs and by clinical examination. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had the distal tibio-fibular joint included was 19/250 (8%) and nonunion rate of those who did not have the distal tibio-fibular joint fused was 14/116 (12%) (p=0.16). There was no significant difference between those who had the distal tibio-fibular joint included versus who did not in wound complication rate (27% vs 31%, p=0.40), time to union (4.9 weeks versus 5 weeks, p =0.54), and DVT/PE rate (5% vs 3%, p=0.41), respectively [Table 1]. There were no major complications. Conclusion: To our knowledge, this is the first study directly comparing nonunion rates and complication rates in patients who underwent primary, open ankle arthrodesis with and without distal tibio-fibular joint arthrodesis. In this study, inclusion of the distal tibio-fibular joint in tibiotalar arthrodesis does not affect nonunion rate in patients undergoing primary, open ankle arthrodesis. Additionally, inclusion of the distal tibio-fibular joint does not affect rate of wound complication, time to union, and DVT/PE rate.

scholarly journals Breast-milk production in Australian women

1981 ◽  
Vol 45 (2) ◽  
pp. 243-249 ◽  
Author(s):  
S. Rattigan ◽  
Ann V. Ghisalberti ◽  
P. E. Hartmann
Keyword(s):  
Breast Milk ◽  
Milk Production ◽  
Breast Feeding ◽  
Normal Values ◽  
Energy Content ◽  
Lactating Women ◽  
Breast Milk Production ◽  
Significant Difference ◽  
Dietary Records ◽  
The Mean

1. Milk productions and 7d dietary records were determined on twenty-seven mothers who had been breast-feeding for 1, 3, 6, 9, 12 and 15 months.2. The mean milk productions for each group of mothers was 1.187, 1.238, 1.128, 0.884, 0.880 and 0.951 kg/24 h at 1, 3, 6, 9, 12 or 15 months of lactation respectively. There was no significant difference between two milk determinations 3–7 d apart on each mother or between the mean milk production of each group of mothers.3. Energy intakes of the infants was found to be higher than the usually-accepted values at 1 and 3 months of age but by 6 months were similar to the accepted normal values.4. Energy intakes of the mothers although greater than those recommended for similar non-lactating women were not sufficient to take into account the energy content of the milk.

scholarly journals Immediate versus Delayed Sarcoma Reconstruction: Impact on Outcomes

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kyle J. Sanniec ◽  
Cristine S. Velazco ◽  
Lyndsey A. Bryant ◽  
Nan Zhang ◽  
William J. Casey III ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Multidisciplinary Treatment ◽  
Wound Dehiscence ◽  
Wound Complication ◽  
Wound Complications ◽  
Immediate Reconstruction ◽  
Intravenous Antibiotics ◽  
Rare Malignancy ◽  
Management Algorithms ◽  
Sarcoma Patient

Background.Sarcoma is a rare malignancy, and more recent management algorithms emphasize a multidisciplinary approach and limb salvage, which has resulted in an increase in overall survival and limb preservation. However, limb salvage has resulted in a higher rate of wound complications.Objective.To compare the complications between immediate and delayed (>three weeks) reconstruction in the multidisciplinary limb salvage sarcoma patient population.Methods.A ten-year retrospective review of patients who underwent sarcoma resection was performed. The outcome of interest was wound complication in the postoperative period based on timing of reconstruction. We defined infection as any infection requiring intravenous antibiotics, partial flap failure as any flap requiring a debridement or revision, hematoma/seroma as any hematoma/seroma requiring drainage, and wound dehiscence as a wound that was not completely intact by three weeks postoperatively.Results.70 (17 delayed, 53 immediate) patients who underwent sarcoma resection and reconstruction met the inclusion criteria. Delayed reconstruction significantly increased the incidence of postoperative wound infection and wound dehiscence. There was no difference in partial or total flap loss, hematoma, or seroma between the two groups.Discussion and Conclusion.Immediate reconstruction results in decreased wound complications may reduce the morbidity associated with multidisciplinary treatment in the limb salvage sarcoma patient.

Effect of Simple Interrupted Suture Spacing on Aesthetic and Functional Outcomes of Skin Closures

2019 ◽  
Vol 23 (6) ◽  
pp. 580-585 ◽  
Author(s):  
Allison Stoecker ◽  
Collin M Blattner ◽  
Stephanie Howerter ◽  
Whitney Fancher ◽  
John Young ◽  
...  
Keyword(s):  
Wound Repair ◽  
Healing Process ◽  
Wound Complication ◽  
Wound Complications ◽  
Low Density ◽  
Tissue Ischemia ◽  
Wound Closure Techniques ◽  
Interrupted Suture ◽  
Scar Assessment ◽  
Significant Difference

Background Dermatologic surgeons are trained in fundamental wound closure techniques that minimize wound tension and tissue ischemia to optimize healing and create discrete scars. These include orienting excisions along resting skin tension lines, handling tissue edges with care, and avoiding strangulation while tying suture. Another variable that may affect wound healing and cosmetic outcomes is the spacing between sutures. Objective This prospective, single-centre, randomized, split-scar comparison trial was designed to explore how suture spacing distance affects wound complication rate and scar cosmesis. Methods Elliptical surgical wounds of the trunk and extremities were repaired with simple interrupted sutures with varying suture spacing. One half of each wound was repaired with high-density suture spacing (approximately 5 mm apart) and the other with low-density suture spacing (approximately 10 mm apart). Wounds were evaluated at 2-week suture removal for complications, and then reevaluated at 3 and 6 months for cosmesis using the Patient and Observer Scar Assessment Scale score. Results Results revealed no significant difference in minor wound complications during the early healing process between high- and low-density suture spacing. At 3 months postoperatively, physicians and patients alike preferred the aesthetics of the low-density suture placement. By 6 months postoperatively, this preference disappeared. Conclusions These results suggest that suture spacing may affect early scar formation. Additionally, placing sutures farther apart results in fewer total puncture wounds, decreases tissue trauma, and saves surgical time while conserving suture material. Therefore, dermatologic surgeons should consider placing fewer percutaneous sutures during wound repair.

scholarly journals Anorectal Malformations Associated With Labioscrotal Fold Malformation and Perineal Mass in Pediatric Patients: Over a Decade of Experience

2021 ◽  
Vol 9 ◽  
Author(s):  
Kai Wang ◽  
Chunhui Peng ◽  
Wenbo Pang ◽  
Zengmeng Wang ◽  
Dongyang Wu ◽  
...  
Keyword(s):  
Medical Records ◽  
Pediatric Patients ◽  
Outpatient Service ◽  
Anorectal Malformations ◽  
Wound Complication ◽  
Mesenchymal Hamartoma ◽  
Telephone Contact ◽  
Age At Surgery ◽  
Low Incidence

Background: The triad of anorectal malformation (ARM), labioscrotal fold malformation, and perineal mass has rarely been reported before. The purpose of this study was to review our experience in these patients, describe their characteristics, and discuss the possible pathogenesis.Methods: Seven pediatric patients diagnosed with ARM associated with both labioscrotal fold malformation and perineal mass were included in this study. Medical records of these patients were retrospectively reviewed, and follow-up was held through telephone contact or outpatient service.Results: Among the seven patients were six females and one male, and the age at surgery was between 5.2 and 12.4 months. The ratio of lateral-type to mid-perineum-type labioscrotal fold malformation was 5:2. The ARM type was all rectoperineal fistula. Operation was excision of the malformation and perineal mass at the same time of anoplasty. The pathology was lipoma (three cases), fibroma (one case), lipofibroma (one case), angiolipoma (one case), and mesenchymal hamartoma (one case). All the seven patients had no wound complication, and during the follow-up period of 7–100 months after surgery, none of the seven patients suffered perineal mass recurrence. Bowel control was satisfactory in the follow-up period.Conclusions: There is a low incidence for the triad of ARM, labioscrotal fold malformation, and perineal mass. The nature of this disease is neoplastic overgrowth of intervening mesenchymal tissue, which impedes the continuity of caudal development into normal labioscrotal fold and affects the extension of urorectal septum, leading to ARM. Prognosis is mainly dependent on the type of ARM.

Synbiotic supplementation is not effective on breast milk selenium concentrations and growth of exclusively breast fed infants: a pilot study

2019 ◽  
Vol 89 (1-2) ◽  
pp. 73-79 ◽  
Author(s):  
Leila Nikniaz ◽  
Reza Mahavi ◽  
Alireza Ostadrahimi ◽  
Zeinab Nikniaz ◽  
Sharare Taghipour
Keyword(s):  
Pilot Study ◽  
Breast Milk ◽  
Graphite Furnace ◽  
Controlled Trial ◽  
Study Groups ◽  
Z Score ◽  
Double Blind ◽  
Significant Difference ◽  
The Mean ◽  
Synbiotic Supplementation

Abstract. In this randomized, double-blind, placebo-controlled trial, 57 lactating mothers were randomly allocated into two groups to receive a daily supplement of synbiotic (n = 30) which contained different probiotic strains (2.0 × 108 CFU) and fructooligosaccharide (394 mg) or a placebo (n = 27) for 30 days. Dietary intake was collected from lactating women by 24-hour recall method. Breast milk selenium contents were determined by atomic absorption spectrometry with graphite furnace. Weight for age Z-score (WAZ) and Height for age Z-score (HAZ) were evaluated for infants. Data analyses were assessed using nutritionist IV, Epi Info and SPSS software and presented as mean ± sd or SEM. The total mean breast milk selenium levels were 50.1 ± 16.1 mcg L−1. At the baseline, the mean breast milk selenium concentrations in the synbiotic and placebo groups were 51.7 ± 20.2 and 48.5 ± 12.1 mcg L−1. The mean breast milk selenium levels increased and decreased in the symbiotic and placebo groups respectively, which were not significant (p > 0.05). Also, comparison of the changes in breast milk selenium concentration showed no significant difference between the two study groups after the intervention. At the baseline, the mean WAZ and HAZ of infants whose mothers’ milk selenium was more than 60 mcg/l was significantly (P < 0.05) higher than for others. In this pilot study, no significant effect was observed by synbiotic supplementation, however, for concise conclusion, more human studies with higher doses of supplements and longer duration of supplementation are needed to determine the effects of synbiotic supplementation on breast milk selenium contents and infants’ growth.

Complications And Recurrence After The Karydakis Flap Surgery

2020 ◽  
Vol 93 (1) ◽  
pp. 15-18
Author(s):  
Murat Çakır ◽  
Mehmet Biçer
Keyword(s):  
Pilonidal Sinus ◽  
Wound Dehiscence ◽  
Recurrence Risk ◽  
Treatment Method ◽  
Pilonidal Sinus Disease ◽  
Study Results ◽  
Surgical Methods ◽  
Postoperative Length ◽  
Male Patients ◽  
The Mean

Introduction: Pilonidal sinus is a disease affecting young age group. Numerous surgical methods have been described in the treatment of pilonidal sinus disease. Currently, there is no treatment method providing a rapid recovery with low recurrence risk. Aim: In this study, we aimed to evaluate the results of our patients who underwent Karydakis surgery. Material and methods: Results of 112 patients operated between 2012 and 2019 were retrospectively evaluated. Only the patients who underwent Karydakis surgery were included in the study. Results: Of all patients, 20 were female and 92 were male. The mean age was 21 years in the female and 20.8 years in the male patients. The mean BMI was 29.6 Kg/m2. Thye patients were followed up for mean 28 months. Postoperative length of stay in hospital was 2.1 days. The complications included wound dehiscence by 10.2%, infection by 3.6%, and bleeding (hematome) by 7.1%. Four patients developed recurrence during follow up. Conclusion: Karydakis surgery is a preferable surgical technique with low rates of complications and recurrence.

scholarly journals Outcomes of Minimally-Invasive Sinus Tarsi Approach for the Treatment of Intra-articular Calcaneal Fracture

2020 ◽  
Vol 7 (2) ◽  
pp. 47-54
Author(s):  
Hooman Shariatzadeh ◽  
◽  
Bijan Valiollahi ◽  
Mehdi Mohammadpour ◽  
Mohammadamin Haghbin ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Wound Complication ◽  
High Rate ◽  
Wound Complications ◽  
Complication Rates ◽  
Invasive Approach ◽  
Calcaneus Fracture ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
The Mean

Background: Open reduction and internal fixation is the standard surgical treatment of calcaneal fractures. However, it is associated with a high rate of wound problems. Objectives: In this study, we evaluated the clinical and radiologic outcomes, as well as the wound complication rates of sinus tarsi minimally-invasive approach in the treatment of intra-articular calcaneus fracture. Methods: In a retrospective study, 62 patients who were referred with an intra-articular calcaneus fracture and treated with a minimally-invasive sinus tarsi approach were included. The radiographic evaluations included the assessment of Bohler and Gissane angles before and after the surgery, as well as the height and length of the calcaneus. The clinical outcome was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire. Results: The Mean±SD age of the patients was 41.8±12.7 years. The Mean±SD follow-up of the patients was 21.3±10 ‎months. After 6 months, in 43 patients (69.3%) both Bohler’s and Gissane’s angles were significantly improved after the surgery (P=0.003 and P<0.001, respectively). The calcaneus height was significantly improved after the surgery (P=0.009), as well. The Mean±SD AOFAS score of the patients was found 79.6±7. Wound infection was seen in only 1 case (1.6%). Delayed wound healing occurred in 4 cases (6.4%). No other wound complication such as dehiscence and skin necrosis was recorded. Conclusion: Minimally-invasive sinus tarsi approach is an efficacious procedure for the treatment of intra-articular calcaneus fracture with a minimized rate of wound complications.

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