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Results for “Prophylactic Surgical Procedures”

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At least 559 records · Page 31Linked to original sources

PubMed1992

[Stress urinary incontinence. Our results with the Burch's technique].

The aim of the surgical procedures utilized in the treatment of stress urinary incontinence (SUI) is to correct the posterior ureterovesical angle defect, thereby improving transmission of intraabdominal pressures to the urethra. We report our experience on 61 patients that had been diagnosed with SUI at our service from June 1984 to December 1990. Treatment was by the same operative procedure (Burch Technique) in all patients. The methods of exploration and the prognostic factors that might influence the outcome of the procedure are described. The short-term (3 months) success rate was 95%, the medium-term (1 year) 85.7% and the long-term (5 years) 77.1%. We underscore the convenience of prophylactic heparin therapy to prevent possible thromboembolic complications.

Aged↗

PubMed1983

Prophylactic antibiotic wound irrigation in gastric, biliary, and colonic surgery.

Intermittent intraoperative antibiotic irrigation from the beginning of an operative procedure to its completion is a valuable supplement to hospital and operating room cleanliness and to good surgical technique. A prospective, randomized, double-blind study of 200 patients undergoing clean-contaminated operations on the gastrointestinal tract demonstrated a marked reduction in the incidence of postoperative wound infection and absolute prevention of postoperative peritonitis.

Anti-Bacterial Agents↗

PubMed1983

One-stage total cystectomy and ileal loop diversion in patients over eighty years' old with bladder carcinoma. Pre- and postoperative functional reserve of various organs.

During the period from 1976 to 1981, 364 patients with bladder carcinoma were seen at the Keio University Hospital. Extensive preoperative investigation of pulmonary, cardiovascular, and renal function was obtained in all patients. Of the 12 patients studied, 9 underwent a one-stage total cystectomy and ileal loop diversion and the remaining 3 a two-stage procedure. Of the 9 patients, decreased FEV 1.0 per cent by spirometry was noted in 5, ECG abnormality such as bundle branch blocks in 8, and diminished creatinine clearance ranging from 28 to 68 ml/min were observed in all 9. Major postoperative complications included pyelonephritis in 2 patients, pneumonia in 1, pelvic abscess in 2, renal insufficiency in 3, and paralytic ileus in 2. There was no immediate postoperative death. In these elderly patients, functional reserve of the lung, heart, and kidney is less than optimal and is further decreased by major surgical procedures. Therefore, total cystectomy in the elderly patients is justifiable only in a selected group of patients, when functional status of the vital organ is thoroughly worked up and prophylactic and therapeutic measures are instituted promptly if indicated.

Aged↗

PubMed2003

Surgical standards in the primary care of melanoma patients.

Excisional biopsy is recommended as the procedure of choice whenever there is suspicion of malignant melanoma. There are only few indications for incisional biopsies, which--in contrast to former opinions--do not worsen the prognosis. For nearly 70 years the debate about the optimal resection safety margin around the primary tumor was influenced by historical case reports and paradigms. Recently, controlled clinical studies provided new insights. Accumulating evidence over the past two decades showed that narrower surgical margins do not have any influence on the rate of advanced metastatic disease. Local recurrence is rare (approximately 0.1%) when primary tumors are thin and is seen more often (approximately 10%) in primary tumors of greater thickness (>4 mm). Analysis of the overall survival in randomized trials shows equal prognosis for malignant melanoma for narrow and wide resection margins. Due to these findings in-toto excisional biopsy for in-situ melanoma, a resection margin of 1 cm for primary tumors with a tumor thickness up to 2 mm and a resection margin of 2 cm for primary tumors greater than 2 mm appears sufficient. By this procedure primary closure of wounds will be possible in nearly all cases, morbidity and costs of surgical approaches will be reduced. For a long time it has been discussed whether prophylactic removal of lymph nodes ('elective lymph node dissection') is of benefit for melanoma patients. More recently 'selective' lymphadenectomy ('sentinel node biopsy', SNB) has been proposed to evaluate the status of the first draining lymph node ('sentinel node') of the regional basin. Several studies now demonstrate that the sentinel node evaluation for underlying metastatic disease reflects the status of the entire lymph node region and is therefore a useful prognostic factor superior to measurement of tumor thickness in primary melanoma. However, it is unclear whether sentinel node biopsy is of benefit for a better survival in affected patients.

Biopsy↗

PubMed1999

[Transfusion of platelet concentrates].

Although a number of research have been realized in the aim of decreasing the use of platelet concentrates, these blood products remain absolutely necessary for patients with therapeutic aplasia and for some surgical patients. After the description of the main rules of platelet transfusion procedures, we will discuss some controversial issues: threshold value for platelet transfusion, platelet doses, place of curative and prophylactic strategies, refractoriness to platelet transfusion, HLA alloimmunization. Then we will focus our review on the future alternatives for platelet transfusion.

Blood Donors↗

PubMed1981

Endoscopic upper gastrointestinal polypectomy. Report of 73 polypectomies in 63 patients.

Seventy-three upper gastrointestinal endoscopic polypectomies were performed in 63 patients over a period of five years. Thiry-eight patients (52%) had adenomatous polyps, two of which contained carcinoma in situ and 26 (36%) were inflammatory in nature. Four lesions were removed from the duodenum. Hemodynamically significant hemorrhage occurred in five cases and persistent symptomatic ulcer in three cases. All complications occurred early in the series and responded to conservative measures. There was no mortality or need for surgical intervention in any case. It was concluded that: 1. upper gastrointestinal tract endoscopic polypectomy is a safe and relatively simple procedure; 2. postprocedural complications can be markedly reduced by prophylactic conservative antiulcer therapy and 3. especially in the area of adenomatous polyps, excision of the entire lesion is superior to biopsy in the detection of early malignancy.

Adenoma↗

PubMed1989

Repair of incisional hernia.

Because wound infection is a major cause of incisional hernia, the question posed is whether or not repairs of incisional hernias are at a higher risk for wound infection also. To answer this, we analyzed the incidence of wound infection after repair of incisional hernias during a 30 month period and compared it with the infection rate in all other clean procedures performed during the same period. All repairs of incisional hernias were performed upon patients with completely healed incisions without clinical signs of infection. Patients undergoing concomitant procedures upon the gastrointestinal tract were excluded. During the 30 month period, 995 clean operations were performed. In the 80 repairs of incisional hernias, there were 13 infections proved by culture, yielding an over-all infection rate of 16 per cent. In the remaining 915 clean procedures, there were 14 wound infections (1.5 per cent, p less than 0.0001). Of these 915 clean operations, 241 were repairs of inguinal hernias. Two infections occurred in this subgroup (0.8 per cent, p less than 0.0001, compared with repairs of incisional hernias). In patients undergoing repairs of incisional hernias with previously documented wound infections, 41 per cent had infected repairs. By comparison, only 12 per cent of patients without a prior infection had infections develop in the hernial repair (p less than 0.05). The infection rate for patients not receiving prophylactic antibiotics (21 per cent) was almost twice the rate for those receiving antibiotics (11 per cent), p = 0.07. We concluded that repair of incisional hernias has a significantly higher rate of infection than do other clean general surgical procedures. Herniorrhaphy of a wound that was previously infected is at a higher risk for reinfection, despite complete healing of the skin and absence of clinical signs of infection. Perioperative antibiotic prophylaxis may be indicated, but randomized studies are needed. For reporting and surveillance purposes, repairs of incisional hernias should not be classified as clean surgical procedures.

Abdominal Muscles↗

PubMed2005

Surgical site infection following elective Caesarian section: a case-control study of postdischarge surveillance.

OBJECTIVES: To ascertain the incidence of postoperative surgical site infection (SSI) following elective Caesarean section (CS) and to compare demographic characteristics and antibiotic administration between infected cases and noninfected control subjects. METHODS: We conducted a retrospective case-control study of patients undergoing elective CS between 1996 and 2002 at a tertiary centre. Infection-control personnel attempted to contact by telephone all women who had had Caesarean sections, 1 month after their surgery. The women they reached were asked to complete a questionnaire based on CDC-validated criteria for infection to determine whether SSI had occurred. Control subjects without SSI were matched on the basis of having had an elective CS and by date of surgery. We then reviewed the hospital records of both groups. RESULTS: Over the study period, 1250 elective Caesarean sections were performed and 124 infected cases were identified, giving an overall SSI incidence of 9.9%. Of the 342 women reviewed (124 cases, 218 control subjects), 23% received prophylactic intraoperative antibiotics. Cases and control subjects differed significantly in terms of estimated blood loss, with fewer control subjects having excessive blood loss (P = 0.04). Among those women receiving postoperative antibiotics, case subjects received a significantly higher number of doses than did control subjects (P = 0.003). The groups did not differ significantly in terms of overall antibiotic administration or other demographic variables. CONCLUSIONS: The incidence of SSI following elective CS according to postdischarge surveillance was 9.9%, which is higher than expected for a low-risk procedure. Because follow-up was not possible for all cases, this incidence may be an underestimate. Underuse of antimicrobial prophylaxis may also be a contributing factor, because prophylactic antibiotics were administered in less than 25% of cases.

Adult↗

PubMed1960