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Special Issue "Prevention, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 25 February 2024 | Viewed by 2226

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Special Issue Editor

Dr. Orestis Ioannidis

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Guest Editor

4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: acute care surgery; surgical infections; nutrition; negative-pressure wound therapy/vacuum-assisted closure (NPWT/VAC); enhanced recovery after surgery (ERAS); open abdomen; vascular access; minimally invasive surgery
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Dear Colleagues,

Surgery is indicated to cure or palliate numerous physical ailments, and millions of operations are performed each year worldwide. While the risk of complication overall is low because of the presence of trained and skilled surgeons and the adaption of good surgical techniques, complications can still occur even with the most experienced of surgeons or in the simplest of cases. Surgery can be complicated by adverse effects that can affect daily living by impairing the quality of life, increase the cost of health systems by longer hospitalization times and even increase mortality and decrease life expectancy. Complications can be more or less severe; can resolve spontaneously or require medical, interventional or surgical treatment; and can be specific to the operation performed or general; but all are significant for the patient and are usually the most difficult part of the patient’s management. Prompt and early diagnosis of the complications and adequate and proper treatment are the cornerstones in the successful management of complications. This Special Issue of the Journal of Clinical Medicine will focus on Prevention, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications.

Dr. Orestis Ioannidis
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

complications
diagnosis
treatment
management
morbidity
abdomen
abdominal surgery
outcome
postoperative

Published Papers (5 papers)

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Research

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Open AccessArticle

The Role of Adipose Tissue Mesenchymal Stem Cells in Colonic Anastomosis Healing in Inflammatory Bowel Disease: Experimental Study in Rats

Georgios Ntampakis

Manousos-Georgios Pramateftakis

Orestis Ioannidis

Stefanos Bitsianis

Panagiotis Christidis

and

Stamatios Angelopoulos

J. Clin. Med. 2023, 12(19), 6336; https://doi.org/10.3390/jcm12196336 - 02 Oct 2023

Abstract

(1) Background: A surgical operation on an inflamed bowel is, diachronically, a challenge for the surgeon, especially for patients with inflammatory bowel disease. Adipose tissue-derived mesenchymal stromal cells are already in use in clinical settings for their anti-inflammatory properties. The rationale of the current study was to use AdMSCs in high-risk anastomoses to monitor if they attenuate inflammation and prevent anastomotic leak. (2) Methods: a total of 4 groups of rats were subjected to a surgical transection of the large intestine and primary anastomosis. In two groups, DSS 5% was administered for 7 days prior to the procedure, to induce acute intestinal inflammation. After the anastomosis, 5 × 10⁶ autologous AdMSCs or an acellular solution was injected locally. Macroscopic evaluation, bursting pressure, hydroxyproline, and inflammatory cytokine expression were the parameters measured on the 8th post-operative day. (3) Results: Significantly less intra-abdominal complications, higher bursting pressures, and a decrease in pro-inflammatory markers were found in the groups that received AdMSCs. No difference in VEGF expression was observed on the 8th post-operative day. (4) Conclusions: AdMSCs attenuate inflammation in cases of acutely inflamed anastomosis. Full article

(This article belongs to the Special Issue Prevention, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications)

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Open AccessFeature PaperArticle

Postoperative Hiatal Hernia after Ivor Lewis Esophagectomy—A Growing Problem in the Age of Minimally Invasive Surgery

Stefan Fichtner-Feigl

Markus K. Diener

and

Jens Hoeppner

J. Clin. Med. 2023, 12(17), 5724; https://doi.org/10.3390/jcm12175724 - 01 Sep 2023

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Abstract

Background: Even though minimally invasive esophagectomy is a safe and oncologically effective procedure, several authors have reported an increased risk of postoperative hiatal hernia (PHH). This study evaluates the incidence and risk factors of PHH after hybrid minimally invasive (HMIE) versus open esophagectomy (OE). Methods: A retrospective single-center analysis was performed on patients who underwent Ivor Lewis esophagectomy between January 2009 and April 2018. Computed tomography scans and patient files were reviewed to identify the PHH. Results: 306 patients were included (152 HMIE; 154 OE). Of these, 23 patients (8%) developed PHH. Most patients (13/23, 57%) were asymptomatic at the time of diagnosis and only 4 patients (17%) presented in an emergency setting with incarceration. The rate of PHH was significantly higher after HMIE compared to OE (13.8% vs. 1.3%, p < 0.001). No other risk factors for the development of PHH were identified in uni- or multi-variate analysis. Surgical repair of PHH was performed in 19/23 patients (83%). The recurrence rate of PHH after surgical repair was 32% (6/19 patients). Conclusions: The development of PHH is a relevant complication after hybrid minimally invasive esophagectomy. Although most patients are asymptomatic, surgical repair is recommended to avoid incarceration with potentially fatal outcomes. Innovative techniques for the prevention and repair of PHH are urgently needed. Full article

(This article belongs to the Special Issue Prevention, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications)

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Open AccessArticle

Factors Influencing Postoperative Complications Following Minimally Invasive Ivor Lewis Esophagectomy: A Retrospective Cohort Study

and

J. Clin. Med. 2023, 12(17), 5688; https://doi.org/10.3390/jcm12175688 - 31 Aug 2023

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Abstract

Background: Complications arising following minimally invasive Ivor Lewis esophagectomy often result from inadequate enteral nutrition, highlighting the need for proactive measures to prevent such issues. One approach involves identifying high-risk cases prone to complications and implementing percutaneous endoscopic jejunostomy (PEJ) tube placement during esophageal resection to ensure timely enteral nutrition. Methods: In this single-center, retrospective cohort study, we examined patients who underwent minimally invasive esophagectomy for esophageal cancer at a high-volume center. The dataset encompassed demographic information, comorbidities, laboratory parameters, and intraoperative details. Our center utilized the EndoVac system pre-emptively to safeguard the anastomosis from harmful secretions and to enhance local oxygen partial pressure. All patients received pre-emptive EndoVac therapy and underwent esophagogastroduodenoscopy in the early postoperative days. The need for multiple postoperative EndoVac cycles indicated complications, including anastomotic insufficiency and subsequent requirement for a PEJ. The primary objectives were identifying predictive factors for anastomotic insufficiency and the need for multi-cycle EndoVac therapy, quantifying their effects, and assessing the likelihood of postoperative complications. Results: 149 patients who underwent minimally invasive or hybrid Ivor Lewis esophagectomy were analyzed and 21 perioperative and demographic features were evaluated. Postoperative complications were associated with the body mass index (BMI) category, the use of blood pressure medication, and surgery duration. Anastomotic insufficiency as a specific complication was correlated with BMI and the Charlson comorbidity index. The odds ratio of being in the high-risk group significantly increased with higher BMI (OR = 1.074, p = 0.048) and longer surgery duration (OR = 1.005, p = 0.004). Conclusions: Based on our findings, high BMI and longer surgery duration are potential risk factors for postoperative complications following minimally invasive esophagectomy. Identifying such factors can aid in pre-emptively addressing nutritional challenges and reducing the incidence of complications in high-risk patients. Full article

(This article belongs to the Special Issue Prevention, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications)

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Open AccessArticle

Appraisal of Intraoperative Adverse Events to Improve Postoperative Care

Larsa Gawria

Ahmed Jaber

Richard Peter Gerardus Ten Broek

and

J. Clin. Med. 2023, 12(7), 2546; https://doi.org/10.3390/jcm12072546 - 28 Mar 2023

Viewed by 793

Abstract

Background: Intraoperative adverse events (iAEs) are associated with adverse postoperative outcomes and cause a significant healthcare burden. However, a critical appraisal of iAEs is lacking. Considering the details of iAEs could benefit postoperative care. We comprehensively analyzed iAEs in a large series including all types of operations and their relation to postoperative complications. Methods: All patients enrolled in the multicenter ClassIntra^® validation study (NCT03009929) were included in this analysis. The surgical and anesthesia team prospectively recorded all iAEs. Two researchers, blinded to each other’s ratings, appraised all recorded iAEs according to their origin into four categories: surgery, anesthesia, organization, or other, including subcategories such as organ injury, arrhythmia, or instrument failure. They further descriptively analyzed subcategories of all iAEs. Postoperative complications were assessed using the Comprehensive Complication Index (CCI^®), a weighted sum of all postoperative complications according to the Clavien–Dindo classification. The association of iAE origins in addition to the severity grade of ClassIntra^® on CCI^® was assessed with a multivariable mixed-effects generalized linear regression analysis. Results: Of 2520 included patients, 778 iAEs were recorded in 610 patients. The origin was surgical in 420 (54%), anesthesia in 283 (36%), organizational in 34 (4%), and other in 41 (5%) events. Bleeding (n = 217, 28%), hypotension (n = 118, 15%), and organ injury (n = 98, 13%) were the three most frequent subcategories in surgery and anesthesia, respectively. In the multivariable mixed-effect analysis, no significant association between the origin and CCI^® was observed. Conclusion: Analyzing the type and origin of an iAE offers individualized and contextualized information. This detailed descriptive information can be used for targeted surveillance of intra- and postoperative care, even though the overall predictive value for postoperative events was not improved by adding the origin in addition to the severity grade. Full article

(This article belongs to the Special Issue Prevention, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications)

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Review

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The Effects of Tissue Healing Factors in Wound Repair Involving Absorbable Meshes: A Narrative Review

Varvara Vasalou

Efstathios Kotidis

Dimitris Tatsis

Kassiani Boulogeorgou

Anastasia Tsingotjidou

and

Stamatis Angelopoulos

J. Clin. Med. 2023, 12(17), 5683; https://doi.org/10.3390/jcm12175683 - 31 Aug 2023

Viewed by 400

Abstract

Wound healing is a complex and meticulously orchestrated process involving multiple phases and cellular interactions. This narrative review explores the intricate mechanisms behind wound healing, emphasizing the significance of cellular processes and molecular factors. The phases of wound healing are discussed, focusing on the roles of immune cells, growth factors, and extracellular matrix components. Cellular shape alterations driven by cytoskeletal modulation and the influence of the ‘Formin’ protein family are highlighted for their impact on wound healing processes. This review delves into the use of absorbable meshes in wound repair, discussing their categories and applications in different surgical scenarios. Interleukins (IL-2 and IL-6), CD31, CD34, platelet rich plasma (PRP), and adipose tissue-derived mesenchymal stem cells (ADSCs) are discussed in their respective roles in wound healing. The interactions between these factors and their potential synergies with absorbable meshes are explored, shedding light on how these combinations might enhance the healing process. Recent advances and challenges in the field are also presented, including insights into mesh integration, biocompatibility, infection prevention, and postoperative complications. This review underscores the importance of patient-specific factors and surgical techniques in optimizing mesh placement and healing outcomes. As wound healing remains a dynamic field, this narrative review provides a comprehensive overview of the current understanding and potential avenues for future research and clinical applications. Full article

(This article belongs to the Special Issue Prevention, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications)

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