Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

Serial measurement of CRP is recommended for screening of infectious complications of colorectal resection. Patients with CRP values above 139 mg/L on POD 5 cannot be discharged from hospital, and require an intensive search for infectious complications, particularly AL. MMP-9 measurement in drainage fluid is not relevant in the detection of AL in patients with colorectal resection.

Serial measurement of CRP in drainage fluid can reliably be used in the detection of AL in patients with colorectal resection. The most significant values obtained on the PODs 5 and 7 were positively correlated with the values registered in

We reported a patient with giant esophageal pedunculated tumor with clinical manifestations of inflammatory pseudotumor and histopathological picture of fibrovascular polyp, that we have not found described in the literature before.

Background/Aim. Hospital-acquired pneumonia (HAP) in a surgical population significantly increases morbidity and mortality, prolongs hospitalization and increases total treatment costs. In the present study, we aimed to determine incidence, in-hospital mortality and risk factors (RFs) of HAP in patients with intra-abdominal surgical procedures hospitalized in a tertiary hospital in Belgrade (Serbia). Methods. Through regular hospital surveillance of patients who underwent intra-abdominal surgical procedures, we prospectively identified postoperative HAP during five years. In the matched case-control study, every surgical patient with HAP was compared with four control patients without HAP. In the group of patients with HAP, those who died were compared with those who survived. Results. Overall 1.4% of all intra-abdominal surgical patients developed HAP in the postoperative period. The incidence of HAP (per 1,000 operative procedures) was greatest in patients undergoing exploratory laparotomy (102.6), followed by small bowel surgery (36.6), and gastric surgery (22.7). Multivariate logistic regression analysis (MLRA) identified three independent risk factors (RF) associated with HAP: multiple transfusion [p = 0.011; odds ratio (OR): 4.26; 95% confidence interval (CI): 1.59-11.33], length of hospital stay (p = 0.024; OR: 1.02; 95%CI: 1.00-1.03) and hospitalization in the Intensive care unit (ICU) (p = 0.043; OR: 2.83; 95%CI: 1.03-7.71). MLRA identified only surgical site infection as an independent RF associated with the poor outcome of HAP (p = 0.017; OR: 5.929; CI95%: 1.37-25.67). Conclusion. The results of the present study are valuable in documenting the relations between RFs and HAP in patients undergoing intra-abdominal surgical procedures.

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SažetakSa razvojem ambulantne hirurgije, povećao se broj hirurških zahvata koji se izvode u uslovima lokalne infiltrativne anestezije. Infiltrativna anestezija se koristi samostalno za obezbeđivanje anestezije kod manjih hirurških procedura ili kao infiltrativna analgezija duž većih operativnih incizija u kombinaciji sa analgeticima, kod operacija u opštoj anesteziji, u sklopu multimodalnog analgetskog pristupa. Jednostruka infiltracija rane, u formi bloka na kraju hirurškog zahvata u opštoj ili regionalnoj anesteziji obezbeđuje kvalitetnu analgeziju u vremenski ograničenom intervalu, te je u cilju produženog delovanja lokalnih anestetika uvedena tehnika kontinuirane infiltrativne analgezije. Infiltrativna lokalna anestezija u kontinuiranom modalitetu smanjuje upotrebu opioidnih i neopioidnih analgetika, produžava trajanje analgezije (uglavom do 72 h) i omogućava mobilizaciju bolesnika. Pozitivan efekat infiltrativne anestezije opisan je kod operacija preponskih kila, dojke, u kardiotorakalnoj, ortopedskoj i ginekološkoj hirurgiji. U abdominalnoj hirurgiji kompleksna inervacija trbušnog zida i intraabdominalnih organa zahteva primenu kombinovanja infiltrativne anestezije sa drugim modalitetima analgezije. Infiltrativna lokalna anestezija je bezbedna tehnika jer ne dovodi do infekcije hirurške rane i ne utiče na pojavu infekcije mesta hirurškog reza. Kako bi lokalna infiltrativna anestezija u potpunosti ispunila i opravdala očekivanja, neophodno je savladati relativno jednostavnu tehniku njene primene i svrsishodno je primenjivati. AbstractA large number of surgical interventions are performed ambulatory under local infiltrative anesthesia. Local anesthetic wound infiltration provides anesthesia for minor surgical procedures and perioperatively improves analgesia after surgery in general anesthesia as part of a multimodal analgesic approach. The effect of a single block wound infiltration at the end of a surgical procedure in general or regional anesthesia provides additional analgesia for several hours. Infiltrative local anesthesia performed in a continuous modality reduces the use of analgesics, prolongs duration of analgesia and enhances the patient's mobilization. Benefits of local infiltrative anesthesia are described in inguinal hernioplasty, breast surgery, sternotomy, orthopedic, and gynecological surgery. However, in abdominal surgery, continuous infiltrative local anesthesia is combined with other analgesic modalities respecting complex innervation of the abdominal wall and intra-abdominal organs,. Wound infiltration is a safe technique without the risk of surgical wound infection. There is a lack of data about cost-benefit ratio when wound infiltration is used. In order for local infiltrative anesthesia to fully meet the expectations it is necessary to have mastery of the relatively simple technique, and the knowledge of when it is suitable to appply.

Introduction. Aortoenteric fistula (AEF) is rare and extremely difficult complication of aortic surgery. We present two cases of secondary aortoduodenal fistula (SADF) as complication after aortic surgery. Case report. First SADF happened 11 y after open abdominal aneurismal resection with GIT bleeding. After negative esophagogastroduodenoscopy (EGDS) we performed Multi Detector Computed Tomography (MDCT) with visualization of contrast leakage in duodenum from 10 cm wide visceral aortal aneurism. Unstable patient was treated with graft excision, aneurismal reduction, sewing of proximal and distal aortal stumps, bowel repair followed by axillobifemoral bypass (AxFF). Patient dismissed on 30 postoperative day. Second case of ADF happens five months after endovascular reconstruction of abdominal aorta (EVAR) with GIT bleeding and fewer. In 8 days, he had 3 negative EGDS. On MDCTwe find signs of endoleak, free air in aneurysmal sac, and signs of blood in intestine. On urgent operation we extracted stent graft, sew proximal and distal aortal stumps, do bowel repair and AxFF.Patientdied a day after operation with signs of sepsis and Multy Organ Failure Syndrome (MOFS). Conclusion. Conventional treatment of ADF means extra-anatomic AxFF with complete excision of infected graft or stent graft, with closure of aorta's proximal and distal stump and duodenal repair. Because of high mortality, prompt diagnostic evaluation and quick decision of adequate operative treatment is necessary. Although ESVS recommendations as a guide are very helpful there is no unique attitude about management of AEF, so each patient has his own specific treatment.