Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
Background: Incisional hernia is an undervalued complication after stoma closure, with rates about 40%. Mesh-reinforced stoma reversal might be a simple and applicable approach to decrease the frequency of incisional hernia. There is a current debate about efficacy of this technique in preventing incisional hernias following stoma closure. Methods: In this prospective clinical study, all patients with temporary stoma who admitted to Mansoura University Hospital at the period from February 2019 to April 2021 and fulfill the eligibility criteria were distributed into 2 groups. In group I conventional sutured fascial closure was done while in group-II mesh reinforced fascial closure was done during stoma reversal.Results: Time to stoma closure had mean values of 26.76 and 24 weeks in Groups 1 and 2 respectively (p = 0.430). Surgical site infections (SSI) were encountered in 20% and 19% of patients in the two groups (p = 0.868). The occurrence of stoma site incisional hernia (SSIH) showed a significant increase in Group 1 (20% vs 2% in the other group -p = 0.009). Conclusion: prophylactic mesh reinforcement throughout stoma closure significantly reduces the incidence of stoma site incisional hernia with no significant increase in the incidence of the stoma site wound infection.
Background: There is a remaining high debate, about mesh fixation involved in laparoscopic inguinal hernia repair (LIHR) that is largely influenced by the individual preferences of each surgeon. In this research study, a comparison is done between mesh fixation in laparoscopic transabdominal preperitoneal (TAPP) using either staples or tissue adhesive (Amcrylate). Methods: This was a prospective randomized controlled study that was applied to 100 patients having an inguinal hernia. Patients included were randomly sorted into two groups based on the closed envelope method; Group I, involved 50 patients previously subjected to laparoscopic TAPP, and tissue adhesive was used for mesh fixation, and GroupII, involved 50 patients subjected to laparoscopic TAPP, and tackers were used for fixation of mesh. Results: We found a difference of statistical significance among the studied groups regarding the assessed VAS score on the 1 st day (P=0.018), 10 th day (P<0.001), and 30 th days (P<0.001), post-operative with a difference that is not statistically significant pre-operative. The statistically analyzed difference among the studied groups was not significant regarding Carolina's Comfort Scale after 6 months, Sensation of mesh, limitation of movement, recurrence, and complications. Conclusion: Mesh fixation using tissue adhesive is preferable to staples because of its association with less post-surgery accompanied pain, earlier return to work, no increase in prompt recurrence rates and complications, better chronic pain experience, and comparable life quality.
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