The use of triclosan-coated sutures in fecal peritonitis surgery reduces the incidence of incisional SSI.

The volvulus of the small bowel is a surgical emergency, causing small bowel obstruction. We performed a retrospective study of all the patients diagnosed and treated with small bowel volvulus between 1977 and 2007 at our institution. One hundred twenty-nine patients were analyzed. Thirty-nine patients presented primary volvulus and 90 secondary ones. The most frequent symptom was sudden abdominal pain. CT scan was the best diagnostic method with an accuracy of 83 per cent. Necrotic small bowel loops appeared in 46.5 per cent of the patients. Eighteen patients had postoperative complications (14%). Mortality rate was 9.3 per cent. A higher mortality is observed among patients with previous abdominal surgeries and cardiopathies. Necrotic loops are associated with higher mortality and incidence of surgical complications; patients with diabetes are associated with a higher incidence of necrotic loops. Cardiopathies are associated with more frequent medical and surgical complications. Recurrence rate was 3.9 per cent associated with simple devolvulation. Primary volvulus are more frequent among males and patients with diabetes. Jejunal location is associated with primary volvulus and these correlate with a higher incidence of necrotic loops. Primary volvulus presents a higher incidence of surgical complications. A bowel obstruction with sudden abdominal pain must be suspicious of small bowel volvulus. The main aim is to achieve an early diagnosis to prevent a necrotic small bowel. CT scan is the imaging test with the best diagnostic accuracy. Primary volvulus, the presence of necrotic loops, and patients with cardiopathies, diabetes mellitus, and with previous abdominal surgery are associated with a worse outcome.

Twenty-eight patients with genital and perianal necrotizing infections are described. The patients were divided into three groups according to the primary site of infection: group 1, anorectal (14 patients); group 2, urologic (ten patients), and group 3, idiopathic (four patients). The overall mortality was 25 percent, 28.5 percent for the anorectal group and 10 percent for the urologic group, although this difference is not statistically significant. Necrotizing infections of anorectal origin were more severe and had a less typical way of presentation, with subsequent delay in diagnosis and a higher rate of myonecrosis. As a consequence, more debridements and more fecal derivations had to be performed. The etiologic agents were the same among the three groups and comprised a number of anaerobes (Bacteroides spp, gram-positive cocci) as well as aerobes (microorganisms belonging to the Enterobacteriaceae and S. faecalis). Necrotizing fasciitis was the pathologic picture of nine of ten patients with Fournier's gangrene of urogenital origin and seven of 14 with an anorectal source. Synergistic necrotizing cellulitis was identified in half of those secondary to anorectal origin and only one of those with a urologic source.

Introduction: visceral arterya neurysmsa re an infrequent entity. most of them are asymptomatic, but when they present as arupture, ahigh mortality is associated.Material and Methods: We review our experience of 18 casesbetween 1988 and 2006.Results: 9males and 9females with amean age of 66,5 years are analyzed. aneurysms were located in splenic artery (9), hepatic artery (2), superior mesenteric artery (2), celiac trunk (3), inferior mesenteric artery (1) and gastroduodenal artery (1). three of them were associated with abdominalaorta aneurysms.fourteen patients were asymptomatic, three presenteda bdominalp ain and one case presented with rupture and intraperitoneal bleeding.surgical treatment was performed in thirteen of the patients and endovascular in five. Twocases of endovascular treatment failed and surgery was necessary.Postsurgical mortality was 0a nd complications appearedi n2patients. mean hospital stay after surgicaltreatmentwas 11 days and 3days after endovascular one. none of the patients presented recurrences, and one has chronic mesenteric ischemia as sequelae of surgical treatment of asuperiormesenteric artery aneurysm.Conclusion: visceral arteryaneurysmsmust be treated if it is feasible, due to the potential risk of rupture. Endovascular treatment associates lower morbimortality rates and shorterhospital stay than surgical one, but nowadays many aneurysms are not suitable for this management. Endovascular treatmenti sat echnically difficult approach, that requires aspecific training and the first cases represent alearning curve.

The addition of intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, to a standard bundle of SSI prevention, reduces the incisional and organ-space SSI and consequently the hospital stay, after elective laparoscopic colorectal cancer surgery (ClinicalTrials.gov Identifier: NCT03081962).

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Laparoscopic Nissen fundoplication appears to be at least as safe and long term in effectiveness for GERD as the open approach, with the associated postoperative advantages of a minimally invasive access.

Radiation enteritis must be initially conservatively managed, but in those cases without response, surgery is indicated. Surgical treatment should not be delayed fearing postoperative complications, which are more susceptible to appear in deteriorated patients. If technically possible, the affected region should be resected, because complications may appear later at this damaged location.