VASCULARSURGICAL ASPECTS IN ABDOMINAL SURGERY – RESULTS OBTAINED IN A TERTIARY CENTER OVER A 10-YEARS TIME PERIOD
Frank Meyer*1, Zuhir Halloul2
1Dept. of General, Abdominal, Vascular and Transplant Surgery; Otto-von-Guericke University with University Hospital, Magdeburg, Germany; 2Division of Vascular Surgery; Dept. of General, Abdominal, Vascular and Transplant Surgery; Otto-von-Guericke University with University Hospital, Magdeburg, Germany
Aim: To investigate perioperative management and outcome of patients of the abdominal-surgery profile including vascular alterations and to assure surgical quality of own therapeutic results at presence and in the near future.
Methods: Through a defined study period, all consecutive cases of the profile mentioned above were i) documented as part of an ongoing prospective unicenter observational study in the Division of Vascular Surgery to reflect daily surgical practice, and ii) retrospectively analyzed. Demografic and patient-, (local) finding- and treatment-associated aspects, such as age profile and sex ratio, preoperative diagnostic spectrum, vascularsurgical/-interventional/-medical therapeutic measures, surgical interventions of the abdominal-surgery spectrum, operation rate/R0 resection rate(s) and postoperative outcome criteria (such as hospital stay, perioperative morbidity, hospital lethality and 5-year survival rate [if indicated]) were determined and compared among various vascular lesions/entities.
Results (corner points): - Over 10 years, 113 cases were registered.
- Pancreas resection including vascular reconstruction showed the highest percentage (30.1 %) – arterial resection and reconstruction (no absolute exclusion criterion) to achieve R0 resection status can be considered in selective cases (according to reported decision criteria).
- Within the single patient groups, similar outcome data was found compared with international reports except in case of mesenteric ischemia, in which, e.g., open surgery was more frequently used.
- The majority of vascular alterations during postoperative course and iatrogenic lesions occurred following pancreas resection – it is therapeutic profile, there are, in particular, two important measures, namely, open surgery (higher morbidity, lethality and significantly longer hospital stay with success of surgical intervention depending considerably on individual experience) and image-guided radiological (e.g., complex cessation of arterial bleedings [coil embolization] and reconstructions [stent])/endoscopic measures.
- The majority of patients with visceral artery aneurysm (considerable potential for rupture or erosion) was more frequently treated with image-guided important for a favorable postoperative outcome to provide early diagnostic and therapy. In the
radiology vs. open surgery according to the today's well established sequential patient- (individual), (local) finding- and, in particular, risk-adapted approach.
Conclusion: Additional vascularsurgical care of problematic situations during abdominal surgery or in case of emergency is challenging including a considerable potential of complications (morbidity) and lethality, which requires the experienced surgeon with great expertise, possibly, in a center of vascular medicine.
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