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Aytac E, Sökmen S, Öztürk E, Rencüzoğulları A, Sungurtekin U, Akyol C, Demirbaş S, Leventoğlu S, Karakayalı F, Korkut MA, Öncel M, Gülcü B, Canda AE, Eray İC, Özgen U, Ersöz Ş, Özer T, Özerhan İH, Bozbıyık O, Haksal M, Oral BM. Management and Morbidity of Major Pelvic Hemorrhage in Complex Abdominopelvic Surgery. Eur Surg Res 2023; 64:390-397. [PMID: 37816336 DOI: 10.1159/000534477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/04/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management, and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdominopelvic surgery. METHODS Patients who had major intraoperative pelvic hemorrhage during complex abdominopelvic surgery at 11 tertiary referral centers between 1997 and 2017 were included. Patient characteristics, management strategies to control bleeding, short- and long-term postoperative outcomes were evaluated retrospectively. RESULTS There were 120 patients with a mean age of 56.6 ± 2.4 years and a mean BMI of 28.3 ± 1 kg/m2. While 104 (95%) of the patients were operated for malignancy, 16 (5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90 (75%). Major pelvic hemorrhage was managed simultaneously in 114 (95%) patients. Electrocauterization 27 (23%), pelvic packing 26 (22%), suturing 7 (6%), thumbtacks application 7 (6%), muscle welding 4 (4%), use of energy devices 2 (2%), and topical hemostatic agents 2 (2%) were the management tools. Combined techniques were used in 43 (36%) patients. Short-term morbidity and mortality rates were 48 (40%) and 2 (2%), respectively. High preoperative CRP levels (p = 0.04), history of preoperative radiotherapy (p = 0.04), longer bleeding time (p = 0.006), and increased blood transfusion (p = 0.005) were the factors associated with postoperative morbidity. CONCLUSION Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdominopelvic surgery.
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Affiliation(s)
- Erman Aytac
- Acibadem Mehmet ali Aydinlar University, Istanbul, Turkey
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- SBU Gulhane Education and Training Hospital, Ankara, Turkey
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Aytac E, Sokmen S, Aktas MK, Colak T, Mentes B, Balik E, Demirbas S, Akyol C, Sungurtekin U, Oncel M, Ozturk E, Obuz F, Ucaroglu B, Leventoglu S, Ozerhan IH, Baca B, Ozgen U, Haksal M, Tumay V, Geçim E, Bugra D. Factors affecting operative morbidity and long-term outcomes in patients undergoing surgery for presacral tumours: a multicentric cohort study from the Turkish Collaborative Group for Quality Improvement in Colorectal and Pelvic Surgery. Colorectal Dis 2023; 25:1795-1801. [PMID: 37547974 DOI: 10.1111/codi.16697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
AIM Data regarding the operative management of presacral tumours present various dilemmas due to their rarity and heterogeneous nature. The aim of this study was to evaluate the management strategy, factors associated with operative morbidity and long-term postoperative outcomes in a large group of patients undergoing surgery for presacral tumours. METHOD This study was designed as a multicentre retrospective cohort study. Records of patients who underwent surgery for presacral tumours at 10 tertiary colorectal centres between 1996 and 2017 were evaluated. RESULTS One hundred and twenty seven patients (44 men) with a mean age of 46 years and body mass index of 27 kg/m2 were included. Fifty eight per cent of the patients had low sacral lesions (below S3). The operative approaches were transabdominal (17%), transsacral (65%) and abdominosacral (17%). The postoperative morbidity was 19%. Thirty per cent of the patients had a malignant tumour. Longer duration of symptoms (p = 0.001), higher American Society of Anesthesiologists score (p = 0.01), abdominosacral operations (p = 0.0001) and presacral tumours located above S3 (p = 0.004) were associated with an increased risk of postoperative morbidity. Overall long-term postoperative recurrence and mortality were 6% and 5%, respectively, within a 3-year mean follow-up period in patients with presacral malignant tumours. CONCLUSION Reduced physical condition, omission of symptoms prior to surgery, combined resections and high sacral tumours are the risk factors associated with postoperative complications in patients undergoing surgery for presacral tumours. Meticulous planning of the operation and intensified perioperative care may improve the outcomes in high-risk patients.
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Affiliation(s)
- Erman Aytac
- Acibadem University Atakent Hospital, Istanbul, Turkey
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- Acibadem Altunizde Hospital, Istanbul, Turkey
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Schultzel M, Ghazaryan N, Schultzel M. Rectocutaneous Fistula Presenting as an Insect Bite at the Distal Posterior Thigh: A Multidisciplinary Approach. Perm J 2022; 26:114-119. [PMID: 36530051 PMCID: PMC9761277 DOI: 10.7812/tpp/22.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Mark Schultzel
- 1United Medical Doctors, San Diego, CA, USA,Mark Schultzel, MD, MBA
| | - Nelli Ghazaryan
- 2Department of Obstetrics and Gynecology, UCSF Fresno, Fresno, CA, USA
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Predicting Postoperative Destination Through Preoperative Evaluation in Elective Open Aortic Aneurysm Repair. J Surg Res 2019; 235:543-550. [DOI: 10.1016/j.jss.2018.10.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/29/2018] [Accepted: 10/25/2018] [Indexed: 12/13/2022]
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