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Reoperations Within the First 30 Days After Pelvic Surgery

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Reoperative Pelvic Surgery

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Abstract

Reoperative problems that present within the first 30 days after pelvic surgery from either a perineal or abdominal approach require not only a high index of suspicion, but also constant vigilance on the part of the clinician in order to avoid unnecessary morbidity. These problems present acutely and demand quick recognition and subsequent treatment. Infection is one of the leading causes of early readmission after abdominal and anorectal surgery, but the surgeon must keep other factors in mind, as well. Kariv et al.1 examined the characteristics of 150 consecutive patients readmitted within 30 days of surgery. The causes of readmission were surgical site infections (SSIs) (33%), ileus or small bowel obstruction (SBO) (23%), medical complications (24%), and others (24%). Risk factors for readmission were chronic obstructive pulmonary disease, low functioning capacity, previous anticoagulant therapy, steroid treatment, and discharge to a location other than home. Disease-related factors actually had little to do with readmission rates. Based on these findings, the authors concluded that in addition to the typical preoperative medical risk stratification, that patients also receive treatment to increase their functional capacities before surgery, minimize steroid use, or stratify perioperative anticoagulant use in order to decrease readmission rates. This study serves as a good reminder that we should keep the patient’s overall condition in mind if we are to minimize the chances for complications. For the purposes of this chapter, we examine reoperative anorectal complications separately from those arising from pelvic operations using an abdominal approach.

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References

  1. Kariv Y, Wang W, Senagore AJ, Hammel JP, Fazio VW, Delaney CP. Multivariable analysis of factors associated with hospital readmission after intestinal surgery. Am J Surg. 2006;191:364–71.

    Article  PubMed  Google Scholar 

  2. Cihan A, Mentes BB, Sucak G, Karamercan A, Naznedar R, Ferahkose Z. Fournier’s gangrene after hemorrhoidectomy: Association with drug-induced agranulocytosis. Report of a case. Dis Colon Rectum. 1999;42:1644–8.

    Article  CAS  PubMed  Google Scholar 

  3. Di Falco G, Guccione C, D’Annibale A, Ronsisvalle S, Lavezzo P, Fregonese D, D’Ambrosio G. Fournier’s gangrene following a perianal abscess. Dis Colon Rectum. 1986;29:582–5.

    Article  PubMed  Google Scholar 

  4. McCloud JM, Jameson JS, Scott AN. Life-threatening sepsis following treatment for haemorrhoids: a systematic review. Colorectal Dis. 2006;8:748–55.

    Article  CAS  PubMed  Google Scholar 

  5. Lehnhardt M, Steinstraesser L, Druecke D, Muehlberger T, Steinau HU, Homann JJ. Fournier’s gangrene after Milligan-Morgan hemorrhoidectomy requiring subsequent abdominoperineal resection of the rectum: report of a case. Dis Colon Rectum. 2004;47:1729–33.

    Article  PubMed  Google Scholar 

  6. Pessaux P, Lermite E, Tuech JJ, Brehant O, Regenet N, Arnaud JP. Pelvic sepsis after stapled hemorrhoidectomy. J Am Coll Surg. 2004;199:844–5.

    Article  Google Scholar 

  7. Jongen J, Bock JU, Peleikis HG, Eberstein A, Pfister K. Complications and reoperations in stapled anopexy: learning by doing. Int J Colorectal Dis. 2006;21:166–71.

    Article  PubMed  Google Scholar 

  8. Bernardi C, Pescatori M. Reconstructive perineoplasty in the management of non-healing wounds after anorectal surgery. Tech Coloproctol. 2001;5:27–32.

    Article  CAS  PubMed  Google Scholar 

  9. Daniel F, Sultan S, de Parades V, Bauer P, Atienza P. Anal fissure and minor anorectal sepsis after stapled hemorrhoidectomy. Dis Colon Rectum. 2004;47:1846–51.

    Article  Google Scholar 

  10. Lan P, Wu X, Zhou X, Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: A systematic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis. 2006;21:172–8.

    Article  PubMed  Google Scholar 

  11. Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, O’Brien PM. Repair techniques for obstetric and sphincter injuries: a randomized controlled trial. Obstet Gynecol. 2006;107:1261–8.

    Article  PubMed  Google Scholar 

  12. Heriot AG, Tekkis PP, Smith JJ, Bona R, Cohen RG, Nicholls RJ. Management and outcome of pouch-vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum. 2005;48:451–8.

    Article  PubMed  Google Scholar 

  13. Tjandra JJ, Han WR, Goh J, Carey M, Dwyer P. Direct repair vs. overlapping sphincter repair: A randomized controlled trial. Dis Colon Rectum. 2003;46:937–42.

    Article  CAS  PubMed  Google Scholar 

  14. Lundy JB, Gadacz TR. Massive fecal impaction presenting with megarectum and perforation of a stercoral ulcer at the rectosigmoid junction. South Med J. 2006;99:525–7.

    Article  PubMed  Google Scholar 

  15. Nessim A, Wexner SD, Agachan F, Alabaz O, Weiss EG, Nogueras JJ, Daniel N, Billoti VL. Is bowel confinement necessary after anorectal reconstructive surgery? A prospective , randomized, surgeon-blinded trial. Dis Colon Rectum. 1999;42:16–23.

    Article  CAS  PubMed  Google Scholar 

  16. A brief overview of the 1999 CDC Guideline for the Prevention of Surgical Site Infection. Centers for Disease Control and Prevention. J Chemother. 2001 Nov;13 Spec No 1(1):35–9.

    Google Scholar 

  17. Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotizing infections of soft tissues—a clinical profile. Eur J Surg. 2002;168:366–71.

    Article  PubMed  Google Scholar 

  18. Brusciano L, Maffettone V, Napolitano V, Izzo G, Rossetti G, Izzo D, Russo F, Russo G, del Genio G , del Genio A. Management of colorectal emergencies: percutaneous abscess drainage. Ann Ital Chir. 2004;75:593–7.

    CAS  PubMed  Google Scholar 

  19. Harisinghani MG, Gervais DA, Hahn PF, Cho CH, Jhaveri K, Varghese J, Mueller PR. CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome. Radiographics 2002;22:1353–67.

    Article  PubMed  Google Scholar 

  20. Men S, Akhan O, Koroglu M. Percutaneous drainage of abdominal abscess. Eur J Radiol. 2002;43:204–18.

    Article  PubMed  Google Scholar 

  21. Schechter S, Eisenstat TE, Oliver GC, Rubin RJ, Salvati EP. Computerized tomographic scan-guided drainage of intra-abdominal abscesses. Preoperative and postoperative modalities in colon and rectal surgery. Dis Colon Rectum. 1994;37:984–8.

    Article  CAS  PubMed  Google Scholar 

  22. Antevil JL, Egan JC, Woodbury RO, Rivera L, Oreilly EB, Brown CV. Abdominal computed tomography for postoperative abscess: is it useful during the first week? J Gastrointest Surg. 2006;10:901–5.

    Article  PubMed  Google Scholar 

  23. Sagap I, Remzi FH, Hammel JP, Fazio VW. Factors associated with failure in managing pelvic sepsis after ileal pouch-anal anastomosis (IPAA)—a multivariate analysis. Surgery 2006;140:691–703.

    Article  PubMed  Google Scholar 

  24. Braakenburg A, Obdeijn MC, Feitz R, van Rooij IA, van Griethuysen AJ, Klinkenbijl JH. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: A randomized controlled trial. Plast Reconstr Surg. 2006;118:390–7.

    Article  CAS  PubMed  Google Scholar 

  25. Tillou A, Weng J, Alkousakis T, Velmahos G. Fascial dehiscence after trauma laparotomy: A sign of intra-abdominal sepsis. Am Surg. 2003;69:927–9.

    PubMed  Google Scholar 

  26. Graham DJ, Stevenson JT, McHenry CR. The association of intra-abdominal infection and abdominal wound dehiscence. Am Surg. 1998;64:660–5.

    CAS  PubMed  Google Scholar 

  27. Riou JP, Cohen JR, Johnson H Jr. Factors influencing wound dehiscence. Am J Surg. 1992;163:324–30.

    Article  CAS  PubMed  Google Scholar 

  28. Heller L, Levin SL, Butler CE. Management of abdominal wound dehiscence using vacuum assisted closure in patients with compromised healing. Am J Surg. 2006;191:165–72.

    Article  PubMed  Google Scholar 

  29. Jethwa P, Lake SP. Using topical negative pressure therapy to resolve wound failure following perineal resection. J Wound Care. 2005;14:166–7.

    CAS  PubMed  Google Scholar 

  30. Ramesh AN, Gajanan K, Fulford PE, Wilson MS, O’Dwyer ST. Myocutaneous flap reconstruction of the perineum after radical abdominoperineal resection. Colorectal Dis. 2007;9:189.

    Article  Google Scholar 

  31. Wang X, Qiao Q, Burd A, Liu Z, Zhao R. Perineum reconstruction with pedicled anterolateral thigh fasciocutaneous flap. Ann Plast Surg. 2006;56:151–5.

    Article  CAS  PubMed  Google Scholar 

  32. Nilsson PJ. Omentoplasty in abdominoperineal resection: A review of the literature using a systematic approach. Dis Colon Rectum. 2006;49:1354–61.

    Article  PubMed  Google Scholar 

  33. Mannaerts GH, Rutten HJ, Martijn H, Groen GJ, Hanssens PE, Wiggers T. Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum. 2001;44:806–14.

    Article  CAS  PubMed  Google Scholar 

  34. Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: A prospective evaluation of 622 patients. Ann Surg. 2004;240:260–8.

    Article  PubMed  Google Scholar 

  35. Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg. 2006;76:579–85.

    Article  PubMed  Google Scholar 

  36. Alberts JC, Parvaiz A, Moran BJ. Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis. 2003;5:478–82.

    Article  CAS  PubMed  Google Scholar 

  37. Garcia-Botello SA , Garcia-Armengol J, Garcia-Granero E, Espi A, Lopez-Mozos F, Lledo S. A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg. 2004;21:440–6.

    Article  CAS  PubMed  Google Scholar 

  38. Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H; Working Group “Colon/Rectum Carcinoma.” Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92:1137–42.

    Article  CAS  PubMed  Google Scholar 

  39. Wong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective comparative study. Dis Colon Rectum. 2005; 48:2076–9.

    Article  CAS  PubMed  Google Scholar 

  40. Laurent C, Nobili S, Rullier A, Vendrely V, Saric J, Rullier E. Efforts to improve local control in rectal cancer compromise survival by the potential morbidity of optimal mesorectal excision. J Am Coll Surg. 2006;203:684–91.

    Article  PubMed  Google Scholar 

  41. Guenaga KF, Matos D, Castro AA, Atallah AN, Willie-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2003;(2):CD001544.

    Google Scholar 

  42. Koh PK, Tang CL, Eu KW, Samuel M, Chan E. A systematic review of the function and complications of colonic pouches. Int J Colorectal Dis. 2007;22:543–8.

    Article  PubMed  Google Scholar 

  43. Ho YH, Brown S, Heah SM, Tsang C, Seow-Choen F, Eu KW, Tang CL. Comparison of J-pouch and coloplasty pouch for low rectal cancers: A randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg. 2002;236:49–55.

    Article  PubMed  Google Scholar 

  44. Remzi FH, Fazio VW, Gorgun E, Zutshi M, Church JM, Lavery IC, Hull TL. Quality of life, functional outcome, and complications of coloplasty pouch after low anterior resection. Dis Colon Rectum. 2005;48:735–43.

    Article  PubMed  Google Scholar 

  45. Azimuddin K, Rosen L, Reed JF 3rd, Stasik JJ, Riether RD, Khubchandani IT. Readmissions after colorectal surgery cannot be predicted. Dis Colon Rect. 2001;44:942–6.

    Article  CAS  Google Scholar 

  46. Ellozy SH, Harris MT, Bauer JJ, Gorfine SR, Kreel I. Early postoperative small bowel obstruction: A prospective evaluation of 242 consecutive abdominal operations. Dis Colon Rectum. 2002;45:1214–7.

    Article  PubMed  Google Scholar 

  47. Miller G, Boman J, Shrier I, Gordon PH. Readmission for a small-bowel obstruction in the early postoperative period: Etiology and outcome. Can J Surg. 2002;45:255–6.

    PubMed  Google Scholar 

  48. Pickleman J, Lee RM. The management of patients with suspected early postoperative small bowel obstruction. Ann Surg. 1989;210:216–9.

    Article  CAS  PubMed  Google Scholar 

  49. Rickard MJ, Young CJ, Bissett IP, Stitz R, Solomon MJ; Research committee of the colorectal surgical society of Australasia. Ileal pouch-anal anastomosis: The Australasian experience. Colorectal Dis. 2007;9:139–45.

    Article  CAS  PubMed  Google Scholar 

  50. MacLean AR, Cohen Z, MacRae HM, O’Connor BI, Mukraj D, Kennedy ED, Parkes R, McLeod RS. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg. 2002;235:200–6.

    Article  PubMed  Google Scholar 

  51. Chessin DB, Enker W, Cohen AM, Paty PB, Weisser MR, Saltz L, Minsky BD, Wong WD, Guillem JG. Complications after preoperative combined modality therapy and radical resection of locally advanced rectal cancer: A 14-year experience from a specialty service. J Am Coll Surg. 2005;200:876–82.

    Article  PubMed  Google Scholar 

  52. Al-Sunaidi M, Tulandi T. Adhesion-related bowel obstruction after hysterectomy for benign conditions. Obstet Gynecol. 2006;108:1162–6.

    Article  PubMed  Google Scholar 

  53. Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG. Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum. 2003;46:1310–9.

    Article  PubMed  Google Scholar 

  54. Fazio VW, Cohen Z, Fleshman JW, et al. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. 2006;49:1–11.

    Article  PubMed  Google Scholar 

  55. Lajer H, Widecrantz S, Heisterberg L. Hernias in trocar ports following abdominal laparoscopy. A review. Acta Obstet Gynecol Scand. 1997;76:389–93.

    Article  CAS  Google Scholar 

  56. Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg. 2004;139:1248–56.

    Article  PubMed  Google Scholar 

  57. Liu CD, McFadden DW. Laparoscopic port sites do not require fascial closure when nonbladed trocars are used. Am Surg. 2000;66:853–4.

    CAS  PubMed  Google Scholar 

  58. Draus JM Jr, Huss SA, Harty JN, Cheadle WG, Larson GM. Enterocutaneous fistula: are treatments improving? Surgery 2006;140:570–6.

    Article  PubMed  Google Scholar 

  59. Goverman J, Yelon JA, Platz JJ, Singson RC, Turcinovic M. The “Fistula VAC,” a technique for management of enterocutaneous fistulae arising within the open abdomen: Report of 5 cases. J Trauma. 2006;60:428–31.

    Article  PubMed  Google Scholar 

  60. Abdel-Baki NA, Bessa SS, Abdel-Razek AH. Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia: a prospective randomized study. Hernia. 2007;11(2):163–7

    Article  CAS  PubMed  Google Scholar 

  61. Schuster R, Singh J, Safadi BY, Wren SM. The use of acellular dermal matrix for contaminated abdominal wall defects: wound status predicts success. Am J Surg. 2006;192:594–7.

    Article  CAS  PubMed  Google Scholar 

  62. Hallbook O, Matthiessen P, Leisskold T, Nystrom PO, Sjodahl R. Safety of the temorary loop ileostomy. Colorectal Dis. 2002;4:361–4.

    Article  PubMed  Google Scholar 

  63. Edwards DP, Leppington-Clarke A, Sexton R, Heald RJ, Moran BJ. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg. 2001;88:360–3.

    Article  CAS  PubMed  Google Scholar 

  64. Juhasz ES, Wolff BG, Meagher AP, Kluiber RM, Weaver AL, van Heerden JA. Incidental cholecystectomy during colorectal surgery. Ann Surg. 1994;219:467–72.

    Article  CAS  PubMed  Google Scholar 

  65. Leff EI, Groff W, Rubin RJ, Eisenstat TE, Salvati EP. Use of ureteral catheters in colonic and rectal surgery. Dis Colon Rectum. 1982;25:457–60.

    Article  CAS  PubMed  Google Scholar 

  66. Hewett PJ, Joseph M, Bokey EL. Ureteric ischemia following major colorectal resection. Aust N Z J Surg. 1995;65:137–9.

    Article  CAS  PubMed  Google Scholar 

  67. Oh BR, Kwon DD, Park KS, Ryu SB, Park YI, Presti JC Jr. Late presentation of ureteral injury after laparoscopic surgery. Obstet Gynecol. 2000;95:337–9.

    Article  CAS  PubMed  Google Scholar 

  68. Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urol Clin North Am. 2006;33:55–66.

    Article  PubMed  Google Scholar 

  69. Beraldo S, Dodds SR. Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum. 2006;49:1772–80.

    Article  PubMed  Google Scholar 

  70. Wassenaar EB, van den Brand JG, van der Werken C. Compartment syndrome of the lower leg after surgery in the modified lithotomy position: Report of seven cases. Dis Colon Rectum. 2006;49:1449–53.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA

    Jeffery Nelson BS, MD (Chief, Colon and Rectal Surgery)

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  1. Jeffery Nelson BS, MD
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Editors and Affiliations

  1. Northwest Colon and Rectal Clinic, Madison Street 1101, Seattle, 98104, U.S.A.

    Richard P. Billingham

  2. Virginia Mason Medical Center, 9th Avenue 1100, Seattle, 98101, U.S.A.

    Kathleen C. Kobashi

  3. Madison Street 1100, Seattle, 98104, U.S.A.

    William A. Peters

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Nelson, J. (2009). Reoperations Within the First 30 Days After Pelvic Surgery. In: Billingham, R., Kobashi, K., Peters, W. (eds) Reoperative Pelvic Surgery. Springer, New York, NY. https://doi.org/10.1007/b14187_2

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  • DOI: https://doi.org/10.1007/b14187_2

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