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Enhanced recovery program in abdominal surgery, also known as ERAS, is a protocol used before, during, and after operations, with the goal of improving the well-being of the patient, by facilitating the recovery and making everything possible to decrease the postoperative complications. This system requires a specialized team, consisting mainly on anaesthesiologists, nurses, and surgeons, however, physiotherapists, nutritionist or administrative department can also be involved, according to the individual needs. ERAS programme is not yet introduced worlwide, not even in most of hospitals, due to a number of difficulties which makes it arduous. According to studies, such problems include accomplishing the compliance and keep it for long term, resistance to implementation, lack of communication or collaboration among the medical professionals, lack of financial resources, and patient education, being the compliance and resistance the most prevalent ones. Embracement of such a multimodal protocol with so many professionals involved is quite difficult, since a traditional surgical dogma has been in hospitals for years, and it takes a long time to change their beliefs. Therefore, first thing to accomplish the implementation is the education, not only for the medical staff, but also for the patients undergoing major surgeries, because a clear understanding of the protocol is the main goal for achievement. This education should be continued for a long term, in order to keep the compliance in high rates, so seminars, informative brochures or any other form of educational material could be taken into account. Another way to success is to make some changes in the postoperative ward, which according to studies they show the lowest compliance rate, so if they are more friendly towards the patient and they are transformed into a rehabilitation center, well-being of the patient could be achieved better than with actual wards. Hence, ERAS programme is a revolutionary protocol for most of the hospitals, which is trying to be introduced, since the goal is facilitating the recovery and well-being of patients undergoing major surgeries. It confronts some difficulties, however solutions can be carried out to achieve the implementation.

Background:For lower abdominal surgeries, nowadays epidural anaesthesia is preferred. To cover the pain after surgery is the anaesthesiologist work. Butarphanol is synthetic opioid which has better effect on post-operative analgesia. The study participants were divided into Control group, Group A receiving 1mg of butarphanol& Group B receiving 2mg of butarphanol. Objectives: The study was conducted to compare two doses 1mg & 2mg of butarphanol for quality of anaesthesia, quality of motor blockade, duration of post-operative analgesia etc. Methods – It was cross sectional studywas conducted at Department of Anaesthesiology, Government Medical College, over a period extending from January 2007 to November 2008. Results:The onset of sensory blockade was found to occur in less than 1 minutes in group B receiving 2mg of butarphanol. In group B, complete motor blockade in about 10.15±0.86 minutes followed by in group A in 13.27±1.67 minutes. Group B patients had maximum sensory blockade for 3.8±0.40 hours & motor blockade for 2.72±0.32 hours. About 82.5% & 77% patients in Group B & A respectively has excellent quality of anaesthesia. Somnolence was the commonest adverse effect seen in about 70% of group B & 40% of group A patients. Conclusion:Butarphanol through epidural route in different doses can provide you better sensory & motor blockade, better quality of anaesthesia, maximum duration of post-operative analgesia.

Background: Healthcare processes in hospitals, likewise processes in companies or governmental organizations, may accumulate problems and obstacles over time, which consequently cause the processes to become ineffective. BPM (Business Process Management) is an approach to process modeling, improvement and automating, which has been used with great success for process improvement. Methods: This work was to examine the possibility of improving healthcare process by using BPM. To implement BPM ideas, a revised TAD (Tabular Application Development) methodology was developed, representing an important contribution to BPM. The first three phases of the TAD methodology were introduced in a step-bystep approach. The first phase deals with process identification, the second develops the "as-is" model, and the third phase discusses process improvement by developing a "to-be" model. Results: We found that (a) the Surgery process is efficient and well organized; (b) patient stay in the Department could be shortened; however for humane and social reasons the leadership prefers to leave the residence time as it is; (c) the process is associated with some time-consuming activities that are performed by other departments and represent the bottleneck of the process. Conclusions: The following were concluded (a) BPM proved to be a suitable approach for carrying out healthcare process improvement; (b) the revised TAD methodology showed to be consistent and efficient in performing BPM approach; (c) The Surgery process discussed was found to be an effective one and no changes or improvements are needed; (d) Concerning time-consuming activities, the leadership decided to discuss this problem with the management of the departments where the activities are executed.

BACKGROUND: Gastrointestinal paralysis, nausea and vomiting and pain are major clinical problems following abdominal surgery. Anaesthetic and analgesic techniques that reduce pain and postoperative nausea and vomiting (PONV), while preventing or reducing postoperative ileus, may reduce postoperative morbidity, duration of hospitalization and hospital costs. This review was first published in 2001 and was updated by new review authors in 2016. OBJECTIVES: To compare effects of postoperative epidural analgesia with local anaesthetics versus postoperative systemic or epidural opioids in terms of return of gastrointestinal transit, postoperative pain control, postoperative vomiting, incidence of anastomotic leak, length of hospital stay and costs after abdominal surgery. SEARCH METHODS: We identified trials by conducting computerized searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 12), MEDLINE (from 1950 to December 2014) and EMBASE (from 1974 to December 2014) and by checking the reference lists of trials retained. When we reran the search in February 2016, we added 16 potential new studies of interest to the list of 'Studies awaiting classification' and will incorporate these studies into formal review findings during the next review update. SELECTION CRITERIA: We included parallel randomized controlled trials comparing effects of postoperative epidural local anaesthetic versus regimens based on systemic or epidural opioids. DATA COLLECTION AND ANALYSIS: We rated the quality of studies by using the Cochrane 'Risk of bias' tool. Two review authors independently extracted data and judged the quality of evidence according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) scale. MAIN RESULTS: We included 128 trials with 8754 participants in the review, and 94 trials with 5846 participants in the analysis. Trials included in the review were funded as follows: charity (n = 19), departmental resources (n = 8), governmental sources (n = 15) ...

Background: The burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge. The objective of the study was to determine the pulmonary complications developing after abdominal and thoracic surgery and the associated risks factors. Methods: A retrospective records review of all abdominal and thoracic surgery patients admitted at a central hospital from January 2014 to October 2014 was done. Data collected included demographic data, surgical history, comorbidities and the PPCs present. Results: Out of the 92 patients whose records were reviewed, 55 (59.8%) were males and 84 (91.3%) had abdominal surgery. The mean age of the patients was 42.6 years (SD = 18.4). The common comorbidities were HIV infection noted in 14(15.2%) of the patients and hypertension in 10 (13.0%). Thirty nine (42.4%) developed PPCs and the most common complications were nosocomial pneumonia in 21 (22.8%) patients, ventilator associated pneumonia in 11 (12.0%), and atelectasis in 6 (6.5%) patients. Logistic regression showed that a history of alcohol consumption, prolonged surgery, prolonged stay in hospital or critical care unit, incision type, and comorbidities were significant risk factors for PPCs (p < 0.05). The mortality rate was 10.9%. Conclusion: PPCs like nosocomial and ventilator associated pneumonia were common and were associated with increased morbidity and adversely affected clinical outcomes of patients. HIV and hypertension presented significant comorbidities which the health team needed to recognize and address. Strategies to reduce the occurrence of PPCs have to be implemented through coordinated efforts by the health practitioners as a team during the entire perioperative period.

Objective: to determine the efficiency of postoperative 3-in-1 parenteral nutrition with Oliclinomel N8-800 in correcting protein-energy malnutrition in patients undergoing extended surgical interventions into the abdominal organs. Subjects and methods. Forty-one patients with gastric and pancreatic neoplasms treated in the intensive care unit, N. N. Burdenko Main Military Clinical Hospital, in January to October 2013 were examined. All the patients were males. The mean age was 63.5±11.87 years. The study design: a prospective controlled randomized trial. Group 1 (a comparison group) entered 21 patients. Conventional parenteral nutrition regimens with Oliclinomel N7-1000E 2000 ml were used on postoperative day 2. The intestine was lavaged with a glucose-electrolyte solution within the first postoperative hours. The glucose-electrolyte solution and standard enteral formula were intraintestinally administered as the absorptive and digestive functions of the small bowel recovered. On postoperative days 7 and 8, the parenteral nutrition was stopped and completely switched to enteral feeding. The dissimilarity of Group 2 (a study group) (n=20) was that it received parenteral nutrition with Oliclinomel N8-800 2000 ml.Results. Complete parenteral nutrition, then mixed parenteral-enteral nutrition stabilized protein metabolic parameters in the patients of both groups in a unilateral fashion, but more promptly in Group 2 than in Group 1. The nutritional support program in Group 2 caused significantly less reduction in the body' cellular weight than in Group 2 in the first and entire period of the follow-up, which appears to be related to the administration of large amounts of nitrogen.Conclusion. The results suggest that the use of Oliclinomel N8-800 for parenteral nutrition adequately corrects postaggressive nitrogen deficiency, promotes the normalization of protein and carbohydrate metabolism and a positive nitrogen balance and the resolution of hypermetabolism/hypercatabolism after extended abdominal surgery. ; Цель исследования — определить эффективность послеоперационного парентерального питания с использованием системы «3 в 1» — Оликлиномель N8-800 в коррекции белково-энергетической недостаточности у больных с обширными хирургическими вмешательствами на органах брюшной полости. Материалы и методы. Исследован 41 больной с новообразованиями желудка и поджелудочной железы, находившихся отделении реанимации Главного военного клинического госпиталя им. Н. Н. Бурденко с января по октябрь 2013 года. Все больные — мужчины. Средний возраст составил 63,5±11,87 лет. Дизайн исследования: проспективное, контролируемое, рандомизированное исследование. В 1-ю группу (группу сравнения) вошел 21 пациент. Начиная со 2-х суток послеоперационного периода парентеральное питание осуществляли по общепринятым схемам с использованием Оликлиномель N-1000E» 2000 мл. С первых часов послеоперационного периода проводили кишечный лаваж глюкозо-электролитным раствором. По мере восстановления всасывательной и переваривающей функции тонкой кишки переходили на внутрикишечное введение глюкозо-электролитного раствора и стандартной смеси энтерального питания. На 7—8-е сутки после оперативного вмешательства парентеральное питание прекращали и полностью переходили на энтеральное. Отличием 2-й группы (основной — 20 больных), было проведение парентерального питания Оликлиномель N8-800 в объеме 2000 мл. Результаты. На фоне полного парентерального питания, а затем смешанного парентерально-энтерального питания стабилизация показателей белкового обмена у больных обеих групп была однонаправленна, однако во 2-й группе происходила в более короткие сроки, чем у больных 1-й группы. На фоне программы нутритивной поддержки во 2-й группе снижение клеточной массы тела за первый и весь период наблюдения достоверно меньше, чем во второй (р<0,05), что, по-видимому, связано с введением большего количества азота. Заключение. Результаты свидетельствуют о том, что применение препарата Оликлиномель N8-800 для парентерального питания адекватно корригирует постагрессивный дефицит азота, способствует нормализации белкового и углеводного обмена, положительного азотистого баланса, разрешению синдрома гиперметаболизма-гиперкатаболизма после расширенных абдоминальных операций.

In 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery. Whereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso. During the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training. Results from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished.

Aims and Objectives: the study was conducted to find out the incidence of postoperative wound infection among obstetric and gynaecological surgeries in the tribal area of Rajasthan region with the objective to identify various preventable risk factors and common responsible pathogen. Material and methods: It was a prospective study conducted in the department of Gynaecology in Government Medical College and Hospital, Dungarpur during the period of six months from August 2019 to January 2020. Results: Out of 300 surgeries performed, 210 surgeries were obstetrics and 90 surgeries were gynaecological. The mean age of obstetrics cases was 26.89±2.5 years and of gynaecological cases was 48.22±4.8 years. Frequency of wound infection in obstetrics cases was 5.23% (11 cases) and was 11.11% (10 cases) in gynaecological surgeries with a total frequency of 7% (21 cases). Mean postoperative day of wound infection was 9.81±5.6, mean postoperative hospital stay was 8.10±5.6 days and the mean duration of surgery was 1.29±0.45 hours. Body mass index (BMI) was >25 (obese) in 61.90% of infected cases. 15 patients (10.41%) out of 144 patients who did not receive antibiotic prophylaxis, developed wound infection. On culture, Escherichia Coli (E.coli) was found to be the most common responsible pathogen (38.09%) followed by Klebsiella species and Staphylococcus aureus (19.04%). Conclusion: Early identification of various risk factors for postoperative wound infection in obstetric and gynaecological surgeries is essential to prevent further morbidities.

The burden of surgical conditions and diseases is increasing in low-income and middle-income countries, but the capacity to meet the demands they present is not following pace. Ongoing initiatives, such as brief visits by surgeons from advantaged countries, sending surgical residents to spend time in a developing country as part of their training, or ships weighing anchor offshore and offering some limited on-shore or on-board services, have not proven successful. More comprehensive and sustainable solutions include the development of local training programs, better retention of trainees with adequate incentives particularly in rural areas, and engaging government and professional associations, as well as academic institutions, to develop and implement policies to address local training needs.

Background: Spinal anesthesia is commonly administered intraoperatively. However, relative short duration of action is associated with local anesthetics. A variety of adjuvants is used for prolongation of postoperative analgesia. Aims and Objectives: Comparative analysis of intravenous dexmedetomidine as a premedication and spinal anesthesia treatment with intrathecal isobaric ropivacain of 0.75% in elective lower limb surgery and lower abdominal surgery. Material and Methods: Following approval by the ethical committee, 60 patients scheduled for elective lower limb orthopedic surgery and lower abdominal surgery were chosen and randomized into two groups (n=30). The patient was then intrathecally administered 3 ml amount of 0.75 percent isobaric ropivacaine in lateral location. Another syringe containing dexmedetomidine was given after 10 minutes of placement, for 10 minutes using syringe pump. Comparison of sensory block initiation, analgesic effects and hemodynamic effects was made between the 2 classes. Results: Comparison of age distribution of (P=0.164) was not statistically important. In Group P, the median age was (40.96 ± 15.3 years) and in Group S (44.33 ± 12.66 years).

PURPOSE: It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries. METHODS: The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results. RESULTS: The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training. CONCLUSION: The platform established in this study was useful for CDCS training.

The author srepresent the original clinical data devoting to the further progress in reconstructive surgery. The methodology of the staged anterior abdominal wall defect reconstruction using the Keystone method was used firstly.The aim of the work is to demonstrate the peculiarity of preoperative preparation of patients with the anterior abdominal wall wounds complicated by small intestinal fistulas.The article uses the clinical materials of the concrete patient treatment in the Department of surgical infection of the South Region Military Medical Clinical Centre (Odessa, Ukraine) using the principle of the reconstructive-restorative surgery.The clinical case of the successful surgical treatment of anterior abdominal wall eventration, resulting from numerous laparotomies with pronounced lateralization of the wound, has shown that the solution to this problem should be based on the principles of reconstructive surgery.Preoperative modelling of full-layer flaps using a combined technique (infrared camera FLIR and portable Doppler SONO Trax) reduces the risk of necrosis of the movable flap and accelerates the process of closing of the defect of the anterior abdominal wall. Staged ("step-by-step") surgical treatment of the postoperative wound of the anterior abdominal wall by reconstruction via to the Keystone method showed a positive and rapid result of solving such a difficult problem as eventration complicated by small intestinal fistula.Restoration of the integrity of the anterior abdominal wall should be considered from the standpoint of reconstructive-restorative features

The author srepresent the original clinical data devoting to the further progress in reconstructive surgery. The methodology of the staged anterior abdominal wall defect reconstruction using the Keystone method was used firstly.The aim of the work is to demonstrate the peculiarity of preoperative preparation of patients with the anterior abdominal wall wounds complicated by small intestinal fistulas.The article uses the clinical materials of the concrete patient treatment in the Department of surgical infection of the South Region Military Medical Clinical Centre (Odessa, Ukraine) using the principle of the reconstructive-restorative surgery.The clinical case of the successful surgical treatment of anterior abdominal wall eventration, resulting from numerous laparotomies with pronounced lateralization of the wound, has shown that the solution to this problem should be based on the principles of reconstructive surgery.Preoperative modelling of full-layer flaps using a combined technique (infrared camera FLIR and portable Doppler SONO Trax) reduces the risk of necrosis of the movable flap and accelerates the process of closing of the defect of the anterior abdominal wall. Staged ("step-by-step") surgical treatment of the postoperative wound of the anterior abdominal wall by reconstruction via to the Keystone method showed a positive and rapid result of solving such a difficult problem as eventration complicated by small intestinal fistula.Restoration of the integrity of the anterior abdominal wall should be considered from the standpoint of reconstructive-restorative features

Introduction: Major surgeries, such as upper abdominal, thoracic and cardiac surgeries are highly complex procedures. They have a higher incidence of respiratory morbidity and mortality compared to other types of surgery. In addition, postoperative pulmonary complications (PPC) are common after major surgeries and they are associated with increased hospital stay, health care costs and surgical patient mortality. Objective: To investigate the most commonly used physical therapy techniques for the prevention and treatment of PPC among thoracic and abdominal surgery patients in all regions of Brazil. Methods: A total of 489 randomly selected physiotherapists who provided perioperative care for patients undergoing elective abdominal, thoracic or cardiac surgeries participated in this study. A questionnaire with nine questions about routine care and therapeutic choices for the surgical population was developed and assessed by 10 specialists before being administered to the physiotherapists. Results: Among the physiotherapists (63% with at least 5 years of experience with surgical patients), 50.9% considered the patient's surgical risk in their treatment either always or often. A total of 53.8% of patients were treated by the physiotherapist following a physician's prescription. The most mentioned physical therapy techniques used to prevent PPC were postoperative mobilization/exercises (59.3%), postoperative lung expansion techniques (52.8%) and preoperative advice (50.7%). In addition, 80.6% of the physiotherapists believe that incentive spirometry prevents PPC, while 72.8% expected this effect from positive airway pressure devices. Conclusion: Most physiotherapists in Brazil who work with surgical patients offer preoperative professional advice and use postoperative early mobilization and lung expansion techniques to prevent PPC. Most physiotherapists consider the patient's surgical risk during treatment. In addition, some physical therapy sessions are routinely performed preoperatively. One worrying aspect is that, due to the current legislation, physiotherapists in Brazil do not have full autonomy to initiate physical therapy care by themselves.

BACKGROUND : Advances in intra-abdominal pressure (IAP) measurement have enabled better monitoring and physiological manipulation of patients with intra-abdominal hypertension or abdominal compartment syndrome. This study aimed to determine the correlation between transvesical (TV), transgastric (TG) and direct transperitoneal (TP) IAP monitoring at different IAPs in porcine models. OBJECTIVES : To assess the statistical agreement between TV, TG and TP pressure monitoring in a pneumoperitoneum and an intestinal obstruction intra-abdominal hypertension model at different IAPs. METHODS : Fifty-nine pigs were divided into six groups: a control group (Cr; n=5), three pneumoperitoneum groups at pressures of 20 mmHg, 30 mmHg, and 40 mmHg (Pn20, Pn30, Pn40; n=40), and two intestinal-occlusion groups at pressures of 20 mmHg and 30 mmHg (Oc20, Oc30; n=14). IAP was simultaneously measured in each pig using the three methods at different times. The control group did not have any intervention to increase the IAP. Intra-class correlation was used to assess agreement between the methods. RESULTS : At pressures >20 mmHg, all three methods showed good correlation with each other (Pn20=0.87; Pn30=0.96; Pn40=0.88; Oc20=0.69; Oc30=0.86). Correlation between TP and TG (Cr=0.0; Pn20=0.85; Pn30=0.94; Pn40=0.90; Oc20=0.78; Oc30=0.78); TP and TV (Cr=0.0; Pn20=0.83; Pn30=0.95; Pn40=0.86; Oc20=0.59; Oc30=0.88); and importantly between TV and TG (Cr=0.0; Pn20=0.95; Pn30=0.98; Pn40=0.88; Oc20=0.69; Oc30=0.91) was good. CONCLUSION : All three measurement methods showed good correlation at pressures >20 mmHg and were unaffected by the type of IAP model. These results suggest that either transvesical or transgastric pressure measurements can be used for IAP measurement when TP pressures are >20 mmHg. ; Grant from Extremadura Regional Government through the Plan Regional de Investigación de Extremadura (PRI09A161 to Minimally Invasive Surgery Center Jesús Usón). ; http://www.sajcc.org.za ; am2018 ; Statistics