Abdominal Surgery in Hiv/Aids Patients: Indications, Operative Management, Pathology and Outcome

Abstract

Despite the increasing number of patients with the human immunodeficiency virus (HIV) infection. surgical experience with these patients remains limited. A retrospective review over a 9 year period (January 1985 to December 1993) was undertaken to determine the indications, operative management. pathologic findings and outcome of major abdominal surgery in these patients. A total of 51 procedures were performed in 45 patients; 30 patients had acquired immunodeficiency syndrome (AIDS) and IS patients had asymptomatic HIV infection. Indications included gastrointestinal bleeding. complicated pancreatic pseudocysts. cholelithiasis. bowel obstruction, immune disorders, acute abdomens. elective laparotomy. colostomy formation. menorrhagia and Caesarean section. Pathologic findings directly related to the HIV infection were found in 81% of the AIDS patients and 35% of the asymptomatic HIV infected patients (P<0.05). These included opportunistic infections. non‐Hodgkin's lymphoma. Kaposi's sarcoma, immune disorders. lymphadenopathy and pancreatic pseudocysts. It was noted that AIDS patients had more complications than asymptomatic HIV infected patients with most complications related to chest problems and sepsis (61 vs 7%; P<0.01). Emergency operations carried a higher complication rate than elective operations though this was not significant. The hospital mortality was 12%. On follow up, 13 of the 25 AIDS patients had died with the median survival of 7 months, while three of the 14 asymptomatic HIV infected patients had died with the median survival of 40 months. Of the remaining patients, the 12 AIDS patients had a median postoperative follow up of 7 months and the 11 asymptomatic HIV infected patients had a median postoperative follow up of 29.5 months. Despite impaired immune function, surgical treatment of HIV infected patients with abdominal pathology can be practised with acceptable mortality and morbidity and be of major benefit to these patients.

The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study

“…[14,15] also reported that, in the HIV-infected patients, only a higher HI viral load and a CD4 cell count less than 50/µL was associated with more surgical complications. These two studies included many different types of surgery, both major and minor, whereas ours was on breast surgery only.…”

Acute Abdomen and HIV Infection

“…Thus, the prognosis is unfortunate 40,41,42 . Surgery will offer no more than palliation of the acute problem with slight advantage in prognosis 4,8,14,42 . Small-bowel resection can be carried out with primary anastomoses, whereas large bowel resection may call for fecal diversion 38 .…”

“…Although profound immunodeficiency is associated with poor prognosis, asymptomatic HIV-infected patients recover well from surgery and do not appear to suffer delayed healing 6,7 . Yet, with new antiviral therapy the operative mortality has dropped as much as necessary for emergency abdominal surgery and the riskbenefit analysis is now more in favour of laparotomy 5,8,9 .…”

Successful curative resection of gastric cancer with AIDS infection

“…In the present patient, candidiasis of the esophagus was observed in an endoscopic examination. Moreover, the CD4 T lymphocyte count was 100/mm 3 . As a result, his clinical stage was IV, according to the staging system of Montaner et al [7], which provides a prognostically meaningful classification.…”

“…As the number of people infected with human immunodeficiency virus (HIV) has increased, the opportunity to treat HIV infection associated with other diseases, such as malignant neoplasms, is increasing [1][2][3]. With the introduction of new pharmacological agents and a better understanding of HIV infection, survival in these patients has improved.…”