ABDOMINAL-SURGERY IN HIV AIDS PATIENTS - INDICATIONS, OPERATIVE MANAGEMENT, PATHOLOGY AND OUTCOME

Despite the increasing number of patients with the human immunodeficie ncy virus (HIV) infection, surgical experience with these patients rem ains limited. A retrospective review over a 9 year period (January 198 5 to December 1993) was undertaken to determine the indications, opera tive management, pathologic findings and outcome of major abdominal su rgery in these patients. A total of 51 procedures were performed in 45 patients; 30 patients had acquired immunodeficiency syndrome (AIDS) a nd 15 patients had asymptomatic HIV infection. Indications included ga strointestinal bleeding, complicated pancreatic pseudocysts, cholelith iasis, bowel obstruction, immune disorders, acute abdomens, elective l aparotomy, colostomy formation, menorrhagia and Caesarean section. Pat hologic findings directly related to the HIV infection were found in 8 1% of the AIDS patients and 35% of the asymptomatic HIV infected patie nts (P < 0.05). These included opportunistic infections, non-Hodgkin's lymphoma, Kaposi's sarcoma, immune disorders, lymphadenopathy and pan creatic pseudocysts. It was noted that AIDS patients had more complica tions than asymptomatic HIV infected patients with most complications related to chest problems and sepsis (61 vs 7%; P < 0.01). Emergency o perations carried a higher complication rate than elective operations though this was not significant. The hospital mortality was 12%. On fo llow up, 13 of the 25 AIDS patients had died with the median survival of 7 months, while three of the 14 asymptomatic HN infected patients h ad died with the median survival of 40 months. Of the remaining patien ts, the 12 AIDS patients had a median postoperative follow up of 7 mon ths and the 11 asymptomatic HIV infected patients had a median postope rative follow up of 29.5 months. Despite impaired immune function, sur gical treatment of HIV infected patients with abdominal pathology can be practised with acceptable mortality and morbidity and be of major b enefit to these patients.