Comparison Between Primary Resection Anastomosis and Hartmann Procedure for the Treatment of Hinchey III and IV Acute Diverticulitis in the Emergency Setting

Aim: The surgical management of perforated sigmoid diverticulitis and generalised peritonitis is challenging. We aimed to evaluate the safety and efficacy of primary anastomosis reducing end-stoma rate and to identify the appropriate surgical timing in the emergency setting for Hinchey III and IV acute diverticulitis. Method: Pertinent data of all patients who underwent Hartmann or primary resection anastomosis (PRA) for Hinchey III and IV diverticulitis, performed between January 2014 and April 2019, were entered in a prospectively maintained database. A retrospective analysis was conducted. Results: During the study period 365 patients underwent emergency surgery for colorectal diseases, 84 for acute left-sided colonic diverticulitis. Patients with Hinchey Stage IIb, stenosis and diverticular hemorrhage were excluded. After selection, a total of 36 Hinchey III and Hinchey IV patients, comparing 19 primary resections anastomosis and 17 Hartmann procedures, were finally enrolled in this study. Patient characteristics were equivalent between groups. The primary anastomosis group showed a reduction in reoperation rate for postoperative complications (5.3%, 1/19 vs 23.55%, 4/17; p=0.335) compared with the Hartmann group. Mortality was 10.5% (2/19) vs 29.4% (5/17) for the primary anastomosis versus Hartmann resection groups (p=0.256). Among patients, there was a statistically significant increase in reversal rate for the primary anastomosis group (42.1% vs 0%; p=0.002). Conclusion: PRA and protective ileostomy approaches for Hinchey III and IV acute diverticulitis may be safe and feasible, resulting in satisfactory perioperative outcomes, postoperative complications and reversal rate. The study is ongoing to confirm these results with increased sample size and confidence

Hepatic abscess. An uncommon complication after laparoscopic appendectomy

Laparoscopic appendectomy is currently the treatment of choice for acute appendicitis in emergency setting. When appendicitis is clinically suspected, an appendicolith can be found in 30% of the patients. Retained or dropped appendicoliths are an uncommon complication that may occur as a consequence of stone expulsion from the appendix, before or during laparoscopic appendectomies. This is very rare with only 30 reported cases of intra-abdominal abscess secondary to an appendicolith in the literature over the past 40 years. The objective of this case report is to illustrate an intrahepatic localization of a dropped appendicolith causing liver abscess

Influence of blunt needles on surgical glove perforation and safety for the surgeon

BACKGROUND: Round-tipped blunt needle (BN) may decrease the risk of needlestick injuries and hand contamination. We prospectively determined the incidence of glove perforations in emergency abdominal procedures and the efficacy of BN in increasing the safety for surgeons. METHODS: TWO hundred patients were randomized to undergo closure of the abdominal fascia using sharp needle (SN) or BN. Gloves were tested at the end of the procedure. RESULTS: Surgeons had 14 needlestick injuries and 76 perforations recorded in 69 pair of gloves. Sharp needles were responsible for ail injuries and 58 (76%) perforations (P <0.00004 and P <0.00001, respectively). This difference was still higher when considering the perforations related to the abdominal fascia closure (BN 7% Versus SN 50%; P <0.0006). CONCLUSION: The risk of glove perforation is sevenfold greater if SN are used. Blunt needles reduce sharp injuries and improve safety for surgeons. (C) 1996 by Excerpta Medica, Inc

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p&nbsp;=&nbsp;0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3&nbsp;days, with an OR (95%CI) at 4-7&nbsp;days or ≥&nbsp;8&nbsp;days of 1.25 (1.04-1.48), p&nbsp;=&nbsp;0.015 and 1.31 (1.11-1.55), p&nbsp;=&nbsp;0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or &gt;= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care