Missing intrauterine devices, laparoscopic and a_x000D_ conventional management: A single–center experience

Introduction: Intrauterine contraception devices (IUCD) are frequently and safely used in pregnancy control. Migration related complications, such as adhesions and perforations, can be encountered as the most important_x000D_ but rare circumstances. In such cases, the laparoscopic approach is beneficial with the least harm principle._x000D_ Materials and Methods: This study included ten patients who were admitted to our hospital between 2015–_x000D_ 2019 with chronic abdominal pain, induced by migrated intrauterine devices. Patients’ complaints, radiological methods used in diagnosis, IUCD insertion timing, migration of IUCD and time interval to diagnosis, intra–abdominal migration points, and types, as well as surgical interventions, were evaluated retrospectively._x000D_ Results: While all patients were diagnosed with abdominal ultrasonography and gynecological examination, some patients underwent computed tomography 60% and plain radiogram 20% as additional imaging._x000D_ While the intra–abdominal migration site of IUCD was ascertained as the most common localization in the_x000D_ lower right quadrant of the omentum (30%), the placement in the umbilical hernia site was the rarest and the_x000D_ only one in the literature. Three different types of IUCD were detected; Copper–T (80%) was the most common, while IUCDs were laparoscopically removed in all patients except for the patient who underwent open_x000D_ surgery due to acute cholecystitis. All patients who had laparoscopic surgery were discharged the next day._x000D_ Conclusion: In conclusion, the IUCD’s frequency of use is increasing as the current method of contraception,_x000D_ dislocation of the device may be encountered if the required conditions are not taken into consideration_x000D_ during the application. In such a situation, laparoscopic removal of a dislocated IUCD is a safe, feasible, and_x000D_ less invasive method

Effectiveness of the laparoscopic appendectomy on_x000D_ second half of the pregnancy

Aim: Although the debate regarding fetal loss and preterm delivery continues, the use of laparoscopic appendectomy (LA) to treat_x000D_ pregnant women has gained legitimacy owing to the advantages it brings, such as less uterine manipulation, less postoperative_x000D_ pain, and an early return to normal daily activity. This present study aims to compare the impact of LA on women in early and late_x000D_ gestation periods with regard to surgical outcomes._x000D_ Material and Methods: After scanning the files of 4,295 cases, 29 patients who underwent LA for acute appendicitis during pregnancy_x000D_ were enrolled in the study and were assessed retrospectively. The patients were divided into two groups: women with a gestation_x000D_ period less than 20 weeks (group 1; n=19) and those over 20 weeks (group 2; n=10). Data from these two groups, including patient_x000D_ perioperative characteristics and morbidity, were compared._x000D_ Results: The results showed no statistical difference between the two groups. No statistically significant difference was detected_x000D_ in terms of mean age, body mass index, length of hospital stay, operation time or median ASA score (p > 0.05). Moreover, mean_x000D_ INR (International normalized ratio), hemoglobin, hematocrit, white blood cell count, neutrophil-to-lymphocyte ratio, plateletto-lymphocyte ratio, red cell distribution width, platelet distribution width and histopathological examination of the appendicitis_x000D_ revealed no statistical difference between the two groups (p > 0.05). Most importantly, comparison of surgical site infection (6.8%),_x000D_ intra-peritoneal collection (3.4%), fetal distress and preterm delivery rate (6.8%), and abortus imminens (3.4%) also showed no_x000D_ significant difference (P > 0.05). In this study, no fetal loss was recorded._x000D_ Conclusion: The results of present study suggest that LA for acute appendicitis in pregnant women can be performed safely during_x000D_ the second half of pregnancy

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)