Elderly versus young patients with appendicitis 3 years experience

AbstractBackgroundAppendicitis in the elderly continues to be a challenging surgical problem. Patients continued to present late with atypical presentations. Results might improve with earlier consideration of the diagnosis in elderly patients with abdominal pain, followed by prompt surgical operation. We aimed to present our experience with a series of elderly patients with acute appendicitis who were subjected to appendectomy to find out the difference in the course and outcome of acute appendicitis in elderly patients.Patients and methodsWe reviewed medical records of elderly patients (aged>60years) who underwent appendectomy for acute appendicitis at our hospital. Variables selected for analysis included age, sex, presenting symptoms, operative approach, operative findings, duration of hospitalization. Patients were compared to a control group, less than 31years admitted during the same period.ResultsTwenty-three patients’ records aged>60years with acute appendicitis were compared to a group of 40 patients aged<30years. There were significant differences between the two groups with regard to duration of symptoms preoperative hospital stay and total hospital stay. All young patients group had an uneventful postoperative recovery only two cases (5%) had wound infection. There was one death in the elderly group thus mortality rate was 4.3%. These two groups of patients showed significant differences in relation to the stage of disease at operation and postoperative complications. Elderly group of patients had perforated appendix in 16 cases (69.5%) while in group II patients eight cases (20%) had perforated appendix.ConclusionAcute appendicitis in the elderly remains a challenge for practicing surgeons and continues to be associated with high morbidity and mortality. Results might improve with earlier consideration of the use of CT abdomen for diagnosis in elderly patients with abdominal pain, followed by prompt surgical operation

Retrograde (fundus first) Laparoscopic Cholecystectomy in Situs Inversus Totalis

Situs i nversus totalis (SIT) is an uncommon anomaly characterised by transposition of organs to the opposite side of the body in a mirror image of normal. It may cause difficulties in the diagnostic and therapeutic management of abdominal pathology due to the mirror-image anatomy. We report the management of a case of symptomatic cholilithiasis with emphasis on its surgical technique

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

Prospective, randomized controlled trial of LigaSure™ versus conventional hemorrhoidectomy for grade III and IV hemorrhoids

Background: Performing hemorrhoidectomy with LigaSure™ vessel sealing system is a rapid and simple new technique. The aim of this study was to evaluate LigaSure™ hemorrhoidectomy (LH) to open hemorrhoidectomy (OH) performed by the conventional diathermy. Patients and methods: One hundred and sixteen patients with grades III and IV hemorrhoids were prospectively randomized to either LigaSure™ or open conventional diathermy hemorrhoidectomy. Primary end point was postoperative pain. Secondary end points were operative time, blood loss, complications, need for analgesics and time to achieve complete wound healing. Results: The LigaSure™ group achieved a significant reduction in operative time, blood loss, first postoperative day pain score, seventh day pain score and overall pain score. Patients in the LigaSure™ group required less pethidine analgesia on the first postoperative day. Time to achieve complete wound healing were shorter in the LigaSure™ group. There was no difference in postoperative complications. Conclusion: LigaSure™ hemorrhoidectomy provides a valid alternative to conventional hemorrhoidectomy. Based on our results, further studies addressing long-term functional results are needed to prove that LigaSure™ hemorrhoidectomy is the ideal method of hemorrhoidectomy for the patients

Laser Hair Removal as Adjunct to Surgery for Pilonidal Sinus: Our Initial Experience

Background : Chronic pilonidal disease is a common debilitating condition. It is a cause of considerable morbidity and social embarrassment. This prospective randomized study compared permanent laser hair removal following the excision of pilonidal disease with conventional methods for hair removal. Materials and Methods : Patients undergoing surgery for pilonidal disease were randomized to two groups: those using laser hair removal methods following completed healing of wounds (group I) or regular post-healing conventional methods for hair removal, mainly razor and depilatory creams, for at least 6 months (group II). Group I patients received regular, monthly laser hair treatment sessions using Alexandrite laser for four sessions. Results : Group I patients had a mean age of 23.6 ± 4.7 years. Group I patients had monthly laser hair removal session and then they were regularly followed up within the proposed schedule. They found the procedure comfortable with no complications. Group II patients had a mean age of 23.7 ± 6.6 years; they reported difficulty in maintaining hair removal with these conventional methods, and mostly, by the end of the first year, all cases stopped maintaining regular hair removal. Recurrence occurred in Group II patients (two cases) mostly due to failure in maintaining hair removal and area hygiene. Conclusions : We advocate the use of laser epilation after surgery for pilonidal sinus as it decreases the chance of recurrence but larger studies with long-term follow-up are still needed to approve this conclusion

Early versus interval cholecystectomy for acute cholecystitis: 5 years local experience

Early laparoscopic cholecystectomy for acute cholecystitis is technically demanding procedure associated with more rate of conversion to open cholecystectomy and more complications. Recently some studies demonstrate the feasibility of laparoscopic cholecystectomy for acute cholecystitis. However, many surgeons still prefer delayed laparoscopic cholecystectomy for acute cholecystitis. Our aim of this prospective randomized study was to compare the operative time, conversion rate, hospital stay, outcome and cost of early versus delayed laparoscopic cholecystectomy for acute cholecystitis Patients and Methods. Between January 2010and January 2015, 62patients with a diagnosis of acute cholecystitis underwent early laparoscopic cholecystectomy within 72 h of admission (group I). This study group was compared with a control group of 114patients of acute cholecystitis, who underwent delayed laparoscopic cholecystectomy after an initial period of conservative treatment (group II). Results. There was no significant difference in the conversion rates (3 in group I versus 2 in group II), duration of postoperative stay (2days in group I versus 3.5 days in group II) postoperative analgesia requirements and postoperative pain scores. However, duration of surgery was significantly more in group I (110 minutes versus 85 minutes in group II).No mortality was seen in either group. Total costs were higher (6450 ± 875.4 versus 8570 ± 775 Saudi Ryal; P = 0.0001) in group II patients. Conclusions. Early laparoscopic cholecystectomy for acute cholecystitis is safe, feasible, with shorter hospital stay and cost effective management of acute cholecystitis cases

Laparoscopic cholecystectomy as a day surgery operation: two centers experience

Background: Day-surgery laparoscopic cholecystectomy (DSLC) become the standard management of chronic gall bladder diseases worldwide due to its safety and feasibility. The aim of the present study was to study DSLC at two secondary care governmental hospitals in Saudi Arabia with a separate day-surgery unite in terms of complications, same-day discharge, to identify early discharge associated problems, and to determine patient satisfaction. Methods: Over a 3-years period, all patients undergoing elective laparoscopic cholecystectomy under the authors were prospectively studied. Patients fulfill criteria for DSLC were offered the procedure. All patients were asked on follow up postoperatively about their satisfaction and recommendation of DSLC for their relatives and friends. Results: Eight hundred and sixteen patients underwent elective day surgery laparoscopic cholecystectomies, predominantly female (89.7%) and ASA I (77.2%) with a mean age 38.1± 18.7 years. Eighty eight percent of the patients were discharged directly from the day surgery unite, and nearly 89.6% of the patients were discharged within 24 hours of the operation. Re-admission following hospital discharge was necessary for 3 patients (0.37%). The overall rate of complications was 1.35% (11patients). At follow-up, 701 patients (97.36%) were satisfied with their experience undergoing DSLC. Conclusions: Our findings support the evidence that DSLC is safe and feasible. Many patients satisfied with their length of stay and day surgery ward care although we extend the criteria for DSLC