Pub Date : 2021-09-30DOI: 10.23937/2378-3397/1410130
D. Bawa, Saleem Khan, Y. Khalifa, Shashi Sharma, Amal A Alghamdi, H. Albishi, Nasser Al Tufail
Background: There is a high prevalence of goiter in Bisha despite more than 15 years of the national campaign for increased dietary iodine supplementation. The cause is multifactorial. It is associated with non-neoplastic and neoplastic conditions. Surgical management has evolved over many years. Purpose: To describe the pathological types of goiter in Bisha along with their management and to discuss current surgical considerations. Methodology: A retrospective review of 339 patients with goiter diagnosed by FNAC and or histopathological examination and managed surgically or non-surgically. Results: There were 339 patients, of which 280 (82.6%) were females and 59 (17.4%) males. Age range was seven to 94 years with a mean of 39.18 ± 13.87 years. There were 138 (40.7%) multinodular goiters, 82 (24.2%) colloid goiters, 8 diffuse goiters (2.4%), 40 (11%) solitary thyroid nodules, 10 thyroid nodules (2.9%), 14 thyroid cysts (4.1%), 20 Hashimoto’s thyroiditis (5.9%) and two de Quervain’s thyroiditis (0.6%). Benign thyroid neoplasms comprised of 25 (7.4%) follicular adenomas and 11 (3.2%) Hürthle cell adenomas. Malignant thyroid disorders consisted of 18 (5.3%) papillary thyroid cancers, 7 (2.1%) mixed papillary/ follicular thyroid cancers, one (0.3%) mixed follicular/ papillary thyroid cancer, and three (0.9%) follicular thyroid cancers respectively. There were 128 (37.1%) total thyroidectomies, 70 (20.6%) hemithyroidectomies, 10 (2.9%) subtotal thyroidectomies and, 5 (1.5%) near-total thyroidectomies. There were 125 (36.9%) patients who had no surgery. The overall complication rate was 14.5%. Conclusion: Thyroid disorders are still prevalent despite years of dietary iodine supplementation campaigns. The rate of complications following total thyroidectomy is significant and guidelines are changing.
{"title":"Retrospective Study on the Incidence of Thyroid Disorders in Bisha and Evolving Surgical Management Considerations","authors":"D. Bawa, Saleem Khan, Y. Khalifa, Shashi Sharma, Amal A Alghamdi, H. Albishi, Nasser Al Tufail","doi":"10.23937/2378-3397/1410130","DOIUrl":"https://doi.org/10.23937/2378-3397/1410130","url":null,"abstract":"Background: There is a high prevalence of goiter in Bisha despite more than 15 years of the national campaign for increased dietary iodine supplementation. The cause is multifactorial. It is associated with non-neoplastic and neoplastic conditions. Surgical management has evolved over many years. Purpose: To describe the pathological types of goiter in Bisha along with their management and to discuss current surgical considerations. Methodology: A retrospective review of 339 patients with goiter diagnosed by FNAC and or histopathological examination and managed surgically or non-surgically. Results: There were 339 patients, of which 280 (82.6%) were females and 59 (17.4%) males. Age range was seven to 94 years with a mean of 39.18 ± 13.87 years. There were 138 (40.7%) multinodular goiters, 82 (24.2%) colloid goiters, 8 diffuse goiters (2.4%), 40 (11%) solitary thyroid nodules, 10 thyroid nodules (2.9%), 14 thyroid cysts (4.1%), 20 Hashimoto’s thyroiditis (5.9%) and two de Quervain’s thyroiditis (0.6%). Benign thyroid neoplasms comprised of 25 (7.4%) follicular adenomas and 11 (3.2%) Hürthle cell adenomas. Malignant thyroid disorders consisted of 18 (5.3%) papillary thyroid cancers, 7 (2.1%) mixed papillary/ follicular thyroid cancers, one (0.3%) mixed follicular/ papillary thyroid cancer, and three (0.9%) follicular thyroid cancers respectively. There were 128 (37.1%) total thyroidectomies, 70 (20.6%) hemithyroidectomies, 10 (2.9%) subtotal thyroidectomies and, 5 (1.5%) near-total thyroidectomies. There were 125 (36.9%) patients who had no surgery. The overall complication rate was 14.5%. Conclusion: Thyroid disorders are still prevalent despite years of dietary iodine supplementation campaigns. The rate of complications following total thyroidectomy is significant and guidelines are changing.","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127136599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-30DOI: 10.23937/2378-3397/1410131
Ogolo Donald E
Background: Bladder cancer (CAB) is a urological malignancy that significantly contributes to morbidity and mortality, especially when detected late. Aim: This study highlights the challenges of late presentation and changing histological trend of the condition in a low resource region. The objectives were to establish the relationship between demographic factors, and to elucidate some characteristics of histological patterns in our region. Methods: A retrospective cohort study of all cases of bladder cancer seen at our facility between 2011 and 2015 was carried out utilizing data from patient case notes. Extracted data was analyzed using descriptive statistics. Results: A total of 18 cases of histologically confirmed bladder cancer were reviewed-12 males (66.7%) and 6 females (33.3%), with a male to female ratio of 2:1. The patients were aged between 19 and 78 years. Majority were petty traders (44%). Transitional cell carcinoma (TCCAB) was confirmed in 12 cases (66.7%) and squamous cell cancer (SCCAB) in 6 cases (33.3%). Majority of the cases of SCCAB were seen in patients below 30 years of age (66.7%) while majority for TCCAB were above 50 years (91.7%). The commonest presenting complaint was total, painless haematuria with associated clots (77.8%) with average duration from time of onset to presentation at this facility of 2 months and 3 weeks for SCCAB and 17 months for TCCAB. Hemoglobin level at presentation was between 6-8 g/dl in 44.4% of cases. Majority seen on abdominal ultrasound scan and cystoscopy were flat masses (61.1%). Most cases were stage I for TCCAB (58.3%) and stage II for SCCAB (83.3%), while 11.1% were metastatic requiring chemotherapy. There was one case of recurrence (stage II) within the first year of follow up. Conclusion: TCCAB is taking an increasing prominence relative to SCCAB in the region. Effective treatment of bladder cancer is highly dependent on early presentation and diagnosis, and prevention entails prompt risk factor identification and intervention.
{"title":"Cancer of the Bladder in South East Nigeria: Epidemiological Patterns in a Low Resource Region","authors":"Ogolo Donald E","doi":"10.23937/2378-3397/1410131","DOIUrl":"https://doi.org/10.23937/2378-3397/1410131","url":null,"abstract":"Background: Bladder cancer (CAB) is a urological malignancy that significantly contributes to morbidity and mortality, especially when detected late. Aim: This study highlights the challenges of late presentation and changing histological trend of the condition in a low resource region. The objectives were to establish the relationship between demographic factors, and to elucidate some characteristics of histological patterns in our region. Methods: A retrospective cohort study of all cases of bladder cancer seen at our facility between 2011 and 2015 was carried out utilizing data from patient case notes. Extracted data was analyzed using descriptive statistics. Results: A total of 18 cases of histologically confirmed bladder cancer were reviewed-12 males (66.7%) and 6 females (33.3%), with a male to female ratio of 2:1. The patients were aged between 19 and 78 years. Majority were petty traders (44%). Transitional cell carcinoma (TCCAB) was confirmed in 12 cases (66.7%) and squamous cell cancer (SCCAB) in 6 cases (33.3%). Majority of the cases of SCCAB were seen in patients below 30 years of age (66.7%) while majority for TCCAB were above 50 years (91.7%). The commonest presenting complaint was total, painless haematuria with associated clots (77.8%) with average duration from time of onset to presentation at this facility of 2 months and 3 weeks for SCCAB and 17 months for TCCAB. Hemoglobin level at presentation was between 6-8 g/dl in 44.4% of cases. Majority seen on abdominal ultrasound scan and cystoscopy were flat masses (61.1%). Most cases were stage I for TCCAB (58.3%) and stage II for SCCAB (83.3%), while 11.1% were metastatic requiring chemotherapy. There was one case of recurrence (stage II) within the first year of follow up. Conclusion: TCCAB is taking an increasing prominence relative to SCCAB in the region. Effective treatment of bladder cancer is highly dependent on early presentation and diagnosis, and prevention entails prompt risk factor identification and intervention.","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132204768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-30DOI: 10.23937/2378-3397/1410132
alfred ogwal, K. K. Toitole, Vincent Medeyi, Emmanuel Nkonge, Herbert Ariaka, Felix Oyania
{"title":"Telemedicine Clinic Reviews as an Alternative to Traditional Postoperative Clinic Visits: Sub-Saharan Africa Dilemma","authors":"alfred ogwal, K. K. Toitole, Vincent Medeyi, Emmanuel Nkonge, Herbert Ariaka, Felix Oyania","doi":"10.23937/2378-3397/1410132","DOIUrl":"https://doi.org/10.23937/2378-3397/1410132","url":null,"abstract":"","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133694650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"International Journal of Surgery Research and Practice","authors":"Karmakar Shilpi, Singh Arun Kumar, Karmakar Saurabh","doi":"10.23937/2378-3397","DOIUrl":"https://doi.org/10.23937/2378-3397","url":null,"abstract":"","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128423990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-04DOI: 10.23937/2378-3397/1410106
Pannu Arslan, Dar Ghulam Murtaza, A. Shahzad, Hajibandeh Shahab, Hajibaneh Shahin, Lawrence Eloise, J. Salman, K. Khurram, S. Rishabha, M. Ahmad
Introduction: Controversy exists regarding the role of laparoscopic peritoneal lavage in patients with perforated diverticulitis. Our objective was to conduct the first meta-anal ysis of Randomized Controlled Trials (RCT’s) to compare the outcomes of patient undergoing laparoscopic peritoneal lavage with sigmoidectomy in patients with perforated di verticulitis. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) state ment standards, we conducted a systematic search of elec tronic information sources, including MEDLINE; EMBASE; CINAHL; CENTRAL; The World Health Organization Inter national Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall morbidity, mortality, and postoperative complications were defined as the prima ry outcome parameters. Procedure time and length of hos pital stay were secondary outcomes. The combined overall effect sizes were calculated using fixed-effect or random-ef fects models. Results: We identified 4 RCT’s comparing outcomes of lap aroscopic peritoneal lavage and open sigmoidectomy for perforated diverticulitis. All studies included only Hinchey grade III diverticulitis. The subsequent analysis, including 390 patients, demonstrated that laparoscopic peritoneal lavage of perforated diverticulitis was associated with significantly increased rates of overall morbidity (OR: 1.30, 95% CI 1.07-1.57, p = 0.007) and intra-abdominal abscess (OR: 3.10, 95% CI 1.71-5.63, p = 0.0002) compared to sig -moidectomy. However, there was no significant difference in mortality (OR: 0.86, 95% CI 0.42-1.77, p = 0.69) and re-operation (OR: 1.20, 95% CI 0.36-4.02, p = 0.77) rates between the two groups. Between-study heterogeneity was non-significant in all analyses, except reoperation rate (I 2 = 79%, p = 0.002). The available data did not allow an appro priate analysis of procedure time, length of hospital stay and other postoperative complications. Conclusions: Our analysis of randomised trials demon strated that laparoscopic peritoneal lavage of perforated diverticulitis may lead to more adverse events than open sigmoid resection. Future high quality RCT’s are indeed re quired to provide stronger evidence as no definitive conclu sion can be drawn considering the limited number of avail able RCT’s.
导读:关于腹腔镜下腹腔灌洗在穿孔性憩室炎患者中的作用存在争议。我们的目的是对随机对照试验(RCT)进行首次荟萃分析，比较腹腔镜腹膜灌洗和乙状结肠切除术治疗穿孔性椎体炎患者的结果。方法:按照PRISMA (Preferred Reporting Items for Systematic Reviews and meta - analysis)声明标准，系统检索电子信息源，包括MEDLINE;EMBASE;CINAHL;中央;世界卫生组织国际临床试验登记处;ClinicalTrials.gov;ISRCTN注册表和参考书目列表。我们应用了自由文本和受控词汇搜索的组合，适应于上述每个数据库中的同义词典标题、搜索操作符和限制。总体发病率、死亡率和术后并发症被定义为主要结局参数。手术时间和住院时间是次要观察指标。使用固定效应或随机效应模型计算综合总体效应大小。结果:我们确定了4项RCT，比较了腹腔镜下腹腔灌洗和乙状结肠切除术治疗穿孔性憩室炎的结果。所有研究仅包括Hinchey III级憩室炎。随后的分析，包括390例患者，表明腹腔镜腹膜灌洗穿孔性憩室炎的总发病率(OR: 1.30, 95% CI 1.07-1.57, p = 0.007)和腹腔脓肿(OR: 3.10, 95% CI 1.71-5.63, p = 0.0002)与征状窦切除术相比显著增加。然而，两组患者的死亡率(OR: 0.86, 95% CI 0.42-1.77, p = 0.69)和再手术率(OR: 1.20, 95% CI 0.36-4.02, p = 0.77)差异无统计学意义。除再手术率(i2 = 79%， p = 0.002)外，所有分析的研究间异质性均不显著。现有的数据不允许对手术时间、住院时间和其他术后并发症进行适当的分析。结论:我们对随机试验的分析表明，腹腔镜下腹腔灌洗治疗穿孔性憩室炎可能比乙状结肠切除术导致更多的不良事件。由于可用的随机对照试验数量有限，因此无法得出明确的结论，因此确实需要未来的高质量随机对照试验提供更有力的证据。
{"title":"Laparoscopic Peritoneal Lavage versus Sigmoidectomy for Management of Perforated Diverticulitis: Meta-Analysis of Randomized Controlled Trials","authors":"Pannu Arslan, Dar Ghulam Murtaza, A. Shahzad, Hajibandeh Shahab, Hajibaneh Shahin, Lawrence Eloise, J. Salman, K. Khurram, S. Rishabha, M. Ahmad","doi":"10.23937/2378-3397/1410106","DOIUrl":"https://doi.org/10.23937/2378-3397/1410106","url":null,"abstract":"Introduction: Controversy exists regarding the role of laparoscopic peritoneal lavage in patients with perforated diverticulitis. Our objective was to conduct the first meta-anal ysis of Randomized Controlled Trials (RCT’s) to compare the outcomes of patient undergoing laparoscopic peritoneal lavage with sigmoidectomy in patients with perforated di verticulitis. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) state ment standards, we conducted a systematic search of elec tronic information sources, including MEDLINE; EMBASE; CINAHL; CENTRAL; The World Health Organization Inter national Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall morbidity, mortality, and postoperative complications were defined as the prima ry outcome parameters. Procedure time and length of hos pital stay were secondary outcomes. The combined overall effect sizes were calculated using fixed-effect or random-ef fects models. Results: We identified 4 RCT’s comparing outcomes of lap aroscopic peritoneal lavage and open sigmoidectomy for perforated diverticulitis. All studies included only Hinchey grade III diverticulitis. The subsequent analysis, including 390 patients, demonstrated that laparoscopic peritoneal lavage of perforated diverticulitis was associated with significantly increased rates of overall morbidity (OR: 1.30, 95% CI 1.07-1.57, p = 0.007) and intra-abdominal abscess (OR: 3.10, 95% CI 1.71-5.63, p = 0.0002) compared to sig -moidectomy. However, there was no significant difference in mortality (OR: 0.86, 95% CI 0.42-1.77, p = 0.69) and re-operation (OR: 1.20, 95% CI 0.36-4.02, p = 0.77) rates between the two groups. Between-study heterogeneity was non-significant in all analyses, except reoperation rate (I 2 = 79%, p = 0.002). The available data did not allow an appro priate analysis of procedure time, length of hospital stay and other postoperative complications. Conclusions: Our analysis of randomised trials demon strated that laparoscopic peritoneal lavage of perforated diverticulitis may lead to more adverse events than open sigmoid resection. Future high quality RCT’s are indeed re quired to provide stronger evidence as no definitive conclu sion can be drawn considering the limited number of avail able RCT’s.","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125466616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-31DOI: 10.23937/2378-3397/1410105
A. Kusay, B. Bashar, Banjah Bassel
Introduction: Epiphrenic diverticulum is a relatively rare clinical case. It is defined as an outpouching of the mucosal and submucosal layers through the muscular layer of esophagus in association with motility disorders. Most patients are asymptomatic and the other manifest with variable symptoms including dysphagia, regurgitation, halitosis, vomiting, heartburn and weight loss. Presentation of case: Herein we report a case of a 50-year-old female who presented to our hospital with complaint of dysphagia and weight loss. The clinical and radiological findings suggested left epiphrenic diverticulum about 3 cm in diameter. As the best and most appropriate treatment, we performed laparoscopic transhiatal diverticulectomy, Heller esophageo cardiomyotomy and Dor anterior fundoplication. The patient was discharged home in the second day with some recommendations and she was well. Discussion: The main treatment of epiphrenic diverticula is diverticulectomy transhiatal via laparoscopy followed by Heller myotomy and antireflux procedure. Conclusion: We advise surgeons to consider the operative approach because it is safe, effective and has less complications compared the other approaches.
{"title":"A Case Report of an Epiphrenic Esophageal Diverticulum was Treated via Laparoscopic Transhiatal Diverticulectomy","authors":"A. Kusay, B. Bashar, Banjah Bassel","doi":"10.23937/2378-3397/1410105","DOIUrl":"https://doi.org/10.23937/2378-3397/1410105","url":null,"abstract":"Introduction: Epiphrenic diverticulum is a relatively rare clinical case. It is defined as an outpouching of the mucosal and submucosal layers through the muscular layer of esophagus in association with motility disorders. Most patients are asymptomatic and the other manifest with variable symptoms including dysphagia, regurgitation, halitosis, vomiting, heartburn and weight loss. Presentation of case: Herein we report a case of a 50-year-old female who presented to our hospital with complaint of dysphagia and weight loss. The clinical and radiological findings suggested left epiphrenic diverticulum about 3 cm in diameter. As the best and most appropriate treatment, we performed laparoscopic transhiatal diverticulectomy, Heller esophageo cardiomyotomy and Dor anterior fundoplication. The patient was discharged home in the second day with some recommendations and she was well. Discussion: The main treatment of epiphrenic diverticula is diverticulectomy transhiatal via laparoscopy followed by Heller myotomy and antireflux procedure. Conclusion: We advise surgeons to consider the operative approach because it is safe, effective and has less complications compared the other approaches.","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127600653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-29DOI: 10.23937/2378-3397/1410104
Yorke Joseph, A. Williams, A. George, H. Bernard, Boateng Edward Amoah, G. Frank, Aitpillah Francis Somiah-Kwaw, Ababio Kwabena Acheamfour, Ahulu Dorcas, Yorke Dennis Afful, A. Emmanuel
Retained surgical sponges (gossypiboma) are very rare but occur even under the presumed correct sponge counts postoperatively. Gossypiboma has the ability to cause significant harm to the patient and carry heartfelt medicolegal and professional repercussions to clinicians and hospitals. Its mani-festations may be non-specific and may take weeks, months or even years from the time of surgery. Therefore, diagnosis is based on a high index of suspicion with careful assessment of the patient’s history, physical examination, and investigation. Retained sponges may extrude externally through a fistulous tract or internally into the rectum, vagina, bladder, intestinal lumen or through direct migration; however, intra-luminal migration is relatively rare. It is in consonance with this rarity that we report a case of an intestinal obstruction secondary to an intra-luminal foreign body. Intra-operative findings revealed a laparotomy towel accidentally left behind during a laparotomy for a ruptured acute appendicitis.
{"title":"Intestinal Obstruction Secondary to Intra-Luminal Retained Laparotomy Towel: A Case Report","authors":"Yorke Joseph, A. Williams, A. George, H. Bernard, Boateng Edward Amoah, G. Frank, Aitpillah Francis Somiah-Kwaw, Ababio Kwabena Acheamfour, Ahulu Dorcas, Yorke Dennis Afful, A. Emmanuel","doi":"10.23937/2378-3397/1410104","DOIUrl":"https://doi.org/10.23937/2378-3397/1410104","url":null,"abstract":"Retained surgical sponges (gossypiboma) are very rare but occur even under the presumed correct sponge counts postoperatively. Gossypiboma has the ability to cause significant harm to the patient and carry heartfelt medicolegal and professional repercussions to clinicians and hospitals. Its mani-festations may be non-specific and may take weeks, months or even years from the time of surgery. Therefore, diagnosis is based on a high index of suspicion with careful assessment of the patient’s history, physical examination, and investigation. Retained sponges may extrude externally through a fistulous tract or internally into the rectum, vagina, bladder, intestinal lumen or through direct migration; however, intra-luminal migration is relatively rare. It is in consonance with this rarity that we report a case of an intestinal obstruction secondary to an intra-luminal foreign body. Intra-operative findings revealed a laparotomy towel accidentally left behind during a laparotomy for a ruptured acute appendicitis.","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120974368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-25DOI: 10.23937/2378-3397/1410101
Ming-yong Liu, Liang Zhang, Liang Zhang, Jian-hua Zhao, Peng Liu, W. Fan, X. Ying, Y. Liu
The thoracolumbar region (T11 to L2) is more susceptible to injury than other parts of the spine, and posterior pedicle screw-based instrumentation and fusion is a widely accepted procedure to restore alignment and achieve instant and long term segmental stability of the injured spine through fusion, while the key factors determining the level of fusion remain unclear. To study the influence of vertebral endplate, Posterior Ligamentous Complex (PLC) and neural function on fusion strategy for thoracolumbar fractures via a posterior approach, a prospective study was committed. Here we report that neurological status and the integrity of the involved endplates and PLC are crucial for fusion strategy in thoracolumbar fractures. It is recommended that fusion segments are limited to the levels of the severely injured endplates and/or PLC and implantation is removed early at non fusion segments to preserve the mobility function. Mingyong Liu, Liang Zhang, Liangmin Zhang, Jianhua Zhao* and Peng Liu* Department of Spine Surgery, Daping Hospital, Third Military Medical University, China
{"title":"Vertebral Endplate, Posterior Ligamentous Complex and Neural Dysfunction: Key Factors for Posterior Fusion Strategy in Thoracolumbar Fractures","authors":"Ming-yong Liu, Liang Zhang, Liang Zhang, Jian-hua Zhao, Peng Liu, W. Fan, X. Ying, Y. Liu","doi":"10.23937/2378-3397/1410101","DOIUrl":"https://doi.org/10.23937/2378-3397/1410101","url":null,"abstract":"The thoracolumbar region (T11 to L2) is more susceptible to injury than other parts of the spine, and posterior pedicle screw-based instrumentation and fusion is a widely accepted procedure to restore alignment and achieve instant and long term segmental stability of the injured spine through fusion, while the key factors determining the level of fusion remain unclear. To study the influence of vertebral endplate, Posterior Ligamentous Complex (PLC) and neural function on fusion strategy for thoracolumbar fractures via a posterior approach, a prospective study was committed. Here we report that neurological status and the integrity of the involved endplates and PLC are crucial for fusion strategy in thoracolumbar fractures. It is recommended that fusion segments are limited to the levels of the severely injured endplates and/or PLC and implantation is removed early at non fusion segments to preserve the mobility function. Mingyong Liu, Liang Zhang, Liangmin Zhang, Jianhua Zhao* and Peng Liu* Department of Spine Surgery, Daping Hospital, Third Military Medical University, China","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128456393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-27DOI: 10.23937/2378-3397/1410100
Wafa Ala, E. Mustafa, Friwan Rawad, Baio Abdulaziz
Background: The role of laparoscopy in abdominal trauma has increased in the last years in diagnosis as well as therapeutic interventions. It is a viable alternative for the diagnosis of intra-abdominal injury in both penetrating and blunt trauma. The number of negative laparotomies decreased since the use of laparoscopy in trauma patients. Methods: A retrospective study of twenty eight patients with abdominal trauma (22 penetrating trauma, 6 blunt trauma) were laparoscopic intervention done by general surgery department at Aljazeera Hospital for Orthopedic and Specialized Surgery from January 2017 to March 2019. All patients underwent clinical assessment and FAST-Scan, CT-scan done for twenty patients and unavailable for eight patients. All of the patients included for the research were stable with normal blood pressure. Results: In our series twenty-eight patients with abdominal trauma, 22 penetrating trauma (78.57%) all were shotgun injuries, and 6 blunt trauma (21.43%). In penetrating trauma therapeutic laparoscopy for seven patients (31.8%), diagnostic laparoscopy for 10 patients (45.5%), and negative laparoscopy for 5 cases (22.7%). In blunt trauma therapeutic laparoscopy for 2 cases (33.3%), diagnostic laparoscopy for 3 cases (50%), and negative laparoscopy for 1 case (16.7%). The rate of conversion to laparotomies was 8 cases (28.5%) for both penetrating and blunt trauma. Conclusion: Laparoscopy can be safely performed in hemodynamically stable patients with abdominal trauma for both diagnostic and therapeutic purposes; also it helps to cut down the number of non-therapeutic laparotomies.
{"title":"Role of Laparoscopy in Abdominal Trauma","authors":"Wafa Ala, E. Mustafa, Friwan Rawad, Baio Abdulaziz","doi":"10.23937/2378-3397/1410100","DOIUrl":"https://doi.org/10.23937/2378-3397/1410100","url":null,"abstract":"Background: The role of laparoscopy in abdominal trauma has increased in the last years in diagnosis as well as therapeutic interventions. It is a viable alternative for the diagnosis of intra-abdominal injury in both penetrating and blunt trauma. The number of negative laparotomies decreased since the use of laparoscopy in trauma patients. Methods: A retrospective study of twenty eight patients with abdominal trauma (22 penetrating trauma, 6 blunt trauma) were laparoscopic intervention done by general surgery department at Aljazeera Hospital for Orthopedic and Specialized Surgery from January 2017 to March 2019. All patients underwent clinical assessment and FAST-Scan, CT-scan done for twenty patients and unavailable for eight patients. All of the patients included for the research were stable with normal blood pressure. Results: In our series twenty-eight patients with abdominal trauma, 22 penetrating trauma (78.57%) all were shotgun injuries, and 6 blunt trauma (21.43%). In penetrating trauma therapeutic laparoscopy for seven patients (31.8%), diagnostic laparoscopy for 10 patients (45.5%), and negative laparoscopy for 5 cases (22.7%). In blunt trauma therapeutic laparoscopy for 2 cases (33.3%), diagnostic laparoscopy for 3 cases (50%), and negative laparoscopy for 1 case (16.7%). The rate of conversion to laparotomies was 8 cases (28.5%) for both penetrating and blunt trauma. Conclusion: Laparoscopy can be safely performed in hemodynamically stable patients with abdominal trauma for both diagnostic and therapeutic purposes; also it helps to cut down the number of non-therapeutic laparotomies.","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130907779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Non traumatic acute abdomen is an acute onset of abdominal disease entities that require immediate surgical intervention in most of the cases. The causes of non-traumatic surgical acute abdomen and their relative incidence vary in different populations. Objective: The aim of this study was to assess the management outcome and associated factors of surgically treated non-traumatic acute abdomen. Methods: Hospital-based prospective cross sectional study was conducted on surgically treated non-traumatic acute abdomen cases admitted at Attat catholic hospital surgical ward starting from January 2017 to September 2018. Data was collected using history, physical examination, patients’ card and operation registration book as necessary. The collected data were checked for incorrectness and inconsistencies and SPSS version 21 used for the descriptive, binary and multivariate logistic regression analysis of the data. On binary logistic regression analysis a p-value < 0.25 was used as a candidate for multivariate logistic regression analysis. Statistical significant association was tested at a p-value of < 0.05. Results: There were 192 non-traumatic emergency surgical acute abdomens admitted in surgical ward and 171 (89%) of cases were managed surgically while 11% were managed conservatively. The three top causes of acute surgical abdomen were acute appendicitis accounting 48% followed by bowel obstruction 28% and Peritonitis 24%. Late presentation of patients before intervention, sex, age and postoperative complications were independent predictors with management outcome in our study. The total postoperative complication rate was 17% of which the commonest early postoperative complications were wound infection (5.4%), sepsis (4.3%) and pneumonia (2.3%). About 90.1% were discharged well while 9.35% were passed away in the hospital which is unacceptably high mortality. Conclusion and recommendation: The overall mortality was more in cases from rural area due to delay at presentation, on higher extreme age patients, those who developed peritonitis and postoperative complications. To decrease this problem, creation of health awareness on acute abdomen to the general population and to the low and mid-level health care providers for early referral, pre and postoperative management to decrease postoperative complications and death has great importance.
背景:非外伤性急腹症是一种急性发作的腹部疾病实体，在大多数情况下需要立即手术干预。非外伤性急腹症的病因及其相对发病率在不同人群中存在差异。目的:探讨非外伤性急腹症手术治疗的预后及相关因素。方法:对2017年1月至2018年9月在阿塔特天主教医院外科病房接受手术治疗的非创伤性急腹症患者进行前瞻性横断面研究。必要时使用病史、体格检查、患者卡和手术登记簿收集资料。对收集到的数据进行不正确和不一致的检查，并使用SPSS version 21对数据进行描述性、二元和多元逻辑回归分析。在二元逻辑回归分析中，使用p值< 0.25作为多变量逻辑回归分析的候选值。以p值< 0.05检验有统计学意义的相关性。结果:外科病房收治非外伤性急腹症192例，手术治疗171例(89%)，保守治疗11%。急性手术腹部的前三位病因是急性阑尾炎，占48%，其次是肠梗阻，占28%，腹膜炎占24%。在我们的研究中，干预前患者的晚期就诊、性别、年龄和术后并发症是影响治疗结果的独立预测因素。术后并发症发生率为17%，其中最常见的术后早期并发症为伤口感染(5.4%)、脓毒症(4.3%)和肺炎(2.3%)。90.1%的患者出院，9.35%的患者在医院死亡，死亡率高得令人无法接受。结论和建议:农村地区因就诊延迟、高龄患者、腹膜炎患者和术后并发症患者的总死亡率较高。为了减少这一问题，提高普通民众和中低级别卫生保健提供者对急腹症的健康意识，以便及早转诊、进行术前和术后管理，以减少术后并发症和死亡，是非常重要的。
{"title":"Management Outcome and Associated Factors of Surgically Treated Non Traumatic Acute Abdomen at Attat Hospital, Gurage Zone, Ethiopia","authors":"Gebrie Tekalign Admasu, Handiso Tilahun Beyene, Hagisso Shemsu Nuriye","doi":"10.23937/2378-3397/1410099","DOIUrl":"https://doi.org/10.23937/2378-3397/1410099","url":null,"abstract":"Background: Non traumatic acute abdomen is an acute onset of abdominal disease entities that require immediate surgical intervention in most of the cases. The causes of non-traumatic surgical acute abdomen and their relative incidence vary in different populations. Objective: The aim of this study was to assess the management outcome and associated factors of surgically treated non-traumatic acute abdomen. Methods: Hospital-based prospective cross sectional study was conducted on surgically treated non-traumatic acute abdomen cases admitted at Attat catholic hospital surgical ward starting from January 2017 to September 2018. Data was collected using history, physical examination, patients’ card and operation registration book as necessary. The collected data were checked for incorrectness and inconsistencies and SPSS version 21 used for the descriptive, binary and multivariate logistic regression analysis of the data. On binary logistic regression analysis a p-value < 0.25 was used as a candidate for multivariate logistic regression analysis. Statistical significant association was tested at a p-value of < 0.05. Results: There were 192 non-traumatic emergency surgical acute abdomens admitted in surgical ward and 171 (89%) of cases were managed surgically while 11% were managed conservatively. The three top causes of acute surgical abdomen were acute appendicitis accounting 48% followed by bowel obstruction 28% and Peritonitis 24%. Late presentation of patients before intervention, sex, age and postoperative complications were independent predictors with management outcome in our study. The total postoperative complication rate was 17% of which the commonest early postoperative complications were wound infection (5.4%), sepsis (4.3%) and pneumonia (2.3%). About 90.1% were discharged well while 9.35% were passed away in the hospital which is unacceptably high mortality. Conclusion and recommendation: The overall mortality was more in cases from rural area due to delay at presentation, on higher extreme age patients, those who developed peritonitis and postoperative complications. To decrease this problem, creation of health awareness on acute abdomen to the general population and to the low and mid-level health care providers for early referral, pre and postoperative management to decrease postoperative complications and death has great importance.","PeriodicalId":326011,"journal":{"name":"International Journal of Surgery Research and Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114496967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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