S. Alotaibi, A. Alotaibi, S. Sait, N. Alghanmi, A. Sibiany
Burkitt's lymphoma (BL) is an uncommon cause of non-Hodgkin lymphoma in adults. BL-related intussusception causing intestinal obstruction in adults is rare. Symptoms are often misleading and make diagnosis difficult. We aim to present an adult case of a Colonic BL related to bowel obstruction. Here, we are presenting a case of a 29-year-old Saudi male patient who presented with symptoms of bowel obstruction. Abdominal examination found abdominal distention with a palpable mass in the right lower quadrant with mild tenderness. After chest, abdomen, and pelvic enhanced computed tomography with intravenous contrast, colonoscopy, and histopathological examination, the patient was diagnosed with colonic BL, which caused him bowel obstruction. Chemotherapy has been started based on Hyper CVAD chemotherapy protocol. After receiving the complete Chemotherapy on July 2019, patient's symptoms improved; there is no longer abdominal pain; he is passing stool, usually with no blood or mucus. Two months post last cycle of chemotherapy the patient presented again to the hospital with symptoms and images showed refractory disease to first-line chemotherapy. He passed away one month after this admission.
{"title":"Colonic Burkitt's lymphoma related to bowel obstruction in adults: A case report and literature review","authors":"S. Alotaibi, A. Alotaibi, S. Sait, N. Alghanmi, A. Sibiany","doi":"10.4103/ssj.ssj_50_19","DOIUrl":"https://doi.org/10.4103/ssj.ssj_50_19","url":null,"abstract":"Burkitt's lymphoma (BL) is an uncommon cause of non-Hodgkin lymphoma in adults. BL-related intussusception causing intestinal obstruction in adults is rare. Symptoms are often misleading and make diagnosis difficult. We aim to present an adult case of a Colonic BL related to bowel obstruction. Here, we are presenting a case of a 29-year-old Saudi male patient who presented with symptoms of bowel obstruction. Abdominal examination found abdominal distention with a palpable mass in the right lower quadrant with mild tenderness. After chest, abdomen, and pelvic enhanced computed tomography with intravenous contrast, colonoscopy, and histopathological examination, the patient was diagnosed with colonic BL, which caused him bowel obstruction. Chemotherapy has been started based on Hyper CVAD chemotherapy protocol. After receiving the complete Chemotherapy on July 2019, patient's symptoms improved; there is no longer abdominal pain; he is passing stool, usually with no blood or mucus. Two months post last cycle of chemotherapy the patient presented again to the hospital with symptoms and images showed refractory disease to first-line chemotherapy. He passed away one month after this admission.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123202931","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}
Situs inversus totalis (SIT) is a rare congenital anomaly, in which both the thoracic and the abdominal viscera are transposed to the opposite side of the body. The diagnosis of surgical diseases in patients with SIT is often delayed, leading to complications. Surgery in these patients has been reported to be more challenging for right-handed surgeons. We herein present a case of a 30-year-old woman, not known to have SIT, with a history of intermittent left upper quadrant pain related to food for more than a year. After clinical examination, chest X-ray, and abdominal ultrasound, she was diagnosed with SIT and chronic cholecystitis, and underwent laparoscopic cholecystectomy performed by a right-handed surgeon. We believe that this case report will be informative for surgeons in managing chronic cholecystitis in patients with SIT, and for physicians to always look for clues for SIT in patients presenting with abdominal pain.
{"title":"Laparoscopic cholecystectomy in a patient with situs inversus totalis","authors":"A. Aljahdali, Saad Almowallad, T. Habib","doi":"10.4103/ssj.ssj_64_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_64_21","url":null,"abstract":"Situs inversus totalis (SIT) is a rare congenital anomaly, in which both the thoracic and the abdominal viscera are transposed to the opposite side of the body. The diagnosis of surgical diseases in patients with SIT is often delayed, leading to complications. Surgery in these patients has been reported to be more challenging for right-handed surgeons. We herein present a case of a 30-year-old woman, not known to have SIT, with a history of intermittent left upper quadrant pain related to food for more than a year. After clinical examination, chest X-ray, and abdominal ultrasound, she was diagnosed with SIT and chronic cholecystitis, and underwent laparoscopic cholecystectomy performed by a right-handed surgeon. We believe that this case report will be informative for surgeons in managing chronic cholecystitis in patients with SIT, and for physicians to always look for clues for SIT in patients presenting with abdominal pain.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115164355","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}
Maryam Mozafarinia, Nikki Ow, K. Mate, Magdalena Cordoba, Haider Alyaseen, Layla Ajasim, C. Cordoba
Background: Urgent safety measures and management protocols of COVID-19 are continuously being updated. Surgical residents, amongst other health-care professionals, need to modify their clinical practice both in and out of the operating room. Understanding and applying the communicated guidelines are crucial to limit the spread of the virus. Objective: To estimate the extent of association between clinical behaviors and the recommended practice guidelines, issued by national and international health agencies, during the COVID-19 pandemic among surgical residents in the Eastern Province of Saudi Arabia. Methods: A descriptive, cross-sectional study was conducted with 52 surgical residents training in affiliated teaching public and private hospitals. Correlations were conducted to estimate the associations between knowledge, perception, motivation, and surgical residents' clinical behavior. Further cluster analysis was conducted to identify groups of people with similar patterns of clinical behavior. Results: The response rate was 52%. Surgical residents' behavior and their adherence to practice guidelines were varied and individualized. Nearly 50% lacked some fundamental bio-medical and disease specific knowledge. Despite demonstrating a fair knowledge on the transmission aspect of the disease, less than 60% agreed on ways of infection control and usefulness of personal protective equipment and nearly 50% did not endorse the use of facemasks and gloves. High levels of stress with respect to COVID-19 was reported by 63%; 58% were confident with their personal safety techniques, and 80% needed more information about the COVID-19. Conclusion: The results suggest a collective action is needed at both the personal and institutional level to increase compliance with the recommended guidelines.
{"title":"Surgeons in training in the face of COVID-19 pandemic in the eastern province of Saudi Arabia: A cross sectional study tackling capabilities, opportunities, and motivation","authors":"Maryam Mozafarinia, Nikki Ow, K. Mate, Magdalena Cordoba, Haider Alyaseen, Layla Ajasim, C. Cordoba","doi":"10.4103/SSJ.SSJ_32_20","DOIUrl":"https://doi.org/10.4103/SSJ.SSJ_32_20","url":null,"abstract":"Background: Urgent safety measures and management protocols of COVID-19 are continuously being updated. Surgical residents, amongst other health-care professionals, need to modify their clinical practice both in and out of the operating room. Understanding and applying the communicated guidelines are crucial to limit the spread of the virus. Objective: To estimate the extent of association between clinical behaviors and the recommended practice guidelines, issued by national and international health agencies, during the COVID-19 pandemic among surgical residents in the Eastern Province of Saudi Arabia. Methods: A descriptive, cross-sectional study was conducted with 52 surgical residents training in affiliated teaching public and private hospitals. Correlations were conducted to estimate the associations between knowledge, perception, motivation, and surgical residents' clinical behavior. Further cluster analysis was conducted to identify groups of people with similar patterns of clinical behavior. Results: The response rate was 52%. Surgical residents' behavior and their adherence to practice guidelines were varied and individualized. Nearly 50% lacked some fundamental bio-medical and disease specific knowledge. Despite demonstrating a fair knowledge on the transmission aspect of the disease, less than 60% agreed on ways of infection control and usefulness of personal protective equipment and nearly 50% did not endorse the use of facemasks and gloves. High levels of stress with respect to COVID-19 was reported by 63%; 58% were confident with their personal safety techniques, and 80% needed more information about the COVID-19. Conclusion: The results suggest a collective action is needed at both the personal and institutional level to increase compliance with the recommended guidelines.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133009303","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}
Heterotopic ossification (HO) is the presence of bone in nonossifying tissue. Mesenteric HO usually results from previous abdominal trauma or surgery. This is a case report of 87-year-old lady who presented with subacute intestinal obstruction, she had neither previous history of abdominal trauma nor surgery. On exploration, there was spiral ossified tissue trapping small bowel that was removed and the condition resolved completely. As long as to our knowledge, this is the first reported case of intra-abdominal Heterotopic ossification without previous cause in English articles. HO should keep in mind in any ossified peritoneal lesion even without previous surgery or trauma.
{"title":"Primary heterotopic mesenteric ossification","authors":"Raafat R. A. Alturfi, Mohammed E. Atallah","doi":"10.4103/SSJ.SSJ_30_20","DOIUrl":"https://doi.org/10.4103/SSJ.SSJ_30_20","url":null,"abstract":"Heterotopic ossification (HO) is the presence of bone in nonossifying tissue. Mesenteric HO usually results from previous abdominal trauma or surgery. This is a case report of 87-year-old lady who presented with subacute intestinal obstruction, she had neither previous history of abdominal trauma nor surgery. On exploration, there was spiral ossified tissue trapping small bowel that was removed and the condition resolved completely. As long as to our knowledge, this is the first reported case of intra-abdominal Heterotopic ossification without previous cause in English articles. HO should keep in mind in any ossified peritoneal lesion even without previous surgery or trauma.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"287 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133624383","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}
Introduction: Acute abdominal pain (AAP) accounts for a substantial proportion of patients arriving at a surgical emergency department. As AAP may be caused by both life-threatening diseases and conditions that are spontaneously resolved, a correct diagnosis is of importance for the prognosis of the patient. Materials and Methods: Clinical, laboratory, and imaging studies were done in patients presenting with a history of acute, nontraumatic pain in the abdomen in the Department of Surgery of NKP SIMS and Lata Mangeshkar Hospital, Nagpur, over a period of 2 years. Results: A total of 400 patients with a mean age of 38.05 ± 11.45 with a male: female ratio of 2.07:1 were enrolled. Of them, 233 patients underwent exploration and 167 were managed conservatively. During univariate analysis, age group, pulse rate, temperature, hemoglobin, total leukocyte count (TLC), tenderness, guarding, distension, bowel sounds, chest radiograph, and abdominal radiograph were found to be significant. On multivariate analysis, hemoglobin, TLC, tenderness, distension, and abdomen radiograph were significantly associated with exploration. Conclusion: In a patient of nontraumatic acute abdomen, clinical predictors such as tenderness and distension, laboratory predictors such as hemoglobin and TLC, and abdominal standing radiograph as an imaging predictor were the most statistically significant for exploration.
{"title":"Clinical, laboratory, and imaging predictors of surgical exploration in nontraumatic acute abdomen","authors":"Abhiram Mundle, Satish Deshmukh, M. Akhtar","doi":"10.4103/SSJ.SSJ_8_20","DOIUrl":"https://doi.org/10.4103/SSJ.SSJ_8_20","url":null,"abstract":"Introduction: Acute abdominal pain (AAP) accounts for a substantial proportion of patients arriving at a surgical emergency department. As AAP may be caused by both life-threatening diseases and conditions that are spontaneously resolved, a correct diagnosis is of importance for the prognosis of the patient. Materials and Methods: Clinical, laboratory, and imaging studies were done in patients presenting with a history of acute, nontraumatic pain in the abdomen in the Department of Surgery of NKP SIMS and Lata Mangeshkar Hospital, Nagpur, over a period of 2 years. Results: A total of 400 patients with a mean age of 38.05 ± 11.45 with a male: female ratio of 2.07:1 were enrolled. Of them, 233 patients underwent exploration and 167 were managed conservatively. During univariate analysis, age group, pulse rate, temperature, hemoglobin, total leukocyte count (TLC), tenderness, guarding, distension, bowel sounds, chest radiograph, and abdominal radiograph were found to be significant. On multivariate analysis, hemoglobin, TLC, tenderness, distension, and abdomen radiograph were significantly associated with exploration. Conclusion: In a patient of nontraumatic acute abdomen, clinical predictors such as tenderness and distension, laboratory predictors such as hemoglobin and TLC, and abdominal standing radiograph as an imaging predictor were the most statistically significant for exploration.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130661899","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}
Purpose: Stapled hemorrhoidopexy (SH) is associated with shorter operative time, reduced inpatient stay, less pain, and earlier return to normal activities. The present study was conducted to assess the clinical consequences of SH and to establish the suitability of SH for all patients of grade III or IV hemorrhoids. Patients and Methods: This study included 250 patients who underwent SH at Aarogya Hospital, Raipur, India, from January 1, 2012 to December 31, 2017 and follow-up completed on December 31, 2019. SH procedure was performed according to the LONGO technique. The pain was assessed using a visual analog scale (VAS). Patients were followed up after 1 week, then monthly for 2 months, and 6 monthly for 2 years. Results: There were 163 males (65.2%) and 87 (34.8) females. Preoperatively, 87.2% of cases had anal bleeding, constipation in 73.2% cases, and associated pain in 52.4% cases. Operative time duration ranged between 25 and 50 min. Two-hundred and twenty-one (88.4%) patients were discharged within 24 h postoperatively and remaining within 48 h. Discussion: The most important advantage of SH as cited by various studies is a profound reduction in postoperative pain analgesia requirement and better quality of life. The postoperative pain rapidly decreased in severity to the VAS score of 2, in 73.6 cases within 24 h, facilitating early discharge of the patients our recurrence rates were nil in SH. Conclusion: Our study demonstrates that SH is a safe, effective, and well-tolerated procedure with minimum postoperative pain and complication rates.
{"title":"Stapled hemorrhoidopexy: A single-center 8 years' experience","authors":"R. Agrawal, Priti Agrawal, Jyotirmay Chandrakar","doi":"10.4103/SSJ.SSJ_36_20","DOIUrl":"https://doi.org/10.4103/SSJ.SSJ_36_20","url":null,"abstract":"Purpose: Stapled hemorrhoidopexy (SH) is associated with shorter operative time, reduced inpatient stay, less pain, and earlier return to normal activities. The present study was conducted to assess the clinical consequences of SH and to establish the suitability of SH for all patients of grade III or IV hemorrhoids. Patients and Methods: This study included 250 patients who underwent SH at Aarogya Hospital, Raipur, India, from January 1, 2012 to December 31, 2017 and follow-up completed on December 31, 2019. SH procedure was performed according to the LONGO technique. The pain was assessed using a visual analog scale (VAS). Patients were followed up after 1 week, then monthly for 2 months, and 6 monthly for 2 years. Results: There were 163 males (65.2%) and 87 (34.8) females. Preoperatively, 87.2% of cases had anal bleeding, constipation in 73.2% cases, and associated pain in 52.4% cases. Operative time duration ranged between 25 and 50 min. Two-hundred and twenty-one (88.4%) patients were discharged within 24 h postoperatively and remaining within 48 h. Discussion: The most important advantage of SH as cited by various studies is a profound reduction in postoperative pain analgesia requirement and better quality of life. The postoperative pain rapidly decreased in severity to the VAS score of 2, in 73.6 cases within 24 h, facilitating early discharge of the patients our recurrence rates were nil in SH. Conclusion: Our study demonstrates that SH is a safe, effective, and well-tolerated procedure with minimum postoperative pain and complication rates.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"274 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116552179","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}
Alamri, R. Alenezi, K. Alanazi, Mishal M Alrsheedi, B. Z. Alshammary, Hani A Almutair
Acute chylous peritonitis is an extensively rare condition; chylous ascites may result from many pathological conditions, including congenital defects of the lymphatic system, trauma, peritoneal infections, and malignant neoplasms. In most cases, the presence of tenderness and rebound leads the patients to be misdiagnosed with acute appendicitis. In our case, the preoperative diagnosis was perforated acute appendicitis.
{"title":"Acute chylous peritonitis: Report of a case and literature review","authors":"Alamri, R. Alenezi, K. Alanazi, Mishal M Alrsheedi, B. Z. Alshammary, Hani A Almutair","doi":"10.4103/SSJ.SSJ_5_19","DOIUrl":"https://doi.org/10.4103/SSJ.SSJ_5_19","url":null,"abstract":"Acute chylous peritonitis is an extensively rare condition; chylous ascites may result from many pathological conditions, including congenital defects of the lymphatic system, trauma, peritoneal infections, and malignant neoplasms. In most cases, the presence of tenderness and rebound leads the patients to be misdiagnosed with acute appendicitis. In our case, the preoperative diagnosis was perforated acute appendicitis.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133383864","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}
J. Daniels, I. Albakry, R. Braimah, M. Samara, R. Albalasi, F. Begum, Mana A. Al-Kalib
Background: Panfacial fractures are defined as fractures of the craniomaxillofacial complex involving bones in the lower, middle, and upper thirds of the facial skeleton. The aim of the current study is to report the prevalence, sociodemographics, and pattern of panfacial fractures in Najran, Kingdom of Saudi Arabia. Materials and Methods: This was a retrospective study of panfacial fractures seen and managed in a major referral hospital in the southern province of the Kingdom of Saudi Arabia over a 10-year period from 2008 to 2018. Data collected include demographics such as age, gender, etiological factor, and pattern of bone fracture involved in the panfacial fracture. Data were stored and analyzed using IBM SPSS Statistics for IOS Version 25 (Armonk, NY, USA: IBM Corp.). Results were presented as simple frequencies and descriptive statistics. Statistical significance was set at P ≤ 0.05. Results: A total of 1057 patients presented with maxillofacial injuries, of which 43 male patients suffered from panfacial fractures during the study period giving a prevalence rate of 4.1%. The age ranged from 16 to 45 years with mean ± standard deviation (26.6 ± 8.3) years. The age group of 21–30 years had the highest frequency of panfacial fracture, whereas the age group of 41–50 years had the least occurrence with a statistically significant difference. Most of the mandibular fractures involved the symphysis and parasymphysis (27.9% and 23.3%), respectively. In the midface, Le Fort I and II were the most common maxillary fractures. Conclusion: Inquiry into the prevalence, sociodemographics, and pattern of panfacial fractures is essential in decision-making by the attending clinicians for the patients' overall management. This study has reported a prevalence rate of 4.1% with only male preponderance.
背景:全面骨折被定义为颅颌面复合体的骨折，涉及面部骨骼的下、中、上三分之一的骨骼。本研究的目的是报告沙特阿拉伯王国Najran地区全面骨折的患病率、社会人口统计学和模式。材料和方法:这是一项回顾性研究，研究对象是2008年至2018年10年间沙特阿拉伯王国南部省份一家主要转诊医院的全面骨折患者。收集的数据包括人口统计学，如年龄、性别、病因因素和涉及全面骨折的骨折类型。使用IBM SPSS Statistics for IOS Version 25 (Armonk, NY, USA: IBM Corp.)对数据进行存储和分析。结果以简单频率和描述性统计表示。P≤0.05，差异有统计学意义。结果:1057例患者出现颌面损伤，其中男性43例，患病率为4.1%。年龄16 ~ 45岁，平均±标准差(26.6±8.3)岁。21 ~ 30岁年龄组全面骨折发生率最高，41 ~ 50岁年龄组发生率最低，差异有统计学意义。大多数下颌骨骨折累及联合骨和副联合骨(分别占27.9%和23.3%)。在中面部，Le Fort I和II是最常见的上颌骨折。结论:了解全面骨折的患病率、社会人口学特征和类型对临床主治医师对患者的整体治疗决策至关重要。该研究报告的患病率为4.1%，仅男性占优势。
{"title":"Panfacial fractures: Prevalence, sociodemographics, and pattern of presentation in a major referral hospital in the Southern province of the Kingdom of Saudi Arabia","authors":"J. Daniels, I. Albakry, R. Braimah, M. Samara, R. Albalasi, F. Begum, Mana A. Al-Kalib","doi":"10.4103/ssj.ssj_35_19","DOIUrl":"https://doi.org/10.4103/ssj.ssj_35_19","url":null,"abstract":"Background: Panfacial fractures are defined as fractures of the craniomaxillofacial complex involving bones in the lower, middle, and upper thirds of the facial skeleton. The aim of the current study is to report the prevalence, sociodemographics, and pattern of panfacial fractures in Najran, Kingdom of Saudi Arabia. Materials and Methods: This was a retrospective study of panfacial fractures seen and managed in a major referral hospital in the southern province of the Kingdom of Saudi Arabia over a 10-year period from 2008 to 2018. Data collected include demographics such as age, gender, etiological factor, and pattern of bone fracture involved in the panfacial fracture. Data were stored and analyzed using IBM SPSS Statistics for IOS Version 25 (Armonk, NY, USA: IBM Corp.). Results were presented as simple frequencies and descriptive statistics. Statistical significance was set at P ≤ 0.05. Results: A total of 1057 patients presented with maxillofacial injuries, of which 43 male patients suffered from panfacial fractures during the study period giving a prevalence rate of 4.1%. The age ranged from 16 to 45 years with mean ± standard deviation (26.6 ± 8.3) years. The age group of 21–30 years had the highest frequency of panfacial fracture, whereas the age group of 41–50 years had the least occurrence with a statistically significant difference. Most of the mandibular fractures involved the symphysis and parasymphysis (27.9% and 23.3%), respectively. In the midface, Le Fort I and II were the most common maxillary fractures. Conclusion: Inquiry into the prevalence, sociodemographics, and pattern of panfacial fractures is essential in decision-making by the attending clinicians for the patients' overall management. This study has reported a prevalence rate of 4.1% with only male preponderance.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129973362","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}
Priya Singh, A. Baghel, A. Silodia, Virendra Saytode, S. Yadav, H. Damde, R. Kothari
Introduction: Our aim was to evaluate the surgical outcome and ethical considerations in adopting stapled hemorrhoidopexy (SH) in low-resource settings. Methods: This prospective comparative study of patients with Grade III hemorrhoids was conducted at our institute from December 2017 to July 2019. Short-term surgical outcome and the results of a short questionnaire associated with ethics were evaluated. Results: Sixty patients were operated on for third-degree hemorrhoids, thirty each in Group conventional hemorrhoidectomy (CH) and Group SH. The SH group had better postoperative pain control at 0, 1, and 4 weeks (P = 0.001), but this difference became insignificant at 12 weeks. Overall recurrence was more in SH group (11.37%) as compared to CH group (2.7%), and it was statistically significant (P = 0.01). The mean operative time was significantly less in the SH group (43 min vs. 50 min, P = 0.006). Similarly, the mean hospital stay was significantly less in the SH group as compared to the CH group (2.27 days vs. 3.83 days, P = 0.001). Survey of the operating surgeons revealed that all the three surgeons involved assessed the effectiveness and safety of SH through literature; the main motivation behind performing new technique in resource-poor settings was learning a new technique and teaching purpose. Conclusion: The main value of this research is to describe the adoption of surgical stapler into clinical practice in low-resource settings. Our analysis suggests that, in a rapidly developing area of surgical innovation, adoption of SH in resource-poor settings can give the same outcome as in expert hands.
简介:我们的目的是评估在低资源环境下采用钉状痔疮切除术(SH)的手术结果和伦理考虑。方法:2017年12月至2019年7月在我院对III级痔疮患者进行前瞻性比较研究。评估短期手术结果和与伦理相关的简短问卷调查结果。结果:三度痔疮手术60例，常规痔切除术组和SH组各30例。SH组在0、1、4周时疼痛控制较好(P = 0.001)，但在12周时差异不显著。SH组总复发率(11.37%)高于CH组(2.7%)，差异有统计学意义(P = 0.01)。SH组平均手术时间明显少于对照组(43 min vs. 50 min, P = 0.006)。同样，与CH组相比，SH组的平均住院时间显著缩短(2.27天对3.83天，P = 0.001)。对手术外科医生的调查显示，所有三位外科医生都通过文献评估了SH的有效性和安全性;在资源贫乏的环境中实施新技术的主要动机是学习新技术和教学目的。结论:本研究的主要价值是描述在低资源环境下外科吻合器在临床实践中的应用。我们的分析表明，在快速发展的外科创新领域，在资源贫乏的环境中采用SH可以获得与专家相同的结果。
{"title":"Surgical outcome and ethics in adopting new surgical technique in low resource settings: A case study in haemorrhoid surgery","authors":"Priya Singh, A. Baghel, A. Silodia, Virendra Saytode, S. Yadav, H. Damde, R. Kothari","doi":"10.4103/ssj.ssj_41_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_41_20","url":null,"abstract":"Introduction: Our aim was to evaluate the surgical outcome and ethical considerations in adopting stapled hemorrhoidopexy (SH) in low-resource settings. Methods: This prospective comparative study of patients with Grade III hemorrhoids was conducted at our institute from December 2017 to July 2019. Short-term surgical outcome and the results of a short questionnaire associated with ethics were evaluated. Results: Sixty patients were operated on for third-degree hemorrhoids, thirty each in Group conventional hemorrhoidectomy (CH) and Group SH. The SH group had better postoperative pain control at 0, 1, and 4 weeks (P = 0.001), but this difference became insignificant at 12 weeks. Overall recurrence was more in SH group (11.37%) as compared to CH group (2.7%), and it was statistically significant (P = 0.01). The mean operative time was significantly less in the SH group (43 min vs. 50 min, P = 0.006). Similarly, the mean hospital stay was significantly less in the SH group as compared to the CH group (2.27 days vs. 3.83 days, P = 0.001). Survey of the operating surgeons revealed that all the three surgeons involved assessed the effectiveness and safety of SH through literature; the main motivation behind performing new technique in resource-poor settings was learning a new technique and teaching purpose. Conclusion: The main value of this research is to describe the adoption of surgical stapler into clinical practice in low-resource settings. Our analysis suggests that, in a rapidly developing area of surgical innovation, adoption of SH in resource-poor settings can give the same outcome as in expert hands.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133324264","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: The relation between the resected stomach volume (RSV) and the weight loss after laparoscopic sleeve gastrectomy (LSG) appears conflicting in the literature. The aim of the present research was to find the correlation of RSV after LSG, the percentage of excess weight loss (%EWL) at 6-month and 1-year follow-up, and the initial body mass index (BMI). Materials and Methods: Sixty patients aged between 18 and 60 years who underwent LSG were included. Preoperatively, the baseline data of patients such as BMI and presence of Type 2 diabetes mellitus were noted. LSG was performed under general anesthesia. The resected stomach was punctured with Veress needle and insufflated with CO2. The maximum volume was recorded as RSV. The sleeve volume was measured by the amount of methylene blue used to distend the stomach during the leak test. %EWL was calculated at 6 months and 12 months. The primary outcome measures were to find the correlation of RSV with %EWL and BMI, whereas the secondary outcome measure was to find the correlation of vertical length of staple line with %EWL. Comparison of categorical and continuous variables was done using Chi-square test/Fisher's exact test and unpaired t-test, respectively. Correlation analysis was done using Pearson's correlation technique. Results: The RSV positively correlated with initial BMI (r = 0.456). There was no significant correlation of RSV, sleeve volume, and vertical length of staple line with %EWL at 6-month and 12-month postoperative intervals. Conclusion: RSV positively correlated with baseline BMI, but not correlated with %EWL.
{"title":"Volume of resected stomach after laparoscopic sleeve gastrectomy and its correlation with initial body mass index and weight loss","authors":"Kshitij Kirane, Deepak S. Phalgune, S. Shah","doi":"10.4103/ssj.ssj_26_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_26_20","url":null,"abstract":"Background: The relation between the resected stomach volume (RSV) and the weight loss after laparoscopic sleeve gastrectomy (LSG) appears conflicting in the literature. The aim of the present research was to find the correlation of RSV after LSG, the percentage of excess weight loss (%EWL) at 6-month and 1-year follow-up, and the initial body mass index (BMI). Materials and Methods: Sixty patients aged between 18 and 60 years who underwent LSG were included. Preoperatively, the baseline data of patients such as BMI and presence of Type 2 diabetes mellitus were noted. LSG was performed under general anesthesia. The resected stomach was punctured with Veress needle and insufflated with CO2. The maximum volume was recorded as RSV. The sleeve volume was measured by the amount of methylene blue used to distend the stomach during the leak test. %EWL was calculated at 6 months and 12 months. The primary outcome measures were to find the correlation of RSV with %EWL and BMI, whereas the secondary outcome measure was to find the correlation of vertical length of staple line with %EWL. Comparison of categorical and continuous variables was done using Chi-square test/Fisher's exact test and unpaired t-test, respectively. Correlation analysis was done using Pearson's correlation technique. Results: The RSV positively correlated with initial BMI (r = 0.456). There was no significant correlation of RSV, sleeve volume, and vertical length of staple line with %EWL at 6-month and 12-month postoperative intervals. Conclusion: RSV positively correlated with baseline BMI, but not correlated with %EWL.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130747497","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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