Context: Systemic inflammatory response syndrome (SIRS) can be a result of ischemia, inflammation, trauma, infection, or a combination of several “insults.” Aims: The present study aims to estimate the relationship between SIRS and different predictive factors including sex, renal disease, diabetes (DM), comorbidities ultrasound, computed tomography (CT) abdomen, operative intervention, and other operational findings of inflamed appendicitis, gangrenous and perforated appendicitis, and postoperative complications. Settings and Design: Retrospective cohort study was conducted at Al-Noor Hospital Emergency Department in Makkah. Materials and Methods: Data were collected from 259 patients with acute appendicitis presented to the Al-Noor Hospital Emergency Department in Makkah during 1435H. Variables such as comorbidities, vital sign on presentation, the result of certain investigation (white blood cell count, arterial blood gas, ultrasound, and CT abdomen), interventions provided, postoperative complication, intensive care unit length stay, and outcome along with SIRS criteria were followed to collect the data. Statistical Analysis Used: A secondary logistic analysis was also performed (SPSS version 19.0) on key risk factors, in order to exclude confounding covariates. Results: The findings of the study indicate a significant relation between SIRS criteria and the operation findings of perforation with collection with a significant P = 0.001. The presence of gangrenous appendicitis intraoperatively provided almost significant relationship with SIRS criteria (0.065). Conclusion: The present study concluded that SIRS has a significant predictive value with the presence of complicated appendicitis in the form of perforation and gangrene.
背景:全身性炎症反应综合征(SIRS)可由缺血、炎症、创伤、感染或几种“损伤”的组合引起。目的:本研究旨在评估炎性阑尾炎、坏疽性阑尾炎、穿孔性阑尾炎的性别、肾脏疾病、糖尿病(DM)、合并症超声、腹部CT、手术干预等手术表现与SIRS的关系及术后并发症。背景和设计:回顾性队列研究在麦加Al-Noor医院急诊科进行。材料和方法:收集1435H期间在麦加Al-Noor医院急诊科就诊的259例急性阑尾炎患者的数据。随访的变量包括合并症、就诊时的生命体征、某些调查结果(白细胞计数、动脉血气、超声和腹部CT)、提供的干预措施、术后并发症、重症监护病房住院时间和结果以及SIRS标准。使用统计分析:为了排除混杂协变量，还对关键危险因素进行了二次logistic分析(SPSS version 19.0)。结果:本研究结果表明SIRS标准与收集穿孔的手术结果有显著相关性，P = 0.001。术中坏疽性阑尾炎的存在与SIRS标准几乎有显著的相关性(0.065)。结论:本研究认为SIRS对以穿孔和坏疽形式出现的复杂阑尾炎具有重要的预测价值。
{"title":"Complicated appendicitis is predicted by the presence of systemic inflammatory response syndrome","authors":"H. Bukhari, M. Mirza","doi":"10.4103/ssj.ssj_6_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_6_20","url":null,"abstract":"Context: Systemic inflammatory response syndrome (SIRS) can be a result of ischemia, inflammation, trauma, infection, or a combination of several “insults.” Aims: The present study aims to estimate the relationship between SIRS and different predictive factors including sex, renal disease, diabetes (DM), comorbidities ultrasound, computed tomography (CT) abdomen, operative intervention, and other operational findings of inflamed appendicitis, gangrenous and perforated appendicitis, and postoperative complications. Settings and Design: Retrospective cohort study was conducted at Al-Noor Hospital Emergency Department in Makkah. Materials and Methods: Data were collected from 259 patients with acute appendicitis presented to the Al-Noor Hospital Emergency Department in Makkah during 1435H. Variables such as comorbidities, vital sign on presentation, the result of certain investigation (white blood cell count, arterial blood gas, ultrasound, and CT abdomen), interventions provided, postoperative complication, intensive care unit length stay, and outcome along with SIRS criteria were followed to collect the data. Statistical Analysis Used: A secondary logistic analysis was also performed (SPSS version 19.0) on key risk factors, in order to exclude confounding covariates. Results: The findings of the study indicate a significant relation between SIRS criteria and the operation findings of perforation with collection with a significant P = 0.001. The presence of gangrenous appendicitis intraoperatively provided almost significant relationship with SIRS criteria (0.065). Conclusion: The present study concluded that SIRS has a significant predictive value with the presence of complicated appendicitis in the form of perforation and gangrene.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"82 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":"127722415","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: Bile leakage is a well-known serious complication of treatment of gallstones and other procedures on the bile duct. They are important because they are preventable; however, once they occur, they may be associated with considerable morbidity and mortality. This study intends help to get a differentiated point of view of treating bile leak. Materials and Methods: This was a prospective study. All bile leak cases admitted between August 1, 2015, and July 31, 2020, were examined and the results were noted. Results: A total of 1485 cholecystectomies were done in the given period. Chronic cholecystitis was the most common indication for surgery. Most leaks were treated conservatively. Conclusions: Most common site of bile leak was found to be gall bladder bed, duct of Luschka, and other minor bile ducts. Most of the postoperative bile leaks were managed conservatively and by endoscopic procedures, rarely requiring re-operation.
{"title":"Management of postcholecystectomy biliary leakage: Five-year experience of a tertiary centre in Northeast India","authors":"A. Roy, N. Das, U. Deka","doi":"10.4103/ssj.ssj_39_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_39_20","url":null,"abstract":"Background: Bile leakage is a well-known serious complication of treatment of gallstones and other procedures on the bile duct. They are important because they are preventable; however, once they occur, they may be associated with considerable morbidity and mortality. This study intends help to get a differentiated point of view of treating bile leak. Materials and Methods: This was a prospective study. All bile leak cases admitted between August 1, 2015, and July 31, 2020, were examined and the results were noted. Results: A total of 1485 cholecystectomies were done in the given period. Chronic cholecystitis was the most common indication for surgery. Most leaks were treated conservatively. Conclusions: Most common site of bile leak was found to be gall bladder bed, duct of Luschka, and other minor bile ducts. Most of the postoperative bile leaks were managed conservatively and by endoscopic procedures, rarely requiring re-operation.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"3 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":"128475699","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 reported incidence of bacteria in bile is extremely variable from 8% to 42%. Several authors have been able to correlate the bacteria cultured from bile at pancreatico-duodenectomy (PD) with those subsequently causing wound infections and septicemia in the postoperative period. In addition, preoperative biliary intervention increases the risk of bactibilia that can translate into increased postoperative morbidity. Materials and Methods: This study was a prospective study conducted at the Department of Surgical Gastroenterology in Sher-I-Kashmir Institute of Medical Sciences from January 2015 to July 2020. A total of 71 patients who underwent PD were included in the study. Results: All patients had intraoperative bile culture (IBC). IBC was positive in forty (56.3%) patients. IBC was more likely to be positive in patients with preoperative intervention as compared to those with no intervention (86.11% vs. 13.89%). IBC was polymicrobial in 28/40 (70%) patients, with Escherichia coli and Klebsiella Pneumoniae both cultured together in 40% of patients. The monomicrobial infection was mainly due to E. coli in 22.5% of patients. Six/40 (15%) patients with bactibilia had wound infection and 4/40 (10%) patients had intra-abdominal collection. Patients with intervention had more of bactibilia (31/36 [86.11%]) compared to that of noninterventional group (9/35 [25.71%]), showing that the intervention was associated with an increased risk of biliary infection. The percentage of multidrug-resistant strains in our study was 97.7%. Conclusion: Positive IBC can determine the cohort of patients who are at risk of postoperative morbidity. Patients with preoperative intervention should be considered potentially infected who deserve careful operative technique to avoid spillage of bile to minimize wound infection and other morbidity. IBC also allows for early appropriate antibiotic use.
{"title":"Correlating intraoperative bile culture with postoperative morbidity in pancreaticoduodenectomy","authors":"M. Lattoo, Sadaf Ali","doi":"10.4103/ssj.ssj_43_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_43_20","url":null,"abstract":"Background: The reported incidence of bacteria in bile is extremely variable from 8% to 42%. Several authors have been able to correlate the bacteria cultured from bile at pancreatico-duodenectomy (PD) with those subsequently causing wound infections and septicemia in the postoperative period. In addition, preoperative biliary intervention increases the risk of bactibilia that can translate into increased postoperative morbidity. Materials and Methods: This study was a prospective study conducted at the Department of Surgical Gastroenterology in Sher-I-Kashmir Institute of Medical Sciences from January 2015 to July 2020. A total of 71 patients who underwent PD were included in the study. Results: All patients had intraoperative bile culture (IBC). IBC was positive in forty (56.3%) patients. IBC was more likely to be positive in patients with preoperative intervention as compared to those with no intervention (86.11% vs. 13.89%). IBC was polymicrobial in 28/40 (70%) patients, with Escherichia coli and Klebsiella Pneumoniae both cultured together in 40% of patients. The monomicrobial infection was mainly due to E. coli in 22.5% of patients. Six/40 (15%) patients with bactibilia had wound infection and 4/40 (10%) patients had intra-abdominal collection. Patients with intervention had more of bactibilia (31/36 [86.11%]) compared to that of noninterventional group (9/35 [25.71%]), showing that the intervention was associated with an increased risk of biliary infection. The percentage of multidrug-resistant strains in our study was 97.7%. Conclusion: Positive IBC can determine the cohort of patients who are at risk of postoperative morbidity. Patients with preoperative intervention should be considered potentially infected who deserve careful operative technique to avoid spillage of bile to minimize wound infection and other morbidity. IBC also allows for early appropriate antibiotic use.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"23 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":"127416723","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}
We report a case of diaphragmatic hernia of Morgagni with a unique clinical presentation. It is important to know all the possible complications and acute presentations of Morgagni hernia. Before the innovation of laparoscopy in the treatment of diaphragmatic hernia, it is used to be treated either through abdominal approach or, in most cases, thoracic approach.
{"title":"Laparoscopic treatment of Morgagni hernia","authors":"B. Assakran, Shaima A. Alharbi, F. Alharbi","doi":"10.4103/ssj.ssj_13_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_13_20","url":null,"abstract":"We report a case of diaphragmatic hernia of Morgagni with a unique clinical presentation. It is important to know all the possible complications and acute presentations of Morgagni hernia. Before the innovation of laparoscopy in the treatment of diaphragmatic hernia, it is used to be treated either through abdominal approach or, in most cases, thoracic approach.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"234 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":"124567530","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: Traumatic diaphragmatic injury (TDI) is one of the injuries that can occur after blunt and penetrating trauma and can be neglected or missed due to the masking of accompanying organ injuries. In this study, we delved into the difficulties in the diagnostic and treatment approaches for TDI patients. Methods: We retrospectively examined 22 TDI cases who were urgently operated following blunt (n = 14) and penetrating (n = 8) traumas in thoracic and general surgery clinics between January 2004 and 2019. We recorded information such as trauma type, diagnostic techniques, concomitant organ injuries, the location of diaphragmatic injury and its stage, the herniated organs toward the chest cavity, and surgical method. Results: The average mean age of the cases in the study was 41.5 years (22–66 years), and all of them were male. Among these, the percentage of pericardial rupture was significant (23%). In abdominal approaches, thorax was examined with an optical camera through the diaphragmatic rupture. TDI was classified into five groups based on the severity of the injury. Additionally, diaphragmatic ruptures in the central tendon or subpericardial area were examined. The entire central diaphragmatic injury was found as blunt trauma. This group was diagnosed with a high rate of multiple organ injuries (100%) and pericardial rupture (30%). Morbidity was 36%, and mortality was 14%. Conclusion: TDI should be taken into consideration in thoracoabdominal traumas. The frequency of organ injury in high-level TDI is also high. Therefore, laparoscopic and thoracoscopic evaluations should be needed. A good preoperative and peroperative strategy diminishes mortality and morbidity. We suggest that laparoscopy and thoracoscopy will be a lifesaving method in high-grade TDIs.
{"title":"Thoracoscopic examination of the thoracic cavity during laparotomy in traumatic diaphragm injuries","authors":"Y. Pi̇rhan, Tevrat Özalp","doi":"10.4103/ssj.ssj_40_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_40_20","url":null,"abstract":"Background: Traumatic diaphragmatic injury (TDI) is one of the injuries that can occur after blunt and penetrating trauma and can be neglected or missed due to the masking of accompanying organ injuries. In this study, we delved into the difficulties in the diagnostic and treatment approaches for TDI patients. Methods: We retrospectively examined 22 TDI cases who were urgently operated following blunt (n = 14) and penetrating (n = 8) traumas in thoracic and general surgery clinics between January 2004 and 2019. We recorded information such as trauma type, diagnostic techniques, concomitant organ injuries, the location of diaphragmatic injury and its stage, the herniated organs toward the chest cavity, and surgical method. Results: The average mean age of the cases in the study was 41.5 years (22–66 years), and all of them were male. Among these, the percentage of pericardial rupture was significant (23%). In abdominal approaches, thorax was examined with an optical camera through the diaphragmatic rupture. TDI was classified into five groups based on the severity of the injury. Additionally, diaphragmatic ruptures in the central tendon or subpericardial area were examined. The entire central diaphragmatic injury was found as blunt trauma. This group was diagnosed with a high rate of multiple organ injuries (100%) and pericardial rupture (30%). Morbidity was 36%, and mortality was 14%. Conclusion: TDI should be taken into consideration in thoracoabdominal traumas. The frequency of organ injury in high-level TDI is also high. Therefore, laparoscopic and thoracoscopic evaluations should be needed. A good preoperative and peroperative strategy diminishes mortality and morbidity. We suggest that laparoscopy and thoracoscopy will be a lifesaving method in high-grade TDIs.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"11 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":"125448055","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: Pain management is a vital part of postoperative treatment. Pain management in the postoperative period is based on a number of factors such as the extent of surgery, patient profile and surgeon experience, etc. The numbers of subjective scoring system were proposed to scale the severity of pain. Materials and Methods: This prospective audit was performed between November 2015 to January 2016. Pain scores were recorded in all patients underwent surgery for initial three days by numerical rating scale (NRS). Results: A total of 92 patients were included in this audit. The patients were broadly divided into the two groups: non-malignancy group and malignancy group. Pain scores were found higher in adult patients, in malignancy patients, and in patients who require wide excision. The scores were found on the lower side in the ear and throat surgery group in comparison to the nose surgery group. Discussion: Postoperative pain is an individual multi-factorial experience. Poor management is likely to increases the chances of local and systemic complications and delays in the recovery of the patients. Appropriate selection of analgesics would reduce hospital financial burden to a great extent but the side effect profile of each drug should be kept in mind.
{"title":"An audit of pain management at a tertiary care center","authors":"Dhananjay Kumar, B. Jat, S. Pachaury, H. Verma","doi":"10.4103/ssj.ssj_44_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_44_20","url":null,"abstract":"Introduction: Pain management is a vital part of postoperative treatment. Pain management in the postoperative period is based on a number of factors such as the extent of surgery, patient profile and surgeon experience, etc. The numbers of subjective scoring system were proposed to scale the severity of pain. Materials and Methods: This prospective audit was performed between November 2015 to January 2016. Pain scores were recorded in all patients underwent surgery for initial three days by numerical rating scale (NRS). Results: A total of 92 patients were included in this audit. The patients were broadly divided into the two groups: non-malignancy group and malignancy group. Pain scores were found higher in adult patients, in malignancy patients, and in patients who require wide excision. The scores were found on the lower side in the ear and throat surgery group in comparison to the nose surgery group. Discussion: Postoperative pain is an individual multi-factorial experience. Poor management is likely to increases the chances of local and systemic complications and delays in the recovery of the patients. Appropriate selection of analgesics would reduce hospital financial burden to a great extent but the side effect profile of each drug should be kept in mind.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"45 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":"134515567","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}
The COVID-19 pandemic has impacted health-care systems worldwide, mandating novel measures to protect patients and health-care workers. In addition to the stratification of risks in terms of patient, anesthesia, and surgery, surgeons will now have to consider infectious risks associated with the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus in their preoperative assessment. It is imperative that surgeons adapt to this new challenge, which is likely to be a part of the foreseeable future. This review aims to guide the operating surgeon to make informed decisions regarding risks associated with the virus, and how to best prepare for the same. It is a collation of the current knowledge in the field and covers (a) SARS-CoV-2 epidemiology, clinical characteristics, and testing; (b) strategies for stratification of surgeries; (c) preoperative testing; (d) preoperative considerations; (e) intraoperative concerns; (f) precautions to be followed in the performance of open as well as laparoscopic surgery; and (e) issues related to resumption of elective surgery.
{"title":"Surgery during the COVID-19 pandemic","authors":"D. Bhandarkar, L. Pinto","doi":"10.4103/ssj.ssj_29_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_29_20","url":null,"abstract":"The COVID-19 pandemic has impacted health-care systems worldwide, mandating novel measures to protect patients and health-care workers. In addition to the stratification of risks in terms of patient, anesthesia, and surgery, surgeons will now have to consider infectious risks associated with the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus in their preoperative assessment. It is imperative that surgeons adapt to this new challenge, which is likely to be a part of the foreseeable future. This review aims to guide the operating surgeon to make informed decisions regarding risks associated with the virus, and how to best prepare for the same. It is a collation of the current knowledge in the field and covers (a) SARS-CoV-2 epidemiology, clinical characteristics, and testing; (b) strategies for stratification of surgeries; (c) preoperative testing; (d) preoperative considerations; (e) intraoperative concerns; (f) precautions to be followed in the performance of open as well as laparoscopic surgery; and (e) issues related to resumption of elective surgery.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"1 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":"121881541","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}
M. Rabie, Ahmad Al Hazmi, Ismaeel El Hakeem, Rifaat Shakik, Asim Elias, A. Al Qahtani, T. Malatani, Saeed Al Khiar
Currently, bariatric surgery procedures has witnessed an upsurge in its utilization to control obesity and its allied morbidities. However, gastric or anastomotic leak, though rare, is its most dreadful complication. In this report we describe the clinical course of a 41 year-old-male, with a body mass index of 41.6, who underwent open mini gastric bypass which was followed by leak. A second laparotomy was performed in which intraperitoneal drains were inserted and a feeding jejunostomy was constructed. This was followed by the insertion of a mega stent, along with the application of over the scope clip at the site of the leak. Few days later, he appeared in our hospital with manifestations of sepsis. Computerized tomography scan showed persistence of leak with a perisplenic collection. A third laparotomy was performed and after tedious dissection, the stent was found eroding through the site of gastrojejunostomy. The defect was closed over a T tube and the perisplenic collection was drained. The patient tolerated surgery well, but he developed wound infection with disruption. Conservative treatment was followed to create a controlled incisional hernia, to be dealt with later. After a lengthy hospital stay, radioloic studies showed cessation of the leak with no collection. T tube, drains and jejunostomy tube were removed in time and the patient was discharged in good condition for OPD follow-up.
{"title":"Controlled fistula: A valid option for the management of post bariatric surgery leak","authors":"M. Rabie, Ahmad Al Hazmi, Ismaeel El Hakeem, Rifaat Shakik, Asim Elias, A. Al Qahtani, T. Malatani, Saeed Al Khiar","doi":"10.4103/ssj.ssj_45_20","DOIUrl":"https://doi.org/10.4103/ssj.ssj_45_20","url":null,"abstract":"Currently, bariatric surgery procedures has witnessed an upsurge in its utilization to control obesity and its allied morbidities. However, gastric or anastomotic leak, though rare, is its most dreadful complication. In this report we describe the clinical course of a 41 year-old-male, with a body mass index of 41.6, who underwent open mini gastric bypass which was followed by leak. A second laparotomy was performed in which intraperitoneal drains were inserted and a feeding jejunostomy was constructed. This was followed by the insertion of a mega stent, along with the application of over the scope clip at the site of the leak. Few days later, he appeared in our hospital with manifestations of sepsis. Computerized tomography scan showed persistence of leak with a perisplenic collection. A third laparotomy was performed and after tedious dissection, the stent was found eroding through the site of gastrojejunostomy. The defect was closed over a T tube and the perisplenic collection was drained. The patient tolerated surgery well, but he developed wound infection with disruption. Conservative treatment was followed to create a controlled incisional hernia, to be dealt with later. After a lengthy hospital stay, radioloic studies showed cessation of the leak with no collection. T tube, drains and jejunostomy tube were removed in time and the patient was discharged in good condition for OPD follow-up.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"19 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":"132978834","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}
I. Alnaami, S. Shakir, K. Almalwi, A. Alquzi, M. Asiri, M. Asiri, Nasser G Alqahtani, Shehata F Shehata
Objectives: The current study aimed to assess the impact of microdiscectomy surgery on quality of life (QOL) in postoperative patients across many facets of life to identify the most commonly affected ones. Our research question was, “does majority of postlumbar microdiscectomy patients have good QOL postsurgery?” Patients and Methods: In a single tertiary care center in southern region, Saudi Arabia, ninety-seven patients who underwent discectomy at Aseer Central Hospital (ACH) in southwestern Saudi Arabia from 2015 to 2017 were included in this study. ACH is the only tertiary care center in Asir province. Patients with spinal fractures or incomplete files were excluded. Patients' files were reviewed for data extraction. A phone call was made to all patients and they were asked to answer the five questions of the five domains of the EuroQoL 5-dimension 5-level (EQ-5D-5 L) QOL questionnaire. After considering other variables and adjusting for potential confounders, we assessed the amount of patients' satisfaction in the 5 domains of EQ-5D-5 L. Results: The study included 97 patients whose ages ranged from 28 to 56 years with a mean age of 42.6 ± 10.8 years. Nearly 61% of the patients were male. In all, 56.7% of patients reported a high QOL, while 4.1% of them had a poor QOL. About 82% of the included patients had no or minimal self-care problems, while 65.9% of the patients had no or minimal pain. Conclusions: The researchers concluded that about half of the patients who underwent lumbar microdiscectomy had a high QOL. The greatest improvements following microdiscectomy were recorded for self-care, mobility, and psychological status, while the lowest improvements were noted for pain and discomfort.
{"title":"Quality of life in post lumbar microdiscectomy patients using the EuroQol 5-dimension 5-level scale","authors":"I. Alnaami, S. Shakir, K. Almalwi, A. Alquzi, M. Asiri, M. Asiri, Nasser G Alqahtani, Shehata F Shehata","doi":"10.4103/ssj.ssj_31_19","DOIUrl":"https://doi.org/10.4103/ssj.ssj_31_19","url":null,"abstract":"Objectives: The current study aimed to assess the impact of microdiscectomy surgery on quality of life (QOL) in postoperative patients across many facets of life to identify the most commonly affected ones. Our research question was, “does majority of postlumbar microdiscectomy patients have good QOL postsurgery?” Patients and Methods: In a single tertiary care center in southern region, Saudi Arabia, ninety-seven patients who underwent discectomy at Aseer Central Hospital (ACH) in southwestern Saudi Arabia from 2015 to 2017 were included in this study. ACH is the only tertiary care center in Asir province. Patients with spinal fractures or incomplete files were excluded. Patients' files were reviewed for data extraction. A phone call was made to all patients and they were asked to answer the five questions of the five domains of the EuroQoL 5-dimension 5-level (EQ-5D-5 L) QOL questionnaire. After considering other variables and adjusting for potential confounders, we assessed the amount of patients' satisfaction in the 5 domains of EQ-5D-5 L. Results: The study included 97 patients whose ages ranged from 28 to 56 years with a mean age of 42.6 ± 10.8 years. Nearly 61% of the patients were male. In all, 56.7% of patients reported a high QOL, while 4.1% of them had a poor QOL. About 82% of the included patients had no or minimal self-care problems, while 65.9% of the patients had no or minimal pain. Conclusions: The researchers concluded that about half of the patients who underwent lumbar microdiscectomy had a high QOL. The greatest improvements following microdiscectomy were recorded for self-care, mobility, and psychological status, while the lowest improvements were noted for pain and discomfort.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"347 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":"121613081","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}
Charu Tiwari, H. Shah, Vikrant Kumbhar, D. Makhija, Jyoti Bothra, Gursev Sandlas
Background: Left-sided Bochdalek congenital diaphragmatic hernia (CDH) is the most common type of CDH. The right-sided Bochdalek CDH is rare and usually contains only the liver as its content. We describe four children with right CDH managed at our institution over 3 years. Materials and Methods: We present a retrospective analysis of four patients with right CDH managed at our institution from 2012 to 2015 with respect to age at presentation, sex, presenting symptoms, investigations, associated anomalies, management, and outcome. Results: The average age at presentation was 1.5 years, with range being 5 days to 4 years. The three older children presented with a history of frequent respiratory tract infections. The neonate was a preterm low-birth weight baby and had respiratory distress since birth. A chest radiograph suggested right pneumothorax for which intercostal chest drain insertion was done. A repeat chest X-ray showed suspicion of right-sided CDH which was confirmed on computerized tomography. All four patients underwent right thoracotomy with repair of the CDH. The neonate expired on the 4th postoperative day. The other three children had an uneventful postoperative recovery. Conclusion: Right-sided CDH is rare and has varied presentations and poorer outcome.
{"title":"Right congenital diaphragmatic hernia: Four cases and literature review","authors":"Charu Tiwari, H. Shah, Vikrant Kumbhar, D. Makhija, Jyoti Bothra, Gursev Sandlas","doi":"10.4103/ssj.ssj_42_17","DOIUrl":"https://doi.org/10.4103/ssj.ssj_42_17","url":null,"abstract":"Background: Left-sided Bochdalek congenital diaphragmatic hernia (CDH) is the most common type of CDH. The right-sided Bochdalek CDH is rare and usually contains only the liver as its content. We describe four children with right CDH managed at our institution over 3 years. Materials and Methods: We present a retrospective analysis of four patients with right CDH managed at our institution from 2012 to 2015 with respect to age at presentation, sex, presenting symptoms, investigations, associated anomalies, management, and outcome. Results: The average age at presentation was 1.5 years, with range being 5 days to 4 years. The three older children presented with a history of frequent respiratory tract infections. The neonate was a preterm low-birth weight baby and had respiratory distress since birth. A chest radiograph suggested right pneumothorax for which intercostal chest drain insertion was done. A repeat chest X-ray showed suspicion of right-sided CDH which was confirmed on computerized tomography. All four patients underwent right thoracotomy with repair of the CDH. The neonate expired on the 4th postoperative day. The other three children had an uneventful postoperative recovery. Conclusion: Right-sided CDH is rare and has varied presentations and poorer outcome.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126219211","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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