International Journal of Surgery Open最新文献

Introduction

and Importance: Trauma, particularly from motor vehicle accidents, causes significant morbidity and mortality worldwide. Isolated jejunal perforation resulting from blunt abdominal trauma is rare but challenging to diagnose. This article sheds light on this infrequent condition, emphasizing the need for early recognition for optimal outcomes.

Case presentation

A 30-year-old male presented with abdominal pain after a motor vehicle accident. Examination and tests showed signs of jejunal perforation. Urgent surgery revealed a 2 cm perforation, contusions, and deserosalizations. The perforation was repaired, and the patient recovered well postoperatively.

Clinical discussion

Blunt abdominal trauma is a major cause of injury, with motor vehicle accidents being prominent. Hollow visceral injuries, though rare, pose diagnostic and management challenges. In this context, recognizing the indications for surgical intervention is complex. Imaging, especially CT scans, plays a critical role in diagnosis. This case underscores the importance of CT findings in diagnosing and deciding the need for surgical exploration.

Conclusion

Isolated jejunal perforation from blunt abdominal trauma is rare but demands clinical attention. Timely diagnosis through CT scans and immediate surgical intervention are crucial for successful outcomes. Surgery involves careful exploration, repairing the perforation and associated injuries, and meticulous postoperative care. Research and knowledge sharing are vital for improving approaches and reducing complications and mortality in these cases.

Background

Post-operative haemorrhage can lead to significant complications and even mortality. These utilise scarce healthcare resources and increase hospital costs, as well as negatively impacting on patient's quality of life. Haemostats that exhibit additional adhesive properties can reduce the rate of bleeding complications. Standard gelatin sponges have been used safely in surgery for over 75 years but have almost no adhesive properties. This article reports the performance of a novel adhesive gelatin patch in human surgery for the first time.

Methods

A CE-marked gelatin foam patch (TenaTac®, Selentus Science, UK) has been created through a physical modification of the sponge surface, avoiding the need for the addition of blood-derived components or additional chemicals to stimulate adhesion. Real-world, post-approval clinical evaluations of the device were undertaken, and a structured data form was utilised to collect information on the device's performance during these procedures.

Results

In total, 63 evaluations were undertaken by 40 surgeons in 13 countries, covering 29 different surgical procedures. When assessing the adherence of TenaTac, 83 % (48/58) of the surgeons assessed the adhesion as very good or excellent. Both “haemostatic effect” and “time to haemostasis” achieved median scores of 4/5 (IQR 4–5), which equated to “very good” on the questionnaire. When surgeons were asked to compare their experience with TenaTac against their usual haemostat, 91.7 % (55/60) rated it as good, very good or excellent. When surgeons were asked if they would recommend the use of TenaTac, 96.5 % (55/57) of the surgeons responded positively to this question.

Conclusion

Real world evaluation of the novel adhesive patch, TenaTac, has confirmed that it exhibits very good adhesive and haemostatic qualities and could be considered for use by a wide variety of surgical specialities.

Introduction

Endoscopic retrograde appendicitis therapy (ERAT) is a new colonoscopy-based, non-invasive procedure used in the management of acute appendicitis. The results and future prospects of ERAT seem promising. In this study, we aim to study and compare the outcomes of the management of acute appendicitis done through ERAT and laparoscopic appendectomy.

Methods

The protocol for this study was prospectively registered. Electronic databases were searched for relevant articles, and all the comparative studies that compared the results of ERAT and laparoscopic appendectomy published in English were included. The mean difference was used as an effect measure for continuous variables, and the odds ratio was used for dichotomous data.

Results

Compared to laparoscopic appendectomy, ERAT had 10.93 min lesser procedural time (MD: 10.93; 95% CI: (−14.46) – (−7.40); n = 404; I² = 92%, p-value= < 0.00001), 5.46 times lesser odds of achieving technical success (OR: 5.46; 95% CI: 1.17–25.53; n = 329; I² = 0%, p-value = 0.03), 14.25 times more odds of developing recurrence (OR: 14.25; 95% CI: 2.67–76.12; n = 327; I² = 0%, p-value = 0.002), and cost of care was 611.99 USD lesser (MD: 611.99; 95% CI: (−940.48) – (−283.51); n = 204; I² = 98%, p-value = 0.0003). Analysis of length of hospital stay and adverse events did not show a significant difference between the two groups.

Conclusion

ERAT is a safe and appendix-conserving procedure that has a lesser procedural time compared to laparoscopic appendectomy; however, recurrence and therapeutic failure remain higher in the ERAT group.

Background

Continuous positive airway pressure (CPAP) is a simple, inexpensive, and gentle mode of respiratory support for neonates.This is beneficial for spontaneously breathing neonates by maintaining functional residual capacity in the alveoli to prevent atelectasis and improve oxygen exchange. The aim of this study was to assess the practice of continuous positive airway pressure application in neonatal intensive care.

Methods

A hospital based prospective observational descriptive study was conducted on 60 neonates from March 15, 2022 to July 30, 2022 at NICU Unit at XXX Comprehensive Specialized Hospital, July 2022, North-west Ethiopia.

Descriptive statistical analysis with SPSS version 25 was used.

Results

The overall practice of CPAP use were (73.4%), with assessment of parameters such as initial nursing care before initiation of CPAP (82.2%), Setting up of CPAP (94.1%), preparing the Baby for CPAP (65.3%), Connecting the nasal prong system to the neonate (50%), Methods of Securing CPAP device (96.7%), Performing safety check for Troubleshooting in CPAP (78.3%) and Monitor of CPAP and On-going assessments (46.6%).

Conclusion

The practice of CPAP application was good at Initial nursing care before initiation of CPAP, Setting up of CPAP, and Methods of Securing CPAP device. However, there was poor practice in connecting the nasal prong system to the neonate, preparing the Baby for CPAP, performing safety checks for troubleshooting in CPAP, Monitoring of CPAP and On-going assessments.