RESUMEN

The diagnosis of appendicitis is based on clinical picture. The aim of this retrospective study was to analyse variation of outcomes and impact of increasing use of radiological investigations and laparoscopy over a 5-year period. A retrospective audit of appendicectomies over the last 5 years (01 January 2007-31 December 2011) was conducted. The negative appendicectomy rate (NAR), perforation rate and complication rate were used as outcome endpoints. A statistical analysis was performed to evaluate the difference in outcomes with surgical approach and use of radiology. One thousand fifty-five appendicectomies were performed in this period. The NAR was 22.65 % (21 % for open and 28 % for laparoscopic) and perforation rate was 14 %. There was no statistically significant difference in NAR with the use of ultrasound (P 0.3814) but there was a significant reduction in NAR with the use of computed tomography (CT) (P <0.0001). Intra-abdominal abscess (2.3 %) and wound infection (1.4 %) were the common complications with the former being higher with laparoscopy and the latter with open appendicectomy. Over 5 years, there were no significant changes in appendicectomy outcomes. The impact of diagnostic imaging on NAR varies with age, gender and the use of CT. CT can significantly reduce the negative appendicectomy rate in equivocal presentations. Complication rates vary with surgical approach.

RESUMEN

INTRODUCTION: It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors: acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age >70 years. Current evidence-based guidance on antibiotic prophylaxis during laparoscopic cholecystectomy (LC) is based on elective procedures and does not take into account these factors. The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint. METHODS: One hundred consecutive patients undergoing LC under the care of a single consultant surgeon during a one-year period were studied prospectively. Data collected included patient demographics (age, sex) as well as details of the history of gallstone disease to determine those with complex disease and risk factors for bactibilia. A single dose of antibiotics (second generation cephalosporin and metronidazole) was administered on induction to patients with a risk factor present. Information relating to all radiologically or microbiologically confirmed infections was documented. RESULTS: Eighty-four of the patients were female and the mean age was 47.7 ±16.0 years. Nineteen LCs were performed as emergencies and the remainder were elective procedures. A risk factor for bactibilia was present in 35 patients. A wound infection was identified in four cases, two of which were Staphylococcus aureus (one methicillin resistant), one was a coagulase negative Staphylococcus and one wound cultured a mixed anaerobic growth. Three of the infections occurred in patients receiving prophylaxis (2 staphylococcal and 1 anaerobic) at intervals of 7, 14 and 19 days respectively. One patient with a body mass index of 32kg/m² in the 'no prophylaxis' group developed a coagulase negative staphylococcal infection at 10 days. No intra or extra-abdominal abdominal infections were identified. CONCLUSIONS: This study has demonstrated that restricting antibiotic prophylaxis to high risk patients has no detrimental effects in terms of increasing the rate of infections in those with no risk factors. Furthermore, the act of not prescribing to low risk patients will limit costs and the risk of adverse events. It will also reduce the risk of resistance and clostridial infections in this cohort.

Asunto(s)

Profilaxis Antibiótica/métodos , Colecistectomía Laparoscópica/métodos , Infección de la Herida Quirúrgica/prevención & control , Antibacterianos/administración & dosificación , Cefalosporinas/administración & dosificación , Colecistitis Aguda/microbiología , Colecistitis Aguda/cirugía , Tratamiento de Urgencia , Femenino , Cálculos Biliares/microbiología , Cálculos Biliares/cirugía , Humanos , Masculino , Metronidazol/administración & dosificación , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureus , Resultado del Tratamiento

RESUMEN

AIM: While there is evidence that laparoscopy creates fewer adhesions, evidence regarding decreased episodes of adhesive obstruction in laparoscopic colorectal resection (LCR) is still lacking. The aim of our study was to compare the incidence of adhesion-related admissions/surgery in patients undergoing LCR and open colorectal resection (OCR). METHOD: We conducted a retrospective analysis of a prospectively collected database that included all patients undergoing LCR and OCR between 2001 and 2010. Patients with <6 months of follow-up were excluded. Patients who were converted to open surgery were included in the laparoscopic group. Details regarding readmission rates and surgery for adhesive obstruction were obtained from clinical portals and the theatre database. Statistical analysis was performed using Fisher's exact test, the Mann-Whitney U-test and the Student's t-test. RESULTS: One-hundred and forty-four patients had LCR with a median (range) follow-up of 24.5 (6-108) months. One-hundred and eighty-seven patients underwent OCR, with a median (range) follow-up of 49 (6-104) months. Six (4.2%) of 144 patients in the LCR group had adhesion-related admission/obstruction compared with 13 (6.95%) of 187 patients in the OCR group (P = 0.34). Three (2.1%) of 144 patients who had LCR required surgery for adhesive obstruction compared with five (2.7%) of 187 who had OCR (P = 0.73). CONCLUSION: In our study there was no statistically significant difference in the incidence of postoperative adhesive intestinal obstruction between LCR and OCR groups.

Asunto(s)

Enfermedades del Colon/cirugía , Obstrucción Intestinal/etiología , Laparoscopía/efectos adversos , Enfermedades del Recto/cirugía , Adherencias Tisulares/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/métodos , Femenino , Estudios de Seguimiento , Humanos , Análisis de Intención de Tratar , Obstrucción Intestinal/cirugía , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo , Adherencias Tisulares/etiología

RESUMEN

Thigh subcutaneous emphysema is an usual orthopaedic presentation normally associated with musculoskeletal problems or penetrating wounds. But, sometimes it can be related to abdominal pathology. We present a case of subcutaneous emphysema of the thigh secondary to para-caecal abscess.

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Portal vein gas is an uncommon ominous radiological sign usually harbouring an intra abdominal catastrophe. When accompanied by pneumatosis intestinalis, it is more predictive of bowel ischemia. We present a case presented with both signs, who suffered from a rare complication of Meckel's diverticulum.