RESUMEN
Background: Acute appendicitis is one of the most frequent surgical emergencies and is a common cause of non-traumatic acute abdominal emergencies that require surgical intervention. Most complicated appendicitis started de novo as simple appendicitis raising the notion that it is a disease in evolution that has become of clinical importance due to delayed or missed diagnosis. Complicated appendicitis has been associated with a significant risk of postoperative septic complications, including wound infections and intra-abdominal abscess formation. This study aimed to evaluate the types of complicated appendicitis and their relationship to patient's demographic data, postoperative course and the length of hospital stay in Al-Basra Teaching Hospital. Methods: This was a prospective clinical study involving patients with acute appendicitis admitted to Al-Basra Teaching Hospital from January 2017 to October 2019. The demographic data, types of complicated appendicitis, hospitalization duration, and postoperative complications were evaluated. The patients were divided into six groups according to age. All data were recorded and analyzed. Results: A total of 1210 patients, age from 6 to 69 years, mean age of patients was 23.45, males out-numbered females. Perforated appendicitis represents the main type of complicated appendicitis, and it was reported mostly among elderly patients. Patients with complicated appendicitis had a longer hospitalization and more postoperative complications than patients with non-complicated appendicitis. Conclusion: we concluded that nearly one third of the patients with acute appendicitis had complicated appendicitis, so they need a special pre and postoperative care and old age had non classical clinical picture with poor outcome.
Asunto(s)
Humanos , Apendicitis/complicaciones , Cuidados Posoperatorios , Complicaciones Posoperatorias/prevención & control , Cirugía General , Infección de Heridas/prevención & control , Estudios Prospectivos , Absceso Abdominal/prevención & control , Diagnóstico Tardío , Tiempo de InternaciónRESUMEN
INTRODUCTION: Acute appendicitis is the main cause of emergency surgical care. Post-operative patients with complicated acute appendicitis present complications, many of them expected. The use of drains is one of the measures to prevent these complications; however, recent meta-analyzes do not justify this therapeutic measure. This study evaluates the relationship between use and non-use of drains, post-operative complications in patients with complicated peritonitis secondary to acute appendicitis. METHODS: A retrospective observational cohort study was conducted. The outcomes were analyzed by Chi-square test and Student's t-test; Fisher exact test was performed. RESULTS: The average operating time was 1.46 h (1.0-2.5) and 1.66 (1-3) for patients without drains and with drains, respectively, the difference was significant (p = 0.001). Post-operative fever was more prevalent in group with a drains odds ratio (OR) 3.4 (confidence interval [CI] 95% 1.4-7.9). The mean time of hospitalization was 7.3 (3-20) and 8.8 days (3-35) for patients without drains and with drains, respectively. (p = 0.01). The Chi-square analysis was significant for evisceration Grade III and residual collection p = 0.036, OR not evaluable. Reoperation was not significant among both groups, p = 0.108 OR 6.3 (CI 95% 0.6-62.4). CONCLUSIONS: There is a relationship between the non-use of drains and collections and evisceration in post-operative patients with open appendectomy, by complicated acute appendicitis.
ANTECEDENTES: La apendicitis aguda es la principal causa de emergencia quirúrgica. Los pacientes posoperados de apendicitis aguda complicada presentan complicaciones, muchas de ellas esperadas. El uso de drenajes es una de las medidas para prevenir estas complicaciones; sin embargo, recientes metaanálisis no justifican esta medida terapéutica. Este estudio evalúa la relación del uso o no uso de drenajes con las complicaciones en los pacientes con peritonitis secundaria a apendicitis aguda. MÉTODO: Se realizó un estudio de cohorte observacional retrospectivo. Los resultados se analizaron mediante la prueba de ji al cuadrado, la prueba t de Student y la prueba exacta de Fisher. RESULTADOS: El tiempo operatorio promedio fue de 1.46 horas (rango: 1.0-2.5 h) y de 1.66 horas (rango: 1-3 h) para pacientes sin drenajes y con drenajes, respectivamente; la diferencia fue significativa (p = 0.001). La fiebre posoperatoria fue más prevalente en el grupo con drenajes (odds ratio [OR]: 3,4; intervalo de confianza [IC] del 95%: 1,4-7,9). El tiempo promedio de hospitalización fue de 7.3 días (rango: 3-20 días) y de 8.8 días (rango: 3-35 días) para los pacientes sin y con drenajes, respectivamente (p = 0.01). La prueba de ji al cuadrado fue significativa para evisceración de grado III más colección residual (p = 0.036; OR no evaluable). Las tasas de reoperación no fueron significativamente diferentes entre ambos grupos (p = 0.108; OR: 6.3; IC 95%: 0.6-62.4). CONCLUSIONES: Existe relación entre la no utilización de drenajes y la presencia de colecciones y evisceración en pacientes posoperados con apendicetomía abierta por apendicitis aguda complicada.
Asunto(s)
Apendicitis/complicaciones , Drenaje , Peritonitis/etiología , Complicaciones Posoperatorias/etiología , Absceso Abdominal/epidemiología , Absceso Abdominal/etiología , Absceso Abdominal/prevención & control , Antibacterianos/uso terapéutico , Apendicectomía , Apendicitis/tratamiento farmacológico , Apendicitis/cirugía , Terapia Combinada , Drenaje/efectos adversos , Femenino , Fiebre/epidemiología , Fiebre/etiología , Hospitales Públicos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , México/epidemiología , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Utilización de Procedimientos y Técnicas , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Dehiscencia de la Herida Operatoria/epidemiología , Dehiscencia de la Herida Operatoria/prevención & control , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Procedimientos InnecesariosRESUMEN
INTRODUCTION: Accidental rupture of the gallbladder is an event which occurs in up to 20% of laparoscopic cholecystectomies, mainly in those where dissection is difficult, or during extraction when the gallbladder is withdrawn directly through the laparoscope port. It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection. It is common practice, therefore, for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs. OBJECTIVE: To compare 2 groups of similar patients, to determine whether administration of antibiotics, started during surgery, is actually useful in reducing the risk of residual abscess or infection in the surgical wound. PATIENTS AND METHOD: The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy. This total was divided at random into 2 groups: group A (80 patients) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture, followed by 2 more doses at intervals of 8 hours in the immediate postoperative period; and group B (86 patients) who did not receive any antibiotic treatment at all. The dependent variables observed were surgical wound infection and residual abscess: and the control variables were age, sex, length of operation time, intercurrent illnesses, and American Society of Anesthesiologists (ASA) classification. RESULTS: Two patients (2.5%) in group A developed a surgical wound infection, against 3 cases (3.4%) in group B, the result having no statistical significance. No patients developed residual abscess. In a multivariant analysis, the following were identified as independent factors significantly associated with the onset of surgical wound infection (P<0.001): diabetes mellitus, being over 60 years of age, operation time lasting longer than 70 minutes, and ASA 3. CONCLUSIONS: Routine application of an antibiotic to patients experiencing accidental perforation of the gallbladder during laparoscopic cholecystectomy is not necessary. In the case of patients with diabetes mellitus, those who are older than 60, or who have an ASA classification of 3 or more, or if the operation itself is likely to last more than 70 minutes, the recommendation is to start antibiotic therapy in the preoperative phase immediately before surgery.
Asunto(s)
Antibacterianos/administración & dosificación , Profilaxis Antibiótica/estadística & datos numéricos , Cefotaxima/administración & dosificación , Colecistectomía Laparoscópica/efectos adversos , Vesícula Biliar/lesiones , Complicaciones Intraoperatorias/tratamiento farmacológico , Complicaciones Intraoperatorias/etiología , Absceso Abdominal/etiología , Absceso Abdominal/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Esquema de Medicación , Femenino , Vesícula Biliar/cirugía , Humanos , Cuidados Intraoperatorios/métodos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Estudios Prospectivos , Rotura , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Intra-abdominal abscesses and adhesions play important roles on isolation of a septic process and on organism protection against bacteremia. On the other hand, such phenomenon difficults the afflux of immune factors and antibiotics to the septic site. The purpose of the present study was to evaluate the effect of abscess inhibition on survival of abdominal sepsis. METHODS: Thirty adult Wistar rats were submitted to intraperitoneal injection of 50% rat feces solution. The animals were divided into three groups (n = 10). Group 1: control - feces solution; group 2: feces solution plus 0.9% saline solution; and group 3: feces solution plus 1% carboxymethylcellulose to inhibit abdominal adhesions. The three groups were divided into two subgroups (n = 5). Subgroup A: relaparorotomy after 4 days and investigation of the abdominal cavity; and subgroup B: follow-up during 30 days to evaluate the mortality and its cause. The Fisher test was utilized for statistical analyses. RESULTS: The injection of 0.9% saline solution did not increase the mortality of the rats. However, the mortality enhanced in the group that received carboxymethylcellulose comparing with control group. That group developed less adhesions and abscesses. CONCLUSION: This study demonstrated that the reduction of abscess formation and of intraperitoneal adhesions increases the mortality due to abdominal septic disease.
Asunto(s)
Absceso Abdominal/prevención & control , Peritonitis/complicaciones , Sepsis/mortalidad , Absceso Abdominal/etiología , Animales , Carboximetilcelulosa de Sodio/uso terapéutico , Modelos Animales de Enfermedad , Masculino , Ratas , Ratas Wistar , Adherencias Tisulares/etiología , Adherencias Tisulares/prevención & controlRESUMEN
RACIONAL: Atribui-se aos abscessos intra-abdominais e às aderências peritoniais a função de isolar os processos sépticos e proteger o organismo da bacteremia. Por outro lado, esses fenômenos também dificultam o afluxo de fatores imunitários e antibióticos para a região infectada. OBJETIVO: Avaliar o efeito da prevenção de abscessos na sobrevida após peritonite bacteriana. MÉTODOS: Foram estudados 30 ratos Wistar machos que receberam solução de fezes a 50 por cento intra-abdominal e que foram distribuídos em três grupos (n = 10). Grupo 1: controle (solução de fezes); grupo 2: solução de fezes mais solução salina a 0,9 por cento; grupo 3: solução de fezes mais carboximetilcelulose a 1 por cento, para inibir a formação de aderências. Os três grupos foram divididos em dois subgrupos (n = 5): subgrupo A: nova laparotomia, após 4 dias, para inspeção da cavidade abdominal; e subgrupo B: acompanhamento durante 30 dias para avaliação da mortalidade e da causa de morte. A análise estatística utilizou o teste exato de Fisher. RESULTADOS: O acréscimo de solução salina a 0,9 por cento não aumentou a mortalidade do grupo. Entretanto, no grupo em que se acrescentou a solução de carboximetilcelulose, houve menor formação de abscessos, que também foram mais tênues e a mortalidade aumentou em relação ao grupo controle. CONCLUSÃO: A inibição na formação de aderências peritoniais e de abscessos acompanha-se de maior mortalidade decorrente do processo séptico intra-abdominal generalizado.
Asunto(s)
Animales , Masculino , Ratas , Absceso Abdominal/prevención & control , Peritonitis/complicaciones , Sepsis/mortalidad , Absceso Abdominal/etiología , Carboximetilcelulosa de Sodio/uso terapéutico , Modelos Animales de Enfermedad , Ratas Wistar , Adherencias TisularesRESUMEN
Se trata de un estudio retrospectivo, en el que se analiza los pacientes que fueron diagnosticados de absceso intra-abdominal postapendicectomía (AIPA), en el Hospital Pablo Arturo Suárez, entre enero de 1990 a diciembre de 1995. El 2.25 por ciento de los pacientes apendicectomizados, tuvieron AIPA. La perforación y la gangrena apendicular fueron observadas en el 91.7 por ciento de los casos con AIPA. El promedio de horas transcurridas entre el ingreso del paciente a emergencia y la cirugía fue de 14,25 horas, rango 3-45 horas. La fosa ilíaca derecha fue la localización más frecuente de AIPA (50 por ciento). El 66.7 por ciento de los pacientes con AIPA se sometieron a drenaje quirúrgico del absceso más antibiotico-terapia. Nos se observó mortalidad en este grupo de estudio. El cirujano debe desarrollar su criterio diagnóstico, para identificar pacientes en riesgo de AIPA y dar celeridad en el tratamiento quirúrgico d este tipo de paciente...