Abdomen In Group Research Articles

PREEMPTIVE DEEP TENSION SUTURING IN PREVENTION OF BURST ABDOMEN

Background :Burst abdomen is a major complication associated with contaminated or dirty surgeries, including emergency midline laparotomy. Possible causative factors involve wound sepsis, patients’ overall pressure inside the abdomen, and many system problems. Conventional oncosurgical approaches could prove inadequate, leading to evaluation of preventive methods, such as DTS, of minimizing such adverse outcomes. Objectives :To evaluate the level of success of deep tension suturing done before the primary closure of the abdomen against formation of burst abdomen, wound infection, and incisional hernia than mass closure techniques. Study design: A Cross sectional study. Place and duration of study. This Cross Sectional study was carried out at Setting: Done at Ziauddin Hospital, Civil Hospital- ward 06, and PAF Hospital, Karachi from Change the dates in duration of study as follows: January 2019 to Jan 2022 Methods: A Cross Sectional study which involved 100 adults who were posted for emergency midline laparotomy due to generalized peritonitis. Patients were divided into two groups: Group A: conventional mass closure Group B: closure with DTS. Both groups received simple polypropylene sutures for wound closure as in the standard mesh repair technique but not in group B they also received four deep tension sutures using the rubber tubing to distribute tension over wider areas of the tissue. Patients with diabetes, immunosuppression, or use of corticosteroids were excluded as a result. Results The age in years of the participants was 31.61 ± 9.31 years; the maximum age was 61 years, the minimum was 18 years. The observation was made that the incidence of burst abdomen in Group B was 4 and that of Group A was 18 (p<0.05). Bacteremia was noticed in 10 Pt’s in Group B and 17 Pt’s in Group A(p<0.05). Postoperative incisional hernia was identified in seven patients in Group A and none in Group B with p<0.05. These outcomes show decreases in all of the primary complications when implementing DTS on the approaches as there were statistically significant improvements for all of them. Conclusion :The pro-active use of deep tension sutures in emergency midline laparotomy dramatically decreases the rate of burst abdomen, wound infection, and incisional hernia. As tension on the wound edges is reduced by DTS, the study shows that postoperative complications are preventable in high-risk surgeries, patient benefits maximized, and reoperations minimized.

Optimal timing and influencing factors of laparoscopic cholecystectomy for acute cholecystitis

Objective To explore the best operative time of laparoscopic cholecystectomy for acute cholecystitis, and analyze the causes of laparotomy. Methods The clinical data of 82 cases of laparoscopic cholecystectomy in the Department of General Surgery, the Eighth People's Hospital of Taiyuan from January 2014 to July 2018 were retrospectively analyzed.According to the onset to operation time, the patients were divided into four groups: group A (21 cases, the onset to surgery time was within 48 h), group B (26 cases, the onset to surgery time was 48-72 h), group C(19 cases, the onset to surgery time was>72 h-1 week), group D (16 cases, the onset to surgery time was more than 1 week). The operative time, intraoperative blood loss, conversion of abdominal cavity and complication rate were compared, and the risk factors of conversion to laparotomy were analyzed. Results The open abdominal rates of group A-D were 4.76%(1/21), 19.23%(5/26), 26.32%(5/19) and 18.75%(3/16), respectively.The rate of open abdomen in group C was the highest, which of group A was the lowest.There were statistically significant differences between group A and the other three groups (χ2=3.635, 4.181, 3.682, 3.552, 3.448, all P<0.05). Single factor analysis showed that the laparotomy was related to the enlargement of the gallbladder, the thickness of the gallbladder, and the time of operation (all P<0.05). The analysis of multiple factors showed that the thickness of the gallbladder wall more than 6 mm[OR=1.310 (95% CI: 0.681-1.264), P=0.001], the time of operation more than 48 h[OR=2.672 (95% CI: 0.261-0.961), and P=0.000] were independent risk factors for transabdominal surgery of acute cholecystitis laparoscopy. Conclusion Laparoscopic surgery within 48 hours of acute cholecystitis can reduce the risk of transabdominal surgery.The thickness of the gallbladder and the timing of the operation are independent risk factors affecting the transabdominal operation. Key words: Cholecystitis, acute; Cholecystectomy, laparoscopic; Operative timing; Factor analysis, statistical

Comparison of Graft Survival between Fat Harvested from Abdomen and Medial Thigh for Facial Contour Deformity: A Randomised Control Trial.

To compare the graft survival between fat harvested from abdomen and medial thigh for facial contour deformity. Randomised control trial (RCT) . Jinnah Burn and Reconstructive Surgery Center, Lahore, from October 2015 to April 2017. Patients fulfilling the inclusion criteria were randomly divided into two groups. Fat was harvested from medial thigh in Group A and from abdomen in Group B. Outcome was measured in terms of fat survival by comparing mean fat at baseline, first and 12ᵗʰ week. Final fat survival thickness >6.00 mm at 12ᵗʰ week was considered as excellent. ANOVA was used for comparison of mean fat thickness (mm) between the groups, and Chi-square test for outcome and complications among groups with p-value <0.05 as statistical significance. Mean age of subjects was 27 +7.44 (range 12 to 60) years. Mean final fat thickness in Group A was 6.030 +0.095 mm and in Group B was 4.989 +0.094 mm (p=0.001). Thirty patients (76.9%) in Group A and none in Group B showed excellent response (p=0.001). Outcome of graft survival with fat harvested from medial thigh was better as compared to that from abdominal fat.

COMPARISON OF A NEW VERESS NEEDLE ENTRY METHOD AND CLASSIC VERESS NEEDLE ENTRY METHOD IN GYNECOLOGIC LAPAROSCOPY: A PROSPECTIVE RANDOMIZED STUDY

Background: To compare cranial 15º angulation of Veres needle to classic Veress needle entry in closed laparoscopic entry in obese patients.&#x0D; Method: Patients with BMI index&gt;30 were divided into two groups. Initial entry into the abdomen in Group 1 (n=29) was performed with the intraumbilical insertion of Veress needle in 90o angle relative to the horizontal plane. In Group 2 (n=31) the Veress needle was placed intraumbilically in a cranial direction, the tip of the needle towards the thoracic cavity, with an angle of 15o to the horizontal plane. Two groups were compared with respect of the operative outcomes.&#x0D; Results: In Group 2, the mean number of Veress needle entries attempt was significantly lower than Group 1 (p=0.01). Time to insertion of the Veress needle was found to be significantly shorter in Group 2 than in Group 1 (p&lt;0.001). While entry failure occurred in 3 patients in Group 1 (10.3%), no failures were monitored in any patients in Group 2 (p= 0.01). Complication rate was significantly lower in Group 2 than in Group 1 (p= 0.03).&#x0D; Conclusion: Placement of Veress needle intraumbilically in a cranial direction at 15°angle to the horizontal plane increases entry success and reduces complications.

A Comparative Study of Polydioxanone and Nylon for Abdominal Wall Closure With Interrupted Figure of Eight in Peritonitis Cases

Background: In emergency and elective settings, some surgeons prefer continuous or interrupted closure of abdominal fascia, because in a continuous suturing, cutting out of even a single bite of tissue leads to opening of the entire wound and high risk of burst abdomen, whereas in interrupted method, they found much lower risk of burst abdomen. The aim is to assess the complication rate with the same closure technique between two different sutures. The best suture is one that maintains tensile strength throughout the healing process with good tissue approximation and less wound infection, is well tolerated by patient and is technically simple and expedient. The aim was to compare the non-absorbable sutures (nylon) and delayed absorbable sutures (polydioxanone (PDS)) for abdominal wall closure in cases of peritonitis. We used a different technique to close the abdominal wall fascia and study the postoperative complications. Methods: This was a prospective study carried out in the Department of Surgery, MMIMSR, Mullana, Ambala from March 2014 to April 2015, a single unit by a single surgeon. A total of 60 patients underwent interrupted closure of abdominal fascia by figure of eight techniques with polyamide (nylon No. 1) suture in group A and polydiaxanone (PDS No. 1) suture in group B. The incidence rates of wound infection, dehiscence, suture sinus formation and incisional hernia were recorded. Patients were followed up for a period of 1 year. Results: Out of the 60 patients, the rates of wound pain, discharge and dehiscence in group A were 30%, 23.3% and 26.7% and in group B were 6.7%, 16.6% and 23.3%. There was 0 burst abdomen in group A compared to one burst abdomen in group B. Suture sinus formation, chronic wound infection and stitch granuloma was one each in group A and was 0 in group B. Incisional hernia was not found in any of the group. We have concluded that condition of the wound depends on the comorbidity of the patient like smoking, malnutrition, and old peritonitis. It also mainly depends on the technique used for closure of the wound and also on the material used. Conclusion: Though wound complications were found more in non-absorbable suture but the rate of wound complications between the two sutures was found insignificant. The purpose of the study is to assess the presence of differences in abdominal wall closure in patients with risk criteria, with the same closure technique between slowly absorbable sutures and non-absorbable sutures. Sutures were placed and tied such that fascial edges were well approximated but not compressed tightly together. J Curr Surg. 2016;6(3-4):65-72 doi: https://doi.org/10.14740/jcs306e

Risk Stratification of Necrotizing Fasciitis Based on the Initial Procalcitonin Concentration: A Single Center Observational Study

Necrotizing fasciitis (NF) is a potentially fatal subcutaneous tissue and fascia infection. We studied the role of serum procalcitonin in the identification and assessment of severity of sepsis in patients with NF. A retrospective analysis was conducted from January 2000 to December 2013 for all patients who admitted to surgical intensive care with provisional diagnosis of NF. Patients were categorized into four groups based on the initial procalcitonin concentrations (Group I: <0.5 low risk, Group II: ≥0.5-<2 moderate risk, Group III: ≥2-<10 high risk, and Group IV: ≥10 ng/mL high likelihood of severe sepsis). During the study period, 331 cases were identified to have NF with a mean age of 51 ± 14 years. Serum procalcitonin was tested in 62 cases (only between 2011 and December 2013) and all were positive (Group I: 22%, Group II: 18%, Group III: 21%, and Group IV: 39%). The most common affected regions were thigh and chest in Group II (46% and 9%, respectively), lower limbs in Group III (46%), and perineum and abdomen in Group IV (25% and 21%, respectively). In the four groups, 21 patients developed septic shock (Group I: 0%, Group II: 14%, Group III: 24%, and Group IV: 62%). The cut off procalcitonin value for septic shock was 5.6 ng/mL. Using receiver-operating characteristic curve, this cut off with the Area under the Curve (AUC) of 0.77 was found to have sensitivity 81% and specificity 67%. Sequential Organ Failure Assessment (SOFA) score was substantially greater in Group III and Group IV in comparison to Group I and Group II, p = 0.006. Procalcitonin levels were correlated well with SOFA score (r = 0.34, p = 0.007). There were 17 deaths in the four groups (Group I: 6%, Group II: 23%, Group III: 12%, and Group IV: 59%). Initial procalcitonin concentration in NF carries an important prognostic value and it correlates well with SOFA score and can predict the development of septic shock early in patients with NF.

The influence of hormonal treatment with beta-human chorionic gonadotropin for cryptorchidism on future fertility in rats

There have been two treatment modalities for cryptorchidism such that surgical and hormonal; the latter being highly controversial. While some authors suggest that hormonal treatment increases the number and maturation of germ cells in cryptorchid testes, others believe just the opposite. We aimed to find out the sperm counts and testicular index; briefly fertility potential of the normally descended contralateral testes in adulthood period in rats treated with Beta-HCG in early period of their lives. Three groups, each including 10 rats aged 22 days old, in which delactation and normal feeding can be started, were formed to be Group 1: Sham operated, Group 2: Experimental cryptorchidism (EC) and Group 3: Hormone-treated after experimental cryptorchidism was performed (HT-EC). Left testis was placed in the abdomen in group 2 and 3. In group 1, a sham operation was performed. The rats in EC-HT group received subcutaneous injections of 50 IU/kg Beta-HCG daily for 7 days. Right orchidectomy was performed when they reached reproductive period to evaluate fertility potential with sperm counts and testicular index. Testicular index was calculated according to the formula "testicular length × width/weight of rat". Epididymal sperm count was made with hemocytometer. We evaluated the physical characteristics and fertility potential (sperm counts) of contralateral normal testes during adulthood in rats that underwent experimental unilateral cryptorchidism during infancy. A relationship between testis weight and sperm counts were also investigated. We could not find any direct correlation of sperm count with either testicular weight or testicular index in our study. Although the rats had normal testes at birth, we found decreased sperm counts in contralateral normal testes in EC group. This suggests that unilateral cryptorchidism may cause some systemic effects that reach the other testis. Hormone treatment was not beneficial. This is comparable to Nambirajan et al. who reported histological changes and decreased spermatogenic cell count in contralateral scrotal testes in experimentally induced unilateral cryptorchidism in early period of life in rats. Heiskanen et al. reported that treatment with Beta-HCG leads to decreased total sperm counts in the future due to increased germ cell apoptosis caused by hormonal withdrawal after treatment. Cortes et al. also reported decreased number of germ cells in 1-3 year-old boys who underwent surgery after unsuccessful Beta-HCG treatment. The reasons could be delayed testicular descent or adverse effect of hormone treatment though. Our results concurred with them. Apparently, our model has failed to mimic the pathophysiologic mechanisms of congenital cryptorchidism in humans. Furthermore, we applied hormone treatment in normal rats with normally descended testes. Therefore, the "by-product" information of our study is that, unnecessary use of Beta-HCG during infancy may impair future fertility. Our study suggests that Beta-HCG treatment may decrease sperm counts and decrease the future fertility potential. We could not find any direct correlation of sperm count with either testicular weight or testicular index.

Comparison of clinical manifestations and BILAG disease activity index in systemic lupus erythematosus patients with and without gastrointestinal vasculitis

Objective: To investigate the clinical features and British Isles Lupus Assessment Group index (BILAG) in systemic lupus erythematosus (SLE) patients with gastrointestinal vasculitis. Methods: A retrospective study was conducted in SLE patients admitted to our hospital due to gastrointestinal manifestations from January 2000 to May 2008. The diagnosis of gastrointestinal vasculitis was made by clinical features and abdominal CT scan findings. Chart reviews identified 42 patients with a total of 61 admissions for gastrointestinal vasculitis (group A). Another 21 patients without gastrointestinal vasculitis, which was confirmed by abdominal CT scans, were enrolled as the control group (group B). Results: The mean age and disease duration in group A were 27.6 years and 5.6 years respectively. Rebound tenderness of the abdomen in group A was found in 57.4% of admissions. There were no significant differences in the demographic data, clinical features, autoantibody profiles and other serologic parameters between SLE patients in the two groups. However, SLE patients in group A had higher BILAG global score at the time of investigation. Conclusion: Gastrointestinal vasculitis is a common cause of abdominal pain in patients with active SLE. Except BILAG global score, the common clinical manifestations and BILAG components do not correlate with the occurrence of gastrointestinal vasculitis in lupus patients.

Vehicle-moose accidents in Newfoundland.

During 1987 and 1988, in Newfoundland, there were 661 motor-vehicle accidents involving a moose; 133 people were injured and three died. This constitutes a major problem for the provincial health-care system. In 95 per cent of the patients who were involved in fifty-five primary collisions (the vehicle hit only the moose), the injury-severity score was less than 9 (mean and standard deviation, 3.2 +/- 4.6). There were thirty-six secondary collisions: in eighteen, the vehicle hit other objects after avoiding the moose (group A), and in the other eighteen, the vehicle hit the moose and then hit other objects (group B). In group A, the mean injury-severity score was 4.2 +/- 2.9 and in group B, it was 19.6 +/- 27.1. The three patients who died were in group B. There were more injuries to the thorax, thoracolumbar spine, and abdomen in group B than in the single-collision groups (primary-collision group and group A).