Abdominal Surgical Conditions Research Articles

Surgical conditions in experimental laparoscopy: effects of pressure, neuromuscular blockade, and pre-stretching on workspace volume.

Establishing a pneumoperitoneum for laparoscopy is common surgical practice, with the goal to create an optimal surgical workspace within the abdominal cavity while minimizing insufflation pressure. Individualized strategies, based on neuromuscular blockade (NMB), pre-stretching routines, and personalized intra-abdominal pressure (IAP) to enhance surgical conditions are strategies to improve surgical workspace. However, the specific impact of each factor remains uncertain. This study explores the effects and side-effects of modifying intra-abdominal volume (IAV) through moderate and complete NMB in a porcine laparoscopy model. Thirty female Landrace pigs were randomly assigned to groups with complete NMB, regular NMB and a control group. Varying IAP levels were applied, and IAV was measured using CT scans. The study evaluated the maximum attainable IAV (Vmax), the pressure at which the cavity opens (p0), and the ease of expansion (λexp). Cardiorespiratory parameters, including peak inspiratory pressure (PIP), mean arterial pressure (MAP), heart rate (HR), and cardiac output (CO), were continuously recorded to evaluate side-effects. There were no significant weight differences between NMB groups (median 21.1kg). Observed volumes ranged from 0 to 4.7 L, with a mean Vmax of 3.82 L, mean p0 of 1.23mmHg, and mean λexp of 0.13hPa-1. NMB depth did not significantly affect these parameters. HR was significantly increased in the complete NMB group, while PIP, MAP, and CO remained unaffected. Repeated insufflation positively impacted Vmax; ease of opening; and expanding the cavity. In this porcine model, the depth of NMB does not alter abdominal mechanics or increase the surgical workspace. Cardiorespiratory changes are more related to insufflation pressure and frequency rather than NMB depth. Future studies should compensate for the positive effect of repeated insufflation on abdominal mechanics and surgical conditions.

Características clínicas, epidemiológicas y quirúrgicas de la apendicitis aguda en un hospital de Lima

Mr. Editor: Acute appendicitis represents the most prevalent abdominal surgical condition globally, affecting approximately 10% of the population. Notably, its incidence is higher during the second and third decades of life, constituting the main cause of acute abdomen in the young adult population. In view of its prevalence, it is imperative that an early diagnosis be established and appropriate treatment applied to prevent associated complications. It is important to note that the mortality rate for uncomplicated cases is 0.6%, but it can rise to between 2-3% in cases of perforation and 5-15% in the elderly population.

BF2-Azadipyrromethene Fluorophores for Intraoperative Vital Structure Identification.

A series of mono- and bis-polyethylene glycol (PEG)-substituted BF2-azadipyrromethene fluorophores have been synthesized with emissions in the near-infrared region (700-800 nm) for the purpose of fluorescence guided intraoperative imaging; chiefly ureter imaging. The Bis-PEGylation of fluorophores resulted in higher aqueous fluorescence quantum yields, with PEG chain lengths of 2.9 to 4.6 kDa being optimal. Fluorescence ureter identification was possible in a rodent model with the preference for renal excretion notable through comparative fluorescence intensities from the ureters, kidneys and liver. Ureteral identification was also successfully performed in a larger animal porcine model under abdominal surgical conditions. Three tested doses of 0.5, 0.25 and 0.1 mg/kg all successfully identified fluorescent ureters within 20 min of administration which was sustained up to 120 min. 3-D emission heat map imaging allowed the spatial and temporal changes in intensity due to the distinctive peristaltic waves of urine being transferred from the kidneys to the bladder to be identified. As the emission of these fluorophores could be spectrally distinguished from the clinically-used perfusion dye indocyanine green, it is envisaged that their combined use could be a step towards intraoperative colour coding of different tissues.

Laparotomy in Children in a Tertiary Hospital in a Developing Country: Indications, Complications and Outcome

Background: Pediatric laparotomy is important surgical procedure necessary for the diagnosis and treatment of abdominal surgical conditions in children. The objective of this study was to evaluate our experience on pediatric laparotomy in terms of indications, complications and outcome. Methodology: This was a retrospective study of children aged 15 years and younger who had laparotomy (for various indications) between January 2017 and December 2018 at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. Results: A total of 202 pediatric laparotomies were performed during the study period. There was male predominance and the median age of the patients was 5 years. Majority of the patients were infants and most of the laparotomies were performed as emergency surgeries. The mean duration of hospital stay of the patients was 10 days and abdominal pain was the most common symptom. At presentation, one-half and one-quarter of the patients had low hemoglobin and electrolyte derangement respectively. Abdominal ultrasound and x rays were diagnostic in about 50% of the patients. Intussusception was the most common indication for laparotomy and surgical site infection was the most common post-operative complication. Eleven (5.4%) patients expired. Conclusion: Laparotomy in children can be lifesaving and infants with intussusception were the largest group of patients in the current series. Abdominal pain, Page -01 World Journal of Clinical Surgery Open Access https://www.wjclinicalsurgery.com anemia and electrolyte derangement were the common indices at presentation. Pediatric laparotomy can be associated with morbidity and mortality.

Emergency laparotomy at district hospitals in a developing nation: a review of indications and outcomes of treatment

Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals. Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance. Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%). Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.

Problem of the Care of Digestive Surgical Emergencies at the Visceral Surgery Department of Donka National Hospital in Conakry

Introduction: The goal was to highlight the issue of management of digestive surgical emergencies in our department. Methods: This was a prospective study that brought together patients treated for digestive surgical emergencies over a 10-month period (January - October 2014). Results: We collected 135 patients or 21% of all abdominal surgical conditions during the period (N=649). The average age of our patients was 34 years (range: 11 and 80); The sex ratio was 2.19. Public transport was the means used by patients. The reasons for consultation were: abdominal pain (89.63%), vomiting (77.78%), cessation of materials and gas (60%). The average consultation time was 6 days (range: 2 hours and 21 days). Acute generalized peritonitis was the most common (44.44%). The average time to treatment was 11 hours (range: 1 and 29 hours). The management was medico-surgical. The postoperative consequences were simple in (50.37%), the postoperative complications were dominated by parietal infection (30.53%), evisceration (3.70%) and scrotal hematoma (2.96%). One death was noted in (17.04%). The average length of stay was 12 days (range: 1 and 54 days). Conclusion: The management of digestive surgical emergencies remains a challenge. Morbidity and mortality would be revised downwards by reducing the diagnostic delay due to dysfunction of the care system and problems of access to care.

A study of post operative pleuropulmonary complications of abdominal surgeries attending in a tertiary care hospital at Kakinada

Introduction: Postoperative pulmonary complications (PPCs) following abdominal surgery are frequent and associated with increased morbidity and mortality and hospital length of stay. Incidence rates vary dramatically, ranging from 2% to 40%. The incidence of pleuro-pulmonary complications shows wide variations & has the diversity of various influencing factors, including patient existing lung conditions, habitual history, selection of surgery, anaesthetic risks and post-surgical recovery. Material and Methods: 100 patients are selected from in & out patient department & causality in GGH, Kakinada attending for abdominal surgical conditions. It is a prospective- observational, cross sectional study. Results: In the studied group of 100 person’s total of 27 persons affected with pulmonary complications in overlapped manner. Following pulmonary complications observed with incidence rates respectively in the order of ATELECTASIS (74.07%), PLEURAL EFFUSION (62.96%), PNEUMONIA (62.96%), RESPIRATORY FAILURE (11.11%). Conclusion: The incidence of postoperative pleuropulmonary complications of abdominal surgeries in our study in GGH, Kakinada is 27%, which includes atelecasis as the predominant one (74%) followed by pleural effusion and pneumonia each carrying equal incidence (62.96%) and finally respiratory failure that occupied least. Early prediction of postoperative pulmonary complications is possible to have the early interventions to reduce the post op morbidity, hospital length of stay and cost. Keywords: Atelectasis, Pleural effusion, Pneumonia, Respiratory failure.

Barriers and facilitators of laparoscopic surgical training in rural north-east India: a qualitative study

Introduction: Laparoscopic surgery has advantages for treating many abdominal surgical conditions, but its use in low and middle-income countries (LMICs) is limited by many factors, including a lack of training opportunities. The aim of this study was to explore the training experiences of surgeons in rural north-east India to highlight the barriers and facilitators to laparoscopic surgery. Methods: Eleven surgeons with experience in laparoscopy in rural north-east India were recruited using purposive and convenience sampling. Ethical approval was obtained from the Institutional Ethics Committee, Maulana Azad Medical College, New Delhi, India and the Leeds Institute of Health Sciences Research Ethics Sub-Committee, West Yorkshire, England. Consenting participants took part in semi-structured interviews, either between May 20 and 25, 2019 in rural north-east India or via Skype or at the University of Leeds in June 2019. Interviews were audio-recorded and transcribed and thematic content analysis performed. Results: Exposure to laparoscopy during postgraduate training was common, but training experiences were inconsistent and informal. Alternative training opportunities are limited by availability and cost. There is high demand for a structured curriculum, incorporating formal assessment and credentialing, to include observation and assistance in live surgery and laparoscopic simulation. Conclusions: Laparoscopic training experiences are highly variable, with limited training resources and lack of a curriculum. Poor accessibility is consistent with that recorded in literature. Current recommendations include government support and funding to guide development of a standardized curriculum and widen access to training programs for surgeons in rural settings.

Pediatric appendicitis- five year experience at tertiary care pediatric surgery department: a cohort study

Background: Acute appendicitis is one of the most common abdominal surgical condition in pediatric population. It accounts for 1-8% of children presenting in pediatric surgical emergency. The aim of this study was to evaluate pediatric appendectomy in our department.Methods: It was a hospital based prospective cohort study spanning over a period of 5 years, where all diagnosed cases of pediatric appendicitis were enrolled. Demographic profile, clinical features and operative findings were analyzed. Patients were kept on regular follow-up and complications were noted.Results: During the study period 146 patients were enrolled for the study. Male: female ratio was 1:1. Maximum patients belonged to age group of 11-15 years (42%). Pain in abdomen and fever were the most common presenting symptoms. Tenderness in right iliac fossa was the most common clinical sign (89.72%) and inflamed appendix was the most common operative finding in the study (83.91%).Conclusions: The diagnosis of acute appendicitis is based on clinical examination. Atypical symptoms may lead to delay in the diagnosis and management. Imaging and lab investigations are supportive. Early recognition of symptoms, access to healthcare facility with a surgeon can significantly reduce the morbidity and complication rates in pediatric age group.

Depth of Neuromuscular Block Is Not Associated with Abdominal Wall Distention or Surgical Conditions during Gynecologic Laparoscopic Operations. A Prospective Trial.

The influence of the degree of a neuromuscular block (NMB) on surgical operating conditions during laparoscopic surgery is debated controversially. The extent of abdominal distension during the time course of the NMB was assessed as a new measurement tool. In 60 patients scheduled for gynecologic laparoscopic surgery, the increase of the abdominal wall length induced by the capnoperitoneum was measured at 5 degrees of the NMB: intense NMB—post-tetanic count (PTC) = 0; deep NMB—train-of-four count (TOF) = 0 and PTC = 1–5; medium NMB—PTC > 5 and TOF = 0–1; shallow NMB—TOF > 1; full recovery—train-of-four ratio TOFR > 90%. Simultaneously, the quality of operating conditions was assessed with a standardized rating scale (SRS) reaching from 1 (extremely poor conditions) to 5 (excellent conditions). Fifty patients could be included in the analysis. The abdominal wall length increased by 10–13 mm induced by the capnoperitoneum. SRS was higher during intense NMB (4.7 ± 0.5) vs. full recovery (4.5 ± 0.5) (mean ± SD; p = 0.025). Generally, an intense NMB did not increase abdominal wall length induced by capnoperitoneum. Additionally, its influence on the quality of surgical operating conditions seems to be of minor clinical relevance.

Enterostomies for acute abdominal surgical condition in children: An experience in a developing country

Background: Pediatric abdominal surgical condition that is complicated by gross peritoneal contamination may require enterostomy as a damage control or salvage procedure. Late presentations mostly seen in developing countries make creation of enterostomy a relatively common surgical procedure. The aim of this study was to evaluate the creation of enterostomy in children who presented with acute abdominal surgical conditions. Methods: This was a retrospective study of children that had enterostomy in the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. Medical records of pediatric patients that had enterostomy over a 10-year period were assessed. Results: There were 32 cases of enterostomies performed during the study period. There were 25 males (78.1%) and 7 females (21.9%) with a male to female ratio of 3.6:1. The age range of the patients was 3 weeks to 180 months, with a median age of 96 months. There were 1 neonate (3.1%), 10 infants (31.3%) and 21 children (65.6%) older than 1 year. The primary diagnoses were typhoid intestinal perforation in 21 patients (65.6%), intussusception 10 (31.3%) and intestinal atresia 1 (3.1%). Ileostomy was performed in 31 patients (96.9%) and jejunostomy in 1 patient (3.1%). Enterostomy was created at the time of initial laparotomy (damage control) in 21 patients (65.6%) while 11 patients (34.4%) had their enterostomy as a salvage procedure at the time of re-exploration. Peristomal skin complication was the most common complication recorded in our patients. Mortality was 12.5%. Conclusion: Enterostomy is lifesaving in the management of acute abdominal surgical condition when there is gross peritoneal contamination in severely ill children. Proper surgical technique and electrolyte derangements are important considerations when enterostomies are created.

An international comparison of the utilisation of and outcomes from minimal access surgery for the treatment of common abdominal surgical emergencies

BackgroundMinimal access surgery (MAS) has suggested improvements in clinical outcomes compared to open surgery in several abdominal elective and emergency surgeries. The aims of this study were to compare England with the United States in the utilisation of MAS and mortality from four common abdominal surgical emergencies.MethodsBetween 2006 and 2012, the rate of MAS and in-hospital mortality for appendicitis, incarcerated or strangulated abdominal hernia, small or large bowel and peptic ulcer perforation were compared between England and the United States. Univariate and multivariate analyses were performed to adjust for differences in baseline patient demographics.Results132,364 admissions in England were compared to an estimated 1,811,136 admissions in the United States. Minimal access surgery was used less commonly in England for appendicitis (odds ratio (OR) 0.27, 95% CI 0.267–0.278), abdominal hernia (OR 0.16, 95% CI 0.15–0.17), small or large bowel perforation (OR 0.33, 95% CI 0.32–0.35) and peptic ulcer perforation (OR 0.93, 95% CI 0.87–0.99). In-hospital mortality was increased in England compared to the United States for all four conditions: appendicitis (OR 2.11, 95% CI 1.66–2.68), abdominal hernia (OR 3.25, 95% CI 3.10–3.40), small or large bowel perforation (OR 3.88, 95% CI 3.76–3.99) and peptic ulcer perforation (OR 3.09, 95% CI 2.94–3.25). In England, after adjustment for patient demographics, open surgery was associated with increased in-hospital mortality for abdominal hernia (OR 1.80, 95% CI 1.26–2.71), small or large bowel perforation (OR 1.59, 95% CI 1.37–1.87) and peptic ulcer perforation (OR 2.31, 95% CI 1.91–2.82).ConclusionsMinimal access surgery was performed less commonly and in-hospital mortality was increased in England compared to the United States for common abdominal surgical conditions. Therefore, strategies to enhance adoption of MAS in emergency conditions in England need to be optimised and include appropriate patient selection and improved surgeon MAS training.

Optimizing Care for Ugandans with Untreated Abdominal Surgical Conditions.

Background:Abdominal operations account for a majority of surgical volume in low-income countries, yet population-level prevalence data on surgically treatable abdominal conditions are scarce.Objective:In this study, our objective was to quantify the burden of surgically treatable abdominal conditions in Uganda.Methods:In 2014, we administered a two-stage cluster-randomized Surgeons OverSeas Assessment of Surgical Need survey to 4,248 individuals in 105 randomly selected clusters (representing the national population of Uganda).Findings:Of the 4,248 respondents, 185 reported at least one surgically treatable abdominal condition in their lifetime, giving an estimated lifetime prevalence of 3.7% (95% CI: 3.0 to 4.6%). Of those 185 respondents, 76 reported an untreated condition, giving an untreated prevalence of 1.7% (95% CI: 1.3 to 2.3%). Obstructed labor (52.9%) accounted for most of the 238 abdominal conditions reported and was untreated in only 5.6% of reported conditions. In contrast, 73.3% of reported abdominal masses were untreated.Conclusions:Individuals in Uganda with nonobstetric abdominal surgical conditions are disproportionately undertreated. Major health system investments in obstetric surgical capacity have been beneficial, but our data suggest that further investments should aim at matching overall surgical care capacity with surgical need, rather than focusing on a single operation for obstructed labor.

Outcomes of surgery for necrotizing enterocolitis and spontaneous intestinal perforation in Finland during 1986–2014

BackgroundNecrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are the most common abdominal surgical conditions in preemies. Associated mortality remains high and long periods of parenteral nutrition (PN) may be required. We assessed the developments in the outcomes of surgically treated NEC and SIP in the two largest Finnish neonatal intensive care units (NICU). MethodsRetrospective observational study based on hospital records during 1986–2014. Main outcome measures were three-month survival during 1986–2000 compared with 2001–2014 and predictors of mortality. ResultsIncluded were 225 patients (NICU A 131 and NICU B 94) with NEC in 142 (63%) and SIP 83 (37%). The median birth weight (BW) (870 vs 900 g) and gestation age (GA) (27 vs 27 weeks, p = 0.96) were similar in NEC and SIP. Small intestine was affected in 85% of NEC and 76% of SIP patients (p = 0.12). In 5% of patients NEC was panintestinal. Median small intestinal loss was 25% in NEC and 4.0% in SIP (p < 0.001). Ileocecal valve was resected in 29% of NEC and 14% of SIP patients (p = 0.01). Enterostomy was performed in 78% of patients and primary anastomosis in 18%; 4% died of extensive NEC without definitive surgery. Overall survival was 74% (NEC 73%, SIP 77%, p = 0.48; NICU A 82%, NICU B 65%, p = 0.003). From 1986–2000 to 2001–2014 overall survival increased from 69 to 81% (p = 0.04). Treating NICU was the strongest predictor of survival, RR = 2.8 (95% CI = 1.4–5.1), p = 0.003. ConclusionsOverall survival improved significantly from the early (1986–2000) to the late (2001–2014) study period. Strongest predictor of mortality was the treating neonatal intensive care unit. Level of evidenceIII.

Medical conditions mimicking the acute surgical abdomen in children

Background: We present our experience with children landing up in our pediatric surgery emergency with potentially confounding medical conditions that evade diagnosis. It is imperative to apply sound clinical judgement in the evaluation of these patients so that an unnecessary laparotomy can be avoided but, at the same time, a lifesaving intervention is not denied. Patients and methods: This is a retrospective descriptive analysis pertaining to all patients who were admitted in our department from 1 January 2014 to 31 July 2017. A total of 27 867 patients presented to our out-patient department of these, 3034 were admitted to our ward. A total of 1531 surgeries were performed, of which 288 were for various abdominal surgical conditions. A total of 16 patients, representing 0.5 % of the admissions, were eventually found to have an acute abdomen secondary to a medical cause. Results: Out of the above 16 patients, 10 had to undergo exploratory laparotomy (62.5%). Eight patients of the 10 operated had a negative laparotomy. Two of the 10 operated were found to have a surgically correctable cause, one with ovarian torsion and one with severe colonic edema secondary to Kawasaki’s disease causing intestinal obstruction. Conclusion: Although eight patients with negative laparotomy result constitute only 0.5% of all the surgeries and 2.7% of all the laparotomies, it still forms the bulk (i.e. 8/16=50%) of the patients with underlying medical cause of the surgical abdomen. There were two deaths, representing a mortality of 12.5% (2/16=12.5%), with one in the operated group and one in the nonoperated group. This is why we want to stress the importance of caution and sound clinical judgement in evaluating this subset of patients. Keywords: acute abdomen, medical conditions mimicking, surgical abdomen in children

Globalization: challenges in abdominal surgery for migrants and refugees

The increasing number of refugees, migrants and international travelers influences the surgical spectrum of abdominal diseases. The aim of this review is to familiarize surgeons with specific diseases which are endemic in the patients' countries of origin and are likely to be diagnosed with increasing incidence in Germany. Low levels of hygiene in the countries of origin or refugee camps is associated with a high incidence of numerous infections, such as helminth infections, typhoid fever or amoebiasis, which if untreated can cause surgical emergencies. Historically, some of them were common in Germany but have been more or less eradicated because of the high socioeconomic standard. Echinococcosis and Chagas disease are frequently treated surgically while schistosomiasis can mimic intestinal cancer. Abdominal tuberculosis presents in avariety of abdominal pathologies and frequently causes diagnostic uncertainty. Sigmoid volvulus has avery low incidence among Europeans, but is one of the most common abdominal surgical conditions of adults in endemic countries. The number of patients who eventually undergo surgery for these conditions might be relatively low; however, surgeons must be aware of them and consider them as differential diagnoses in refugees and migrants with acute or chronic abdominal symptoms.

Optimizing surgical care delivery in Uganda to address untreated abdominal surgical conditions

Optimizing surgical care delivery in Uganda to address untreated abdominal surgical conditions

Study profile of recurrent pain abdomen in children examined by ultrasonography

Background: Abdominal pain is a frequent condition in children, pain localization in younger children is poor, and in a suffering child, physical examination is often limited, thus, sonographic evaluation of the abdomen is frequently performed in children to investigate the reason for the pain and to exclude other acute abdominal surgical conditions. With the routine use of high-frequency transducers, detection of enlarged abdominal lymph nodes (EALNs) is very common. Methods: After approval from ethical committee 50 patients within age range from 1 to 16 years attending paediatric department at BLDE Shri BM Patil medical college hospital Bijapur, Karnataka, India from January 2014 to December 2014 presenting with abdominal pain of various etiological causes subjected to ultrasonographic examination were included in this study . Results: Maximum numbers (46%) of patients are from 5-8 years age group, more number of boys (54%) is affected as compared with the girls. Maximum (62%) patients had total of 1-5 episodes and next infrequency are patients of multiple episodes, 30 % of patients had school loss due to pain abdomen. Right lower quadrant of the abdomen was most commonly affected (30%) followed by left lower (24%) and para-aortic (16%). Conclusions: We can conclude that -EALNs are frequently seen children with pain abdomen 5- 8 yrs with girls more commonly affected than boys. Most paeirnts presented with 1-5 episodes, 30 % of patients had school loss due to pain abdomen. Right lower quadrant of the abdomen was most commonly affected (30%) followed by left lower (24%) and para-aortic (16%).

First steps of laparoscopic surgery in Lubumbashi: problems encountered and preliminary results.

For many reasons, laparoscopic surgery has been performed worldwide. Due to logistical constraints its first steps occurred in Lubumbashi only in 2008. The aim of this presentation was to report authors’ ten-month experience of laparoscopic surgery at Lubumbashi Don Bosco Missionary Hospital (LDBMH): problems encountered and preliminary results. The study was a transsectional descriptive work with a convenient sampling. It only took in account patients with abdominal surgical condition who consented to undergo laparoscopic surgery and when logistical constraints of the procedure were found. Independent variables were patients’ demographic parameters, staff, equipments and consumable. Dependent parameters included surgical abdominal diseases, intra-operative circumstances and postoperative short term mortality and morbidity. Between 1stApril 2009 and 28th February 2010, 75 patients underwent laparoscopic surgery at the LDBMH making 1.5% of all abdominal surgical activities performed at this institution. The most performed procedure was appendicectomy for acute appendicitis (64%) followed by exploratory laparoscopy for various abdominal chronic pain (9.3%), adhesiolysis for repeated periods of subacute intestinal obstruction in previously laparotomised patients (9.3%), laparoscopic cholecystectomy for post acute cholecystitis on gall stone (5.3%) and partial colectomy for symptomatic redundant sigmoid colon (2.7%). There were 4% of conversion to laparotomy. Laparoscopic surgery consumed more time than laparotomy, mostly when dealing with appendicitis. However, postoperatively, patients did quite well. There was no death in this series. Nursing care was minimal with early discharge. These results are encouraging to pursue laparoscopic surgery with DRC Government and NGO's supports.

Intraperitoneal microdialysis as a monitoring method in the intensive care unit.

Studies on surgical patients provide some evidence of prompt detection of enteric ischemia with microdialysis. The purpose of the study was to measure intraperitoneal microdialysis values (glucose, glycerol, pyruvate, and lactate) in patients hospitalized in an intensive care unit (ICU) with an underlying abdominal surgical condition and to correlate these values with patients' outcomes. Twenty-one patients, 10 female, were enrolled in the study. The intraperitoneal metabolite values were measured for 3 consecutive days, starting from the first day of ICU hospitalization. Descriptive and inferential statistics were performed. The t-test, repeated measures analysis, Holm's test, and a logistic regression model were applied. Level of statistical significance was set at P = 0.05. Mean age of participants was 68.10 ± 8.02 years old. Survivors exhibited statistically significantly higher glucose values on day 3 (6.61 ± 2.01 against 3.67 ± 1.62; P = 0.002). Mean lactate/ pyruvate (L/P) values were above 20 (35.35 ± 27.11). All non-survivors had a mean three day L/P values greater than 25.94. Low L/P values were related to increased survival possibilities. High microdialysis glucose concentration, high L/P ratio and low glucose concentration were the major findings during the first three ICU hospitalization days in non-survivors. Intraperitoneal microdialysis may serve as a useful tool in understanding enteric ischemia pathophysiology.