Adhesive Intestinal Obstruction Research Articles

A PROSPECTIVE COMPARATIVE STUDY BETWEEN EARLY AND INTERVAL APPENDICECTOMY FOR APPENDICULAR MASS

Acute appendicitis remains the most common cause of acute abdomen requiring surgical intervention. Patients presenting late in acute appendicitis are complicated by the development of an inammatory mass in the right iliac fossa. The treatment of appendicular mass is controversial. However, 1 there are several other management options for appendicular mass. Traditionally, these patients are managed conservatively, followed by interval appendicectomy 4-6 weeks later. Advocates of the initial conservative approach claim a lower rate of complications compared to the early 2 operative approach. Objective: To study the safety and feasibility of emergency appendicectomy for appendicular mass by comparing the complications, morbidity and mortality with conservatively treated patients. Materials & Methods: This is a prospective and comparative study conducted at Gitam Institute of Medical Sciences and Research, Visakhapatnam, from January 2018 to December 2019. A total of 60 patients with appendicular mass were divided into two groups of 30 each. Group I included patients who underwent emergency appendicectomy, while Group II consisted of patients who were managed conservatively. Results:In this study, patients' mean age was 27.58 yrs with a male to female ratio of 2.66:1. Intraoperative ndings in Group I - 20(70%) cases had simple mass, 8(26.66%) had adhesions and loculated pus in 2(6%). In Group II, 14(53.84%) patients had normal ndings, 4(15.38%) cases had simple mass, 6(23%) had adhesions, 1(3.84%) had loculated pus and adhesive intestinal obstruction. Postoperatively, In Group I, 3(10%) patients had wound infection, and 1(3.33%) patient developed fecal stula, which was managed conservatively. In Group II, 2(6.66) patients had wound infection, 4(13.33%) had failure of conservative treatment, four had lost follow-up, 3 had respiratory tract infection, and one patient developed intestinal obstruction due to adhesions. Mean length of hospital stay was 5.3 days in Group I and 8.5 days in Group II. Fewer complications, reduced number of days of parenteral medication, and reduced duration of total hospital stay were noted in Group I compared to Group II, indicating that emergency appendicectomy is a safe and feasible method of managing patients with appendicular mass.

ПЛАЦЕНТАРНАЯ ДИСФУНКЦИЯ И СПОСОБ ЕЕ КОРРЕКЦИИ ПРИ ОСТРОЙ КИШЕЧНОЙ НЕПРОХОДИМОСТИ У БЕРЕМЕННЫХ

To study the effect of plasmapheresis on the functional state of the uterine-placental complex in adhesive acute intestinal obstruction in pregnant.

A case of idiopathic myointimal hyperplasia of the mesenteric veins presenting with small bowel obstruction

BackgroundIdiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare ischemic bowel disease with venous occlusion resulting from the proliferation of smooth muscles in the venous intima. In most patients, the disease affects rectosigmoid colon and causes persistent abdominal pain and hematochezia, which is similar to inflammatory bowel disease (IBD). In addition, it is difficult to make a precise diagnosis of IMHMV without surgery.Case presentationAn 81-year-old woman was admitted to our hospital with mild abdominal pain, nausea and vomiting. Repeated adhesive ileus was suspected due to the previous open and laparoscopic surgeries. Surgery was planned to treat small bowel obstruction. Intraoperatively no adhesive lesions were observed. However, a mass lesion was seen at the terminal ileum, which was suspected to have caused her bowel obstruction. Partial resection of the small intestine was performed. Macroscopic and histopathological examinations of the excised specimen showed circumferential ulceration with scarring, a thickened venous wall with active inflammation, and fibrotic changes that consequently produced stenosis and obstruction of the venous lumen in the subserosa. Additionally, Elastica van Gieson staining demonstrated thickening of the venous intima. The final diagnosis was IMHMV. At two years and 8 months after the operation, the patient was well without any additional medication.ConclusionIMHMV of the small intestine is rare. We described a case of IMHMV that was associated with ileus.

Surgical treatment?s possibilities of late adhesive intestinal obstruction in children.

Objectives: To study the adhesions prevalence in the abdominal cavity and to determine the possibilities of surgical treatment of Late Adhesive Intestinal Obstruction (LAIO) in children. Materials and Methods: 73 children were operated on for LAIO. 35 children were in a comparison group (comprehensive treatment by traditional methods) and 38 children were in the main group. In the main group was used an anti-adhesive solution which containing sodium hyaluronate and decamethoxin to prevent recurrence of Adhesive Intestinal Obstruction (AIO). The following surgical interventions were performed: Adhesiolysis, adhesiolysis and resection of the small intestine, adhesiolysis and making of the ileostomy, elimination of the cause without total adhesiolysis, elimination of the cause without total adhesiolysis and with resection of the small intestine, elimination of the cause without total adhesiolysis and with making of ileostomy. The Adhesion Process (AP) in the abdominal cavity was evaluated by the type of adhesions and their projection on the anterior abdominal wall. Results: The most common causes of LAIO were adhesive conglomerates (32.88%), moorings (23.28%) and visceral-visceral adhesions (21.92%) in lesser extent visceral-parietal and omentalvisceral adhesions, accordingly 10.96% and 10.96%. In main group recurrent AIO was seen in 3 of 38 children (7.89%) and resolved conservatively. In comparison group recurrent AIO occurred in 7 of 35 children (20%). In comparison group, 4 of 7 children required relaparotomy. The method of cause eliminating was used at AIO without total adhesiolysis using sodium hyaluronate for the operated children. When children were observed between 1 and 7 years, recurrence of AIO was in 1 patient who resolved conservatively. Conclusion: Mesothelium damaging leads to the emergence of the primary AP of the abdominal cavity with spreading to the surrounding structures and projection on the areas of the anterior abdominal wall. In operations for LAIO in children, it is advisable to use the operation of the cause eliminating (separation or resection of the conglomerates, cutting of the mooring) without total adhesiolysis in combination with intraoperative use of sodium hyaluronate solution with decamethoxine. Keywords Late Adhesion Intestinal Obstruction (LAIO), Children.

Abdominal adhesions: Surgical treatment and prevention (literature review)

The ongoing discussion on the diagnosis and tactics of surgical treatment of painful forms of adhesions of the abdominal cavity and adhesive intestinal obstruction testifies to the persistent urgency of this problem. The presence of a postoperative scar and recurrent abdominal pain are interpreted by surgeons and gastroenterologists as adhesive disease, with the appointment of the same type of treatment. At the same time, patients have a reduced critical attitude to their condition, which leads them to late seeking medical help. For the occurrence of the adhesion process, a long-term effect of a complex of factors is necessary, an important place among which is blood supply, oxygen access to tissues and peristalsis in the early postoperative period. The most effective methods of treatment and prevention of intestinal obstruction are low-traumatic surgical technologies. There was no statistically significant difference between open and laparoscopic adhesiolysis in the number of intraoperative intestinal injuries, wound infections and mortality. Laparoscopic operations have fewer general and pulmonary complications than open ones. Reducing fibroblast proliferation, minimizing hypoxia and inflammation are a new preventive solution to the problem of adhesion formation.

Changing pattern of adult intestinal obstruction in Nigeria: A narrative review

Intestinal obstruction is a failure of craniocaudal propagation of intestinal contents and may be due to a mechanical or functional pathology. Acute mechanical intestinal obstruction is one of the leading causes of surgical admissions in most emergency departments worldwide and is a significant cause of morbidity and mortality, especially when associated with bowel gangrene or perforation. It accounts for 15% of all emergency visits from acute abdominal pain. In Nigeria and most of Africa, external hernias were the main causes of intestinal obstruction throughout the 20th century; however, at the onset of the 21st century, some reports have shown a rising frequency of adhesive obstruction in our environment. We conduct this narrative review to determine if there is a changing pattern of adult intestinal obstruction in Nigeria. Literature search was conducted by two independent reviewers. The keywords used were “adult,” “intestinal obstruction,” “cause,” and “Nigeria.” The keywords were combined using the Boolean logic. The keywords were searched in PubMed and Google Scholar. The overall mean age of the study population is 44.3 years, with a male-to-female ratio of 3.6:1. Of the 1435 cases of intestinal obstruction reported in the studies selected, post-operative adhesive intestinal obstruction was responsible for 590 of them, which is equivalent to 41.1% of all the obstruction. Obstructed external hernias were responsible for 357 cases of obstruction, which is equivalent to 25.9%. The most common cause of intestinal obstruction in Nigeria is post-operative adhesion.

Hepatic distress syndrome in surgery: concept, pathogenesis, prevention and correction

To establish the universality and regularity of hepatic disorders, their role in pathogenesis of homeostasis impairment and determine scientific base for a new syndrome - hepatic distress syndrome in surgery. Chronic experiments on outbred dogs were carried out. Acute peritonitis was simulated in the first group (n=15), acute destructive pancreatitis in the second group (n=15), acute obstructive intestinal obstruction in the third group (15). In the fourth group, experimental acute peritonitis (n=15) was followed by Remaxol infusions (20 ml/kg). Liver function was evaluated using the indicators of endogenous intoxication, lipid metabolism markers, as well as composition of lipids in liver tissue. Clinical studies included 44 patients with peritonitis (the first subgroup - standard therapy (n=20), Remaxol infusion in the second subgroup (n=24), severe acute pancreatitis (n=18), acute adhesive intestinal obstruction (n=20)). Patients underwent surgery. Along with routine indicators, we analyzed severity of endogenous intoxication, lipid peroxidation, phospholipase activity, serum lipids and red blood cell count. Experimental and clinical studies have shown significant liver damage in all diseases with various pathogenesis. Regardless of urgent disease, one of the leading component is membrane-destabilizing process. The last one is determined by excessive activity of membrane lipid peroxidation and phospholipases in liver tissue. Severe abnormalities are followed by impairment of liver detoxification ability and liver may be a source of toxins per se. Remaxol infusion in the treatment of experimental and clinical acute peritonitis increased liver tolerance to trigger pathogenetic agents. This process resulted improvement of laboratory and clinical parameters. In general, we obtained high significance of liver damage in pathogenesis of acute urgent abdominal pathology. Experimental and clinical data for determining hepatic distress syndrome as important aspect in acute abdominal surgical diseases have been obtained. Hepatic distress syndrome in surgery is a combination of abnormal processes with progression of endogenous intoxication, oxidative stress and phospholipase activity following membrane-destabilizing phenomena and secondary liver dysfunction.

Сучасний погляд на етіологію, діагностику, лікування та профілактику спайкового процесу органів малого таза у жінок репродуктивного віку

The article presents a review of the literature in recent years on the problem of peritoneal pelvic adhesions in women of reproductive age. The main issues of etiology and pathogenesis of peritoneal pelvic adhesions as one of the leading causes of reproductive dysfunction, chronic pelvic pain and surgical complications in patients of reproductive age are highlighted. It has been shown that the main etiological preconditions for formation of adhesions and the development of adhesive intestinal obstruction are a peritoneal injury, intraabdominal bleeding, presence of infection, influence of various aggressive substances, local antibiotic therapy, and regional tissue ischemia. Peritoneal commissures have high health and social significance due to a wide range of surgical procedures causing peritoneal trauma and to a high frequency of adhesive process. Pelvic adhesion is a dynamic differentiated cell vascularized structure. Development of an active inflammatory process, which involving cells and proinflammatory mediators may be into a stage of tissue remodeling, collagen formation, that is the initial symptoms of adhesions. A vicious circle and a cascade of mutually supporting changes leads to adhesive disease and patients’ disability. Whatever reasons of adhesions are, ones are a major cause of pelvic pain, infertility and ovarian failure. Though the researches of the pathophysiological mechanisms of growth of adhesions are going on the attempts to determine effective methods to prevent adhesions do not rule to expected results. Keywords: peritoneal adhesions, adhesive disease, etiology, pathogenesis, prevention, treatment, reproductive age.

Surgical Correction of Hirschsprung's Disease in Children Using the Soave-Boley Technique with Manual Colorectal Anastomosis

Introduction. Current trends in surgical treatment of Hirschsprung's disease are aimed at minimally invasive interventions. However, the experience of using Soave-Boley procedure in surgical treatment of Hirschsprung's disease in children of different ages is valuable in the arsenal of differentiated approach to the treatment of this pathology.
 The objective of the research was to evaluate the results of surgical correction of Hirschsprung's disease in children using the Soave-Boley technique with manual colorectal anastomosis.
 Materials and Methods. The analysis of surgical treatment of 1,187 children with different forms of Hirschsprung’s disease aged from birth to 18 years over the period 1980-2020 was conducted in the National Children's Specialized Hospital“ Okhmatdyt”. Surgical correction of Hirschsprung's disease using the Soave-Boley technique was performed in 597 children. Before surgery, 156 patients underwent the first stage of treatment that consisted in the creation of a protective colostomy; in 441 cases, this intervention was performed without an intestinal stoma; the benefits of the Soave-Boley technique were evaluated.
 Results. All the patients survived. In 15 (2.51%) out of 597 children, in the early postoperative period, there were observed: retrocolic hematoma (n = 2), retrocolic abscess (n = 7), anastomotic leak (n = 2), adhesive intestinal obstruction (n = 3), intussusception (n = 1). Fourteen (2.36%) patients developed surgical complications in the long-term period: residual aganglionosis (n = 9), anastomotic stenosis (n = 4) and coloptosis. Repeated Soave-Boley operation with manual colorectal anastomosis was successfully performed in 26 (4.362%) patients after primary correction of Hirschsprung's disease using different methods. Periodic episodes of fecal smearing in the remote period in 45 (7.53%) children were eliminated by conservative treatment. The success of this technique is confirmed by a much lower number of early (2.51%) and late (2.36%) postoperative surgical complications, as compared to those after using other methods of open surgical correction - 17.52% and 16.35%, respectively.
 Conclusions. Surgical correction of Hirschsprung's disease in children using the Soave-Boley technique with manual colorectal anastomosis allows better control over applying each suture, anatomical joining the edges of the bowel, and reducing trauma to the rectal mucosa, which ensures the high reliability of colorectal anastomosis; it is the most effective way of radical correcting Hirschsprung' s disease in children in an open way in one-stage or two-stage interventions, and this technique is the operation of choice for secondary surgical correction of Hirschsprung's disease.

LAPAROSCOPIC AND ROBOTIC-ASSISTED SURGERYFOR COMPLICATED DIVERTICU

The article presents the results of a longtime experience with the effects of perioperative intestinal decontamination in patients with complicated diverticulitis on the incidence of postoperative complications following delayed minimally invasive sigmoid colectomy and colorectal anastomosis creation. Purpose. This work aims to evaluate the prophylactic potential of selective perioperative intestinal decontamination in patients with sigmoid diverticulitis due to perforation of the inflamed diverticula, as a form of diverticular disease; to study the incidence of postoperative complications in patients with complicated diverticulitis following laparoscopic and robotic-assisted surgery. Results. Of 179 patients included in the study, 136 (76%) did not develop postoperative complications. In Group A, 11 (12%) of 91 patients and in Group B, 17 (19.3%) of 88 patients developed postoperative complications specific to the type of surgery undertaken. The most common complications included colorectal anastomotic leakage, adhesive intestinal obstruction, anastomotic bleeding, intra-abdominal hemorrhage and localized peritonitis. A statistical comparison revealed no statistically significant differences between the groups studied. 8 (8.8%) of 91 patients in Group A and in 7 (8.0%) of 88 patients in Group B were diagnosed with extra-abdominal (nonsurgical) complications. Thus, the total postoperative complication rate was lower in Group A (n=19 (20.9%) than in Group B (n=24 (27.3%)) (Х2 =1.002, р=0.316). Colorectal anastomotic leakage rates were lower in Group A (n=1 (1.1.%)) than in Group B (n=4 (4.6%)) (F=0.205, p>0.05). Wound infection rates in Group A were 6.6% (n=6) patients and in Group В – 11.3% (n=10) patients (Х2*=6.483, р=0.01). No deaths were reported. CONCLUSION. Selective intestinal decontamination combined with oral decontaminating solutions has been shown to reduce the occurrence of colorectal anastomotic leaks, wound infection, surgical and general postoperative complications.

RETRACTED: Smart IoT data platform in hospital and postoperative analgesic effects of orthopedic patients

IOT test this large donor control engineering data can relieve postoperative pain is discussed. One human operation, closed-loop, postoperative analgesic things large data system is designed to alleviate chronic pain. In this system the need of pain relief, when the patient presses the button. Computer interface buttons, the patient's IOT large data after pump. Patients with pain models have been developed to describe the kinetics of chronic pain in people's physiological and psychological reactions. Further including analgesic pharmacokinetic model. Pain model parameters have been adjusted, so that large data things validated self-management of pain behavior mimics a real button, presses the record. Unfortunately, if the adhesion is removed, the inflammation process begins; it is the foundation of a new adhesion causes, creating a vicious cycle difficult to break. Is achieved by electrical stimulation therapy of the small intestine contraction is applied. The results have not been entirely successful, it does not complete the verification of transcutaneous electrical nerve stimulation. However, this idea, a new method is reliable become the treatment of adhesive intestinal obstruction. Effective use of long things big data, as of this site, are, first aid and coherent knowledge of post-operative care, and people to help taking the right medicine for the patient, such research index regret believe that to reduce the occurrence of cans distinguish the analgesic efficacy of the use of different large amounts and compositions of the networking data six hundred and seventy and 9 vertical abdomen, spine and limbs procedures.

Surgical treatment of multiple magnet ingestion in children: A single-center study.

BACKGROUNDSince 2017, the number of magnet ingestion cases has increased year over year in our hospital. Almost all of the ingested magnetic foreign bodies were magnetic beads, and most of the patients experienced intestinal perforations, causing substantial damage.AIMTo summarize our experience with surgical treatment of multiple magnet ingestion in children.METHODSThe data for general surgeries were collected from January 2010 to April 2020, and the clinical characteristics, treatment methods, and outcomes were summarized and analyzed. Several typical cases were selected and discussed.RESULTSFifty-six cases of ingested magnetic foreign bodies were collected, of which 47 were magnetic beads. The average patient age was 4.7 ± 3.0 years old. The number of ingested magnetic foreign bodies ranged from 2 to 73. There were 26 cases with symptoms at the time of admission, including two cases of shock. Thirteen patients were discharged successfully following conservative treatment and 43 were treated by surgery. Laparotomy was the main method of operation. Laparoscopy was used in four cases, of which three were converted to open surgery, and one was treated successfully using surgery through the navel. Postoperative complications occurred in seven cases, incision infections were observed in six, and adhesive ileus was observed in one.CONCLUSIONClinicians need to summarize their experiences with treating magnetic foreign body ingestions in detail and carry out clinical research to reduce the damage to children.

Analysis of Nursing Effect of Surgery Patients with Adhesive Intestinal Obstruction

Analysis of Nursing Effect of Surgery Patients with Adhesive Intestinal Obstruction

Multidisciplinary intestinal rehabilitation in acute type II intestinal failure: Results from an intestinal rehabilitation team

BackgroundType II (acute) intestinal failure (IF) is usually caused by complications of abdominal surgery resulting in enteric fistulas or proximal stomas and requires parenteral nutrition (PN) for several months. This study aimed to evaluate clinical management and outcome of type II IF patients in a single center. MethodsMedical records of patients referred to the Intestinal Rehabilitation Team (IRT) at Samsung Medical Center (Seoul, Korea) were retrospectively analyzed. ResultsFrom 2014 to 2019, 34 patients with IF were referred. 28 patients were type II IF and were included in the analysis. There were 17 males and 11 females. Mean age of patients was 56.7 years. Pathophysiology of IF were high-output stoma in 16 cases, extensive bowel resection (with bowel in continuity) in 7 cases, and enterocutaneous fistula in 5 cases. The catastrophic events necessitating abdominal surgery in the patients were adhesive ileus in 9 cases, superior mesenteric artery thrombosis in 8 cases, internal herniation of bowel in 5 cases, traumatic bowel injury in 3 cases, and ischemic enteritis in 3 cases. Following medical and surgical rehabilitation, 10 patients (35.7%) were weaned off PN and overall mortality was 28.5%. Deaths were related to progression of underlying malignancies in 4 cases, liver failure in 3 cases, and sepsis in 1 case. Thirteen patients underwent surgery to restore bowel continuity. Six postoperative complications occurred in 4 patients (30.7%) and there were no postoperative mortalities. ConclusionStandardized care including restorative surgery resulted in successful outcomes in type II IF patients in this cohort.

Spiral Computed Tomography with Phytocomposition as a Diagnostic Tool for Adhesive Intestinal Obstruction.

Background: Adhesive intestinal obstruction is a common and potentially lethal complication after surgical interventions in the abdomen. Radiologic imaging is the main diagnostic method.Objective: This study aims to analyse the diagnostic value of spiral computed tomography with a novel method (n = 54).Material and Methods: In this multidirectional cohort study, we present the data with non-parallel (historical) control. This study included the analysis of results of patients with a diagnosis of intestinal obstruction (n = 54) who were admitted to the surgical departments of the City Clinical Hospitals (Ufa city) from 2013 to 2019; the patients’ examination methods included computed tomography with conventional enhancement. The proposed novel enhancement method was implemented by ingesting a mixture containing 50 ml of the contrast Unigexol (300 mg) in 1.0 L cold mineral carbonated water, and Computed tomography (CT) was performed during 40 min after ingesting the contrast meal. Further, the patients with suspected obstruction in the colon were administered a pre-prepared contrast enema with a decoction of leaves of smoke-tree (100 g), chamomile flowers (100 g) and calendula flowers (100 g). Additionally, CT was performed. Results: Obstruction was conservatively stopped in 24 (44.4%) patients of the main group. Remaining 30 (55.6%) patients from the main group were operated with minimal surgical access in the early stages. Conclusion: Owing to early diagnosis of intestinal obstruction and application of the phytocomposition during the examination, exerting various effects such as antispasmodic, analgesic, disinfectant, bactericidal, cicatrising, choleretic, tanning and decongestant, unnecessary surgical interventions were prevented.

Surgical management of pancreatic pseudocyst: a single-center experience

Aim Pancreatic pseudocyst is the commonest cystic lesion of the pancreas. It usually develops on a background of pancreatitis. Cyst recurrence is the most feared complication following surgical management of pancreatic pseudocyst. Patients and methods The authors reviewed the data of 48 patients who were managed surgically during the period between 2010 and 2019. Results Biliary pancreatitis was the commonest cause (24 cases − 50%). The mean cyst size was 13.5±6.4 cm (6–42 cm). Most lesions were located in the body and tail of the pancreas (32 cases − 66.7%). Open approach was performed in 45 (93.8%) cases whereas the remaining cases were performed laparoscopically. Cases were managed by cystogastrostomy (39 cases − 81.3%), cyst-jejunostomy (seven cases − 14.6%), combined procedures (one case − 2.1%), or central pancreatectomy (one case − 2.1%). Cholecystectomy was performed in 17 (35.4%) cases. Early postoperative morbidity was encountered in nine (18.8%) cases. After a median follow-up of 68 months, no recurrence was detected. One (2.1%) case developed incisional hernia, and another one (2.1%) had adhesive intestinal obstruction. Conclusion Surgical intervention for pancreatic pseudocysts is a safe and feasible approach. It offers the ability to deal with the primary cause during operation and excellent long-term outcome regarding pseudocyst recurrence.

Peritonitis in Children: Experience in a Tertiary Hospital in Enugu, Nigeria

Background: Peritonitis may be associated with significant morbidity and mortality. The aim of this study was to evaluate our experience with the management of secondary peritonitis in children. Methods: This was a retrospective study of children who had undergone laparotomy for peritonitis in the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) in Enugu, Nigeria over a five-year period. Results: There were 52 cases of laparotomies for peritonitis, with an age range of two weeks to 14 years (median: nine years) and a male to female ratio of 3.3:1. The etiologies of peritonitis were typhoid intestinal perforation in 25 cases (48%), ruptured appendix in nine cases (17.3%), perforated intussusception in eight cases (15.4%), perforated external hernia in three cases (5.8%), perforation due to adhesive intestinal obstruction in three cases (5.8%), perforated necrotizing enterocolitis in three cases (5.8%), and bowel perforation due to trauma in one case (1.9%). The following definitive surgical procedures were performed: closure of bowel perforation in 26 cases (50%), appendectomy plus abscess drainage in nine cases (17.3%), right hemicolectomy with ileotransverse anastomosis in eight cases (15.4%), segmental bowel resection in six cases (11.5%), and insertion of peritoneal drains in three cases (5.8%). The median duration of symptoms prior to presentation and the median duration from presentation to surgery were four days and two days, respectively. Twenty-four patients (46.2%) developed complications that included surgical site infection in 12 cases (23.1%), enterocutanous fistula in five cases (9.6%), intra-abdominal abscess in four cases (7.7%), and wound dehiscence in three cases (5.8%). There were seven deaths, accounting for 13.5% of the patients. Conclusion: Typhoid intestinal perforation was the most common cause of peritonitis in the present study. Keywords: Children; peritonitis; developing country; single center

Jejuno-ileal atresia: evaluation of the efficacy of laparoscopic approach

Jejuno-ileal atresia is a main cause of neonatal intestinal obstructions, and minimal access technique is gaining popularity. Aim of this study was to perform systematic review of laparoscopic approach with regards its management efficacy. Pubmed® was searched using terms ‘jejunal’, ‘jejuno-intestinal atresia’, ‘laparoscopic’ or ‘laparoscopic-assisted’. Data collected included gender, age, weight, comorbidities, surgical technique, duration of surgery, complications, reoperation, mortality, parenteral feeding time. 5 articles (2004–2020) met the inclusion criteria with 63 neonates. Mean weight was 2.6 kg. There were n = 16 comorbidities: cardiac anomalies (n = 5), Meckel’s diverticulum (n = 2), meconium peritonitis (n = 4), unknown (n = 5). All patients had laparoscopic-assisted surgery, out of which n = 25 were single-port approach. Conversion was reported in n = 4 cases due to meconium ileus (n = 2), or significantly dilated bowel (n = 2). There were n = 7 complications (n = 1 sepsis, n = 2 anastomotic leaks, n = 1 cholestasis, n = 3 adhesive ileus). Two reoperations were necessary because of anastomotic dehiscence (n = 1) and adhesive ileus (n = 1). Mean parenteral feeding time was 13 days. There were three lethal outcomes, due to sepsis after anastomotic leak (n = 1), severe cardiac defect (n = 1), pneumonia and adhesive ileus (n = 1). Laparoscopic-assisted is opted for jejuno-ileal atresia when minimal access approach is preferred. It is fast and feasible technique, which offers better cosmesis, may result shorter length of operation and recovery. There is > 10% complication rate, which rarely require reoperation. Limitation of this approach are low weight babies with associated anomalies, or significantly dilated proximal bowels. These remain the main concern for laparoscopic-assisted surgery, which require open approach or conversion.

Comparative effectiveness of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for resected low-grade appendiceal mucinous neoplasm (LAMN): A protocol for systematic review and network meta-analysis.

Background:Whether prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) offers long-term survival benefit to patients with low-grade appendiceal mucinous neoplasms (LAMNs) after resection surgery is still under heated debate. The aim of the present meta-analysis is to investigate the comparative effectiveness and safety of prophylactic HIPEC regimens in LAMNsMethods:A systematic search of MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and controlledtrials.com will be performed. All published RCTs and quasi-RCTs through July 20, 2020 with language restricted in English will be included in this review study. Two reviewers will independently conduct the procedures of study identification, data collection, and methodological quality assessment. The primary outcomes are overall survival (OS) and disease-free survival (DFS). The secondary outcomes consist of peritonitis and sepsis, colonic fistula, chemotherapy-associated adverse events, and adhesive intestinal obstruction. The pooled odds ratios (ORs) or hazard ratios (HRs) and relative 95% confident intervals (CIs) of each outcome measurement will be calculated. EndNote X9 software will be applied to manage all citations. The Stata software version 14.0 and R x64 software version 3.5.1 will be employed for main statistical analyses.Discussion:This study will employ a network meta-analysis to summarize direct and indirect evidence in the specific area to provide detailed individualized guidance on surgical management for LAMNs.Registration:This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 25 July 2020 (registration number INPLASY202070112).

Total Resection of Infected Peripheral Hemodialysis Grafts Has a Favorable Impact on Outcomes

Surgical resection could be an eradication treatment for patients with infected hemodialysis arteriovenous grafts (AVGs). This study aimed to investigate the outcomes of 3 surgical methods, including total resection, subtotal resection, and revision. The patients who underwent surgical excision of infected AVGs performed at a single center from August 2012 to March 2019 were retrospectively analyzed. The following 3 surgical methods were used in our study: revision, subtotal resection, and total resection. Patients' demographics, medical history, perioperative details, reconstruction time, and follow-up data were collected. The outcomes including perioperative complications (within 30days), mortality, reinfection rate of AVGs, with new access reconstruction or not, and the outcomes between reconstruction and nonreconstruction in the follow-up period were evaluated. Forty-one patients had infected AVGs in our study. Patients' mean age was 62years, and 65.9% of the patients were female. The mean duration from the time of diagnosis to the operation was 14.4days. Signs and symptoms at presentation included fever (51.2 %), swelling (43.9%), pain (58.5%), erythematous change (92.7%), and more severe features, such as altered consciousness (14.6%) and hypotension (12.2%). The pathological changes in the infected grafts included bleeding (29.3%), pus formation (73.2%), pseudoaneurysm (26.8%), and graft exposure (17.1%). Wound and graft cultures revealed an infectious etiology with fungi (7.3%), Pseudomonas aeruginosa (12.2%), Enterococcus spp. (2.4%), and Staphylococcus spp. (58.5%), with methicillin-resistant Staphylococcus aureus accounting for only 7.3%. Total resection, subtotal resection, and revision surgery were performed in 17.1%, 63.4%, and 19.5% of patients, respectively. Seven patients with complications required reoperation (17.1%), and adhesion ileus and hospital-acquired pneumonia occurred in only 2.4% and 7.3% of patients, respectively. During follow-up, most patients (82.9%) had reconstruction of the peripheral hemodialysis access with mean time of 64.3 (range: 21-92) days; mean time of use of new access was 90.5days; and mean time of removal of catheter was about 106.3days. Mortality rates in patients without and with reconstructed AV access during follow-up were 50% and 18%, respectively (P<0.004). Eight cases (19.5%) had recurrence of AV access infections during follow-up; of these, 2 had revision surgery and 6 had subtotal resection. However, no patient with total resection had recurrent infections. The total resection group had no recurrent infection compared to the subtotal and revision groups. In addition, patients with reconstruction of peripheral hemodialysis access had a low mortality rate during the follow-up period.