Branch Of Surgery Research Articles

Adequacy of histopathology request forms and specimens sent to two histopathology centers in Khartoum, Sudan

Abstract Background Every branch of surgery relies in some way on histology to obtain a conclusive diagnosis. Since precise and comprehensive information on the request form is crucial to the correct analysis and interpretation of test results, it is anticipated that all patient data and information for any requested test be provided. One of the most significant duties of the peri-operative team is the care and handling of intraoperative surgical specimens. Poor labeling and handling of surgical specimens can lead to unfavorable consequences such as misdiagnosis, incorrect or delayed therapy, and even the need for repeat surgery. The study’s. objective is to highlight the primary mistakes that occur in the pre analytical stage of histopathology request forms and specimens at two Khartoum-based histopathological institutions. Methods A prospective descriptive laboratory based cross-sectional study was carried out on 528 request forms and specimens sent to two histopathology centers between the period of May to August 2019 having gotten Ethical clearance from SMSB. Results A total of 528 laboratory request forms and specimens, Age was written in 75.6% (n 399), while the gender only was written only in 46.2% (n 244). No clinical history in 48.3% (n 255). The differential diagnosis found only in 29.5% (n156) of request forms. Regarding specimen 15.7% (83) were inadequate relative to the size of the container and only 5.3% (28) were not labeled with any information. 17.4% (92) were not sent in formalin but in normal saline. Marking of the specimen was not needed in 60% (317) and among the rest cases; 34.2% was not marked. Conclusion The study shows that laboratory request forms were not properly and thoroughly completed. Most of the specimens sent for histology had inadequate fixative and unsuitable containers, or they were mislabeled and not properly tagged. This for sure will have a detrimental effect on the quality of care.

Intraluminal administration of indocyanine green as a method of intraoperative diagnostic of staple line leak during sleeve gastrectomy in an experiment.

Background: Bariatric surgery is an actively developing branch of surgery. At the same time, thanks to the use of modern hardware methods for disconnecting and stitching tissue, the number of postoperative complications have significantly decreased. However, staple line failure is still quiet high and the cause of severe postoperative complications. Traditional methods for intraoperative diagnosis of leakage are provocative tests: tests with methylene blue and air. One of the promising methods of intraoperative control in surgery is the use of indocyanine green (ICG) test . Aims: The purpose of the study is to assess the diagnostic value of intraoperative using fluorescent imaging with indocyanine green (ICG) in case of staple line leak during sleeve gastrectomy (SG) by modeling in pig models various causes of staple line failure using morphological studies. Methods: The study was carried out on 20 pigs, each of which underwent SG. The animals were divided into few groups: a control group standard SG (n=4), a group of SG with mechanical failure of staple line(n=12), and a group of SG with local ischemia of staple line (n=4). To assess a staple line leak methylene blue and indocynin green was injected into the stomach. The appearance of the methylene blue or visualization of indocyanine green fluorescence was assessed on the staple line. In the ischemia group ICG was administered intravenously. On the 7th day after surgery, the histological material for morphology examination was collected. Results: In the group of SG with mechanical failure of staple line (n=11) positive ISG test was in 10 cases and positive methylene blue test was in 2 cases. In 90% of cases, ICG leakage corresponded to the localization of modeling ischemia zone, while methylene blue leakage was noted in only 20% of cases. Conclusions: The intraluminal administration of indocyanine green in cases of "mechanical" failure of staple line during sleeve gastrectomy is more informative compared to the standart methylene blue test. ICG angiography data fully corresponds to the localization of modeling ischemia zone.

Management of Cardiovascular Disease Patients with Periodontitis Requiring Dental Treatment – A KAP Study among Dental Students

ABSTRACT Background: It is frequently observed that dental students require so many consents to manage medically compromised patients, especially cardiovascular patients with periodontitis requiring dental treatment. Aims and Objectives: The present study aimed to assess the dental students’ knowledge, attitudes, and practices regarding the management of cardiovascular disease (CVD) patients with periodontitis requiring dental treatment. Material and Methods: The cross-sectional study was conducted among 611 dental undergraduate and postgraduate students (branches of Periodontology, Oral and Maxillofacial Surgery, Oral Medicine and Radiology, Endodontics, Prosthodontics, and Public Health and Dentistry) of central Gujrat. Self-administered structured questionnaires with 23 questions were distributed in pen-and-paper physical format. Statistical analysis for descriptive statistics like frequency, percentage, mean, standard deviation, confidence interval, one-way analysis of variance, post hoc test for multiple comparisons, Fisher’s exact test, and Pearson’s correlation has been done by MS Excel and STATA/IC-13. Results: As per the post hoc test, both groups of students have significantly different knowledge (-4.20210*, P = 0.028) and their practices (0.68632, P = 0.968) but no significant difference between their attitudes (-6.22828, P = 0.089). According to the Pearson correlation test, a weak positive/no relationship between knowledge, attitudes, and practice is reported in both study groups. There is a weak positive relation between knowledge and attitudes (0.270) and between knowledge and practices (0.121), and a similar relationship between their attitudes and practices (0.172) was observed in both groups. Conclusion: Correct knowledge, attitudes, and practices regarding dental management of CVD patients with periodontitis can reduce medical consent to improve the treatment quality of dental students.

Aesthetic Surgery & the Indications at A Sub-Urban Tertiary Hospital in Edo State, Nigeria

Background: Aesthetic surgery though growing at an exponential rate in developed countries is still not well developed in Nigeria. Though lately, there has been an increasing demand for cosmetic procedures in Nigeria but still, the practice is still slow growing. Objective: Few reports of the scope of aesthetic surgery are available from the sub region and Nigeria as a whole. In this study we seek to determine the aesthetic procedures and its indications in our centre, a sub urban teaching hospital in Irrua, Edo State, Southern Nigeria. Methods: A retrospective study of all aesthetic surgery cases carried out over a 5-year period – Jan 2019 to December 2023 at Irrua Specialist Teaching Hospital. Data from theatre records and case notes were analysed with respect to age, sex, procedure and indications for surgery done. Descriptive analysis of variables, means and percentages were considered. Results: In the period of study, 1,066 plastic surgery procedures were documented: 34 (3.19%) were for aesthetic indications. Sixteen of the patients (47.1%) were male and 18 (52.9%) female. Age range of patients that had aesthetic surgery was 1 - 60 years and the mean age was 24.1 + 18.08 years. The commonest aesthetic procedure was cleft repair 14 (41.17%) following cleft lip/palate, the rest were scar revisions 6 (17.65%) with the commonest indication being unsightly scar, otoplasties 5 (14.70%) following traumatic injury to the ear, liposuction 3 (8.82%) indicated by lipodystrophy, rhinoplasties 3 (8.82%) post traumatic injury to the nose, mammoplasties 2 (5.88%) which were done post mastectomy, and one (2.94%) cranioplasty following gun-shot orbital injury. Conclusion: There is paucity in the volume of cosmetic procedures in Irrua and the pattern of requests here differs in many respects from western centres. With the current reduced pool of aesthetic surgery, it is advisable to establish an aesthetic surgery sub-unit in most tertiary institutions. This sub-unit should be fully functional including special clinic days, as this could help attract future clients and develop this branch of Plastic Surgery.

Ten Years of Experience on the Effectiveness and Efficiency of the Cleanfield Device in Cardiothoracic Surgery

AbstractThe process of blood management and treatment from the surgical field to produce concentrated red blood cells (RBC) is crucial in the context of cardiothoracic surgery and in other branch of surgery. The role of autotransfusion reservoir is not well described in the literature in terms of superiority suction for hemolysis prevention. In this context, we presented a ten-year single-center retrospective analysis on suction, filtering, and blood collection from surgical field through the use of the Cleanfield Autotransfusion Reservoir (Eurosets SRL, Medolla, Italy) in terms of performance, effectiveness, and safety. From January 2013 to January 2023 were collected and analyzed the consecutive uses of Cleanfield Autotransfusion Reservoir in a single cardiothoracic surgery center Anthea Hospital Gvm Care & Research, Bari, Italy. For single procedure, the number of cleanfield disposable used, the relative maximum blood volume filtered and collected, the suction pressure from devices through vacuum meter and the electronic suction pressure measurements in the devices for suctions and the presence and the incidence of adverse events during the use (implosion, clot formation, inability to cell saver use, inability to suction during the use) were analyzed. 5202 Cleanfield disposable autotransfusion reservoir were analyzed for blood volume suction, filtering and collection on 5199 cardiac surgery procedures, the maximum blood volume filtered and collected was 1997 ± 123 ml, the mean suction pressure measured from the device with vacuum meter during suction use was 38 ± 3 mmHg, the mean suction pressure measured in the device during suction use was 38 ± 2 mmHg, no presence of adverse event was reported for implosion, clot formation, inability to cell saver use, and inability to suction during the use. In our retrospective report, the use of Cleanfield autotransfusion reservoir (Eurosets SRL, Medolla Italy) in cardiothoracic surgery context was safe and effective for blood volume suction, filtering, and collection.

Evaluating the Academic Performance of Mustansiriyah Medical College Teaching Staff vs. Final-Year Students Failure Rates

Background: Evaluating medical colleges' teaching staff performance is an essential topic for evaluating academic performance. Objective: To assess the academic performance of the teaching staff in the pediatric, surgical, and gynecology branches in comparison to the medicine branch performance from 2014 to 2018. Methods: The total number and the number of failed students being examined in final years were obtained officially from the examination committee in Mustansiriyah Medical College for the final 6th-year students for the four main branches (medicine, pediatrics, surgery, and obstetrics and gynecology). The students' number in the medicine branch was used as the control group against which the performance of other branches was compared. We utilized the odds ratio from meta-analysis statistics and compared student failure and success rates. Results: The odd ratio of pediatric branch performance versus medicine branch was 1.02 with a 95% confidence interval of 0.68–1.53, while for surgery, it was 0.67 with a 95% CI (0.46 to 0.98) and 3.13 with a 95% CI (1.79 to 5.47) for the obstetrics and the gynecology departments. Conclusion: The performance of the pediatric branch was the only one compatible with the performance of the medicine branch. In contrast, both the surgery and gynecology branches significantly deviated from the medicine branch's performance. Further research is needed to pinpoint the causes of these performance deviations.

History of Reconstructive Vascular Surgery

This article reflects the history of the development of reconstructive surgery of vascular surgery. From the history it has been found out that reconstructive vascular surgery has achieved certain achievements and was a young branch of clinical surgery. Reconstructive surgery made it possible to continue life with severe vascular pathologies, which in most cases lead to death. The article reflects various clinical cases after certain methods of treatment, after which there are positive results. The history of the literature review describes the methods of surgery performed by various authors, who laid the foundation for reconstructive surgery and their invaluable experience, testifies to truly inexhaustible possibilities for continuing the path of vascular surgery.

Literature Review: Venous Thromboembolism Prophylaxis in Plastic Surgery.

Venous thromboembolism (VTE) is a postoperative complication experienced in all branches of surgery, including plastic surgery. Its occurrence can be lowered with adequate prophylaxis in the light of the patient's risk category and the type of surgery that will be performed. Nevertheless, thromboembolic prophylaxis is not routinely administered in plastic surgery. The prevention of VTE has gained significant attention in the past 5years due to increased knowledge about the disease process and the alarming incidence rates. This literature review is specifically aimed at carrying out a synopsis of VTE prophylaxis trials conducted on plastic surgery patients. Antithrombotic agents have generally been avoided by plastic surgeons due to the increased risk of bleeding or hematomas; however, the prevalence of clinically important bleeding has not been found to increase with their use, as it emerges from numerous studies. VTE events can lead to increased morbidity and mortality rates, as well as a rise in healthcare costs. As it emerges from multiple studies, as a preventive measure against VTE, it is strongly advised to use mechanical prophylaxis along with low-molecular-weight heparin as the primary treatment option for plastic surgery patients who are at a greater risk. Up to date though, this practice is not commonly embraced by physicians. Preventing VTE is crucial, and measures to do so are necessary. However, there is no clear evidence to support the use of anticoagulation for plastic surgery patients, and some surgeons are hesitant to use it due to potential bleeding in extensive dissection areas.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The use of a virtual surgical simulator for practicing otosurgery skills in the course of otorhinolaryngology

Ear surgery is a very specific area in which the practical skills differ significantly from other branches of surgery. At present, there is no standard for training in otosurgery worldwide. The study provides data on the use of a virtual simulator with haptic feedback in teaching ear surgery and compares the objective results of working on the simulator in groups of residents, outpatient doctors, ENT doctors and professional otosurgeons-experts. The study found that such training increases the basic knowledge of students of the anatomy, their spatial understanding of the structures of the temporal bone and its topography, the methods and technologies of ear surgery, which is the most important result for residents and inpatient operating doctors. For polyclinic otorhinolaryngologists, such knowledge is extremely important for understanding the surgical interventions performed in patients transferred to them for supervision from surgical hospitals.

Artificial intelligence in orthopedics: A qualitative exploration of the surgeon perspective.

Artificial intelligence (AI) is currently integrated into many medical services. AI is utilized in many aspects of orthopedic surgery. The scope ranges from diagnosis to complex surgery. To evaluate the perceptions, attitudes, and interests of Sudanese orthopedic surgeons regarding the different applications of AI in orthopedic surgery. This qualitative questionnaire-based study was conducted through an anonymous electronic survey using Google Forms distributed among Sudanese orthopedic surgeons. The questionnaire entailed 4 sections. The first section included the participants' demographic data. The remaining 3 sections included questions for the assessment of the perception, attitude, and interest of surgeons toward (AI). The validity and reliability of the questionnaire were tested and piloted before the final dissemination. One hundred twenty-nine surgeons responded to the questionnaires. Most respondents needed to be more aware of the basic concepts of AI. However, most respondents were aware of its use in spinal and joint replacement surgeries. Most respondents had doubts regarding the safety of (AI). However, they were highly interested in utilizing (AI) in many orthopedic surgical aspects. Orthopedic surgery is a rapidly evolving branch of surgery that involves adoption of new technologies. Therefore, orthopedic surgeons should be encouraged to enroll in research activities to generate more studies and reviews to assess the usefulness and safety of emerging technologies.

Correlation among Sterilization, Antibiotic Resistance and Malnutrition with Surgical Site Infection in a Teritary Level Hospital

Background: Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative techniques, surgical site infection (SSI) continues to be a major problem in all branches of surgery in the hospitals. However, there is no infection control policy that runs effectively in our country. Aim:This study was designed to see the correlation among sterilization, antibiotic resistance and malnutrition with surgical site infection in a tertiary level hospital. Methods: This cross-sectional observational study was conducted in the Department of Surgery, Shaheed Suhrawardy Medical College and Hospital. Informed written consent, detailed history, physical examination and necessary investigations were performed. Total 160 admitted patients undergoing different surgical procedure were included in this study, irrespective of their age, sex, race and ethnic group. Data were collected by using a semi-structured questionnaire. Collected data were analyzed by the SPSS 25. Results: Average age of all patient was 36.10±12.15 years (range: 13-65 years), wherein maximum patients were aged <40 years, male gender (56.3%), had normal BMI (61.3%) and non-smoker (62.07%). About 1/4th patients had diabetes mellitus. Maximum patients had undergone abdominal surgery (34.4%) followed by orthopaedic and traumatology (20.6%),General surgery other than abdominal surgery (18.8%), Neurosurgery (13.8%), Vascular surgery (12.5%). Pre-operative waiting period for surgery was <3 days in most of the cases (48.8%), followed by 3-7 days (31.3%) and >7 days (20%). Mean operation duration was 1.49±0.73 hours. Twenty-nine patients (18%) developed SSI, of which 7% had deep incisional SSI, 6% had superficial incisional SSI and 5% had organ/space SSI. SSI culture reports showed that majority (93.1%) had positive culture growth, wherein 66.7% had single microorganism and rest 33.3% had multiple growth. Staphylococcus aureus (34.48%) was the most frequently found microorganism. surgical team sterility was properly maintained in maximum surgical procedures (71.9%). Besides, OT room and surgical instruments were also properly sterilized in most of the cases (65.6% and 70%, respectively). Older age, abnormal BMI, smoking history, DM, longer pre-operative waiting period and operation duration was significantly associated with development of SSI. Besides, surgical team sterility, OT room sterility and Instrument sterility were not properly maintained in most of the surgical procedures among SSI patients (65.52%, 68.97% and 58.62%, respectively). Conclusion: Abnormal BMI (underweight and overweight or obese) and poor sterilization had significant association with development of SSI. However, further studies are needed to establish and use the findings. J Shaheed Suhrawardy Med Coll 2021; 13(2): 143-149

Expert consensus on technical specifications for the clinical application of photodynamic therapy for cholangiocarcinoma

Photodynamic therapy(PDT) is an effective,minimally invasive method for tumor treatment. It can be applied for treating cholangiocarcinoma in combination with the implementation of biliary stent/external biliary drainage,or with systemic treatments including chemotherapy. Moreover,it is a primary application in the treatment of unresectable cholangiocarcinoma as well as an adjuvant treatment of residual postoperatively or locally recurrent tumors. It can control local tumor progression effectively,relieve biliary obstruction,improve life quality,and prolong survival,with the advantages of minimally invasive,precise and repeatable. To date,clinical evidence-based medicine for applying PDT to treat cholangiocarcinoma was limited,and there has been a lack of clinical specifications and consensus regarding the technique. Based on this,Group of Operative Surgery,Branch of Surgery,Chinese Medical Association,Group of Biliary Surgery,Branch of Surgery,Chinese Medical Association and Chinese Committee of Biliary Surgeons organized experts to discuss the indications,contraindications,technical protocol,efficacy evaluation,and management of complications when using PDT to treat cholangiocarcinoma. The consensus aims to provide a reference for promoting the clinical application of PDT in the treatment of cholangiocarcinoma.

Antonio Scarpa (1752-1832): His Contribution to the History of Surgery.

Antonio Scarpa (1752-1832) is generally remembered for his discoveries in the field of anatomy, but he also provided some important contributions to the history of surgery. We analyzed main treatises written by Scarpa, highlighting how he contributed to the development of modern surgery. Scarpa made great innovations in three branches of surgery: abdominal surgery (hernia), orthopedics (clubfoot) and vascular surgery (aneurism). Furthermore, he contributed to the birth of modern ophthalmology.

Surgical cervicology as an independent branch of surgery — utopia or the near future?

Surgical cervicology as an independent branch of surgery — utopia or the near future?

Alternative Options of Blood Vessels Anastomosis

For a number of centuries, the problem of bleeding arrest from damaged vessels remains the major issue of surgery (alongside with infectious complications and fight against the pain syndrome). The development of vascular surgery began exactly when bleeding from a damaged vessel was arrested by tying it, and the introduction of reconstructive vascular surgery, being one of the most outstanding achievements of the 20th century, was the peak of creation. With the advent and development of this relatively young branch of clinical surgery, it became possible to effectively help patients with various vascular pathologies, previously considered incurable and doomed to death. However, the development of each industry is necessarily associated with the development of technical support. The lack of high-quality suture material and instruments has restrained the development of reconstructive vascular surgery for a long time; this fact forced researchers and surgeons to develop techniques for the seamless connection of blood vessels. Despite the widespread use of manual surgical suture, it is not always possible to use this option due to altered vascular walls. Development of technology for manufacturing synthetic materials allowed for techniques providing fast and high-quality connection of blood vessels, significantly reducing the time required for reconstruction and, as a result, reducing the incidence of complications.

Chinese expert consensus on transanal drug administration for constipation (2022 edition )

Constipation is a clinical symptom. It can be caused by environment, habit, disease and drugs. Chronic constipation is a disease that can occur at any age and its prevalence increases with age. Transanal administration is a common method to treat all kinds of constipation, especially to relieve stool blockage. However, the method and dose of transanal administration vary by age, drug and preparation types of drugs, and the effect of defecation is also quite different. At present, there is no expert consensus to follow in China or abroad. This consensus was convened by Anorectal Branch of Chinese Medical Doctor Association, Colorectal Surgery Group of Branch of Surgery of Chinese Medical Association and Chinese Journal of Gastrointestinal Surgery, to incorporate the latest evidence in China and abroad. This consensus addressed common transanal preparations, principles of administration, and efficacy for constipation. The evidence quality was assessed and the recommendation intensity was graded according to the GRADE system. The consensus aims to help standardize drug selection in practice and guide clinical application.

Development of bariatric surgery in the context of precision medicine

Precision medicine, which is based on individualized medicine, is a new medical model developed with the cross-application of genome sequencing technology, bioinformatics, and big data science. The establishment of precision medicine model is conducive to maximize the efficient utilization of medical resources and patient benefits. Bariatric surgery is an emerging branch of general surgery in the new century. Although the development of bariatric surgery still has a long way to go, precision medicine will add significant value to the rapid and positive development of the branch of bariatric surgery. In the context of precision medicine, bariatric metabolic surgery is now in its infancy. Currently, the successful implementation of precision control in bariatric surgery is initially focusing on the prediction of postoperative weight and the study of body weight differences in epigenetics. However, there are still gaps to be filled in the area of postoperative recovery, nutritional support treatment, and realization of individualized treatment based on big data. In the future, the integration of large-scale resource and data information can be realized by establishing the multi-center clinical sample library and perfecting the data collection of long-term follow-up and clinical information. Meanwhile, we can conduct deep biological data mining effectively with the big data platform, while using data reference to achieve accurate prediction and control of obesity treatment, so as to formulate detailed implementation plans and detailed procedure standard. Last but not least, we should pay attention to the patients' privacy and prevent personal health information leakage.

Is the Beauty Industry a Virus Invading the Medical Profession?

The practice of medicine and the medical sciences have progressed tremendously in the past half century. This talk explores the background and causes of this transformation in medicine as seen through the lens of a surgeon who has practiced medicine for over 50 years. If Medicine is the science and practice of diagnosis, treatment, prevention, alleviation, or cure of disease… If our role as Medical Professionals is to protect, promote, and restore good health… If our Hippocratic oath speaks to the notion of Primum Non Nocere. First, do no harm… Then… Can the newly created branches of cosmetic and aesthetic surgery within the field of Reconstructive and Plastic Surgery be considered “Medicine”? Should Medicine be in the business of beauty services? Should beauty standards remain in the domain of art? Is the beauty industry a virus in the Medical Profession? How do we ensure our Profession stays true to its promise, its oath?

Prof. dr. Alexandru Moruzi s life cues and opening lesson at the Faculty of medicine of iași

Professor Dr. Alexandru Moruzi lived in the first half of the XX century. Born in an aristocratic family, he studied in Paris where he graduated from both high school and the Faculty of Medicine. It was also in Paris that Moruzi worked as a young doctor and specialised in general surgery and neurosurgery, a domain that just then was being born as an independent field. He was trained in Dr. Maurice Robineau`s service and in Professor Thierry de Martel`s surgery clinic, two outstanding French medical personalities of the time. In October 1929, Dr. Moruzi returned to Bucharest, where he completed his military service and enrolled as a reserve medical officer lieutenant. In 1930 he was a secondary surgeon in the Third Surgical Clinic of the Coltea Hospital in Bucharest, directed by the great surgeon, Prof. Dr. Amza Jianu, a pioneering Romanian neurosurgeon. One year later, in 1931, Moruzi started his brilliant career in Iasi, when he was appointed senior [primar] doctor in the Surgery Service of the “Caritatea” [Charity] Hospital. A complex medical personality, he systematically opened new fields of surgical activity and teaching, in keeping with the latest advances of Western European medicine. Due to his qualities and expertise, Prof. Dr. Leon Ballif, director of the “Socola” Hospital of Nervous and Mental Diseases in Iasi, decided to set up a separate pavilion for neurosurgical interventions in 1933, and Moruzi was appointed coordinator of this first Neurosurgery Service ever established in Romania. Little by little, similarly to his masters, De Martel and Robineau, Moruzi enabled neurosurgery to gain the status of an autonomous branch of surgery in his country, too. An assistant professor since 1935, he was promoted full professor of the Faculty of Medicine of Iasi, in 1938. He became professor of External Pathology and Surgery and Orthopedic, as well as professor of Surgery Clinic and Diseases of the Urinary Tract. During World War II he assisted the wounded with great devotion. This article outlines several aspects of Professor Moruzi`s professional life and points out the main ideas of his inaugural lecture, given in November 1938. Not only outstanding medical personalities and their work were sketched, but concepts, trends, tendencies and debates were pointed out, reflecting the complex surgery metamorphoses of those days. Alexandru Moruzi lived in a revolutionary era of surgery and he took part in the important modernisation of medical teaching and practice in Iasi. Until now, his lecture illustrates a substantial and personally experienced lesson of history of medicine.

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study.

Pediatric neurosurgery is a highly specialized branch of surgery in which surgical site infections (SSIs) are potentially serious complications that can also adversely affect a good surgical outcome, compromising functional recovery and, in some cases, even putting the patient’s life at risk. The main aim of this consensus document is to provide clinicians with a series of recommendations on antimicrobial prophylaxis for neonates and children undergoing neurosurgery. The following scenarios were considered: (1) craniotomy or cranial/cranio-facial approach to craniosynostosis; (2) neurosurgery with a trans-nasal-trans-sphenoidal approach; (3) non-penetrating head injuries; (4) penetrating head fracture; (5) spinal surgery (extradural and intradural); (6) shunt surgery or neuroendoscopy; (7) neuroendovascular procedures. Patients undergoing neurosurgery often undergo peri-operative antibiotic prophylaxis, with different schedules, not always supported by scientific evidence. This consensus provides clear and shared indications, based on the most updated literature. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, and represents, in our opinion, the most complete and up-to-date collection of recommendations on the behavior to be held in the peri-operative setting in this type of intervention, in order to guide physicians in the management of the patient, standardize approaches and avoid abuse and misuse of antibiotics.