This study documented a significant (10-fold) decrease in overall wound infections when single-dose, intravenous AS was used during Lichtenstein hernia repair. Deep infections and wound infection-related readmissions were also reduced by the use of AS. Proponents of mesh repairs may therefore be advised to use prophylactic single-dose intravenous antibiotic coverage in the light of the results of this trial. AS proved to be an effective antimicrobial agent.
The development of a postoperative trocar site hernia may be prevented by the closure of 10-mm trocar sites in patients who are older than 60 years, obese, and who have a longer duration of operation.
The immediate success and flow of a newly constructed arteriovenous fistula is mainly dependent on arterial inflow and subclavian venous flow. An arterial inflow rate of 40 ml/min or more and subclavian venous flow rate of 400 ml/min or more measured by colour flow duplex imaging prior to the operation will be associated with better outcomes, and therefore the use of colour flow duplex imaging is warranted during the evaluation of patients who are candidates for an arteriovenous fistula operation.
Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective multicenter study, we aimed to outline the specific features of spigelian hernias and patients' characteristics more clearly. Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34 patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications and is very well tolerated by the patient.
Laparoscopic Nissen fundoplication is an effective operation that controls the typical symptoms and improves the quality of life of patients, but new-onset symptoms affect postoperative well-being. For closer evaluation of the benefits of the operation, we need new questionnaires that comprehensively evaluate the symptom spectrum of GERD both preoperatively and postoperatively.
Background
There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates.
Methods
We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020.
Results
Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country.
Conclusions
BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.
Management of intraperitoneally retained gallstones after laparoscopic cholecystectomy (LC) is controversial, as their natural course is not known. This study was undertaken to assess the probable effects of stone morphology and clinically obvious infection on the outcome of retained gallstones in a mouse model. Forty albino mice were divided into four groups. Group I served as the control group (simple laparotomy, n = 10). Groups II, III, and IV (n = 10 in each group) were study groups. "Intact-sterile-cholesterol" (group II), "crushed-sterile-cholesterol" (group III), and "intact" (n = 5) [group IVa] and "crushed" (n = 5) [group IVb] "infected-cholesterol" gallstones aseptically retrieved from three different human patients were implanted to the peritoneal cavity of the animals. Group IV animals were implanted with stones retrieved from an acutely inflamed gallbladder with proven infection. Animals were sacrificed 6 and 12 weeks after the operations. Cultures and tissue samples were obtained. No animal was lost, no microscopic or macroscopic abnormality was observed in groups I and II, and cultures remained negative. In group III, adhesions surrounding the fragmented stones were evident at the 12th week, and no mortality was encountered. The histopathology revealed a fibroblastic reaction, and cultures remained negative in group III. In group IV, three animals from group IVb and one animal from group IVa died because of intra-abdominal sepsis before their sacrifice. All remaining mice showed severe adhesions with localized abscesses at the 12th week. In conclusion, intraperitoneally retained cholesterol gallstones remain inert and do not cause serious peritoneal reaction unless they are crushed into fragments or are from an acutely inflamed gallbladder. It is for this group of patients that laparotomy for total stone clearance is probably not justifiable. Better stone retrieval techniques or even laparotomy may be worthwhile considering in patients with crushed and particularly infected retained stones.
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