Transvaginal evisceration of the intra-abdominal organs is a rare emergency event. In this paper, we discuss the case of a 97-year-old female who presented to the emergency department due to abdominal pain and a large prolapse with visible extrusion of the small bowel per vagina. Past surgical history was significant for a total abdominal hysterectomy and surgical repair for pelvic organ prolapse; both performed more than 15 years prior to the patient's current presentation. The eviscerated bowel was initially reduced through a vaginal vault defect into the abdominal cavity. A lower midline laparotomy was undertaken for further assessment, and the vault defect was closed by transabdominal repair with no evident compromise to bowel function. We suggest that a multidisciplinary approach to prompt examination and management by gynaecology and general surgery is vital in reducing the risk of morbidity and mortality.
Widening participation to medicine aims to remove barriers to medical education for under-represented groups. This study examined the impact of a widening participation workshop for medical school applicants. The intervention was delivered by a team of medical student volunteers operating in the North West of England: Manchester Outreach Medics. Methods 39 pupils, typically aged 16-17, attended the workshop at Royal Blackburn Hospital, Lancashire. Activities included a variety of lectures and interactive group sessions. Using questionnaires, participants highlighted their understanding in areas relating to the medical school application process on a scale of zero to ten. This was performed before and after the intervention to allow for comparison. The results were evaluated using a one-tailed paired t-test and Cohen's d effect size. Results There was a significant improvement (p <0.001, Cohen's d >0.8) in the understanding of all topics assessed. The largest improvements were seen in topics that the participants had little understanding in prior to attending the workshop. Conclusions This student-led activity improved participant understanding in areas pertaining to the medical school application
Clinicians have learnt valuable lessons throughout the COV-SARS-2 pandemic, many of which have produced solutions that we aim to continue to implement within the foreseeable future. Optimising patients' surgical pathways to reduce the length of stay and complications is an area of particular importance, both for maximal utilisation of available resources and for reduction of the exposure of inpatient and elective patients to an increased risk of infection within healthcare facilities.The aim of this review was to investigate the possible implications of using low-pressure laparoscopic gynaecological surgery versus standard-or high-pressure pneumoperitoneum surgeries. The primary outcome was postoperative pain, with secondary outcomes including duration of surgery, length of inpatient stay and rate of complications. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to December 2020. We searched for published randomised control trials comparing low-pressure laparoscopic surgery (≤8 mmHg) to at least one additional standardised pneumoperitoneum pressure (≥12 mmHg and/or ≥15 mmHg). A total of 203 studies were reviewed, five of which were included in this analysis. Studies comparing low-pressure laparoscopic surgery against gasless abdominal cavities were excluded.The meta-analysis of the results was pooled and calculated within RevMan 5.0 software (Cochrane, London, England). Studies using a visual analogue scale (1-10) to compare low versus standard pneumoperitoneum pressures did not display a significant diminution of postoperative pain at ≤ 6 or 24 hours: -0.30 [95% CI -0.63, 0.03] and -0.66 [95% CI -1.35, 0.02], respectively. Studies additionally demonstrated worse visualisation of the surgical field within the low-pressure group (risk ratio 10.31; 95% CI, 1.29-82.38 I 2 = 0%). Studies measuring postoperative pain using a numerical rating scale displayed significant pain reduction at all hours measured (p ≤ 0.01). The rate of intraoperative complications was 1% for all groups measured. Cumulative analysis of the duration of surgery did not differ significantly between groups (p = 0.99).The pandemic has revealed new issues that must be addressed by clinicians to promote the safety of patients and the efficiency of inpatient stay. This review has paved the way for new possibilities and innovative approaches to address the issue of optimising patient surgical pathways; however, at present, we cannot give a firm justification for the use of low-pressure gynaecological laparoscopy. Reasons for this include the minimal reduction in pain scores between low, standard and high pneumoperitoneum pressures, leading to a mixture of statistically significant results, as well as a reduction in the visualisation of the surgical field and the small population sizes in the reviewed papers. Additional research is required to further explore the potential clinical benefits of gynaecological laparoscopy to ensure its effective ambulatory use within mainstream surgical operations.
Laparoscopic appendicectomy has been the subject of several encouraging reports, but has not as yet gained widespread acceptance. We present a series of 159 consecutive laparoscopic appendicectomies performed, over a 4 yr period, in both adults and children. We find the procedure as safe as its open counterpart, with patients fit to leave hospital within the same time period. Perforated appendices were amenable to this procedure, and the location of the appendix did not alter the outcome. Children responded as well as adults post-operatively. Obesity may be an indication for this form of treatment. Removal of displaced faecoliths associated with perforated appendicitis is a difficult technical problem in less than 5 per cent of patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.