BackgroundAlthough surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown.ObjectiveWe estimated the incidence of SSI after appendectomy at global and regional levels.DesignSystematic review and meta-analysis.ParticipantsAppendectomy patients.Data sourcesEMBASE, PubMed and Web of Science were searched, with no language restrictions, to identify observational studies and clinical trials published between 1 January 2000 and 30 December 2018 and reporting on the incidence of SSI after appendectomy. A random-effect model meta-analysis served to obtain the pooled incidence of SSI after appendectomy.ResultsIn total, 226 studies (729 434 participants from 49 countries) were included in the meta-analysis. With regard to methodological quality, 59 (26.1%) studies had low risk of bias, 147 (65.0%) had moderate risk of bias and 20 (8.8%) had high risk of bias. We found an overall incidence of SSI of 7.0 per 100 appendectomies (95% prediction interval: 1.0–17.6), varying from 0 to 37.4 per 100 appendectomies. A subgroup analysis to identify sources of heterogeneity showed that the incidence varied from 5.8 in Europe to 12.6 per 100 appendectomies in Africa (p<0.0001). The incidence of SSI after appendectomy increased when the level of income decreased, from 6.2 in high-income countries to 11.1 per 100 appendectomies in low-income countries (p=0.015). Open appendectomy (11.0 per 100 surgical procedures) was found to have a higher incidence of SSI compared with laparoscopy (4.6 per 100 appendectomies) (p=0.0002).ConclusionThis study suggests a high burden of SSI after appendectomy in some regions (especially Africa) and in low-income countries. Strategies are needed to implement and disseminate the WHO guidelines to decrease the burden of SSI after appendectomy in these regions.Prospero registration numberCRD42017075257.

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Duraplasty alone with a flap of pericranium remains the simplest and least expensive method of treatment. Cranioplasty is not necessary in young children.

Introduction: A depressed skull fracture is an inward buckling of the skull bones. It is referred to as a ping-pong ball fracture in neonates; in older children, some fractures take a cup shape mimicking ‘ping-pong’ ball fractures. Objective and Methods: The aim of this study was to assess the use of an obstetric vacuum extractor to elevate cup-shaped depressed skull fractures in children irrespective of age. All children admitted into the Central Hospital of Yaounde between 1999 and 2004 with a cup-shaped simple depressed skull fracture and treated with the vacuum extractor were included. Results: Nine children aged from 3 months to 17 years were treated with the vacuum extractor. The cosmetic and radiographic results were satisfactory. The procedure was simple and without any complication. Conclusion: The elevation of ‘ping-pong-ball-like’ or ‘cup-shaped’ skull fractures in older children (beyond the neonatal period) is a simple, effective and safe procedure.

HighlightsLocked pubic symphysis is a serious injury of the pelvis.Very few cases has been reported in the literature.This nosological entity shows peculiarities in its manually difficult reduction and associated complications.A good outcome can be obtained after management with simple gestures, possible even in ressource-limited settings.