Aims: Superficial parotidectomy (SP) is a commonly performed procedure which traditionally requires a drain and overnight hospital stay. This series aimed to show the safety and efficacy of drainless day case parotidectomy using ARTISS [Solution for Sealant] fibrin glue. Materials and Methods: Patients with a superficial parotid lump with benign preoperative sampling underwent an SP. We initially used both ARTISS and a drain, which was removed when output was <40 mls. ARTISS without drain was then introduced and once confident patients were sent home the same day. Objectives: We prospectively collected data and divided groups into ARTISS alone and ARTISS with a drain to compare patients' length of stay and complication rates. Results: 88 patients were included; 52 ARTISS alone, 22 as a day case. 42.3% of patients where ARTISS alone was used were discharged within 24 hours, with the remainder between 24-48 hours. Comparatively, no ARTISS and drain patients were discharged within 24 hours and 86.1% were discharged between 24-48 hours with the remainder over 48 hours. There were 3 postoperative haematomas and none in the drainless group; a statistically significant difference (p = 0.034). Of the 6 recorded salivary leaks, 4 were in the drain group and 2 in the ARTISS alone group (p > 0.05). Conclusions: Comparable complication rates and reduced length of stay suggest that ARTISS in SP is safe and effective. These findings stand to benefit both patients and the NHS by improving the patient journey and reducing overall costs.
Between 2009-2012, 215 implants were done in 173 patients, with complication rates found to be 7.5% and 14.5% for major and minor respectively. From 2013-2017, a total of 403 implants were implanted in 291 patients. Major and minor complication rates were 10.64% and 53.19% respectively in the first year, followed by an overall decline in rates to 2.7% and 4.1% respectively (figure 3). The disparity in rates between those recorded for 2009-2012 and the initial complication rates recorded in 2013 were likely due to the introduction of a new and robust method of reporting complications.
Background In patients with right iliac fossa pain, the need for surgery is largely determined by the likelihood of appendicitis. Patients often undergo ultrasound scanning despite a low diagnostic accuracy for appendicitis. This study aimed to determine the feasibility of a larger trial of computed tomography in the evaluation of patients with atypical right iliac fossa pain. Materials and methods A single-centre, unblinded, parallel randomised controlled trial of computed tomography in the assessment of patients with atypical right iliac fossa pain. After a retrospective evaluation, standard care was defined as serial examination with or without ultrasound. Atypical right iliac fossa pain was defined as no firm diagnosis after initial senior review. Simple descriptions of the risks and benefits of computed tomography were devised for patients to consider. Primary objectives were to assess feasibility and acceptability of the study procedures. Results A total of 71 patients were invited to participate and 68 were randomised. Final analysis included 31 participants in the standard care arm and 33 in the computed tomography arm, with comparable demographics. Computed tomography was associated with superior diagnostic accuracy, with 100% positive and negative predictive value. The proportion of scans that positively influenced management was 73% for computed tomography and 0% for ultrasound. In the computed tomography arm, there was a trend towards a shorter length of stay (2.3 vs 3.1 days) and a lower negative laparoscopy rate (2 of 11 vs 4 of 9). Conclusion A large randomised trial to evaluate the use of unenhanced computed tomography in atypical right iliac fossa pain appears feasible and justified.
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