Use of oCP in a continuous fashion following conservative surgery for endometriosis is more beneficial to cyclic use.

Background Current guidelines recommend laparoscopic cholecystectomy be offered for patients with acute cholecystitis except those deemed as high risk. Few studies have examined the impact of frailty on outcomes for patients undergoing laparoscopic cholecystectomy. Therefore, the aim of this study was to determine the association of frailty with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. Methods Patients undergoing laparoscopic cholecystectomy for acute cholecystectomy were identified from 2005 to 2010 in the American College of Surgeons National Surgical Quality Improvement Project (NSQIP). The Modified Frailty Index (mFI) was used a surrogate for frailty, and patients were stratified as non-frail (mFI 0), low frailty (mFI 1-2), intermediate frailty (mFI 3-4) and high frailty (mFI ≥ 5). Univariable and multivariable analyses were performed. Receiver operator curves (ROC) and an area under the curve (AUC) were generated to determine accuracy of mFI in predicting postoperative morbidity and mortality. Results Of the 6898 patients undergoing laparoscopic cholecystectomy, 3245 (47%) patients were non-frail. There were 2913 (42%) patients with low-frailty, 649 (9%) patients with intermediate frailty, and 91 (2%) with high frailty. Clavien IV complications were higher for intermediate frail patients (OR 1.81, 95% CI 1.00-3.28, p = 0.050) and high-frail patients (OR 4.59, 95% CI 1.98-10.7, p < 0.001). Additionally, mortality was higher for patients with intermediate frailty (OR 4.69, 95% CI 1.37-16.0, p = 0.014) and high frailty (OR 12.2, 95% CI 2.67-55.5, p = 0.001). The mFI had excellent accuracy for mortality (AUC = 0.83) and Clavien IV complications (AUC = 0.73). Conclusion Frailty is associated with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.

The frequency of surgical site infections (SSIs) after clean neck surgery is low and antibiotic prophylaxis is not recommended. This retrospective study investigated the effect of perioperative prophylactic antimicrobial therapy on the development of infections. A total of 807 consecutive patients undergoing clean neck surgery were included in the study. Antimicrobial prophylaxis with intravenous cefuroxime was administered in 518 cases. Although patients who received prophylaxis had a lower rate of SSIs than those who did not receive antibiotics, this was not statistically significant (0.4% vs 1.4% respectively, p=0.19). Older age was the only variable associated with the development of SSIs (p=0.014). Clean neck operations (thyroidectomy, parathyroidectomy and lymph node resection) are among the most common operations performed worldwide. Most guidelines do not recommend the routine use of perioperative antimicrobial prophylaxis for these procedures 1,2 because the frequency of surgical site infections (SSIs) is generally low (<1%).3,4 However, prophylaxis is still often used in these cases as some surgeons and anaesthetists feel that this advice is not appropriate for a part of the globe in which multidrug resistant infections are endemic. In this context, we studied the frequency of postoperative infections after clean neck surgery and examined the effect of perioperative prophylactic antimicrobial therapy on the development of infections. MethodsThis was an observational, retrospective study performed in a 140-bed private clinic (Department of Endocrine Surgery, Central Clinic) in Athens, Greece, over a 5-year period (2010)(2011)(2012)(2013)(2014). The study was approved by the clinic's ethics committee. All patients undergoing clean neck surgery (regardless of age, sex and co-morbidity) were included. All operations were performed by the same primary surgeon and surgical team. Apart from the primary operator, there were also three assistants and one of two anaesthetists. Administration of perioperative prophylaxis was at the discretion of the anaesthetist. The first anaesthetist did not provide antibiotic prophylaxis in any patient while the second administered antibiotics to all patients. Selection of the anaesthetist was independent of patient characteristics and operation plan. All data were retrieved from patient files. The patients were divided into two groups based on whether antimicrobial prophylaxis was administered. Among the patients in the antibiotics cohort, only those who received intravenous cefuroxime were studied. The primary outcome was the rate of SSIs or remote infections. Statistical analysis ResultsDuring the study period, 849 patients underwent surgery. Of these, 34 were excluded because data were missing, 7410 Ann R Coll Surg Engl 2017; 99: 410-412

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BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents, but fortunately has an incidence of less than 1%. CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, alcoholic liver cirrhosis, portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis. On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention. CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents, with one causing perforation. In addition, we review the relevant literature on migrated stents.

Hepatic tuberculosis as a part of disseminated tuberculosis is seen in 50-80% of cases. Isolated hepatic tuberculosis is very uncommon even in countries with high prevalence of tuberculosis. It can occur as a primary case or due to reactivation of an old tubercular focus. We report a case of a 59-year-old Caucasian woman who presented with persistent right upper quadrant pain and a hepatic lesion on an abdominal CT. She had a history of pulmonary tuberculosis 15 years ago with localised lung tuberculosis treated with lobectomy and antituberculous drugs.

BACKGROUND Controversy exists regarding the impact of preoperative bowel preparation on patients undergoing colorectal surgery. This is due to previous research studies, which fail to demonstrate protective effects of mechanical bowel preparation against postoperative complications. However, in recent studies, combination therapy with oral antibiotics (OAB) and mechanical bowel preparation seems to be beneficial for patients undergoing an elective colorectal operation. AIM To determine the association between preoperative bowel preparation and postoperative anastomotic leak management (surgical vs non-surgical). METHODS Patients with anastomotic leak after colorectal surgery were identified from the 2013 and 2014 Colectomy Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and were employed for analysis. Every patient was assigned to one of three following groups based on the type of preoperative bowel preparation: first group-mechanical bowel preparation in combination with OAB, second group-mechanical bowel preparation alone, and third group-no preparation. RESULTS A total of 652 patients had anastomotic leak after a colectomy from January 1, 2013 through December 31, 2014. Baseline characteristics were assessed and found that there were no statistically significant differences between the three groups in terms of age, gender, American Society of Anesthesiologists score, and other preoperative characteristics. A χ 2 test of homogeneity was conducted and there was no statistically/clinically significant difference between the three categories of bowel preparation in terms of reoperation. CONCLUSION The implementation of mechanical bowel preparation and antibiotic use in patients who are going to undergo a colon resection does not influence the treatment of any possible anastomotic leakage.

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