Background: Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan. Patients and methods: This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months. Results: 90 patients were evaluated, 54 (60%) patients were female and 36 (40%) patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6%) patients and failed in 22 (24.4%) patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients), appendicular abscess (3 patients) and appendicular mass (4 patients). Conclusion: Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery. Highlights:

Background: The main objective was to compare the outcome of single layer interrupted extra-mucosal sutures with that of double layer suturing in the closure of colostomies. Subjects and Methods: Sixty-seven patients with closure colostomy were assigned in a prospective randomized fashion into either single layer extra-mucosal anastomosis (Group A) or double layer anastomosis (Group B). Primary outcome measures included mean time taken for anastomosis, immediate postoperative complications, and mean duration of hospital stay. Secondary outcome measures assessed the postoperative return of bowel function, and the overall mean cost. Chi-square test and student t-test did the statistical analysis.. Results:  Thirty-two patients were allocated to group A and 35 patients to group B. The mean time taken for anastomosis was significantly shorter in group A (23.25 ± 1.20 min in group A vs. 36.71 ± 1.93 min in group B; P<0.001). A significant shorter duration of hospital stay was seen in group A (7.00 ± 1.778 days in group A vs. 9.74 ± 1.990 days in group B; P<0.001). The detection of bowel sound was substantially quicker in group A as compared to group B (4.56 ± 0.50 days in group A vs. 6.46±0.50 days in group B; P<0.001). There was no significant discrepancy between the two groups regarding anastomotic leak rates (P= 0.543). The mean cost of double layer intestinal anastomosis method was significantly higher than that of single layer anastomosis (P<0.001). Conclusions: The use of single layer extra-mucosal anastomosis of the intestine has the advantage of taking less time, less morbidity and cost-effective to perform with the same rate of anastomotic leak in the closure of colostomy.

Background: A core set of checks have been incorporated into World Health Organization (WHO) WHO surgical safety checklist.  Lack of access to basic surgical care remains a major concern in low-income settings. Objective: We use a WHO surgical safety checklist items to improve team communication and cooperation to help in reduction of morbidity and mortality of surgical procedures. Methods: This is a prospective study involving 300 patients after applying the 19 items of the surgical safety checklist with different types of operations had been operated in the surgical theater at Al-Kindy Teaching Hospital during the period 1st of September 2016 until 1st of March 2017. We follow up the patients until 30 days after surgical intervention. Results: After applying  the 19 items of surgical  safety checklist, the risk of the  surgical site infection, respiratory complications, retained gauze and risk of  blood loss [14% , 4.6% , 1.3% , and 2%  respectively] was comparable to  the results of the World  Health Organization.  Using the pulse oximetry in 94 % and site marked in 65.3%.  In 64.6% of patients received antibiotic prophylaxis in which just 4 % developed surgical site infection [SSI], while in extended regime 36.67% there is 10% developed SSI. No mortality reported during collection of the data.  Conclusions: The surgical safety checklist is a simple method, and there is evidence for its effectiveness in reducing complications in clinical use. WHO recommends use of the checklist in all surgical operations and encourages clinicians to modify the list for different specialties and hospitals.