Compared to younger patients admitted to an acute care surgery service, patients over 80 years old have a higher risk of complications, are more likely to require ICU admission, and stay longer in the hospital.
This paper evaluates a new technique that can lead to excision of pilonidal sinus with less healing time and low recurrence rate. A prospective randomized double-blind controlled study on 142 patients with pilonidal sinus conducted during the period from September 2008 to March 2012. The patients were prospectively randomized to be operated with one of four surgical techniques, excision and primary closure, or excision after using hydrogen peroxide (H 2 0 2 ) and primary closure, or excision without closure, or excision after injection of H 2 0 2 without closure. The main outcome measures were the healing time and the recurrence rate. Out of 142 patients, 118 patients were males (83%), and 24 were females (17%). The mean age was 24.5 years. The recurrence rate in patients treated with excision after injection of H 2 0 2 without closure was the lowest (1.8%) with Pvalue , 0.005, and the mean duration of healing was 30.7 days with P-value , 0.005. We recommend using excision after injection of H 2 0 2 without closure in management of PNS. Injection of H 2 0 2 into the pilonidal tracts can give a precise delineation of the affected tracts, which can be excised with minimal amount of surrounding normal tissues and hence lead to a quicker recovery and low recurrence rate.
Introduction: Many poly-trauma patients sustain chest wall injuries. Flail chest is considered one of the uncommon injuries that may happen in traumatized patients and may increase morbidity and mortality in polytrauma patients. Pulmonary contusion, mechanical ventilation, pneumonia, sepsis and poor pain control are expected to be common complications in patients sustaining chest wall injuries. We hypothesize that the use of epidural analgesia can lead to improved clinical outcomes in this group of patients.
Operative classification of ventral abdominal hernias: new and practical classification. Yasser Selim. From the Ministry of Health.Background: Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system for ventral hernias. One of the more accepted classification systems is that of the European Hernia Society (EHS). Its limitation is that it does not include individual patient risk factors and wound classification. The aim of this work was to find out the basic principles of hernia etiology and pathogenesis, clarify the factors that are important in treatment of ventral hernias, and categorize hernia patients according to those factors. Methods: This retrospective study included 238 patients who presented to our surgery department between 2010 and 2020. A full description of ventral hernias was made, including their type according to the EHS. In addition, abdominal wall components were assessed, including strength of rectus muscles, lateral abdominal muscles, and abdominal fascia, namely the linea alba. Patients with spontaneous hernias were grouped according to the size of the defect and the condition of the rectus abdominis muscles, the fascia and other abdominal muscles. Results: Patients were put into 6 clinical categories: type 1A, type 1B, type 2, type 3, type 4, and type 5. The grouping of patients was done according to the factors we believed affect the choice of surgical procedure and the prognosis of repair. Patients with types 1 and 2 have normal abdominal muscles, whereas those with types 3 and 4 have weak muscles and weak stretched fascia (linea alba). Type 5 includes incisional hernias. Conclusion: The primary purpose of any classification should be to improve the possibility of comparing different studies and their results. By describing hernias in a standardized way, different patient populations can be compared. Numerous classifications for groin and ventral hernias have been proposed over the past 5-6 decades. For primary abdominal wall hernias, there was agreement with EHS classification on the use of localization and size as classification variables.
Bariatric patients are difficult to assess clinically for signs of postoperative complication. Diagnostic laparoscopy (DL) is used to investigate patients suspicious for complications such as anastomotic leak (AL) and intra-abdominal hemorrhage (IH). Most bariatric surgeons use DL in the presence of sustained tachycardia; however, the rate of this procedure and its clinical value have not been sufficiently investigated.A retrospective review of patients undergoing bariatric surgery from January 2010 to December 2011 was performed. Data from 4 collaborative bariatric centres of excellence were included in this analysis. From among all elective bariatric procedures, cases that required early reoperation were selected for further evaluation.A total of 1001 elective bariatric procedures were identified. Of these, 952 (95%) were primary bariatric procedures, including 866 (91%) Roux-en-Y gastric bypasses and 86 (9%) sleeve gastrectomies. The remaining 48 cases represented revisional proced ures. Of these, 11 patients (1.1%) returned to the operating room within 72 hours for DL: 64% were primary cases (n = 7) and 36% revisional cases (n = 4). Intraoperative findings included AL (45%, n = 5), IH (27%, n = 3), no pathology identified (18%, n = 2) and small bowel obstruction (9%, n = 1). Of the 9 patients with complications, all were tachycardic (heart rate > 100 beats/min), and 4 of the 5 patients with AL were febrile (t > 37.5). There were no reported adverse events directly related to the use of DL.Diagnostic laparoscopy is a useful and safe option for both the diagnosis and treatment of suspected complications after bariatric surgery. The majority of patients returning to operating room had significant findings, and all were treated laparoscopically. Persistent postoperative tachycardia or fever were highly predictive of positive findings during DL. An emphasis on early decisionmaking and expeditious return to the operating room for laparoscopy should be the standard for bariatric patients on clinical suspicion of a postoperative complication.
4Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding. A
Purpose: The coronavirus disease 2019 (COVID-19) pandemic has placed major limitations on trauma health care systems. This survey aims to identify how Canadian trauma centres altered their processes to care for injured patients and protect their staff during the pandemic.
Methods: A survey was distributed to trauma directors at level 1 Canadian adult trauma centres in July 2020. Questions included changes made to the trauma service in preparation for the pandemic, modification to clinical practice and expected lasting modifications after the pandemic.
Results: The response rate was 68.4%. All trauma centres modified their treatment and investigation protocols for the pandemic. Most respondents adopted online platforms for meetings and educational activities and used simulation to prepare for COVID-19-infected trauma patients. The approach to who would intubate trauma patients, which trauma patients should be tested for COVID-19 and who should use N95 ventilators, varied among the sites surveyed.
Conclusion: All centres modified some of their treatment and investigation protocols for the pandemic but not all modifications were adopted universally. Knowing these steps and comparing them with other global centres will help organize disaster plans for the current and future pandemics.
Background: Self-inflicted trauma (SIT) is a public health issue ranking 4th as leading cause of death and disability in young adults. Methods: Retrospective descriptive analysis of patients admitted to a level 1 trauma centre with self-inflicted injuries, 2008-2013. Results: Over a 5-year period, 268 patients with SIT presented to our hospital, 177 (66%) male, average age 39.4 years (SD 16). The most common mechanism of injury was stabbing, (47%), followed by jumping (26.86%). Jumpers had higher ISS (22 v. 9). Seasonal variation showed summer with highest incidence (34%), winter having the lowest (17%). Patients from rural areas accounted for 28%, these were younger (30 v. 42 years, p = 0.002), had lower ISS (9 v. 14, p = 0.007), presented with more firearm injuries (18.6% vs. 2.3%). Overall, 63 (23%) patients had pre-existing psychiatric disease; these patients had longer LOS (20 v. 7 days, p = 0.002), and had jumping from height as predominant mechanism (p = 0.01). Mortality was 13.8%. Patients that died were older (42 v. 30 years, p = 0.002), had higher ISS (14 v. 9, p = 0.007), longer LOS (13.5 v. 6 days, p = 0.004), with fall being the predominant mechanism associated with mortality (p < 0.0001).
Conclusion:Our study defines and characterizes the population at risk for SIT in an attempt to implement appropriate prevention strategies and improve the existing post-injury care pathway.Abdominal compartment syndrome in the child. Gilgamesh Eamer,* Ioana Bratu.
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