Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Abebe, Kirubel; Geremew, Biniyam; Lemmu, Befekadu; Abebe, Engida

doi:10.4314/ejhs.v30i5.13

Cited by 4 publications

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References 16 publications

(108 reference statements)

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“…[13,14] Surgical re-exploration is a surrogate for severity of disease; the more surgically compromised patient is generally more likely to receive a re-exploration and may have a poorer outcome. [15,16] Surprisingly, and unlike international data where nutritional status has been shown to influence paediatric liver transplant recipient outcomes, [17][18][19][20] our cohort did not demonstrate a statistically significant association between risk of mortality and nutritional status, perhaps because of the decreasing trend towards transplanting moderately and severely malnourished recipients (z-scores <-2). Despite the internationally comparable graft and patient survival rates, our surgical complication rate remains ~60%.…”

Section: Discussioncontrasting

confidence: 90%

The paediatric liver transplant experience in Johannesburg, South Africa: A broad overview and update

Kinandu,

Beeton,

Beretta

et al. 2024

S Afr Med J

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Background: The Wits Transplant Unit performed its first paediatric liver transplant in 2005. Initial experiences from the unit were published in 2012 and 2014. Since then, significant progress has been made in capacity-building the unit, improving outcomes and enhancing service delivery. This paper presents a broad overview and update of the unit’s 17-year experience. Methods: We conducted a retrospective review of all paediatric liver transplants performed in Johannesburg from 1 January 2005 to 31 December 2021 with a minimum one-year follow-up. Data were accessed from the Wits Donald Gordon Medical Centre Paediatric Liver Transplant Research Database (University of the Witwatersrand Human Research Ethics approval: M190749). The following data were collected: donor and recipient sociodemographic and clinical characteristics, details of transplant procedures, donor grafts and recipient outcomes (post-operative complications, graft and recipient survival). Results: A total of 270 transplants were performed during the review period. Two thirds of recipients (n=180, 67%) were younger than 5 years at time of transplant and half (n=135, 50%) received a living donor graft. The most common indication for liver transplant was biliary atresia, followed by acute liver failure. Unadjusted recipient survival was 80% (95% CI: 75-85%) at one year, and 68% (95% CI: 59-75%) at five years. Waiting list mortality decreased from 27.3% in 2017 to 5.9% in 2021. One hundred and fifty-four (57.0%) recipients experienced at least one type of intervention requiring surgical complication - the most common being biliary in nature (n = 91; 33.7%). Conclusion: Over last seventeen years, a sustainable paediatric liver transplantation service has been established in Johannesburg. Living donor, split and ABO incompatible liver transplants have been incorporated in response to the severe organ shortage in South Africa. However, our outcomes can be improved. Additionally, a national transplant initiative to coordinate timeous referrals and expand access to liver transplantation for children with severe acute and chronic liver failure is advised.

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Section: Discussioncontrasting

confidence: 90%

The paediatric liver transplant experience in Johannesburg, South Africa: A broad overview and update

Kinandu,

Beeton,

Beretta

et al. 2024

S Afr Med J

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Epidemiological Characteristics, Antimicrobial Susceptibility Profile, and Surgical Outcome of Complicated Intra-Abdominal Infection at a Tertiary Hospital in Somalia

Yasin¹,

Ali²,

Ahmed³

et al. 2022

IJGM

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Background Intra-abdominal infections (IAIs) are common surgical emergencies and one of the leading causes of non-trauma deaths in hospitals worldwide. Because of limited resources, most patients in low-income countries experience delayed diagnosis and treatment. To the best of our knowledge, this is the first study to evaluate the epidemiological characteristics, antimicrobial susceptibility profile, and outcome of patients with complicated IAI at a tertiary hospital in Somalia. Methods This study included all patients with confirmed IAIs who underwent laparotomy or percutaneous drainage, either emergency or elective, and whose cultures showed growth. Sociodemographic and clinical characteristics, culture results, antimicrobial susceptibility profile, and the type of source control were reviewed. Results The prevalence of CIAI was 5.3%, 144 (70%) were male, and 61 (30%) were female. The mean age was 38.6±8.5 years. Appendicitis was the most common source of infection, accounting for 32%, followed by bowel perforation in 37 (18%). Out of 15 patients with liver abscesses, ten patients had diabetes (67%). E. coli 82 (40%) was the most common isolated organism, followed by Klebsiella pneumonia (n = 44, 21.5%). The prevalence of extended-spectrum beta-lactamase-producing and multidrug-resistant pathogens was 6.8% and 5.9%, respectively. The pathogens revealed a higher antimicrobial resistance against penicillins in 62%, cephalosporins in 54%, and fluoroquinolones in 44%. E. coli showed 2.5–13% antimicrobial resistance against carbapenems, lower than Klebsiella pneumonia in about 4.5%. Tigecycline, teicoplanin, and linezolid revealed the highest sensitivity against pathogens, about 100%. Source control was achieved by laparotomy in 81%, while the 19% were managed in a percutaneous approach. The mortality rate in our study was 9.3%. Conclusion The prevalence of CIAI in our study was 5.3%, with an increasing number of MDR microorganisms isolated from cultures. CIAI and intra-abdominal abscess are significant sources of high morbidity and mortality with sepsis and poor clinical outcome; thus, early detection and intervention are crucial.

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Comparison of the effectiveness of planned and «on-demand» relaparotomies in patients with secondary diffuse peritonitis (review of literature)

Сигуа

Котков

Ignatenko

2022

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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INTRODUCTION. The main component of the treatment of patients with secondary diffuse peritonitis is surgical intervention aimed at controlling the source of infection. In some cases, a single intervention is not enough for effective sanation of the abdominal cavity, which requires relaparotomy. There is currently no generally accepted approach to the timing and order for such interventions. The OBJECTIVE was to carry out a comparative analysis of the immediate results of patients with secondary diffuse peritonitis treatment using strategies of planned and «on-demand» relaparotomies.METHODS AND MATERIALS. The inclusion criteria for the review were randomized and cohort controlled trials comparing the efficacy of planned and «on-demand» relaparotomies in the treatment of secondary diffuse peritonitis. Primary sources comparing the results of these surgical strategies in adult patients were searched using the CENTRAL, MEDLINE, Scopus and eLibrary databases. The studies were independently assessed for inclusion by two review authors according to the stated eligibility criteria followed by data extraction. The methodological quality of randomized trials was assessed using the Cochrane tool for assessing the risk of bias, nonrandomized ones – using the Russian version of the Newcastle-Ottawa scale. Arising disagreements were resolved through discussions.RESULTS. The review included one randomized controlled trial according to the inclusion criteria and 16 nonrandomized cohort studies with a total of 3672 participants (1835 and 1837 patients undergoing planned and «on-demand» relaparotomies, respectively). Given the significant statistical heterogeneity of the included studies (χ2=119.2, df=16, p<0.00001, I2=87 %), a random effects model was used to assess the intervention effect: the resulting risk of death ratio was 0.68 (95 % CI 0.42–1.10) in favor of planned relaparotomies. The assessment of the systematic review sensitivity, performed by changing the inclusion criteria, showed a similar conclusion: the risk of death ratio was 0.79 in favor of the planned relaparotomies (95 % CI 0.46–1.36).CONCLUSION. The obtained data demonstrated the presence of a statistically insignificant (p=0.11) decrease in postoperative mortality rate in the subgroup of patients with planned relaparotomies. Given the average risk of systematic and significant risk of publication bias in the included studies, these conclusions should be accepted with caution. Further studies in the format of randomized trials will undoubtedly increase the level of the evidence reliability.

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Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Cited by 4 publications

References 16 publications

The paediatric liver transplant experience in Johannesburg, South Africa: A broad overview and update

The paediatric liver transplant experience in Johannesburg, South Africa: A broad overview and update

Epidemiological Characteristics, Antimicrobial Susceptibility Profile, and Surgical Outcome of Complicated Intra-Abdominal Infection at a Tertiary Hospital in Somalia

Comparison of the effectiveness of planned and «on-demand» relaparotomies in patients with secondary diffuse peritonitis (review of literature)

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