scholarly journals EP.WE.843Acute Appendicitis Management During the COVID-19 Pandemic: A Prospective Cohort Study From A Large UK Centre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ramez Antakia ◽  
Athanasios XAnthis ◽  
Fanourios Georgiades ◽  
Victoria Hudson ◽  
Justin Davies ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Free Fluid ◽  
P Value ◽  
Delayed Presentation ◽  
Open Approach ◽  
Radiological Evaluation ◽  
Attendance Rate ◽  
Alvarado Score ◽  
Tertiary Centre ◽  
Operative Findings

Abstract Aims The aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of acute appendicitis (AA) during the pandemic. Methods We conducted an observational study in a tertiary centre. Data was collected from all patients (≥16 years) with a diagnosis of AA between 1st November 2019 to 10th March 2020 (pre-COVID period) and 10th March 2020 to 5th July 2020 (COVID period). Results A total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 72.5% (n = 66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n = 28) in the pre-COVID period (p-value<0.001). We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value=0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value<0.001). We observed more open appendicectomies (37.3% versus 0.9%; p-value<0.001) during the COVID period compared to pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value= 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p = 0.027). Conclusions Radiological diagnosis of AA was more frequent during COVID. More conservative management for AA was employed during COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during COVID without affecting the length of hospital stay.

scholarly journals P21 Appendicitis during the COVID-19 pandemic: to operate or not to operate, that is the question

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Ramez Antakia ◽  
Athanasios Xanthis ◽  
Fanourios Georgiades ◽  
Victoria Hudson ◽  
James Ashcroft ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Operative Management ◽  
Free Fluid ◽  
P Value ◽  
Delayed Presentation ◽  
Open Approach ◽  
Tertiary Referral Centre ◽  
Alvarado Score ◽  
Operative Findings ◽  
The Uk

Abstract Background During the Covid-19 pandemic, non-operative management for acute appendicitis (AA) was implemented in the UK. Aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of AA during the pandemic. Materials & Methods We conducted an observational study in a tertiary referral centre. Data was collected from patients (≥16 years) with a diagnosis of AA between 1st November 2019 to 10th March 2020 (pre-COVID period) and 10th March 2020 to 5th July 2020 (COVID period). Results A total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 43.1% (n = 50) of patients pre-COVID were classified as ASA 2 compared to 26.4% (n = 24) during the COVID period (p-value=0.042). 72.5% (n = 66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n = 28) in the pre-COVID period (p-value<0.001). We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value=0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value<0.001). We observed more open appendicectomies (37.3% versus 0.9%; p-value<0.001) during the COVID period compared to the pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value= 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p = 0.027). Conclusion Radiological diagnosis of AA was more frequent during the COVID period. More conservative management for AA was employed during the COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during the COVID period without this affecting the length of hospital stay.

scholarly journals Comparison of Laparoscopic versus Open Appendicectomy

2015 ◽  
Vol 10 (2) ◽  
pp. 75-79
Author(s):  
SM Shahadat Hossain ◽  
Farhana Israt Jahan ◽  
Munshi M Mujibur Rahman ◽  
Md Abdus Samad Al Azad ◽  
Md Shahinur Rahman ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Armed Forces ◽  
P Value ◽  
Surgical Trauma ◽  
Open Approach

Introduction: The advent of laparoscopic surgery has dramatically changed the field of surgery. With improvements in the equipment and increasing clinical experience it is now possible to perform almost any kind of procedure under laparoscopic visualization. The idea of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities, and better cosmetic outcome have made laparoscopic surgery for acute appendicitis very attractive.Objective: The aim of the present study was to compare the laparoscopic approach and the conventional technique in the treatment of acute appendicitis.Method: This prospective randomized clinical trial was conducted at CMH, Savar Cantonment and Navy Hospital, BNS Patenga, Chittagong. A total of 86 patients who underwent appendicectomy during December 2009 to March 2011 were included in this study. A total of 40 patients had laparoscopic appendicectomy and 46 underwent open procedure. Clinical outcome measures were compared between the two groups with respect to several variables.Results: Among the study population, the operating time was shorter for the OA patients than for the LA patients (LA, 35 min vs. OA, 30 min; p value 0.33), which is not statistically significant. The differences in hospital stay of 4 days for the LA group and 8 days for the OA group and p value 0.01 which is statistically significant. Return to oral diet was same in both groups with no statistical difference LA, 20 h vs. OA, 22 h; return to work LA was 14 days vs. OA 18 days. Although the rate for overall complications was lower in the LA group 5% vs. 18% in OA; p value 0.001 which is statistically significant.Conclusion: The laparoscopic approach to appendicectomy in patients with acute appendicitis does offer a significant advantage over the open approach in terms of length of hospital stay, postoperative complications, or quality of life, which are considered as the major advantages of minimally invasive surgery.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

Anatomically Complete Supraclavicular Reoperation for Recurrent Neurogenic Thoracic Outlet Syndrome: Clinical Characteristics, Operative Findings, and Long-term Outcomes

Hand ◽  
2021 ◽  
pp. 155894472098807
Author(s):  
Momodou L. Jammeh ◽  
J. Westley Ohman ◽  
Chandu Vemuri ◽  
Ahmmad A. Abuirqeba ◽  
Robert W. Thompson
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Length Of Hospital Stay ◽  
Functional Improvement ◽  
Scalene Muscle ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
First Rib ◽  
Previous Operation ◽  
Combined Operations ◽  
The Mean ◽  
Operative Findings

Background: The clinical outcomes of reoperations for recurrent neurogenic thoracic outlet syndrome (NTOS) remain undefined. Methods: From 2009 to 2019, 90 patients with recurrent NTOS underwent anatomically complete supraclavicular reoperation after previous operation(s) performed at other institutions using either supraclavicular (Prev-SC = 48), transaxillary (Prev-TA = 31), or multiple/combination (Prev-MC = 11) approaches. Prospectively maintained data were analyzed retrospectively. Results: The mean patient age was 39.9 ± 1.4 years, 72% were female, and the mean interval after previous operation was 4.1 ± 0.6 years. The mean Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 62 ± 2, reflecting substantial preoperative disability. Residual scalene muscle was present in 100% Prev-TA, 79% Prev-SC, and 55% Prev-MC ( P < .05). Retained/residual first rib was present in 90% Prev-TA, 75% Prev-SC, and 55% Prev-MC ( P < .05). There were no differences in operative time (overall 210 ± 5 minutes), length of hospital stay (4.7 ± 0.2 days), or 30-day readmissions (7%). During follow-up of 5.6 ± 0.3 years, the improvement in QuickDASH scores was 21 ± 2 (36% ± 3%) ( P < .01) and patient-rated outcomes were excellent in 10%, good in 36%, fair in 43%, and poor in 11%. Conclusions: Anatomically complete decompression for recurrent NTOS can be safely and effectively accomplished by supraclavicular reoperation, regardless of the type of previous operation. Residual scalene muscle and retained/residual first rib are more frequently encountered after transaxillary operations than after supraclavicular or multiple/combined operations. Supraclavicular reoperation can achieve significant symptom reduction and functional improvement for approximately 90% of patients with recurrent NTOS.

A COMPARATIVE STUDY OF EFFICACY, POTENCY AND RECOVERY OF INTRATHECAL 0.5% ROPIVACAINE WITH FENTANYLAND 0.5% LEVOBUPIVACAINE WITH FENTANYL IN LOWER ABDOMINAL SURGERIES IN PATIENTS OF 18-60YEARS OF AGE

2021 ◽  
pp. 74-76
Author(s):  
Payel Mitra ◽  
Archana Roy ◽  
Aamir Huda
Keyword(s):  
Comparative Study ◽  
Motor Block ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
Outpatient Setting ◽  
P Value ◽  
Equal Concentration ◽  
Medical College ◽  
Institutional Ethics ◽  
Care Surgery

INTRODUCTION:The recent trend in health care centres everywhere is to provide cost effective care to the patients. There is an increasing trend towards ambulatory day care surgery and rapid discharge of the patients. The operation of inguinal hernia or incisional hernia and even simple ligation surgeries are done without much complexities nowadays and can be completed in 60-90min without much intra or postoperative complications. Hence these have become an ideal procedure for outpatient setting and thereby reducing length of hospital stay. AIMS AND OBJECTIVE:A comparative study of efcacy, potency and recovery of intrathecal 0.5% ropivacaine with fentanyl and 0.5% levobupivacaine with fentanyl in lower abdominal surgeries in patients of 18-60years of age. MATERIALS AND METHOD: This is a prospective, comparative, observational study was conducted on 60 patients undergoing various lower abdominal surgeries under subarachnoid block (SAB) at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal. This study was conducted over a period of 24-month. Approval of the Institutional Ethics Committee was taken. Awritten informed consent in the local language was taken from every patient. RESULT AND ANALYSIS: In RF 5 patients (17%) had onset at 3min, 17patients (57%) at 6min, 7 patients (23%) at 9min, 1 patient (3%) at 12min. In LBF 8 patients had onset at 0 min, 22 patients had onset at 3min. p value is less than 0.0001 which is statistically signicant. In RF, 23 patients (77%) had duration of motor block for 150min and 7 patients (23%) had for 180min. In LBF, 26 patients (87%) had duration of motor block for 210 min and 4 patients (13%) had for 180min. The p value is less than 0.0001, which is statistically signicant. SUMMARYAND CONCLUSION: This study was to compare potency, efcacy and recovery between the two groups of drugs. A potency of a drug is a measure of drug activity expressed in terms of the amount required to produce an effect of given intensity. Here both the drugs in comparison was given in equal concentration and found that levobupivacaine produced higher effect, reached Bromage 3 in lesser time than ropivacaine. So levobupivacaine was more potent drug. Efcacy is the ability to get a job done satisfactorily

scholarly journals Treatment of juvenile angiofibromas: 18-year experience of a single tertiary centre in Spain

2012 ◽  
Vol 50 (1) ◽  
pp. 95-103
Author(s):  
Fernando Lopez ◽  
Vanessa Suarez ◽  
Maria Costales ◽  
Carlos Suarez ◽  
Jose L. Llorente
Keyword(s):  
Surgical Approach ◽  
Early Stage ◽  
Tumour Size ◽  
Vascular Supply ◽  
Open Approach ◽  
Tertiary Centre ◽  
Preauricular Approach ◽  
Conventional Open Approach ◽  
Open Surgical Approach

Background: The management of juvenile angiofibroma (JA) has changed during the last decades but it still continues to be a challenge. The objective of this study was to review the used treatment and our outcomes. Methods: From 1992 to 2010, 48 cases of JA were treated at our department. Charts were reviewed for standard demographic, tumour size and location, vascular supply and results of embolization, surgical approach, operative results, adjuvant therapies, recurrence and postoperative follow-up. Results: Most tumours were Andrews-Fisch stages III and IV and surgery was used as the main treatment in all cases. We used an open surgical approach in 37 (77%) patients and 11 (23%) were treated endoscopically. The most common open approach used in this series was the subtemporal-preauricular approach. Until 1995, all tumours were operated on by a conventional open approach. Afterwards, early-stage tumours were operated on through an endoscopic approach. Ten patients were treated through surgery followed by radiosurgery. Two (4%) patients had recurrent disease. Conclusions: These tumours should be treated at centres with expertise in skull base surgery to achieve complete surgical resections with low morbidity. Radiosurgery after surgery seems to be a valuable option in the long-term control of some extended JAs.

scholarly journals Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

2019 ◽  
Vol 6 (6) ◽  
pp. 1954
Author(s):  
Sailendra Nath Paul ◽  
Dilip Kumar Das
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Complication Rates ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

scholarly journals Delayed Presentation of Gluteal Compartment Syndrome: The Argument for Fasciotomy

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
John E. Lawrence ◽  
Duncan J. Cundall-Curry ◽  
Kuldeep K. Stohr
Keyword(s):  
Compartment Syndrome ◽  
Kidney Injury ◽  
Limb Ischaemia ◽  
Delayed Presentation ◽  
Neurological Improvement ◽  
Tertiary Centre ◽  
Acute Limb Ischaemia ◽  
Nerve Recovery ◽  
The Right ◽  
Gluteal Compartment Syndrome

A male patient in his fifties presented to his local hospital with numbness and weakness of the right leg which left him unable to mobilise. He reported injecting heroin the previous morning. Following an initial diagnosis of acute limb ischaemia the patient was transferred to a tertiary centre where Computed Tomography Angiography was reported as normal. Detailed neurological examination revealed weakness in hip flexion and extension (1/5 on the Medical Research Council scale) with complete paralysis of muscle groups distal to this. Sensation to pinprick and light touch was globally reduced. Blood tests revealed acute kidney injury with raised creatinine kinase and the patient was treated for rhabdomyolysis. Orthopaedic referral was made the following day and a diagnosis of gluteal compartment syndrome (GCS) was made. Emergency fasciotomy was performed 56 hours after the onset of symptoms. There was immediate neurological improvement following decompression and the patient was rehabilitated with complete nerve recovery and function at eight-week follow-up. This is the first documented case of full functional recovery following a delayed presentation of GCS with sciatic nerve palsy. We discuss the arguments for and against fasciotomy in cases of compartment syndrome with significant delay in presentation or diagnosis.

An Evaluation of Snake Bites and Antivenin Use at a Regional Medical Center

2010 ◽  
Vol 76 (7) ◽  
pp. 755-758
Author(s):  
Larry I. Watson ◽  
Christy Spivey ◽  
Cen Rema Menon ◽  
Cyrus A. Kotwall ◽  
Thomas V. Clancy ◽  
...  
Keyword(s):  
Medical Center ◽  
Length Of Hospital Stay ◽  
Clinical Information ◽  
P Value ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Snake Bites ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Physical Findings

Snake bites are a rare but challenging problem for surgeons. The purpose of our study was to evaluate our experience with snake bites at a regional medical center. We reviewed patients treated for snake bites from 2004 to July 2008. Demographics, clinical information, and outcomes were documented. Descriptive statistics were used, and χ2, t test, and Fisher exact test were used to compare patients based on antivenin use. A P value < 0.05 was considered significant. Over the study period, 126 patients presented to the emergency department with 44 (35%) requiring hospital admission. The average age was 38 years (range, 2 to 76 years); 66 per cent were male and 95 per cent white. Bites most commonly occurred in the summer and fall months with none from December through March. Copperhead bites accounted for 50 per cent of bites. An average of 4.8 vials of antivenin was given to 61 per cent of admitted patients with 93 per cent receiving the drug within 6 hours. Minor reactions to antivenin occurred in three patients (11%). Two patients required surgery (5%), and the readmission rate was 7 per cent. There was no known morbidity or mortality. When comparing patients who received antivenin with patients who did not, the only significant clinical variables were an increased prothrombin time (12.1 vs 11.7, respectively; P = 0.048) and a longer length of hospital stay (3 vs 1.8 days, P = 0.0006) in patients receiving antivenin. The majority of patients with snake bites can be treated with supportive care and antivenin when indicated. Antivenin use at our institution is largely based on physical findings and not related to laboratory values.

scholarly journals Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anirban P. Mitra ◽  
Evalynn Vasquez ◽  
Paul Kokorowski ◽  
Andy Y. Chang
Keyword(s):  
Hospital Stay ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Operating Time ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Open Approach ◽  
Invasive Approach ◽  
Patients Âgés ◽  
Tertiary Center

Abstract Background Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations. Case presentation We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months). Conclusion Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.

scholarly journals Effects of stage-matched repeated individual behavioural counselling session (RIBCS) as an intervention for decreased and stopping smoking

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Gopal Chawla ◽  
Amrit Pal Kansal ◽  
Kunal Deokar ◽  
Nupur Abrol ◽  
Vishal Chopra ◽  
...  
Keyword(s):  
Nicotine Dependence ◽  
Transtheoretical Model ◽  
Readiness To Change ◽  
Smoking Behaviour ◽  
Point Prevalence ◽  
P Value ◽  
Tertiary Centre ◽  
Motivation To Quit ◽  
High Level

We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was <0.05. The point prevalence of abstinence rate (questionnaire validated) 1 month to 6 months was almost 4 times. Our intervention (RIBCS) succeeded in increasing the abstinence rates during the study period among smokers with a lower motivation to quit (pre-contemplators and contemplators) as well as those ready to quit (preparators). This is significant because of most existing smoking-cessation interventions target only motivated smokers, with few having a positive effect in smokers with a lower motivation to quit.

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