scholarly journals SP4.1.2 Appendicitis during the COVID pandemic – Are we seeing more complicated presentations?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Bianca Wadham ◽  
Tom Connolly ◽  
Phoebe Beer ◽  
Paul Ainsworth
Keyword(s):  
Statistical Analysis ◽  
Primary Endpoint ◽  
Complicated Appendicitis ◽  
Operative Approach ◽  
Exact Test ◽  
Laparoscopic Procedures ◽  
Operative Complications ◽  
Secondary Endpoints ◽  
One Year ◽  
Post Operative Complications

Abstract Aims Studies have suggested a decrease in emergency presentations of appendicitis during the COVID-pandemic along with a nationwide fall in non-COVID related presentations to A&E. We therefore hypothesised that those treated for appendicitis had later presentations resulting in increasing incidence of ‘complicated appendicitis’ and post-operative complications. Methods We retrospectively analysed all patients ≥16years, undergoing emergency appendicectomy during 3-month period of UK national lockdown (pandemic cohort). Data was compared to the same period one year previously (pre-pandemic cohort). Primary endpoint was nature of appendicitis (uncomplicated or complicated). Secondary endpoints were operative approach, LOS and post-operative complications. Statistical analysis was performed using Fisher’s Exact Test. Results A total of 31 patients (median age 35years) underwent emergency appendicectomy in the pre-pandemic cohort and 30 patients in the pandemic group (median age 37). 9/31 (29%) and 18/30 (60%) were found to have complicated appendicitis in each group respectively (p = 0.021). Open procedures took place in 2/31 pre-pandemic, and 12/29 (4 of which were converted from laparoscopic procedures) in the pandemic cohort (p = 0.002). Median LOS was 2 in each group, though the pandemic cohort had a much wider range (0-7 vs 0-25 days). Post-operative complications occurred in 1/31 and 5/30 patients respectively (p = 0.104) with 1 mortality within 30 days. Conclusions Despite overall volume and demographics of patients remaining the same, the COVID-19 pandemic has resulted in a statistically significant increase in complicated presentations of appendicitis to our hospital. Subsequently this has resulted in increasing incidence of open operations and post-operative complications.

MP60-03 IMPACT OF POST-OPERATIVE COMPLICATIONS AND THE NUMBER OF ‘HOSPITAL-FREE DAYS’ FOLLOWING RADICAL CYSTECTOMY ON QUALITY OF LIFE AT ONE YEAR

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Chad R. Ritch ◽  
Michael S. Cookson ◽  
Sam S. Chang ◽  
Peter E. Clark ◽  
David F. Penson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radical Cystectomy ◽  
Operative Complications ◽  
One Year ◽  
Post Operative Complications

MRC SORCE trial: Analysis of patients' presenting characteristics, tumor staging, and surgical approach.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 496-496 ◽  
Author(s):  
Alastair W. S. Ritchie ◽  
Angela M. Meade ◽  
Louise Choo ◽  
Ben Smith ◽  
Andrew Welland ◽  
...  
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Hospital Stay ◽  
Lymph Node Dissection ◽  
Surgical Approach ◽  
Open Surgery ◽  
Node Dissection ◽  
Laparoscopic Procedures ◽  
Operative Complications ◽  
Post Operative Complications

496 Background: SORCE is a randomised double blind trial of sorafenib, given for one or three years, versus placebo for patients at moderate or high risk of disease recurrence after surgical excision of primary renal cell carcinoma (RCC). Methods: Between July 2007 and April 2013, 1,711 patients were recruited from the UK (78%), Australia, France, Belgium, Denmark, The Netherlands and Spain. We describe the presenting characteristics, staging and surgical details of the randomised population. The surgical approach was at the surgeon’s discretion. Results: Baseline information is available for 1,681 patients (98%). Median age was 59 years (range 19 to 86): 1,195 (71%) were male. Histology was conventional/clear cell in 86%. T category was pT1a (<1%), pT1b (11%), pT2 (23%), pT3a-4 (65%). 47% were at high risk of recurrence with Leibovich scores of ≥6. Surgical data are available for 1,528 patients (89%). Total (radical) nephrectomy was performed for 97% of patients with 44% having laparoscopic surgery, of which 60% had a transperitoneal approach and 10% required conversion to open surgery. Some form of lymph node dissection was performed in 25% of patients (33% of open procedures and 15% of lap. procedures). The ipsi-lateral adrenal was removed in 47% and 11% had simultaneous resection of other structures/organs. Excision of venous extension was required in 19%. Laparoscopic procedures were performed for 58% of patients with maximum tumour diameter (MTD) <10cm and 17% of those with MTD ≥ 10 cm. Intra-operative complications were reported in 6% and post-operative complications reported in 12%. Hospital stay was median (IQR) 4 days (3-5) for patients having laparoscopic procedures and 7 days (5-8) for open surgery. Hospital stay was median (IQR) 8 days (6-11) for those having post-operative complications compared to 5 days (4-7) for uncomplicated recovery. Conclusions: These data reveal the varied surgical approaches to excision of primary RCC and will inform future adjuvant trials. The use of lymph node dissection appears arbitrary and evidence of benefit from randomised controlled trials is required. Analysis of the effect of sorafenib on disease free survival is likely to be performed in 2016. Clinical trial information: ISRCTN38934710.

scholarly journals Milyen hatása van a COVID–19-járványnak a gyermekkori akut appendicitisekre?

2021 ◽  
Vol 162 (16) ◽  
pp. 608-610
Author(s):  
Balázs Fadgyas ◽  
Gábor István Garai ◽  
Zoltán Ringwald
Keyword(s):  
Statistical Analysis ◽  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Laparoscopic Appendectomy ◽  
Perforated Appendicitis ◽  
Complicated Appendicitis ◽  
Histological Findings ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Fisher’S Exact Test

Összefoglaló. Bevezetés: A COVID–19-pandémia miatt a gyermekkori appendicitisek kezelésében számos változás történt (laparoszkópia helyett nyílt műtét, antibiotikumkezelés). Világszerte emelkedett a szövődményes appendicitisek aránya. Célkitűzés: Munkánk során a COVID–19-járványnak a gyermekkori akut appendicitisekre kifejtett hatását szerettük volna vizsgálni: lett-e több perforált eset? Módszerek: A 2012 és 2020 között akut vakbélgyulladás miatt operált gyermekeket vizsgáltuk, külön, havi bontásban a 2020-as eseteket. A szövettani diagnózis alapján perforált és nem perforált appendicitis csoportokat alkottunk. A 2020-ban operált betegek COVID–19-statusát is rögzítettük. Statisztikai analízisre a khi2-próbát (’chi2 test for trend’) és a Fisher-féle egzakt tesztet alkalmaztuk. Eredmények: A vizsgált időszakban 1343 appendectomia történt, többségében nem perforált akut appendicitis miatt (1166/1343). 2015-től kezdődően a perforált esetek aránya szignifikáns emelkedést mutat (p = 0,0002). Az igazoltan COVID–19-pozitív betegek között magasabb volt a perforáltak aránya (5/8), mint az igazoltan negatív betegek között (15/92) (p = 0,0075). Megbeszélés: A nemzetközi trendeknek megfelelően 2020-ban osztályunkon is magasabb volt a perforált appendicitisek aránya, mint a korábbi években. Ez az emelkedés 2015-től tart, a pandémiával nem mutat szoros összefüggést. A perforált appendicitisek COVID–19-pozitív betegek között észlelt magas arányának okát nem ismerjük. Következtetés: További vizsgálat indokolt annak feltárására, hogy mi okozza a perforált appendicitisek COVID–19-pozitív betegek között észlelt magas, illetve 2015 óta emelkedő rátáját. Orv Hetil. 2021; 162(16): 608–610. Summary. Introduction: As a result of the COVID-19 pandemic, the management of paediatric appendicitis has changed (open instead of laparoscopic appendectomy, antibiotic treatment). The number of complicated appendicitis cases increased worldwide. Objective: Our aim was to study the effect of the COVID-19 pandemic on paediatric acute appendicitis: has there been more perforated cases? Methods: Children operated because of acute appendicitis between 2012 and 2020 were studied. Cases from the year 2020 were analysed monthly. Patients were divided into perforated and non-perforated appendicitis groups according to their histological findings. COVID-19 status of patients in 2020 was studied. Chi2 test for trend and Fisher’s exact test were used for statistical analysis. Results: In the study period, 1343 appendectomies were performed. The majority of our cases were non-perforated (1166/1343). The rate of perforated appendicitis cases has been increasing from 2015 (p = 0.0002). The number of perforated cases was higher in COVID-19 positive patients (5/8) then in negative ones (15/92) (p = 0.0075). Discussion: In line with the international trend, more perforated appendicitis cases were treated in our departement in 2020. However, this increase started in 2015, and there is no correlation with the COVID-19 pandemic. The cause of the increased number of perforated cases in COVID-19 positive appendicitis patients is unknown. Conclusion: The causes of the high proportion of perforated cases in COVID-19 positive patients and the rising rate of perforated appendicitis cases since 2015 need further studies. Orv Hetil. 2021; 162(16): 608–610.

scholarly journals Surgical Outcomes of Varicose Veins at Universal College of Medical Sciences, Bhairahawa, Nepal

2018 ◽  
Vol 4 (2) ◽  
pp. 14-16
Author(s):  
Santosh Shah ◽  
Sumod Koirala ◽  
Saroj Pradhan ◽  
Ashok Pradhan
Keyword(s):  
Surgical Treatment ◽  
Varicose Vein ◽  
Lower Limb ◽  
Surgical Outcomes ◽  
Varicose Veins ◽  
Medical Sciences ◽  
Operative Complications ◽  
Short Saphenous Vein ◽  
One Year ◽  
Post Operative Complications

INTRODUCTION: This study was conducted to analyse the surgical outcomes of varicose vein at Universal College of Medical Sciences (UCMS), Bhairahawa. MATERIALS AND METHODS: A hospital based prospective study done at UCMS, Bhairahwa, Nepal over the period of one year, where all the patients who had lower limb varicose vein underwent surgery were analyzed. RESULTS: A total of 25 cases of varicose vein were operated at UCMS from August 2015 to July 2016. The post-operative complications like pain, wound abscess, aching, itching were minimal.  CONCLUSION: Surgical treatment by SFJ ligation with stripping long and short saphenous vein is an established effective treatment of varicose vein in our center with minimal post-operative complications. Journal of Universal College of Medical Sciences (2016) Vol.04 No.02 Issue 14, page: 14-16  

scholarly journals 491 Comparison of Pandemic and Pre-pandemic Practices of Managing Acute Appendicitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Salih ◽  
R Sabaratnam ◽  
H K Kim ◽  
K Bevan
Keyword(s):  
Acute Appendicitis ◽  
Open Surgery ◽  
District General Hospital ◽  
Similar Time ◽  
Time Period ◽  
Number Of Patients ◽  
Operative Complications ◽  
One Year ◽  
Post Operative Complications

Abstract Aim Acute appendicitis (AA) is a common indication for abdominal surgery, with more than 30,000 appendicectomies performed in England per year. However, SARS-CoV-2 (COVID-19) changed usual surgical practices following advice to minimise laparoscopic surgery, and instead favouring conservative management, or open surgery for AA. Method In this study, we compared the management of 50 patients with suspected/confirmed AA during the first wave of the COVID-19 pandemic at a district general hospital (DGH) with our usual practices, against 50 patients admitted with suspected/confirmed AA during a similar time period, one year prior to the pandemic. Results Demographics of patients in both groups were comparable with median age of 34 in the pandemic vs 32.5 in the pre-pandemic group. 74% of patients in the pandemic group (PG) underwent imaging to confirm appendicitis, compared to 58% of patients in the pre-pandemic group (PPG). 64% of PG patients were treated conservatively, compared to 8% in PPG patients. Outcomes demonstrated re-attendance events of 12% in the PG, as compared to 10% in the PPG, although the follow up period was longer in the PPG. Despite a significantly smaller number of patients managed surgically during the pandemic, 27% of patients undergoing appendicectomies had post-operative complications in the PG, as compared to 7% in the PPG. Conclusions During the pandemic, more patients at our DGH with AA were treated conservatively, more patients had re-attendance events and post-operative complications when compared to patients in the pre-pandemic group.

scholarly journals Post-operative Complications of Complicated Paediatric Appendicitis in a Tertiary Teaching Hospital

2022 ◽  
Vol 9 (1) ◽  
pp. 9-16
Author(s):  
Aravind C S ◽  
Sam Varkey ◽  
Binu M K
Keyword(s):  
Intestinal Obstruction ◽  
Hospital Stay ◽  
Major Complication ◽  
Complicated Appendicitis ◽  
Paediatric Surgery ◽  
Duration Of Symptoms ◽  
Tertiary Teaching ◽  
Operative Complications ◽  
Adhesive Intestinal Obstruction ◽  
Post Operative Complications

Background: Acute appendicitis is a common surgical problem, with complicated appendicitis having significant post operative complications, which contribute significantly to cost of medical care. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with complicated appendicitis from January 2016 to June 2021. Results: The study had 30.4% surgical site soft tissue infection (SSI). There was 13.48% incidence of major complication, with laparoscopic and open appendicectomies having similar incidence even though not statistically significant. SSI was more common with appendicular abscess and post ileal appendix. Post operative intra-abdominal abscess is more common with open appendicectomy, generalised peritonitis, post ileal appendix and base/proximal perforation of appendix. Post operative adhesive intestinal obstruction was more common with laparoscopic appendicectomy, appendicular abscess and base/proximal perforation of appendix. Total hospital stay correlates significantly with duration of symptoms on presentation with mean hospital stay of 7.72 days. Conclusion: Complicated appendicitis have high incidence of post operative complications, 30.4% SSI and 13.48% serious complications like intra-abdominal collection and adhesive intestinal obstruction. Keywords: Appendicitis, Complication, Surgical site infection, Children.

VASCULAR MALFORMATION OF HAND: CAVERNOUS LYMPHANGIOMA

Hand Surgery ◽  
2004 ◽  
Vol 09 (02) ◽  
pp. 229-231
Author(s):  
Semih Takka ◽  
Kazuteru Doi ◽  
Yasunori Hattori
Keyword(s):  
Free Flap ◽  
Vascular Malformation ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Operative Complications ◽  
One Year ◽  
Post Operative Complications

A case of congenital cavernous lymphangioma of the hand presenting in a newborn is presented. The mass on the dorsum of the hand was removed with the overlying skin and underlying paratenon at three years of age. Re-surfacing was performed with a free flap transfer. There were no post-operative complications during one year of follow-up.

scholarly journals The outcome of pneumatic lithotripsy for the management of ureteric calculi

1970 ◽  
Vol 6 (3) ◽  
pp. 355-360
Author(s):  
B Shrestha ◽  
DV Karki ◽  
JL Baidya
Keyword(s):  
Hospital Stay ◽  
Good Alternative ◽  
Shockwave Lithotripsy ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Ureteric Calculi ◽  
Operative Complications ◽  
The Mean ◽  
One Year ◽  
Post Operative Complications

Background: Various methods have been adopted for the removal of ureteric calculi around the world. Ureteroscopic pneumatic lithotripsy has been used to treat ureteric calculi for more than a decade. Owing to its low price and high degree of effectiveness, it has become the most popular ureteroscopic device amongst many others. Moreover, ureteroscopy has become the method of choice for the quickest way of rendering patients stone-free. Objectives: To determine successful stone fragmentation by ureteroscopic pneumatic lithotripsy in the management of ureteric calculi as well as intra-operative and post-operative complications related to it. Study design: A prospective and descriptive study. The study was conducted in Section of Urology, Department of Surgery, B&B Teaching Hospital, Kathmandu University. The data was collected from April 2005 to April 2006. Materials and methods: Ninety-two consecutive patients having ninety-five ureteric stones were treated with intracorporeal pneumatic lithotripsy over a period of one year. The size, side, number and site of stones along with the results of preoperative routine investigations were noted in the patients. The pneumatic lithotripter was introduced through a 10 or 8 Fr rigid ureteroscope (Karl Storz) to break the stone/s. Successful stone fragmentation, lithotripsy time, intra-operative and post-operative complications and duration of hospital stay were recorded. Results: Complete stone fragmentation was achieved in about 80 % of cases. The mean lithotripsy time was 17.66 minutes. About 76% of patients were stone-free at one week follow-up after the procedure, 92% by the end of eight weeks while 100% stone-free status was achieved by the end of 12 weeks. The mean hospital stay was 1.82 days and complications (both significant and minor) occurred in 51 % of cases. However, majority of them were minor and successfully managed. Conclusion: Intra-operative pneumatic lithotripsy is a minimally invasive, effective and rapid procedure for the management of ureteric calculi. Though it can give rise to considerable complications, they are mainly minor. Moreover, both complications and failure rates can be reduced if patients with ureteric calculi are properly selected. It seems to be a good alternative in patients where extracorporeal shockwave lithotripsy is unsuccessful or not indicated and in patients who need early stone removal. Key words: SIRS- Systemic Inflammatory Response Syndrome, ESWL- Extra corporeal shockwave lithotripsy, JJ stent: Double J stent, URS: Ureterorenoscope, Steinstrasse. doi: 10.3126/kumj.v6i3.1711 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 355-360    

scholarly journals Post-operative complications of displaced unstable distal end radius fracture treated by volar plating

2020 ◽  
Vol 6 (5) ◽  
pp. 1008
Author(s):  
Rajesh K. Ambulgekar ◽  
Vishal Gurnani
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Radius Fracture ◽  
Volar Plating ◽  
Operative Complications ◽  
One Year ◽  
Definition Of ◽  
A Prospective Study ◽  
Post Operative Complications

<p class="abstract"><strong>Background:</strong> Fracture of the distal radius (DRF) is one of the most common fractures present in emergency. The most common operative treatments of these fractures are open reduction and internal fixation with volar locking plates. The incidents and types of complications associated with the use of these operations is an ongoing process till date. The objective of the study was to find demographic profile of patients of displaced unstable distal end radius fracture, and to study the post-operative complications among above patients treated by volar plating.</p><p class="abstract"><strong>Methods:</strong> We performed a prospective study documenting types of complications and their occurrence in a group of patients who received open reduction and internal fixation. Our definition of a complication was a case in which the patient had one or more complications which required an intervention medical or surgical.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 33 patients were included, most of the cases, (63.63%) were from the age group 21-40 years. We had 4 cases (12. 12%) females, and 29 cases (87.88%) males. Post-operative complications were noted in 7 individuals 22.2 % and no complications noted in 26 cases (78.8%). In 30 cases there was no any deformity found in postoperative one year follow up, 2 patients develop prominent ulnar styloid found in follow up of one year ,and 1 residual dorsal tilt found after one year.</p><p class="abstract"><strong>Conclusions:</strong> Our finding that 22.2% suffer from complication when treated using a volar locking plate must be taken into consideration when surgeons choose between conservative or operative treatment for DRF treatment. A few other studies have looked at the incidents of complications and have reported similar results.</p>

scholarly journals Abdominal Drainage in Complicated Appendicectomy - Resources Down the Drain?

2021 ◽  
Vol 18 (4) ◽  
pp. 672-675
Author(s):  
Scarlet Nazarian ◽  
Charlotte Boardman ◽  
Ezzat Chohda ◽  
Ankur Shah
Keyword(s):  
Length Of Stay ◽  
Complicated Appendicitis ◽  
Abdominal Abscess ◽  
Abdominal Drainage ◽  
Operative Complication ◽  
Operative Complications ◽  
Drain Group ◽  
Group 2 ◽  
Group 1 ◽  
Post Operative Complications

Background: There is currently no clear consensus on the use of drains during an appendicectomy to prevent abscess formation. Our aim was to ascertain whether the use of drains in complicated appendicitis reduces post-operative complications and length of stay.Methods: We performed a retrospective review of patients with complicated appendicitis undergoing appendicectomy from March-November 2018. Complicated appendicectomy (perforated or gangrenous appendicitis) patients were divided into two groups; with drain Group 1 (G1) and no drain Group 2 (G2). Groups were compared for post-operative complications and length of stay. Results: Out of a total 76 patients, 26 (34%) had drain (G1) and 50 (66%) had no drain (G2). The pre-operative CRP in G1 vs. G2 (124.8 vs. 48.3, p= 0.02); post-operative complication 9 (34.6%) vs. 6 (12%), p=0.019); intra-abdominal abscess 5 (19.2%) vs. 3 (6%), p=0.07 and LOS 5.5 days vs. 3 days, p=0.0001 were significantly higher in patients with a drain.Conclusions: The use of an intra-operative drain in complicated appendicitis increases the risk of a post-operative complication and increases length of stay.Keywords: Appendicectomy; complicated appendicitis; drain

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