COMPARISON OF PROPHYLACTIC IN-SITU SCREW FIXATION VERSUS OBSERVATION OF THE ASYMPTOMATIC CONTRALATERAL HIP IN SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)

BACKGROUND: Prophylactic fixation of the asymptomatic, radiographically-normal contralateral hip after unilateral (SCFE) is controversial. Children with unilateral SCFE whose contralateral hip is observed are at risk for having a contralateral slip and associated complications such as avascular necrosis (AVN). On the other hand, prophylactic pinning may be an unnecessary surgery that may also result in substantial complications. A comparison of the two treatment options has not been performed. This study seeks to compare the outcomes and nature of complications of patients whose contralateral hip was observed with those whose hip underwent prophylactic in-situ screw fixation. METHODS: We retrospectively reviewed 197 patients treated for a unilateral SCFE over 20 years between the 1997 and 2017 at two hospitals. Medical records and x-rays were reviewed, and variables of interest included age, sex, body mass index (BMI), Modified Oxford Bone Age Score (MOBA) at presentation, length of operation, estimated blood loss (EBL), and length of hospitalization. Additionally, postoperative complications/outcomes such as reoperation in the unaffected hip, pain in the unaffected hip, AVN, chondrolysis, infection. abnormal gait (limp), reslipped epiphysis (growth off of the implanted screw), degenerative joint disease, and development of a limb length discrepancy were recorded. RESULTS: Of the 197 total patients (mean age 11.8) treated for unilateral SCFE, 100 (51%) received prophylactic fixation of their unaffected, contralateral hip and 97 (49%) were observed. Average follow up was 24.5 months. A statistically significant difference was found between groups for age, MOBA Score, EBL, and operative time. No difference was found between groups for BMI, BMI %ile, and length of hospitalization. The unilateral group was older (p<0.001) and had a greater MOBA Score (p=0.006) compared to the prophylactic group (Table 1). Patients in the prophylactic group had greater EBL during surgery (p=0.004) and longer operative time (p<0.001) compared to the unilateral group. In those patients whose contralateral hip was observed, 19% developed a contralateral SCFE which required later in-situ fixation. Amongst those, 2/19 (10%) developed AVN or chondrolysis of the contralateral hip (2% overall). For the contralateral hip, 17/97 (17%) developed hip pain, 10/97 (10%) developed a leg length difference and 24/97 (24%) developed a limp. In those patients who had prophylactic fixation, for the contralateral hip 2/100 (2%) developed AVN, (3/100) 3% required reoperation, 1/100 (1%) developed an infection, 10/100 (10%) developed contralateral hip pain, 4/100 (4%) developed a LLD, and 26/100 (26%) developed a limp. CONCLUSIONS: Surgeons and patients should be able to compare outcomes when deciding whether or not to prophylactically fix the asymptomatic contralateral hip in SCFE. For patients with unilateral SCFE, there are similar rates of AVN (2%) of the asymptomatic contralateral hip whether the hip is prophylactically pinned or observed. Between the two treatment options, there are similar outcomes for length of hospital stay, EBL, rate of infection and development of a limp. There is a higher rate of a LLD and the need for another operation in patients whose contralateral asymptomatic hip is observed, rather than prophylactically pinned. [Table: see text]

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A Prospective Randomized Controlled Study of Fixation of Long Oblique and Spiral Shaft Fractures of the Proximal Phalanx: Closed Reduction and Percutaneous Kirschner Wiring Versus Open Reduction and Lag Screw Fixation

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2002.0807 ◽

2003 ◽

Vol 28 (1) ◽

pp. 5-9 ◽

Cited By ~ 56

Author(s):

T. C. HORTON ◽

M. HATTON ◽

T. R. C. DAVIS

Keyword(s):

Grip Strength ◽

Closed Reduction ◽

Open Reduction ◽

Screw Fixation ◽

Kirschner Wire ◽

Proximal Phalanx ◽

Controlled Study ◽

X Rays ◽

Lag Screw ◽

Significant Difference

Patients with an isolated spiral or long oblique fracture of the proximal phalanx were randomized into two groups. One was treated by closed reduction and Kirschner wire fixation and the second treated by open reduction and lag screw fixation. An independent observer assessed function, pain, movement, grip strength and intrinsic muscle function. X-rays were assessed for malunion. Thirty-two patients were entered the study and 15 in the Kirschner wire and 13 in the lag screw group were reviewed at a mean follow-up of 40 months. There was no significant difference in the functional recovery rates or in the pain scores for the two groups. X-rays showed similar rates of malunion and there were no statistically significant differences in range of movement or grip strength.

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Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity

The American Surgeon ◽

10.1177/0003134820952448 ◽

2020 ◽

pp. 000313482095244

Author(s):

Yoshihiro Inoue ◽

Masatsugu Ishii ◽

Kensuke Fujii ◽

Kentaro Nihei ◽

Yusuke Suzuki ◽

...

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Laparoscopic Liver Resection ◽

Operative Time ◽

Surgical Site Infections ◽

Obese Patients ◽

Visceral Fat Area ◽

Safety And Efficacy ◽

Estimated Blood Loss ◽

Significant Difference

Introduction Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. Methods The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients’ body mass index (BMI) and visceral fat area (VFA). Results Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups ( P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR ( P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR ( P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR ( P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups ( P = .017, < .001, and < .001, respectively). Conclusion LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.

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A Comparison of Two Methods of Hemostasis in Thyroidectomy

The American Surgeon ◽

10.1177/000313480907501109 ◽

2009 ◽

Vol 75 (11) ◽

pp. 1073-1076 ◽

Cited By ~ 7

Author(s):

Michael M. Mcnally ◽

Steven C. Agle ◽

R. Fredrick Williams ◽

Walter E. Pofahl

Keyword(s):

Blood Loss ◽

Thyroid Surgery ◽

Operative Time ◽

Recurrent Laryngeal Nerve Palsy ◽

Chi Square ◽

Ultrasonic Dissection ◽

Gland Weight ◽

Vessel Sealing ◽

Estimated Blood Loss ◽

Significant Difference

Safe thyroid surgery requires meticulous hemostasis. The objective of the current study is to compare the effectiveness and safety of ultrasonic dissection (UD) and electronic vessel sealing (EVS) in patients undergoing thyroidectomy. A retrospective analysis of a prospectively maintained database was performed. Between January 1, 2007 and January 25, 2008, hemostasis was achieved using EVS (LigaSure Precise, Valleylab, Boulder, CO). Since January 25, 2008, hemostasis has been achieved using UD (Harmonic Focus, Ethicon Endo-Surgery, Cincinnati, OH). Operative time, estimated blood loss, gland weight, and postoperative complications were compared. Differences were analyzed using unpaired t test and Chi square with significance assigned P < 0.05. Seventy-four patients underwent total thyroidectomy (EVS n = 59, UD n = 15). Operative time (EVS 115.0 ± 38.3 min, UD 88.0 ± 14.0 min, P = 0.012) was significantly decreased in the UD group compared with the EVS group. There were no significant differences in mean age (EVS 50.4 ± 13.9 years, UD 49.1 ± 15.6 years), gender distribution (EVS 78% female, UD 87% female), estimated blood loss (EVS 49.4 ± 44.7 mL, UD 47.0 ± 70.4 mL), and gland weight (EVS 67.4 ± 66.4 gm, UD 41.3 ± 26.6 gm). Analysis of complications, including hematoma, hypocalcemia, and recurrent laryngeal nerve palsy showed no significant difference. Based on the current analysis, ultrasonic dissection is a safe method of hemostasis for thyroid surgery. Its use decreases operative time when compared with electronic vessel sealing.

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Complicated Appendicitis–Is the Laparoscopic Approach Appropriate? A Comparative Study with the Open Approach: Outcome in a Community Hospital Setting

The American Surgeon ◽

10.1177/000313480707300801 ◽

2007 ◽

Vol 73 (8) ◽

pp. 737-742 ◽

Cited By ~ 22

Author(s):

Naveen Pokala ◽

S. Sadhasivam ◽

R.P. Kiran ◽

V. Parithivel

Keyword(s):

Blood Loss ◽

Operative Time ◽

Laparoscopic Approach ◽

Complicated Appendicitis ◽

Complication Rates ◽

Intraabdominal Abscess ◽

Estimated Blood Loss ◽

Significant Difference ◽

American Society ◽

American Society Of Anesthesiologists

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 ± 16.5 versus 31.3 ± 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 ± 36.2 versus 81.5 ± 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5–9] versus 6 [interquartile range 4–8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.

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Anterior approach in situ resection for total laparoscopic pancreaticoduodenectomy

BMC Surgery ◽

10.1186/s12893-021-01433-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yunqiang Cai ◽

He Cai ◽

Bing Peng

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Anterior Approach ◽

Operative Time ◽

Oral Intake ◽

Laparoscopic Pancreaticoduodenectomy ◽

Periampullary Tumors ◽

Estimated Blood Loss ◽

Male Patients

Abstract Background Laparoscopic pancreaticoduodenectomy (LPD) is gaining popularity in last decade. However, it is still technical challenging to perform LPD for patients with large periampullary tumors. Methods From January 2019 to January 2020, 13 cases of LPD were performed via anterior approach. Data were collected prospectively in terms of demographic characteristics (age, gender, body mass index, pathological diagnosis and tumor size), intra-operative variables (operative time, estimated blood loss, transfusion), and post-operative variables (time for oral intake, post-operative hospital stay, and complications). Results There were five male patients and eight female patients included in this study. The median age of these patients was 52.7 ± 14.5 years. The median size of tumors was 7.2 ± 2.9 cm. One patient converted to open surgery because of uncontrollable hemorrhage. The median operative time was 356 ± 47 min. The median estimated blood loss was 325 ± 216 ml. The mean post-operative hospital stay was 12.4 ± 1.9 days. One patient suffered from grade B pancreatic fistula. One patient suffered from delayed gastric emptying which was cured by conservative therapy. 90-day mortality was zero. Conclusions Laparoscopic pancreaticoduodenectomy via anterior approach is safe and feasible for patients with large periampullary tumors. Its oncological benefit requires further investigation.

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Running suture hemostatic technique versus standard reconstruction of the surgical bed in Zero - Ischemia Time mini-flank Open Partial Nephrectomies. Retrospective, Match-Paired Case-Control Study

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2019.2.69 ◽

2019 ◽

Vol 91 (2) ◽

Author(s):

Petar Kavaric ◽

Aleksandar Magdelinic ◽

Marko Vukovic

Keyword(s):

Blood Loss ◽

Tumor Size ◽

Operative Time ◽

Surgical Techniques ◽

Control Group ◽

Reconstruction Technique ◽

Ischemia Time ◽

Estimated Blood Loss ◽

Significant Difference ◽

Zero Ischemia

Objective: To estimate the efficacy of our technique of zero ischemia time partial nephrectomy (ZTPN) with hemostatic running suture and compare it to the standard technique, in terms of perioperative complications, operative time (OT) and estimated blood loss (EBL). Materials and methods: We retrospectively analysed 180 consecutive patients who underwent ZTPN using a supra 11th or supra 12th rib mini flank approach. First group numbered 90 patients treated with running suture hemostatic technique (RSHT), while the control group enrolled 90 patients in whom we performed standard reconstruction technique (SRT). According the propensity score, both groups were similar in terms of tumor size, age and PADUA score. Patients with solitary tumour limited to the kidney (T1-T2a) were included. Our technique included a running suture of surgical bed edges and closure of the renal cortex by the positioning of peri-renal fat within the cortical bed and fixation with interrupted sutures. Results: PADUA score and tumor size were comparable between groups (7.12 ± 1.33 vs 7.1 ± 2.11, p = 0.4 and 52.9 ± 14.8 vs 50.0 ± 13.2, p = 0.3). The mean operative time (OT) was significantly longer in first group (165.2 vs 95, p = 0.04), while median estimated blood loss (EBL) was significantly reduced (250 vs 460 ml, p = 0.02). Surgical resection margins were negative in 100% of cases and no patient developed a local or distant recurrence during follow up. There was significant difference in postoperative GFR value between groups (p < 0.05). Conclusions: Our technique could be safely performed in local, low volume facilities, thus reducing the need for expensive and more challenging minimal invasive surgical techniques..

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Use of Holmium YAG laser in circumcision: a novel, less complicated and alternative procedure for adolescent

African Journal of Urology ◽

10.1186/s12301-020-00077-y ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Pei-Lin Huang ◽

I-Ching Lee ◽

De-Chan Tsai ◽

Jen-Ho Tsai ◽

Vincent F. S. Tsai ◽

...

Keyword(s):

Operative Time ◽

Alternative Procedure ◽

Efficacy And Safety ◽

Yag Laser ◽

Young Males ◽

Estimated Blood Loss ◽

Significant Difference ◽

Average Operative Time ◽

Group 2 ◽

Group 1

Abstract Background To evaluate the efficacy and safety of Holmium YAG laser circumcision in adolescents. Methods Eighty-one patients underwent circumcision for medical reasons, and patients’ requests were collected retrospectively during February 2017 to February 2019. They were divided into two groups: Holmium YAG laser (group 1, n = 41) and conventional group (group 2, n = 40). The guillotine method with a Holmium YAG laser was applied for circumcisions, and all the procedures were performed by a single urologist who was well-experienced with circumcision practices. Results The average age of group 1 was 15.53 ± 7.35 years old, and the average age was 16.34 ± 9.22 years old in group 2. There was no significant difference in age and indications. The average operative time was significantly shorter in group 1 than in group 2 (24.40 ± 3.94 vs. 27.25 ± 4.35 min, p < 0.01). The estimated blood loss was less in group 1 compared to group 2. There were fewer complications in group 1 than in group 2 (3/41 vs. 10/40, p < 0.01) and patients also felt less pain in group 1 (p < 0.01). All patients tolerated this procedure without severe side effects. Conclusions The use of Holmium YAG laser in circumcision is a novel, less complicated, easy, and less painful alternative procedure for circumcision in young males.

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Optimal operative choice for displaced midshaft clavicle fractures in adolescents: a comparative study of intramedullary flexible nails and plating

10.21203/rs.3.rs-21710/v1 ◽

2020 ◽

Author(s):

Jin Li ◽

Saroj Rai ◽

Renhao Ze ◽

Xin Tang ◽

Ruikang Liu ◽

...

Keyword(s):

Clinical Outcome ◽

Hospital Stay ◽

Operative Time ◽

Implant Removal ◽

Intraoperative Radiation ◽

Elastic Stable Intramedullary Nail ◽

Plate Group ◽

Estimated Blood Loss ◽

Significant Difference ◽

Clavicle Fractures

Abstract Background: Traditionally, operative treatment for displaced midshaft clavicle fractures in adolescents has been achieved by a plate and screws. However, a minimally invasive trend in most of the surgeries has led the pediatric orthopedic surgeons to use elastic stable intramedullary nail (ESIN) for displaced midshaft clavicle fractures. This study aims to compare the clinical outcomes of adolescent patients who were surgically treated with the (ESIN) and plate for displaced midshaft clavicle fractures.Methods: A total of 73 patients, aged between 10 years and 14 years, with displaced midshaft clavicle fractures were treated surgically from January 2014 to January 2018. Patients were categorized into two groups, ESIN (n = 45; male 27, female 18) and plate (n = 28; male17, female 11) according to surgical technique. The preoperative data, including baseline information of the patients, radiographic parameters, and types of surgical procedure, were collected from the hospital database. The postoperative data, including clinical outcome and complications, were collected during the follow-up visit. Clinical outcome was evaluated using the American Shoulder and Elbow Surgeons (ASES).Results: The average age of the patients in the ESIN group was 12.2±1.5 years, and that in the Plate group was 12.2±1.4 years. There was a significantly less operative time, reduced estimated blood loss (EBL), shortened hospital stay and smaller incision for ESIN group as compared to the Plate group (P<0.01). The rate of scar concern was much higher in plate (14/28, 50%) than ESIN (2/45, 4.4%) , (P <0.01). There was no statistically significant difference in shoulder function between the ESIN group (94.5±2.8) and the Plate group (95.1±2.7), P = 0.36. In all the cases, implant removal was performed between 4 and 12 months postoperatively, and the ESIN group had significantly less operative time, EBL and shortened hospital stay as compared to the plate for implant removal (P<0.01).Conclusion: Both the ESIN and Plate are safe and effective treatment methods for displaced midshaft clavicle fractures in adolescents. The ESIN is superior to plate in terms of shorter operative time, less intraoperative radiation exposure, shorter hospital stay, less scar concern and easier implant removals. However, ESIN for heavier kids remain cautious.

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Comparison of Outcomes Between Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy: A Meta-Analysis Based on Comparative Studies

Frontiers in Oncology ◽

10.3389/fonc.2020.592193 ◽

2021 ◽

Vol 10 ◽

Author(s):

Daqing Zhu ◽

Xue Shao ◽

Gang Guo ◽

Nandong Zhang ◽

Taoping Shi ◽

...

Keyword(s):

Partial Nephrectomy ◽

Publication Bias ◽

Comparative Studies ◽

Operative Time ◽

Cochrane Library ◽

Positive Surgical Margin ◽

Robotic Partial Nephrectomy ◽

Estimated Blood Loss ◽

Significant Difference ◽

Matched Design

BackgroundTo compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).MethodsA literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% conﬁdence intervals (CIs) were estimated using ﬁxed-effect or random-effect model. Publication bias was evaluated with funnel plots. Only comparative studies with matched design or similar baseline characteristics were included.ResultsEleven studies embracing 2,984 patients were included. There was no signiﬁcant difference between the two groups regarding conversion to open (P = 0.44) or radical (P = 0.31) surgery, all complications (P = 0.06), major complications (P = 0.07), warm ischemia time (P = 0.73), positive surgical margin (P = 0.87), decline in eGFR (P = 0.42), CKD upstaging (P = 0.72), and total recurrence (P = 0.66). Patients undergoing TRPN had a significant higher minor complications (P = 0.04; OR: 1.39; 95% CI, 1.01–1.91), longer operative time (P < 0.001; WMD: 21.68; 95% CI, 11.61 to 31.76), more estimated blood loss (EBL, P = 0.002; WMD: 40.94; 95% CI, 14.87 to 67.01), longer length of hospital stay (LOS, P < 0.001; WMD: 0.86; 95% CI, 0.35 to 1.37). No obvious publication bias was identified.ConclusionRRPN is more favorable than TRPN in terms of less minor complications, shorter operative time, less EBL, and shorter LOS. Methodological limitations of the included studies should be considered while interpreting these results.

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Etiology, treatment options and prognosis of abdominal abscesses: A tertiary hospital experience

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11277 ◽

2020 ◽

Vol 14 (01) ◽

pp. 59-65 ◽

Cited By ~ 1

Author(s):

Fusun Zeynep Akcam ◽

Tennure Ceylan ◽

Onur Kaya ◽

Ergun Ceylan ◽

Omer Ridvan Tarhan

Keyword(s):

Percutaneous Drainage ◽

Open Surgery ◽

Treatment Options ◽

Tertiary Hospital ◽

Source Control ◽

Abdominal Abscess ◽

Length Of Treatment ◽

Abdominal Abscesses ◽

Significant Difference ◽

Length Of Hospitalization

Introduction: The principle of abdominal abscess treatment is drenage. However, whether this drainage is percutaneous or open surgery is the choice of the specialist or center. Recently, there have been reports indicating that percutaneous drainage is superior. In this study, patients followed up and treated in a ten-year period in our clinic were evaluated for both of the methods that we applied. Methodology: Cases of intra-abdominal abscess followed-up in a ten-year period were evaluated retrospectively. As well as some of the characteristics of the patients, the methods of drainage applied were recorded. The subjects who received percutaneous drainage and those undergoing open surgery were compared in terms of length of hospitalization, length of treatment and prognosis. Results: The most common abscess site was intraperitoneal, and the origins of the abscesses were often hospital-based. The most commonly isolated organism, at a level of 33.8%, was Escherichia coli. Percutaneous drainage was applied at source control in 49 (43.8%) patients and open surgery drainage in 60 (53.6%). However, length of hospitalization, length of treatment and duration of drainage catheter use were statistically significantly higher in the percutaneous drainage group. No significant difference was observed between the groups in terms of prognosis. Conclusion: We attribute these results in disagreement with the literature to more patients being recommended for percutaneous drainage due to the fact that these patients were thought to be incapable of tolerating open surgery and to the higher probability of additional disease and complications.

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