CURRENT RESULTS OF CONVENTIONAL LUMBAR ARTHRODESIS

2021 ◽  
Vol 20 (4) ◽  
pp. 287-290
Author(s):  
Ana Paula Teixeira Gradin ◽  
Karla Marcovich Rossoni ◽  
Laísa Bonato ◽  
Igor de Barcellos Zanon ◽  
José Lucas Batista Junior ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Case Series ◽  
Decompression Surgery ◽  
Level Of Evidence ◽  
Lumbar Degenerative Disease ◽  
Average Hospital ◽  
Single Level ◽  
Suction Drain ◽  
Case Series Study ◽  
Lumbar Arthrodesis

ABSTRACT Objective: To evaluate the peri- and postoperative results and clinical repercussions in patients undergoing decompression surgery and single-level lumbar arthrodesis using the traditional technique (OTLIF) and to compare with the results of minimally invasive techniques (MITLIF) described in the literature. Methods: Our sample consisted of 22 patients who underwent TLIF surgery using the open technique (OTLIF) in the period October 2019 to January 2021, in our hospital. We compared the patients’ functional clinical results using the Oswestry scale in the preoperative period and 15 days after surgery, analyzed variables related to the perioperative period: surgery time, length of hospital stay, blood loss, use of a suction drain, and admission to the ICU, and compared these with the results reported in the literature for patients treated by the MITLIF technique. Results: The average age was 48.95 years and the most operated level was L4-L5 (55%). The average surgery time was 112.63 min. We did not use a suction drain in the postoperative period, there was no need for a blood transfusion in any patient, and no patient was admitted to the ICU. The average hospital stay was 1 day. Regarding the Oswestry Disability Index, the mean preoperative score was 44.73 and after 15 days, it was 24.05. Conclusions: surgical treatment using the OTLIF technique for single-level lumbar degenerative disease showed largely positive results, with improvement in disability scores, short hospital stay and low incidence of complications. When properly indicated, OTLIF is an excellent and safe option for the treatment of degenerative lumbar disease. Level of evidence IV; Case series study.

Laparoscopic Surgical Management of Rectal Cancer at Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3285-3287
Author(s):  
Zubair Yousfani ◽  
Jabeen Atta ◽  
Khenpal Das ◽  
Madhu Bala ◽  
Shagufta Magsi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Operation Time ◽  
Health Sciences ◽  
Care Hospital ◽  
Average Hospital ◽  
Case Series Study

Objective: To evaluate the consequent outcomes in the patients with rectal cancer endured laparoscopic surgical excision at Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro, Hyderabad and to review their curative resection and recurrence rates, postoperative morbidities and complete survival. Methods: This prospective case series study was done at the Department of General Surgery of Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan. All patients of 30-65 years ages with rectal cancer and underwent diagnostic laparoscopy either of gender were included. After removing the tumor, the specimen pinned out on a flat surface and placed in fixative solution to allow the orientation of the specimen and assessments of the exact margins. As the specimens had acceptable clear margins and limited invasion to the submucosa, no further surgical procedure was proceeded. Data was collected via study proforma. Results: A total of 40 patients were studied. Patients in the laparoscopic operation lost less blood with an amount of only 200mL during 190 minutes average operation time. The bowel functioning returned in 2 days averagely with 8 days average hospital stay. Conclusion: It is concluded that laparoscopic surgery for rectal cancer is an effective, safe and feasible approach in terms of less post-operative complications and recovery time as well as Hospital stay. Key words: Rectal Cancer, laparoscopic surgery

Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring hospitalization (MAC-19 PRO): a case series

2020 ◽  
Vol 3 (3) ◽  
pp. 297-310 ◽  
Author(s):  
Rafael Ricafranca Castillo ◽  
Gino Rei A. Quizon ◽  
Mario Joselito M. Juco ◽  
Arthur Dessi E. Roman ◽  
Donnah G De Leon ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Hospital Stay ◽  
Clinical Improvement ◽  
Case Series ◽  
High Dose ◽  
Chest Imaging ◽  
Imaging Findings ◽  
Rt Pcr ◽  
Average Hospital ◽  
Sleeping Problems

 Treatment for coronavirus disease 2019 (COVID19) pneumonia remains empirical and the search for therapies that can improve outcomes continues. Melatonin has been shown to have anti-inflammatory, antioxidant, and immune-modulating effects that may address key pathophysiologic mechanisms in the development and progression of acute respiratory distress syndrome (ARDS), which has been implicated as the likely cause of death in COVID19. We aimed to describe the observable clinical outcomes and tolerability of high-dose melatonin (hdM) given as adjuvant therapy in patients admitted with COVID19 pneumonia. We conducted a retrospective descriptive case series of patients who: 1) were admitted to the Manila Doctors Hospital in Manila, Philippines, between March 5, 2020 and April 4, 2020; 2) presented with history of typical symptoms (fever, cough, sore throat, loss of smell and/or taste, myalgia, fatigue); 3) had admitting impression of atypical pneumonia; 4) had history and chest imaging findings highly suggestive of COVID19 pneumonia, and, 5) were given hdM as adjuvant therapy, in addition to standard and/or empirical therapy. One patient admitted to another hospital, who one of the authors helped co-manage, was included. He was the lone patient given hdM in that hospital during the treatment period. Main outcomes described were: time to clinical improvement, duration of hospital stay from hdM initiation, need for mechanical ventilation (MV) prior to cardiopulmonary resuscitation, and final outcome (death or recovery/discharge). Of 10 patients given hdM at doses of 36-72mg/day per os (p.o.) in 4 divided doses as adjuvant therapy, 7 were confirmed COVID19 positive (+) by reverse transcription polymerase chain reaction (RT-PCR) and 3 tested negative  (-), which was deemed to be false (-) considering the patients’ typical history, symptomatology, chest imaging findings and elevated bio-inflammatory parameters.  In all 10 patients given hdM, clinical stabilization and/or improvement was noted within 4-5 days after initiation of hdM. All hdM patients, including 3 with moderately severe ARDS and 1 with mild ARDS, survived; none required MV. The 7 COVID19(+) patients were discharged at an average of 8.6 days after initiation of hdM. The 3 highly probable COVID19 patients on hdM were discharged at an average of 7.3 days after hdM initiation. Average hospital stay of those not given hdM (non-hdM) COVID19(+) patients who were admitted during the same period and recovered was 13 days. To provide perspective, although the groups are not comparable, 12 of the 34 (35.3%) COVID19(+) non-hdM patients admitted during the same period died, 7/34 (20.6%) required MV; while 6 of 15 (40%) non-hdM (-) by RT-PCR but highly probable COVID19 pneumonia patients also died, 4/15  (26.7%) required MV. No significant side-effects were noted with hdM except for sleepiness, which was deemed favorable by all patients, most of whom had anxiety- and symptom-related sleeping problems previously. HdM may have a beneficial role in patients treated for COVID19 pneumonia, in terms of shorter time to clinical improvement, less need for MV, shorter hospital stay, and possibly lower mortality. HdM was well tolerated. This is the first report describing the benefits of hdM in patients being treated for COVID19 pneumonia.  Being a commonly available and inexpensive sleep-aid supplement worldwide, melatonin may play a role as adjuvant therapy in the global war against COVID19. 

First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

2021 ◽  
pp. 107110072110345
Author(s):  
Chien-Shun Wang ◽  
Yun-Hsuan Tzeng ◽  
Tzu-Cheng Yang ◽  
Chun-Cheng Lin ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hallux Valgus ◽  
Reconstructive Surgery ◽  
Case Series ◽  
Deformity Correction ◽  
Level Of Evidence ◽  
Factors Affecting ◽  
Radiographic Parameters ◽  
Case Series Study ◽  
Adult Acquired Flatfoot Deformity

Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

Long-term Outcomes of Microfracture for Treatment of Osteochondral Lesions of the Talus

2021 ◽  
pp. 107110072199542
Author(s):  
Daniel Corr ◽  
Jared Raikin ◽  
Joseph O’Neil ◽  
Steven Raikin
Keyword(s):  
Survival Rate ◽  
Case Series ◽  
Return To Sport ◽  
Osteochondral Lesions ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Additional Surgery ◽  
Case Series Study

Background: Microfracture is the most common reparative surgery for osteochondral lesions of the talus (OLTs). While shown to be effective in short- to midterm outcomes, the fibrocartilage that microfracture produces is both biomechanically and biologically inferior to that of native hyaline cartilage and is susceptible to possible deterioration over time following repair. With orthobiologics being proposed to augment repair, there exists a clear gap in the study of long-term clinical outcomes of microfracture to determine if this added expense is necessary. Methods: A retrospective review of patients undergoing microfracture of an OLT with a single fellowship-trained orthopedic surgeon from 2007 to 2009 was performed. Patients meeting the inclusion criteria were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the outcome of the procedure and their likelihood to recommend the procedure to a friend with the same problem using 5-point Likert scales. Patient demographics were reviewed and included for statistical analysis. Results: Of 45 respondents, 3 patients required additional surgery on their ankle for the osteochondral defect, yielding a 10-year survival rate of 93.3%. Of surviving cases, 90.4% (38/42) reported being “extremely satisfied” or “satisfied” with the outcome of the procedure. The VAS score at follow-up averaged 14 out of 100 (range, 0-75), while the FAAM-ADL and FAAM-Sports scores averaged 90.29 out of 100 and 82 out of 100, respectively. Thirty-six patients (85.7%) stated that their ankle did not prevent them from participating in the sports of their choice. Conclusion: The current study represents a minimum 10-year follow-up of patients undergoing isolated arthroscopic microfracture for talar osteochondral defects, with a 93.3% survival rate and 85.7% return to sport. While biological adjuvants may play a role in improving the long-term outcomes of microfracture procedures, larger and longer-term follow-up studies are required for procedures using orthobiologics before their cost can be justified for routine use. Level of Evidence: Level IV, retrospective cohort case series study.

scholarly journals Early morbidity associated with fasciotomies for acute compartment syndrome in children

2018 ◽  
Vol 12 (5) ◽  
pp. 480-487 ◽  
Author(s):  
K. B. L. Lim ◽  
T. Laine ◽  
J. Y. Chooi ◽  
W. K. Lye ◽  
B. J. Y. Lee ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Compartment Syndrome ◽  
Wound Closure ◽  
Case Series ◽  
Skin Grafting ◽  
Acute Compartment Syndrome ◽  
Inpatient Stay ◽  
Wound Infections ◽  
Short Term ◽  
Level Of Evidence

Purpose Acute compartment syndrome (ACS) requires urgent fasciotomy to decompress the relevant muscle compartment/s prior to onset of irreversible myonecrosis and nerve injury. A fasciotomy is not a benign procedure. This study aims to describe and quantify early morbidity directly associated with fasciotomies for ACS in children. Methods Clinical charts of 104 children who underwent 112 fasciotomies over a 13-year period at a tertiary children’s hospital were reviewed. The following were analyzed: ACS aetiology, fasciotomy site, number of subsequent procedures, method of wound closure, short-term complications and length of hospital stay. Results Short-term complications included wound infections (6.7%) and the need for blood transfusion (7.7%). Median number of additional operations for wound closure was two (0 to 10) and median inpatient stay was 12 days (3 to 63; SD 11.7). After three unsuccessful attempts at primary closure, likelihood of needing skin grafting for coverage exceeded 80%. Analyses showed that fasciotomy-wound infections were associated with higher risk for four or more closure procedures. Number of procedures required for wound closure correlated with longer inpatient stay as did ACS associated with non-orthopaedic causes. Conclusion Fasciotomy is associated with significant early morbidity, the need for multiple closure operations, and prolonged hospital stay. The decision for fasciotomy needs careful consideration to avoid unnecessary fasciotomies, without increasing the risk of permanent injury from missed or delayed diagnosis. Skin grafting should be considered after three unsuccessful closure attempts. Less invasive tests or continuous monitoring (for high-risk patients) for compartment syndrome may help reduce unnecessary fasciotomies. Level of Evidence Level IV, Case series

scholarly journals Effectiveness of shockwave therapy in the treatment of plantar fasciitis

2020 ◽  
Vol 28 (1) ◽  
pp. 7-11
Author(s):  
Renan Gonçalves Leão ◽  
Marina Mayumi Azuma ◽  
Gustavo Henrique Carillo Ambrosio ◽  
Flavio Faloppa ◽  
Eduardo Shoiti Takimoto ◽  
...  
Keyword(s):  
Plantar Fasciitis ◽  
Case Series ◽  
Sao Paulo ◽  
São Paulo ◽  
Post Intervention ◽  
Level Of Evidence ◽  
Shockwave Therapy ◽  
Case Series Study ◽  
Sf 36

ABSTRACT Objective: To evaluate the effectiveness of single-dose focal shockwave therapy in plantar fasciitis treatment. Methods: a primary, prospective study of a series of cases, conducted in the city of São Paulo, Brazil, by the Department of Orthopedics and Traumatology of the Universidade Federal de São Paulo, in Hospital São Paulo. All outcomes were measured at the time of inclusion of the patient in the study and at the post-intervention moments as it follows: three, six and twelve weeks. The VAS, AOFAS and SF-36 scales were applied by teams other than those who performed the SWT. Results: Data from 56 patients were collected during 2017 and 2018. There was improvement of the parameter evaluated (p < 0.005 and 95%CI) in all the periods in which the patients were reevaluated (3, 6 and 12 weeks), progressive improvement were observed in the three outcomes evaluated. Conclusion: Shock wave therapy was effective for plantar fasciitis treatment according to the proposed protocol considering pain, function and quality of life. Level of Evidence Ic, Case-series Study.

Mini-Invasive Surgery for Distal Radius Fractures: A Double Incision under 12 mm

2020 ◽  
Author(s):  
Elisabete Ribeiro ◽  
Gustavo Campanholi ◽  
Marcelo Acherboim ◽  
Gustavo Mantovani Ruggiero
Keyword(s):  
Distal Radius ◽  
Surgical Techniques ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Radiological Results ◽  
Normal Ranges ◽  
Case Series Study ◽  
Clinical And Radiological Results

Abstract Background Distal radius fracture is one of the most common lesions in adults. Surgical techniques have evolved considerably with a clear tendency toward mini-invasive techniques. Objective Our aim is to push the limits to a 12 mm approach and evaluate its clinical and radiological results. Patients and Methods Ten fractures in nine patients were operated by a double incision with mean size 11.50 ± 3.41 mm (range 8.00–1.00) and using a specially designed volar distal locking plate. Results At the latest follow-up, visual analogue scale score for pain (0.20 ± 0.63 during rest and 0.60 ± 1.07 while making efforts) and quick DASH (quick Disabilities of the Arm, Shoulder and Hand) score (6.14 ± 7.43) were extremely low. All the range of motion parameters and grip strength were above the 95% barrier of the contralateral side, with exception of ulnar deviation. Radiological parameters obtained were located within the normal ranges. Time to return to independent daily tasks and work was 6.67 ± 5.15 and 10.14 ± 14.24 days, respectively. One case of transient carpal tunnel syndrome was solved with watchful waiting and one case of extensor tendons impingement was improved after plate removal. All patients were completely satisfied at the end of the treatment. Conclusion In conclusion, mini-invasive volar technique for distal radius fractures with special designed plates in carefully selected patients allowed us to obtain good clinical and radiological results, minimal complications, fast recovery, and high-satisfactory rates. Level of Evidence This is a Level IV, case series study.

Outcomes of Primary Tibiotalocalcaneal Nailing for Complicated Diabetic Ankle Fractures

2019 ◽  
Vol 40 (12) ◽  
pp. 1382-1387 ◽  
Author(s):  
M. Pierce Ebaugh ◽  
Benjamin Umbel ◽  
David Goss ◽  
Benjamin C. Taylor
Keyword(s):  
Hospital Stay ◽  
Limb Salvage ◽  
Patient Population ◽  
Surgical Complication ◽  
Case Series ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Average Hospital ◽  
The Mean

Background: Ankle fractures in patients with complicated diabetes have significantly increased the rates of complications and poorer functional outcomes when treated nonoperatively, and there have been only modest reductions when treated operatively. We hypothesized that the minimally invasive, robust construct that tibiotalocalcaneal fixation with an intramedullary nail offers would result in high rates of limb salvage, acceptable rates of complications, and less loss of function, in this difficult patient population. Methods: This was an institutional review board–approved retrospective study of 27 patients with complicated diabetes who underwent tibiotalocalcaneal nailing of their ankle fracture as a primary treatment without formal joint preparation. Patients with complicated diabetes were defined as having neuropathy, nephropathy, and/or peripheral vascular disease. The mean clinical follow-up was 888 days. Patients were screened for associated risk factors. Data were collected on surgical complications. The outcomes measured included length of hospital stay, loss of ambulatory level, amputation, and time to death. The mean age was 66 years with an average body mass index of 38 and hemoglobin A1c of 7.4. Six fractures were open. Results: The limb salvage rate was 96%. The average hospital stay was 6 days, and the mean time to weightbearing was 6.7 weeks. The fracture union rate was 88%. The surgical complication rate was 18.5%, with no instances of malunions, symptomatic nonunions, or Charcot arthropathy. Eight patients died by final follow-up (mean, 1048 days). An ambulatory level was maintained in 81% of the patients. Conclusion: With high limb salvage rates, relatively early weightbearing, maintained ambulatory level, and acceptable complication rates, we believe our technique can be considered an appropriate approach to increase the overall survivability of threatened limbs and lives in this patient population. Level of Evidence: Level IV, retrospective case series.

Laparoscopic common bile duct exploration associating with electrohydraulic lithotripsy via choledochoscopy in Vietnam – Thuy Dien - Uong Bi Hospital

2018 ◽  
Vol 8 (2) ◽  
Author(s):  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Case Series ◽  
Common Bile Duct Exploration ◽  
Biliary Stones ◽  
Average Hospital ◽  
Intrahepatic Stones ◽  
Electrohydraulic Lithotripsy ◽  
Case Series Study ◽  
Duration Of Surgery

Tóm tắt Đặt vấn đề: Sỏi đường mật chính thường gặp là ống mật chủ (OMC) là bệnh lý phổ biến ở Việt Nam. Phẫu thuật nội soi (PTSN) để lấy sỏi qua OMC ngày càng được áp dụng rộng rãi trong điều trị bệnh sỏi mật. Kết hợp tán sỏi qua nội soi đường mật trong lúc phẫu thuật nhằm làm sạch sỏi đặc biệt là sỏi trên gan đang được áp dụng ở nhiều cơ sở. Phương pháp nghiên cứu: Nghiên cứu kết quả ứng dụng PTNS và nội soi tán sỏi qua OMC để điều trị sỏi đường mật chính tại bệnh viện VN-TĐ Uông Bí. Phương pháp can thiệp lâm sàng, mô tả tiến cứu. Đối tượng nghiên cứu là những người bệnh có sỏi đường mật chính (sỏi đường mật trong gan và ngoài gan) được PTNS ổ bụng lấy sỏi đường mật qua OMC có kết hợp tán sỏi điện thủy lực được thực hiện tại bệnh viện VN-TĐ Uông Bí từ 9/2014-9/2017. Thông tin của người bệnh được thu thập trước và sau phẫu thuật, xử lý bằng phần mềm thống kê y học SPSS 16.1. Kết quả: Gồm 31 trường hợp (TH) được nghiên cứu, có 9 nam và 22 nữ, tuổi trung bình là 55,45 ± 15,05. Trong đó sỏi OMC đồng thời với sỏi trong gan là 31, sỏi túi mật kết hợp 9 TH. 21 TH lấy hết sỏi đường mật ngay trong phẫu thuật. 10 người bệnh còn sót sỏi trong gan phải lấy sỏi qua đường hầm Kehr sau 1 tháng. 1 người bệnh phải chuyển mổ mở, 2 người bệnh bị rò mật sau mổ. Thời gian phẫu thuật trung bình là 130.65 ± 46.91 phút, thời gian nằm viện trung bình là 8,58 ± 3,59 ngày. Không có tử vong do phẫu thuật. Kết luận: Đây là những kinh nghiệm PTNS mở OMC có kết hợp với nội soi tán sỏi để điều trị sỏi đường mật đầu tiên của chúng tôi. Chúng tôi nhận thấy phẫu thuật có tính khả thi an toàn cũng như hiệu quả tại bệnh viện VN-TĐ Uông Bí. Abstract Introduction: Common bile duct (CBD) stone is endemic in Vietnam. Laparoscopic common bile duct exploration (LCBDE) has gained wide popularity in the treatment of choledocholithiasis. At the same time, electrohydraulic lithotripsy (EHL) via choledochoscopy might help to clear intrahepatic stones. Material and Methods: The aim of this study is to access the results of laparoscopic common bile duct exploration associating with electrohydraulic lithotripsy via choledochoscopy to clear biliary stones Vietnam – Thuy Dien – Uong Bi Hospital. This is a prospective, interventional and descriptive case series study. Patients with both extra-and intra-hepatic stones who underwent laparoscopic common bile duct exploration (LCBDE) from September 2014 to September 2017 were enrolled in our study. The data was prospectively collected and analysed by using SPSS 16.1. Results: There were 9 men and 22 women with age ranging from 12 to 78 years old (average 55,45 ± 3,59). There were 9 patients with gallbladder stones. Complete bile duct clearance was done in 21 patients. 10 patients with residual intrahepatic stones required extracting stones through T tube tunnel by choledochoscopy and EHL. The average duration of surgery was 130.65 ± 46.91 minutes and the average hospital stay was 8,55 ± 3,59 days. There were one conversion to open surgery and two cases of bile leakage. We had non-fatal postoperative complications. Conclusion: This is preliminary experience of LCBDE in my hospital in the management of choledocholithiasis. It should be considered effective and feasible in the treatment of CBD stones in Vietnam – Thuy Dien – Uong Bi Hospital. Keyword: Laparoscopic common bile duct exploration, Electrohydraulic lithotripsy via choledochoscopy

scholarly journals Primitive Isolated Hydatid Cyst of the Spleen: Total Splenectomy Versus Spleen Saving Surgical Modalities

2020 ◽  
Author(s):  
Atef Mejri ◽  
khaoula Arfaoui ◽  
Mohamed Firas Ayadi ◽  
Badreddine Aloui ◽  
Jasser Yaakoubi
Keyword(s):  
Hydatid Cyst ◽  
Hospital Stay ◽  
Surgical Techniques ◽  
Case Series ◽  
Surgical Approaches ◽  
Average Hospital ◽  
Spleen Preserving ◽  
Operative Complications ◽  
Total Splenectomy ◽  
Post Operative Complications

Abstract BackgroundThis study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease.MethodsThis is a descriptive retrospective study carried out over a period of 7 years extended from January 2013 until December 2019 reporting eight cases of isolated primitive splenic localization of hydatid disease. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy.ResultsThe discovery of the pathology was incidental in 50% of cases, while pain in the left upper quadrant of the abdomen and renitent mass in the same quadrant revealed the pathology only in 25% and 12,5% respectively . None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay ( 9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. ConclusionsThe current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures, as the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

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