Surgical sequale of transabdominal preperitoneal approach versus Lichtenstein open repair in a rural setting

Background: The objective was to compare the outcomes perioperative outcomes of transabdominal preperitoneal approach (TAPP) versus Lichtenstein tension (open) free repair for adult unilateral uncomplicated inguinal hernia patients (including both direct and indirect hernias).Methods: The prospective study was conducted between July 2018 to August 2020. A total of 60 patients, 30 in the Lichtenstein tension free repair group and 30 in the TAPP repair group data were collected and analysed.Results: The mean age was 55 in our study. On comparing open versus TAPP, significant difference of p value ≤0.05 was observed in terms of surgical site infections, time to discharge, time to return to work and mesh related pain in TAPP. Operative time was shorter in open group.Conclusions: Laparoscopic transabdominal preperitoneal repair is a valid alternative to open traditional method with lesser morbidity to the patients.

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Routine intraoperative jejunostomy placement and minimally invasive oesophagectomy: an unnecessary step?†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz063 ◽

2019 ◽

Vol 56 (4) ◽

pp. 746-753 ◽

Cited By ~ 5

Author(s):

Tiuri E Kroese ◽

Leonidas Tapias ◽

Jacqueline K Olive ◽

Lena E Trager ◽

Christopher R Morse

Keyword(s):

Weight Loss ◽

Minimally Invasive ◽

Relative Weight ◽

Patient Characteristics ◽

Perioperative Outcomes ◽

P Value ◽

Oral Nutrition ◽

Significant Difference ◽

Minimally Invasive Oesophagectomy ◽

The Impact

Abstract OBJECTIVES: Adequate nutrition is challenging after oesophagectomy. A jejunostomy is commonly placed during oesophagectomy for nutritional support. However, some patients develop jejunostomy-related complications and the benefit over oral nutrition alone is unclear. This study aims to assess jejunostomy-related complications and the impact of intraoperative jejunostomy placement on weight loss and perioperative outcomes in patients with oesophageal cancer treated with minimally invasive Ivor Lewis oesophagectomy (MIE). METHODS: From a prospectively maintained database, patients were identified who underwent MIE with gastric reconstruction. Between 2007 and 2016, a jejunostomy was routinely placed during MIE. After 2016, a jejunostomy was not utilized. Postoperative feeding was performed according to a standardized protocol and similar for both groups. The primary outcomes were jejunostomy-related complications, relative weight loss at 3 and 6 months postoperative and perioperative outcomes, including anastomotic leak, pneumonia and length of stay, respectively. RESULTS: A total of 188 patients were included, of whom 135 patients (72%) received a jejunostomy. Ten patients (7.4%) developed jejunostomy-related complications, of whom 30% developed more than 1 complication. There was no significant difference in weight loss between groups at 3 months (P = 0.73) and 6 months postoperatively (P = 0.68) and in perioperative outcomes (P-value >0.999, P = 0.591 and P = 0.513, respectively). CONCLUSIONS: The use of a routine intraoperative jejunostomy appears to be an unnecessary step in patients undergoing MIE. Intraoperative jejunostomy placement is associated with complications without improving weight loss or perioperative outcomes. Its use should be tailored to individual patient characteristics. Early oral nutrition allows patients to maintain an adequate nutritional status.

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A randomised study to evaluate wound outcome following delayed primary vs primary closure of skin in duodenal perforation peritonitis

International Surgery Journal ◽

10.18203/2349-2902.isj20212716 ◽

2021 ◽

Vol 8 (7) ◽

pp. 2108

Author(s):

Sajal Gupta ◽

Vimal Bhandari ◽

I. B. Dubey

Keyword(s):

Primary Closure ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Duodenal Perforation ◽

P Value ◽

Randomised Study ◽

Delayed Primary Closure ◽

Significant Difference ◽

Perforation Peritonitis ◽

Stitch Abscess

Background: This study aimed to evaluate wound outcome following delayed primary versus primary closure of skin in duodenal perforation peritonitis.Methods: The present study was a randomised interventional study that included 90 patients on accrual of duodenal perforation peritonitis which were divided into primary closure (PC) and delayed primary closure (DPC) groups comprising 45 patients each. The outcome measures were complications, surgical site infections, hospital stay and final wound status during the follow up of 30 days. Data collected was compared taking P-value <0.05 as significant.Results: The patients were in the age group of 12–60 years, with men in majority in both groups. Mean SSI score in PC and DPC was comparable (2.67 SD 1.58 vs. 2 SD1.61, P=0.058). SSI was more in PC group than DPC group (11.11% vs. 2.22%, P<0.05). Wound/pus culture was positive in 62.22% in PC and 46.67% in DPC. Major complications like wound dehiscence was noticed mainly in PC group while minor Complications like Stitch abscess, granuloma, sinus was more in DPC group. Mean of duration of stay (days) was comparable between PC and DPC group (14.07 SD 7.64 vs. 13.96 SD 6.94, P=0.805). Final wound outcome after 30 days was healthy scar in majority of patients in PC and DPC group (57.78% vs. 66.67%) with no significant difference between them (p=0.434).Conclusions: In conclusion, DPC showed comparable results with PC with similar SSI and wound healing without significant complications.

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PENGARUH BRISK WALKING (JALAN CEPAT) TERHADAP FUNGSI HATI PADA OBESITAS SENTRAL

e-CliniC ◽

10.35790/ecl.4.1.2016.10954 ◽

2016 ◽

Vol 4 (1) ◽

Author(s):

Heri Nuryanto ◽

Frans E. N. Wantania ◽

B. J. Waleleng

Keyword(s):

Waist Circumference ◽

Liver Function ◽

Central Obesity ◽

Control Group ◽

P Value ◽

Brisk Walking ◽

Group Data ◽

Significant Difference ◽

Before And After ◽

Post Test

Abstract: Central obesity is considered as a risk factor that strongly associated with several chronic diseases. Men with waist circumference ≥ 90 cm and women with waist circumference ≥80 cm are stated as central obesity. This study aimed to determine the effect of brisk walking on liver function in central obesity. This was an experimental field study with a non-randomized pre-post one group test and control group. This study used consecutive sampling method. There were 30 samples divided into two groups; 15 samples were given intervention and 15 samples as the control group. Data were analyzed with Wilcoxon signed ranks test. The results showed that brisk walking for 1 month decreased the SGPT and SGOT levels, however, statistically there was no significant difference before and after intervention with a p value >0.05. Conclusion: There was no significant influence of brisk walking on liver function in central obesity. Keywords: central obesity, liver function, brisk walking Abstrak: Obesitas sentral dianggap sebagai faktor risiko yang berkaitan erat dengan beberapa penyakit kronis. Laki-laki dengan lingkar pinggang ≥90 cm atau perempuan dengan lingkar pinggang ≥80 cm dinyatakan sebagai obesitas sentral. Penelitian ini bertujuan untuk mengetahui pengaruh brisk walking (jalan cepat) terhadap fungsi hati pada obesitas sentral. Metode penelitian ini yaitu eksperimental lapangan dengan rancangan non – randomized pre-post test with control. Sampel ditentukan dengan teknik pengambilan sampel konsekutif sampling. Terdapat 30 sampel yang dibagi menjadi 2 kelompok yakni 15 sampel yang diberi perlakuan dan 15 sampel sebagai kontrol. Data dianalisis dengan SPSS 20 dan uji Wilcoxon Signed Ranks Test. Hasil penelitian memperlihatkan terjadi penurunan kadar enzim hati SGPT dan SGOT pada sampel yang melakukan brisk walking selama 1 bulan tetapi secara statistik tidak ada perbedaan bermakna sebelum dan sesudah mendapatkan perlakuan dengan nilai p > 0,05. Simpulan: Tidak terdapat pengaruh bermakna dari brisk walking (jalan cepat) terhadap fungsi hati pada obesitas sentral. Kata kunci: obesitas sentral, fungsi hati, brisk walking

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Effect of duration of pre-operative admission on surgical site infection in major abdominal surgeries: an observational study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192422 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2306

Author(s):

Alka Shantiprakash Gupta ◽

Arthika Shetty

Keyword(s):

Surgical Site Infection ◽

Surgical Site Infections ◽

Surgical Patient ◽

P Value ◽

Site Infection ◽

Admission Time ◽

Long Run ◽

Skin Flora ◽

Significant Difference ◽

Prolonged Hospital

Background: Surgical site infection (SSI) are second most common cause of mortality in surgical patient, situation has been further complicated by emergence of drug resistant strains. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stays, need for readmission, high end antibiotic treatment and re-surgery. The study was done to see if incidence of SSI is decreased with decreased pre-operative admission time. Others factors associated with SSI were analysed including the microbiological spectrum.Methods: The study was an analytical, observational, case control study. Sixty (60) cases each of gynaecology and obstetrical post-operative patients who developed SSI within 30 days were taken as cases and who did not develop SSI were taken as controls and preoperative admission time was analysed in both cases and controls to observe if risk of surgical site infections decreases due to decreased exposure to nosocomial pathogens when the pre-operative admission time was less than 48 hours.Results: Author found that there was statistically significant difference in the time between surgery and admission in the gynaecological surgeries with p value 0.023, as compared to the obstetrics surgeries where there was no statistically significant difference. Common organism isolated was E. coli sensitive to gentamicin.Conclusions: From this study, it seems to be a good policy to evaluate the patient on OPD basis and admit them about 24 to 48 hours prior to the surgery rather them keeping them admitted for prolonged duration in wards for diagnostic evaluation. This prevents nosocomial contamination in the patient’s skin flora thereby preventing SSI. This practice not only conserves the hospital resources but also makes the patient turn over faster. Further this might in the long run reduce the antibiotic resistant hospital flora.

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Efektifitas Smartbook Perawatan Paska Seksio bagi Kualitas Pelayanan Keperawatan

Jurnal Kesehatan ◽

10.26630/jk.v9i2.902 ◽

2018 ◽

Vol 9 (2) ◽

pp. 304

Author(s):

Lisa Suarni ◽

Fitarina Fitarina ◽

Sono Sono

Keyword(s):

Service Quality ◽

Discharge Planning ◽

Intervention Group ◽

Control Group ◽

P Value ◽

Nursing Service ◽

Nursing Services ◽

Nurse Midwife ◽

Group Data ◽

Significant Difference

<p class="Addresses">There are 5 highest causes of maternal mortality which include bleeding, hypertension in pregnancy, infection, prolonged labor, and abortion. One of the prevention and management efforts is to provide immediate and efficient help through hospital services (Ministry of Health, 2014). This research has aims to find the quality of nursing services on patients after cesarean surgery using the SmartBook. Methods: This is Quasi-Experiment that provides treatment with the SmartBook for 4 days in the hospital and assessed nursing services quality. Samples were taken using accidental and random sampling (20 for the intervention group and 21 for the control group). Data was collected using observation sheet and questionnaire, then analyzed with a t-test. Result: There are four variables of nursing service quality (p-value<0.05) indicating significant difference: patient safety, self-care, anxiety, and knowledge of discharge planning, while 2 others (comfort and satisfaction) are not (p-value>0.05). Application of the SmartBook for women following cesarean surgery improves nursing service quality. We suggest further research on nurse and midwife perception about the use of the SmartBook as media of care, both about its use and how far can improve job satisfaction of nurse/midwife.</p>

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A comparative study of open versus closed method of establishment of pneumoperitoneum in laparoscopic surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20194075 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3335 ◽

Cited By ~ 1

Author(s):

Adeesh P. Jain ◽

Sarav C. Shah ◽

Purva C. Shah ◽

Karan R. Patel

Keyword(s):

Randomised Control Trial ◽

P Value ◽

Open Method ◽

Medical College ◽

Choice Of Procedure ◽

Gas Leak ◽

Significant Difference ◽

Time Required ◽

Open Versus ◽

Method Group

Background: Laparoscopy has overtaken open surgery as the choice of procedure wherever feasible. More than 50% of complications in laparoscopy occur during creation of pneumoperitoneum. In this study, we are comparing open or Hasson's method and closed or vress method of creation of pneumoperitoneum.Methods: This is a prospective comparative parallel randomised control trial conducted at the Department of Surgery, Baroda Medical College and SSG Hospital from November, 2017 to November, 2018. We divided the patients (n=100) into two groups i.e., open method (group O) (n1=50) and closed method (group C) (n2=50) groups using the envelope method of randomisation. We compared the two techniques in terms of time required to complete the procedures and complications (major and minor) associated with creation of pneumoperitoneum.Results: All the patients that participated in this study belonged to the age group of 10-69 years out of which majority were 15-50 years old. In our study, the mean time required to create pneumoperitoneum by closed method (group C) was 9.3 seconds while by open method (group O), it was 7.84 seconds with p value <0.001. There were 15 cases of gas leak from the port side, all recorded in the open method of establishment of pneumoperitoneum.Conclusions: Even though the open method takes less time to create pneumoperitoneum, both methods are similar in terms of time taken to complete the operation and major and minor complications because there was no statistically significant difference in the frequency of these parameters between the two techniques.

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Proximal Contact Repair of Complex Amalgam Restorations

Operative Dentistry ◽

10.2341/15-180-lr ◽

2017 ◽

Vol 42 (3) ◽

pp. 266-272

Author(s):

MN Zguri ◽

JA Casey ◽

JP Jessup ◽

KS Vandewalle

Keyword(s):

Testing Machine ◽

Tooth Surface ◽

Control Group ◽

Amalgam Restoration ◽

Group Data ◽

Significant Difference ◽

Line Angle ◽

The Mean ◽

Amalgam Restorations ◽

Repair Group

SUMMARY The carving of a complex amalgam restoration may occasionally result in light proximal contact with the adjacent tooth. The purpose of this study was to investigate the strength of complex amalgam restorations repaired with a proximal slot amalgam preparation. Extracted human third molars of similar coronal size were sectioned 1 mm apical to the height of the contour using a saw and were randomly distributed into 9 groups of 10 teeth each. One pin was placed at each line angle of the flattened dentinal tooth surface. A metal matrix band was placed and an admixed alloy was condensed and carved to create a full crown contour but with a flat occlusal surface. A proximal slot was prepared with or without a retention groove and repaired using a single-composition spherical amalgam 15 minutes, 24 hours, one week, or six months after the initial crown condensation. The specimens were stored for 24 hours in 37°C water before fracture at the marginal ridge using a round-ended blade in a universal testing machine. The control group was not repaired. The mean maximum force in newtons and standard deviation were determined per group. Data were analyzed with a 2-way analysis of variance as well as Tukey and Dunnett tests (α=0.05). Significant differences were found between groups based on type of slot preparation (p=0.017) but not on time (p=0.327), with no significant interaction (p=0.152). No significant difference in the strength of the marginal ridge was found between any repair group and the unrepaired control group (p>0.076). The proximal repair strength of a complex amalgam restoration was not significantly different from an unrepaired amalgam crown. Placing a retention groove in the proximal slot preparation resulted in significantly greater fracture strength than a slot with no retention grooves. Time of repair had no significant effect on the strength of the repair.

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Does Skin Preparation Influence Surgical Site Infection in Laparotomy Wounds: Comparative Evaluation of Preoperative Skin Preparation With 4% Chlorhexidine With 5% Povidone Iodine in Laparotomy Wounds: A Prospective Trial

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.4.415 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Ravindran Chirukandath ◽

Manoj P. Elangovan ◽

Agil B. ◽

Reshma A. Cheedhamadathil ◽

Ayana M. Dev ◽

...

Keyword(s):

Surgical Site Infection ◽

Povidone Iodine ◽

Prospective Trial ◽

Surgical Site Infections ◽

P Value ◽

Site Infection ◽

Related Complication ◽

Skin Preparation ◽

Emergency Procedures ◽

Significant Difference

Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109, 5% Povidone iodine prepared patients undergoing various elective n = 114 and emergency procedures n = 123. The overall SSI rates in 7 days in the whole group were 13.44 %. The SSI rates on the 4% Chlorhexidine group were 10.16% and 5% povidone iodine group were 17.27% and it was statically significant with a p value of p = 0.00413 showing significant reduction in the 4% Chlorhexidine group. The study also compared the SSI rates in elective and emergency procedures in both groups with significant difference in emergency procedures. More variables are also compared between the groups and results were analyzed. Conclusion: This study shows the use of Chlorhexidine 4% reduces the morbidity of one of the most common wound related complication in laparotomy patients in all categories of laparotomy wounds.

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Peningkatan Kebahagiaan di Tempat Kerja : Penggunaan Website Tiga Hal Baik pada Pelatihan Kebersyukuran

Jurnal Intervensi Psikologi (JIP) ◽

10.20885/intervensipsikologi.vol12.iss1.art5 ◽

2020 ◽

Vol 12 (1) ◽

pp. 51-64

Author(s):

Nur Rahmat Laba ◽

Erika Setyanti Kusumaputri

Keyword(s):

Data Analysis ◽

Control Group ◽

P Value ◽

Gain Score ◽

Group Data ◽

Score Analysis ◽

Significant Difference ◽

And Control ◽

Experimental Group ◽

Data Analysis Methods

This study aims to determine the effectiveness of gratitude exercise using three good things techniques on happiness at work enhancement. Participants of this study were 15 employees aged 21-28 years divided into two groups: eight participants in the experimental group and seven participants in the control group. The design was a randomized two-group pretest-posttest. Collecting data used to happiness at work scale with Likert model prepared by the researcher. Data analysis methods used by using Mann Whitney U technique for differences of the gain score in the experimental group and control group data score. The result of gain score analysis showed t value = 8.500 and p-value of 0.021 (p<0.05), indicating there is a significant difference between the experimental group and control group after gratitude exercise. The result shows that gratitude exercise using three good things techniques is effective to increase happiness at work of employees.

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Single-Stage Complete Repair versus Multistage Repair of Tetralogy of Fallot with Borderline Pulmonary Arteries

The Heart Surgery Forum ◽

10.1532/hsf.2075 ◽

2018 ◽

Vol 21 (6) ◽

pp. E466-E471

Author(s):

Mohammed Ahmed Dawoud ◽

Mohammed Nabil Abd Al Jawad ◽

Tamer Hikal ◽

Khaled Samir

Keyword(s):

Tetralogy Of Fallot ◽

Pulmonary Arteries ◽

Multislice Ct ◽

Single Stage ◽

P Value ◽

Icu Stay ◽

Complete Repair ◽

Significant Difference ◽

Shunt Group ◽

Repair Group

Background: Tetralogy of Fallot is the most common cyanotic congenital heart defect. Borderline pulmonary anatomy has been associated with a higher risk of mortality and morbidity. Strategies to manage this condition—namely, single- or multistage repair—have long been debated. Objective: The overall outcomes of patients with tetralogy of Fallot with borderline pulmonary arteries (McGoon ratio 1.3 to 1.7) with regard to the need for a single-stage or multistage repair and the outcome of each surgical management were evaluated. Patients and methods: A retrospective, nonrandomized comparative study designed to evaluate patient outcomes comprised 60 patients with tetralogy of Fallot with borderline pulmonary arteries who underwent surgery at the Cardiothoracic Surgery Academy, Ain Shams University, Cairo, Egypt, between January 2016 and December 2017. After gaining approval from the affiliated ethical and research committee, and informed consent of the guardians, the patients were assigned into one of two groups. Shunt group included 30 patients managed surgically by a modified Blalock-Taussig (MBT) shunt as a part of a multistage repair, and repair group included 30 patients managed surgically by single-stage complete repair. The medical records of the patients were reviewed, and data relating to age, sex, weight, and preoperative oxygen saturation were collected. All patients underwent preoperative echocardiography and multislice computed tomography (CT) with angiography. The follow-up was performed by echocardiography at discharge and at one month and six months after surgery. Multislice CT with angiography was performed in patients who received a shunt once the echocardiography showed acceptable pulmonary arteries. Results: The patients’ age ranged from 5 to 50 months with a mean age of 18.63 ± 9.15 (19.84 ± 12.34 for the shunt group and 17.43 ± 8.54 for the repair group). The weight ranged from 5 kg to 18 kg with a mean of 9.6 ± 2.53 (8.82 ± 2.79 for the shunt group and 10.41 ± 2.63 for the repair group). The mean preoperative O2 saturation was 68.95% ± 7.8% for the shunt group and 87.93% ± 6.18% for the repair group. The median McGoon ratio was 1.4 for the shunt group and 1.6 for the repair group, the difference of which was highly significant (P < .0001). The mortality rate in our study was 10% (10% for the shunt group and 10% for the repair group). The morbidity incidence rate was 26.6% for the shunt and repair groups. The ICU stay ranged from 2 to 31 days, with a median of three days for the shunt group (mean 3.61 ± 1.91) and four days for the repair group (mean 6.07 ± 6.63 days). The calculated P value showed a significant difference between the two groups concerning ICU stay. The postoperative SO2 significantly increased to a mean of 85.58 ± 7.05 in the shunt group and 98.14 ± 3.36 in the repair group (P < .0001). Conclusion: There was no statistically significant difference between multistage repair and single-stage complete repair regarding morbidity and mortality. Regarding ICU stay, patients in the single-stage had a better outcome. A McGoon ratio of 1.5 can be used as a guideline in the decision-making process.

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