Compare the Incidence of Surgical Site Infection after Appendectomy Wound Irrigation with Normal Saline and Imipenem Solutions

2021 ◽  
Vol 15 (8) ◽  
pp. 2184-2186
Author(s):  
Ahmad Shah ◽  
Nazeer Ahmad Sasoli ◽  
Farrukh Sami

Objective: To compare the incidence of surgical site infection after appendectomy wound irrigation with regular saline solution and imipenem solution. Study Design: Comparative randomized control trial Place and Duration of Study: Department of Surgery Unit-1, Sandeman Provincial Hospital Quetta from 1st September 2020 to 30th April 2021. Methodology: Eighty patients of both genders were presented in this study. Patients detailed demographics age, sex and body mass index were recorded after taking informed written consent. Patients underwent for appendectomy wound irrigation were included. Patients were equally divided into two equal groups, I and II. Group I had 40 patients and received imipenem and group II irrigated with saline solution with 40 patients. Outcomes were surgical site infection, deep abscess formation was observed post-operatively. Results: The mean age of the patients in group I was 26.11±2.03 years with mean BMI 23.61±3.32 kg/m2 and in group II mean age was 25.14±3.12 years with mean BMI 22.14±4.88 kg/m2. In group I, 32 (80%) patients had inflamed appendix, perforated appendix was in 7 (17.5%) and gangrenous appendix in 1 (2.5%) while in group II inflamed appendix in 34 (85%), perforated appendix in 4 (10%) and gangrenous appendix 2 (5%). Surgical site infection in group I was 3 (7.5%) and abscess formation in 2 (5%) cases while in group II SSI in 6 (15%) and abscess formation in 3 (7.5%) cases. Conclusion: Imipenem irrigation after appendectomy reduces wound infection. Healthcare costs and patient suffering due to infection can be reduced. Keywords: Imipenem solution, Wound irrigation with saline, Appendectomy wound infection

Author(s):  
Aditi Sangwan ◽  
Vani Malhotra

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus.      Mean duration of resuturing was 17.42±6.98 days.  Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.


Author(s):  
A. S. M. Rezbanul Haque ◽  
Bablu Kumar Saha ◽  
M. Mahfuzul Haque ◽  
M. Abdus Sattar ◽  
Upendra Nath Ray ◽  
...  

Background: Appendicular lump is a well-known sequalae of acute appendicitis encountered in 2-6% of patients. Successful management of appendicular lump is controversial with different approaches. This study aims to evaluate the outcome of early appendectomy in an appendicular lump.Methods: A total of 210 patients were admitted in surgery and pediatric surgery department of Rangpur medical college and hospital with the diagnosis of acute appendicitis and its sequalae over two years.Results: In this study, sixty patients were included who were presented with an appendicular lump. Maximum patients (50%) were found in the age group of 21-30 years. Males (66.67%) were more affected. Eighty percent of patients were coming from below-average socio-economic conditions. In group I, early appendicectomy had done and outcomes were satisfactory and favorable. In group II, eighteen patients were operated who were admitted at 6 to 8 days after an attack of acute appendicitis, and twelve patients were continued the conservative treatment. In group II, who had done surgery, among them, fourteen patients (77.78%) were found an appendicular abscess, and four patients (22.22%) were found perforated appendix per-operatively. In group I, the mean recovery period was less and they had minimum complications. In group II, the mean recovery period was more and they had more complications.Conclusions: Based on these findings, it can be concluded that early exploration in appendicular lump patients confirm the diagnosis, cures the problem, reduces the cost of management, and shortens the convalescence period and hospital stay with reasonably satisfactory outcomes.


2021 ◽  
Vol 15 (7) ◽  
pp. 1742-1744
Author(s):  
Aqeel Ahmad ◽  
Muhammad Hammad Muzaffar ◽  
Mumtaz Ahmad Khan ◽  
Arshid Mahmood

Aim: The aim of this study is to compare the surgical site infection, hospital stay and time duration of procedure in patients undergoing laparoscopic and open appendectomy. Study Design: Prospective/ Observational Place & Duration: Department of Surgery, Pak Red Crescent Medical and Dental college, Dina Nath, during from Jan 2020 to March 2021. Methods: In this study 240 patients of both genders with ages >10 years presented with acute appendicitis were included. Patients demographic including age, sex and body mass index were recorded after written consent. Patients were equally divided into two groups. Group I consist of 120 patients and received laparoscopic appendectomy and Group II with 120 patients received open appendectomy. Outcomes such as surgical site infection, hospital stay and time duration of procedure were examined and compare the results between both groups. Data was analyzed by SPSS 23.0. P-value <0.05 was set as significant. Results: There were 140 (58.3%) patients (70 Group I, 70 Group II) were male with mean age 25.7+6.54 years while 100 (41.7%) patients (50 Group I, 50 Group II) were females with mean age 26.9+3.12 years. No significant difference regarding BMI between both groups p=>0.05. There was a significant difference in term of surgery time duration between both groups 48.24+9.59 minutes Vs 35.74+6.86 minutes; P=0.001. No significant difference observed in term of hospital stay (p=0.345). 11 (9.2%) patients in Group II in which 5.83% had Superficial SSI and 3.7% had Deep SSI. 9 (7.5%) patients 5% superficial and 2.5% Deep SSI in Group I had developed surgical site infection with no significant difference (p=0.41). Conclusion: We concluded in this study that open appendectomy is better in term of operative time as compared to laparoscopic appendectomy. We found no significant difference regarding surgical site infection and hospital stay. Keywords: Acute appendicitis, Appendectomy, Laparoscopic, Open, Outcomes


2018 ◽  
Vol 91 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Orest Lerchuk ◽  
Ia. P. Feleshtynskyi ◽  
V.V. Smishchuk ◽  
V. F. Vatamaniuk ◽  
S. A. Svyrydovskyi

The use of the anterior technique of the abdominal wall components separation combined with ‘onlay’ aloplasty (ACST + onlay) in giant incisional hernias (IH) may pose a surgical challenge as it does not exclude increased intra-abdominal pressure (IAP) and the occurrence of abdominal compartment syndrome (ACS). There remains a high incidence of the surgical site complications. In our view, the use of intra-abdominal aloplasty combined with the anterior separation of the anterior abdominal wall components (ACST + IPOM) will contribute to the improvement of surgical outcomes in giant IH. Purpose: to improve the results of surgical treatment of giant IH by the use of ACST + IPOM. Materials and methods. Analysis of surgical treatment of 164 patients with giant IH aged 30 to 75 years (mean age 54.7 ± 3.3). Depending on the surgery, the patients were divided into 2 groups. Group I (82 patients) consisted of patients who underwent our modified technique, including ACST + IPOM. The surgery in group II (82 patients) involved ACST + onlay. Results and discussion. As compared with ACST + onlay, ACST + IPOM surgery contributes to a significantly reduced incidence of ACS [6.1% (group II) versus 0 (group I), (p <0.05)], seroma [25.6% versus 7.3%, p <0.05], surgical site infection (SSI) [4.9% versus 2.4%, p> 0.05], meshoma [3.7% versus 0] and hernia recurrences [6.5% versus 1.6%, p> 0.05]. Conclusions. IAP value equal or exceeding 9.1 mmHg (1.2 kPa) during the surgery in approximated rectus muscles is prognostic for ACS occurrence and requires intraoperative preventive measures. Utilization of ACST + IPOM in giant IH ensures an optimal volume of abdominal cavity without a substantial increase in IAP and reduces the probability of ACS, whereas the use of ACST + onlay results in ACN in 6.1% (p <0.05) patients. A reduced contact of the mesh with the subcutaneous tissue in ACST + IPOM contributes to a significantly lower incidence of seroma [7.3% vs 25.6% (p <0.05)], surgical site infection (SSI) [2.4% vs 4.9% (p> 0.05)], postoperative wound infiltrate [2 (2.4%) vs 11 (13.4%) (p <0.05)], chronic postsurgical pain [1 (1.6%) vs 5 (8.1%) (p> 0.05)] and recurrent IH [1 (1.6%) vs 4 (6.5%) (p> 0.05)] as compared with ACST + onlay technique.


2021 ◽  
Vol 15 (8) ◽  
pp. 2375-2377
Author(s):  
Muhammad Yousaf ◽  
Shahid Khan Afridi ◽  
Gul Sharif ◽  
Wasim Ahmad ◽  
Shoaib Muhammad ◽  
...  

Aim: The aim of this study is to compare the outcomes between laparoscopic and open appendectomy in terms of surgical site infection. Study Design: Prospective/ Observational Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2021 to June 2021. Methods: In this study 200 patients of both genders with ages >10 years presented with acute appendicitis were included. Patients’ demographics including age, sex and body mass index were recorded after written consent. Patients were equally divided into two groups. Group I consist of 100 patients and received laparoscopic appendectomy and Group II with 100 patients received open appendectomy. Outcomes such as surgical site infection, hospital stay and time duration of procedure were examined and compare the results between both groups. Data was analyzed by SPSS 26.0. P-value <0.05 was set as significant. Results: There were 120 (60%) patients (60 Group I, 60 Group II) were males while 80 (40%) patients (40 Group I, 40 Group II) were females. Mean age in group I was 27.9+4.45 years and in group II mean age was 28.5+4.21 years. Mean BMI in group I was 24.08+8.22 kg/m2 and in group II mean BMI was 25.03+6.17 kg/m2. There was a significant difference in term of surgery time duration between both groups 42.88+13.75 minutes Vs 33.35+9.55 minutes; P=0.003.Hospital stay was greater in group II 6.03+3.12 days as compared to group I 4.07+6.13 days. Post operatively less SSI was found among laparoscopic group 6 (6%) in which 4% had superficial SSI and 2% had deep SSI as compared to group II 12 (12%) SSI was found among in which 8% had superficial SSI and 4% had deep SSI. Conclusion: We concluded in this study that laparoscopic appendectomy is better in terms of less hospital stay with less surgical site infection as compared to open appendectomy. We found that less operative time was observed in open appendectomy as compared to laparoscopic. Keywords: Appendectomy, Outcomes, Laparoscopic, Open, Acute appendicitis


2012 ◽  
Vol 5 (1) ◽  
pp. 37-43
Author(s):  
ABMM Alam ◽  
M Moniruzzaman ◽  
MB Alam ◽  
N Islam ◽  
F Khatoon ◽  
...  

Background: CIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction.Methodology: This was a prospective study conducted among the patients who underwent coronary angiography and percutaneous coronary intervention in the Department of Cardiology, Dhaka Medical College Hospital during January 2010 to December 2010. A total of 111 patients age range from 25 to 75 years were included in the study. Serum creatinine level at baseline and at the end of 48 hours was done in all these patients. Study population was divided into two groups according to development of acute kidney injury (AKI). Group-I = AKI, Group II = Not developed AKI. Results: AKI developed 11.7% of the study patient. DM and Preexisting renal insufficiency were significantly higher in group I patients. HTN was (61.5% Vs 44.9%) higher in group I but not significantly. History of ACE inhibitor/ARB, NSAID intake and LVEF <40% were significantly higher in group I patients. The mean±SD volume of CM (Contrast Media) were 156.9±44.8 ml and 115.4±30.0 ml in group I and group II respectively, which was significant. The mean±SD of serum creatinine after 48-72 hours of CAG/PCI was 1.4±0.37 mg/dl and 1.1±0.2 mg/dl in group I and group II respectively. The serum creatinine level increased significantly (p<0.05) after 48-72 hours of CAG/PCI in group I. In group II, S. creatinine level increased but not significant (p>0.05). Impaired renal function was found 76.9% and 2.0% in group I and group II respectively. DM, HTN, preexisting renal insufficiency, ACE inhibitor/ARB, NSAIDs, contrast volume (>150 ml), eGFR (<60 ml/min/ 1.73m2) and LVEF (<40%) are significantly (p0.05) associated for CIN development.Conclusion: CIN is an iatrogenic but preventable disorder results from the administration of contract media. Although rare in the general population, CIN occurs frequently in patients with underlying renal dysfunction and diabetes. In patients with pre angiographic normal renal function, the prevalence is low but in pre-existing renal impairment it may pose a serious threat. Thus risk factors are synergistic in their ability to predispose to the development of CIN. A careful risk-benefit analysis must always be performed prior to the administration of contrast media to patients at risk for CIN. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12227 Cardiovasc. j. 2012; 5(1): 37-43


2019 ◽  
Vol 2 (3) ◽  
pp. 137-141
Author(s):  
Padma Raj Dhungana ◽  
Rajesh Adhikari ◽  
Prem Raj Pageni ◽  
Apsara Koirala ◽  
Anand Nepal

Background: Labor is a naturally occurring physiological process associated with uterine contractions, effacement, dilatation of cervix and descent of presenting part. Drotaverine hydrochloride is a non-anticholinergic isoquinoline derivative which acts by elevating intracellular cyclic Adenosine Mono Phosphate (cAMP) and cyclic Guanosine Mono Phosphate (cGMP) promoting smooth muscle relaxation. Materials and Method: This was a hospital based prospective study on effectiveness of Drotaverine Hydrochloride on enhancing dilatation of cervix and acceleration of active phase of labor. The sample size was 100. Fifty cases of women in active phase of labor received injection drotaverine hydrochloride 40 mg (group i) and fifty cases of women did not receive any drug (group ii) among those at term with singleton pregnancy and vertex presentation. Variables like maternal age, interval between administration of drug and delivery, mode of delivery, apgar score at 5 minutes, NCU (Neonatal Care Unit) admission and neonatal outcomes were recorded. Data analysis was done with the help of SPSS program. Results: The mean interval between drug administration to delivery in primipara and multipara in group i was 3.05 hours and 2.31 hours while in group ii was 4.5 hours and 3.75 hours respectively. The mean interval between drug administration and delivery was shorter in both groups of multipara. In group i, 96% had normal delivery and 4 % had vacuum delivery and in group ii 90% and 10% had normal delivery and vacuum delivery respectively. None of the participants had caeserian section. There were no perinatal mortalities. Conclusion: The administration of drug Drotaverine Hydrochloride is effective in shortening duration of labor with favorable feto-maternal outcome.  


2010 ◽  
Vol 12 (5) ◽  
pp. 525-532 ◽  
Author(s):  
Kyeong Hwan Kim ◽  
Sang-Ho Lee ◽  
Dong Yeob Lee ◽  
Chan Shik Shim ◽  
Dae Hyeon Maeng

Object The purpose of the present study was to evaluate the efficacy of anterior polymethylmethacrylate (PMMA) cement augmentation in instrumented anterior lumbar interbody fusion (ALIF) for patients with osteoporosis. Methods Sixty-two patients with osteoporosis who had undergone single-level instrumented ALIF for spondylolisthesis and were followed for more than 2 years were included in the study. The patients were divided into 2 groups: instrumented ALIF alone (Group I) and instrumented ALIF with anterior PMMA augmentation (Group II). Sixty-one patients were interviewed to evaluate the clinical results, and plain radiographs and 3D CT scans were obtained at the last follow-up in 46 patients. Results The mean degree of cage subsidence was significantly higher in Group I (19.6%) than in Group II (5.2%) (p = 0.001). The mean decrease of vertebral body height at the index level was also significantly higher in Group I (10.7%) than in Group II (3.9%) (p = 0.001). No significant intergroup differences were observed in the incidence of radiographic adjacent-segment degeneration (ASD) or in terms of pain and functional improvement. The incidences of clinical ASD (23% in Group I and 10% in Group II) were not significantly different. There was 1 case of nonunion and 3 cases of screw migration in Group I, but none resulted in implant failure. Conclusions Anterior PMMA augmentation during instrumented ALIF in patients with osteoporosis was useful to prevent cage subsidence and vertebral body collapse. In addition, PMMA augmentation did not increase the nonunion rate and incidence of ASD.


2004 ◽  
Vol 23 (8) ◽  
pp. 413-419 ◽  
Author(s):  
Cetin Kaymak ◽  
Ela Kadioglu ◽  
Hulya Basar ◽  
Semra Sardas

In this study, genotoxic effects of repeated sevoflurane anaesthesia were investigated in rabbits with or without antioxidant supplementation. Twenty-one New Zealand male rabbits were included in the study and randomized into three groups as: placebo treated (Group I), vitamin E supplemented (Group II) and selenium supplemented (Group III). Vitamin E and selenium were given intraperitoneally for 15 days before anaesthesia treatment. Anaesthesia was administered using 3% sevoflurane in 4 L/min oxygen for a 3-hour period and continued for 3 days. Blood samples were collected before anaesthesia (Sample 1), after the first, second and third days of sevoflurane administration (Sample 2, Sample 3 and Sample 4 respectively) and the last samples were taken 5 days after the last sevoflurane administration (Sample 5). Genotoxic damage was examined using the comet assay. The degree of damage is assessed by grading the cells into three categories of no migration (NM), low migration (LM) and high migration (HM) depending on the fraction of DNA pulled out into the tail under the influence of the electric field. The number of comets in each sample was calculated (1 × number of comets in category NM + 2 × number of comets in category LM + 3 ×number of comets in category HM) and expressed as the total comet score (TCS), which summarizes the damage frequencies. In Group I, a significant increase in the mean TCSs was observed for Samples 3 and 4 as compared with Sample 1. However, there were no significant differences between Samples 1, 2 and 5. The mean TCS of Sample 4 was significantly higher than Sample 1, 2 and 3 in Group II. Group III demonstrated no significant mean TCSs for any experimental conditions. Statistical differences were also observed between the groups with significant P values. This experimental study points out the presence of DNA damage with repeated sevoflurane anaesthesia and the genoprotective role of antioxidant supplementation on DNA damage in mononuclear leukocytes of rabbits by highly sensitive comet assay.


1998 ◽  
Vol 39 (5) ◽  
pp. 538-542 ◽  
Author(s):  
R. Andresen ◽  
S. Radmer ◽  
D. Banzer

Objective: the clinical value of spinal quantitative CT (sQCT) and the structural patterns of the vertebral bone were studied Material and Methods: sQCT was performed on 246 patients with a mean age of 57 years for whom conventional lateral radiographies of the thoracic and lumbar spine were available. All patients were suffering from back pain of unknown etiology. the bone mineral density (BMD) of the midvertebral section of 3 lumbar vertebral bodies was determined by means of single-energy-(SE)-weighted QCT (85 kV). Spongiosa architecture and density profile analyses were made in the axial images. This was contrasted to BMD values ascertained in SE QCT. the mean BMD was compared to the number of fractures and the patients were divided into three groups: group I — no fracture; group II — one fracture; and group III 1 fracture Results: the mean BMD was: 134.3 (74.1–187.5) mg hydroxyapatite (HA)/ml in group I; 79.6 (58.6–114.3) mg HA/ml in group II; and 52.4 (13.1–79.1)mg HA/ml in group III. A significant deterioration in spongiosa structure was found with increasing demineralization: strongly rarefied patterns predominated in the fracture groups II and III Conclusion: sQCT provides a good risk assessment of the occurrence of vertebral body insufficiency fractures


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