scholarly journals Laparoscopic Lavage Versus Suction Only in Complicated Acute Appendicitis: A Prospective Randomized Control Trial

2018 ◽  
Vol 103 (7-8) ◽  
pp. 371-377
Author(s):  
Imraan I. Sardiwalla ◽  
Modise Z. Koto
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Randomized Control Trial ◽  
Statistical Power ◽  
Bowel Function ◽  
Complicated Appendicitis ◽  
Excess Risk ◽  
Internal Review ◽  
Randomized Control ◽  
Four Quadrant

Background: Laparoscopic appendectomy for complicated appendicitis presents a challenge with concerns about pelvic collections. It is unclear whether lavage or if simple suctioning of pus influences complications. Methods: A prospective, single,-blinded, randomized control trial was conducted. Patients with suspected acute appendicitis were consented. Those found to have complicated appendicitis (perforation, localized pus, or four-quadrant pus) at laparoscopy were randomized to suction or lavage. Exclusions included conversions and drainage of abscess only. Lavage consisted of 3 liters of lavage. Intra-abdominal abscess that required reintervention (i.e., relook, percutaneous drainage) was the primary outcome. Hospital stay and return of bowel function were also recorded. Results: A total of 213 patients were assessed for eligibility. We excluded 157 patients, as they had simple appendicitis; 7 patients were converted to laparotomies; 5 had abscesses but the appendix was not removed. We analyzed 86 patients. The mean age was 26.6 years (14–74). We lavaged 42 (48.8%) patients and 44 (51.2%) were suctioned. Four-quadrant pus was present in 26 (30.2%) of the patients overall. Complications developed in 20 (47.5%) of the patients that were lavaged versus 12 patients (27.1%) with suction only. The difference did not reach significance due to sample size (P = 0.0739). Operative time was longer in the lavage group by 30 minutes (P = 0.086). If a complication developed, then the hospital stay was significantly prolonged 13.5 days versus 5 days (P < 0.001). The study was stopped by the internal review board due to the excess risk with lavage. Conclusions: This exploratory study into lavage versus suction only in complicated appendicitis revealed potential harm with lavage. The study was stopped prematurely by the internal review due to the excess risk experienced by the lavage group, thus the study did not reach statistical power. If a patient with complicated appendicitis developed any complication, hospital stay was longer.

scholarly journals Comparison of standard and tubeless percutaneous nephrolithotomy for renal calculi: a prospective randomized control trial

2019 ◽  
Vol 6 (4) ◽  
pp. 185
Author(s):  
Manu Muraleedharan Kamalakshi ◽  
Vasantharaja Ramasamy ◽  
Darsan Sadasivan ◽  
Sunil Raveendran ◽  
Selvam Paramasivam ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Randomized Control Trial ◽  
Renal Stones ◽  
Renal Calculi ◽  
Analgesic Requirement ◽  
Operative Duration ◽  
Significant Difference ◽  
Randomized Control ◽  
Tubeless Pcnl

<p class="abstract"><strong>Background:</strong> In the current era of minimally invasive interventions, the mainstay of treatment of renal stones larger than 2 cm is Percutaneous nephrolithotomy (PCNL). PCNL underwent various evolutionary changes minimizing morbidity to the patients. We prospectively compared the outcome of tubeless PCNL (without nephrostomy drainage tube) to reduce the pain and discomfort caused by tube with standard PCNL in the treatment of renal stones.</p><p class="abstract"><strong>Methods:</strong> In this Randomized control trial (RCT), we divided patients satisfying the inclusion criteria of consenting for trial, single access puncture, less than 3 stones each less than 3 cm, operative duration of less than 2 hours into two groups, standard PCNL (group 1) and tubeless PCNL (group 2) with 25 patients each. Randomization and group assignment were done after complete clearance of renal stones.</p><p class="abstract"><strong>Results:</strong> Patient’s age, gender, sides of stone and stone size were comparable between two groups (standard versus tubeless PCNL). Postoperative hemoglobin drop, bleeding, pyrexia, urine leak, and blood transfusion requirement did not show a statistically significant difference between the two groups. Analgesic requirement (190 mg versus 80 mg of tramadol), operative duration (49.80 min versus 38.60 min), postoperative pain score (6/10 versus 3.64/10-visual analog scale) and duration of hospital stay (68.48 hours versus 41.12 hours) showed statistically significant difference favoring tubeless PCNL.</p><p class="abstract"><strong>Conclusions: </strong>Tubeless PCNL may be a safe, acceptable and effective modality of treatment for renal calculi in carefully selected patients comparing standard PCNL resulting in less operative duration, lower postoperative pain, reduced analgesic requirement and shorter hospital stay.</p>

scholarly journals Comparative Efficacy of Phenobarbitone versus levetiracetam in the initial treatment of neonatal seizure

2020 ◽  
Vol 27 (2) ◽  
pp. 182-189
Author(s):  
Md Tafazzal Hossain Khan ◽  
Mohammed Mahfuzur Rahman ◽  
Manisha Banerjee ◽  
Md Zahir Uddin ◽  
Nurun Nahar ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Hospital Stay ◽  
Initial Treatment ◽  
Randomized Control Trial ◽  
Neurodevelopmental Outcome ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
College Hospital ◽  
Medical College ◽  
Randomized Control

Neonatal seizures are common in the first month of life and may impair neurodevelopmental outcome. Phenobarbitone (PB) currently represents the anti epileptic drug (AED) of choice, despite related to cognitive impairment in human subjects and limited efficacy. Intravenous levetiracetam is increasingly being used in the neonatal period to treat seizures. Presently, insufficient data about the efficacy and safety of intravenous levetriacetam in neonates, we have structured a randomized control trial with levetiracetam in the initial treatment of acute neonatal seizure. Objective: To find out the efficacy of levtiraracetam for controlling the convulsions in acute neonatal seizures compared to phenobarbitone. Methodology: The study was a randomized control trial. A total of 100 neonates from 0 day to 28 days of age irrespective of sex with clinical presentation of neonatal seizures admitted in the special care baby unit (SCABU) of Dhaka Medical College Hospital were included in the study and were randomly assigned to either levetiracetam or Phenobarbitone group after matching inclusion and exclusion criteria. The outcome variables were seizure control, times taken to be seizure free, and hospital stay. Outcome was evaluated through routine monitoring up to 48 hours and followed up to discharge or death. Result: The study groups were almost similar with respect to their demographic characteristics like age, sex and gestational age. According to maternal obstetric data i.e- antenatal care (ANC), modes of delivery in the both groups were statistically not significant. Seizures status was nonsignificant in both groups. The study demonstrated that controlling the seizure with levetiracetam & Phenobarbitone were 66.0% and 34.0% respectively. Length of the hospital stay was shorter in levetiracetam group. Eventually the phenobarbitone group required more than one drug to control seizures.. But immediate adverse effect was not significant in both groups. Conclusion: The study concluded that levetiracetum significantly control the convulsion in comparison to phenobarbitone as first line antiepileptic drug in the initial treatment of acute neonatal seizures. Both the modalities of treatment were found to have no adverse effect. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 182-189

Complicated Acute Appendicitis during COVID-19 Pandemic: The Hidden Epidemic in Children

2021 ◽  
Author(s):  
Carlos Delgado-Miguel ◽  
Antonio J. Muñoz-Serrano ◽  
Miriam Miguel-Ferrero ◽  
María De Ceano-Vivas ◽  
Cristina Calvo ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
Complicated Appendicitis ◽  
Number Of Patients ◽  
Novel Coronavirus ◽  
Symptom Progression ◽  
Complicated Acute Appendicitis

Abstract Introduction Since home confinement for novel coronavirus disease 2019 (COVID-19) pandemic began, pediatric visits to the emergency department (ED) have decreased, including consultation for abdominal pain. Our aim is to investigate the incidence of complicated acute appendicitis (AA; peritonitis or appendicular mass) during confinement for COVID-19 pandemic and to compare it with the previous 5 years. Materials and Methods A retrospective study was performed in children with AA who underwent surgery between March 9 and April 13 from 2015 to 2020; patients were divided into six groups according to the year of surgery. We analyzed demographic variables, time from onset of symptoms, mean hospital stay, cumulative incidence, and incidence rate of complicated appendicitis. Results A total of 168 patients were included with no differences in the number of patients, gender, and age between groups. Patients in 2020 (COVID-19 group) presented longer symptom progression time (46.8 hours; p = 0.046), higher rate of complicated appendicitis (48.4%; p = 0.004), longer mean hospital stay (4.9 days; p < 0.001), increased cumulative incidence (8.27 cases per 100,000 children per 0.1 years; p < 0.001), and increased incidence rate of complicated appendicitis (83 cases per 100,000 children; p < 0.001) when compared with other groups. Conclusion Delayed ED visit of children with AA during home confinement lead to an increased rate of complicated appendicitis. It is crucial to make parents aware of the importance of early diagnosis and treatment of abdominal pain.

scholarly journals Impact of COVID-19 pandemic on outcome of acute appendicitis: a retrospective analysis

2021 ◽  
Vol 8 (12) ◽  
pp. 3516
Author(s):  
Linganagouda S. Patil ◽  
Reena Jagadeesha
Keyword(s):  
Health Care ◽  
Observational Study ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Demographic Variables ◽  
Complicated Appendicitis ◽  
Epidemic Outbreak ◽  
Duration Of Hospital Stay ◽  
The Mean ◽  
Time Of Presentation

Background: Acute appendicitis is the most common abdominal surgical emergency. Lockdown and stay-at-home orders are strategies that were implemented globally during the acute pandemic period of COVID-19 to prevent disease dissemination, health system overload and mortality. However, there are concerns that patients did not seek necessary health care because of these rules.Methods: Retrospective observational study was conducted on patients who presented with acute appendicitis from January 2020 to May 2020. They were classified according to the time of presentation that is before declaration of the state of alarm (pre-COVID-19), and after its declaration (post-COVID-19) in India (24 March 2020). An evaluation was made of demographic variables, complications and duration of hospital stay in both the groups.Results: 45 patients were included, 20 in pre-COVID-19 group and 25 in post-COVID-19 group. In post-COVID-19 group, the interval from onset of symptoms to admission was 65.0 hour, which is significantly longer than the 17.3 hour interval noted in pre-COVID-19 group (p<0.001). The prevalence of complicated appendicitis after the epidemic outbreak was significantly higher than before the outbreak (52% versus 20%, p<0.001).The mean hospital stay was longer in post-COVID-19 group (5.6±5.9 versus 3.2±4.3 days; p=0.041).Conclusions: COVID-19 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Complicated appendicitis was more common in patients with acute appendicitis after the outbreak of COVID-19 pandemic.

scholarly journals Laparoscopic transabdominal preperitoneal inguinal repair versus open Lichtenstein repair: a randomized control trial

2017 ◽  
Vol 5 (1) ◽  
pp. 77
Author(s):  
Darshan A. Manjunath ◽  
Umeshchandra D. Gurugunti ◽  
Veerabhadra Radhakrishna
Keyword(s):  
Hernia Repair ◽  
Hospital Stay ◽  
Randomized Control Trial ◽  
Operative Time ◽  
Preperitoneal Repair ◽  
Lichtenstein Repair ◽  
Transabdominal Preperitoneal ◽  
Operative Complications ◽  
The Mean ◽  
Randomized Control

Background: There have been a plenty of evolution in surgical techniques of hernia repair. The current standard technique is tension-free repair. The different studies show different results with the use of laparoscopy in performing tension-free hernia repair. Hence a study was conducted to compare the laparoscopic transabdominal preperitoneal repair with open Lichtenstein repair regarding operative complications, pain, analgesic usage, and time to return to normal activities.Methods: A randomized control trial was conducted in the Department of General Surgery in a tertiary center from December 2010 to May 2012. All patients underwent either open Lichtenstein repair or laparoscopic transabdominal preperitoneal repair (TAPP). Both the procedures included a recording of operative time, operative complications, pain, analgesic usage, hospital stay, surgical site infection (SSI), and time to return to normal activities. Mann Whitney U test, student ‘t’ test and Fisher’s exact test were used to study the significance of the difference. A p-value <0.05 was considered significant.Results: The open Lichtenstein procedure was found to have a significantly less operative time compared to TAPP procedure (54±15 minutes vs. 75.7±31.6 minutes; p=0.001; CI=95%; Mann Whitney ‘U’ test). TAPP group had a significantly low pain at 12hrs and 24hrs postoperatively. There was no difference between the TAPP group and Lichtenstein group regarding the mean hospital stay (37.2±12.1 hours vs. 38.2±13.6 hours; p=0.7; CI=95%; Mann Whitney ‘U’ test). The mean time to return to work was 12.1±11.8 days in TAPP group, which was significantly lesser than the Lichtenstein group (20.9±4 days; p= 0.04; CI=95%; student ‘t’ test). No recurrence was found.Conclusions: Laparoscopic TAPP was a safe and effective procedure for inguinal hernia repair, and it can replace open procedure.

scholarly journals Efficacy of Local use of Metronidazole Solution among Acute Appendicitis Patients for the Prevention of Wound Infection after Appendectomy: A Randomized Control Trial

2020 ◽  
Vol 6 (1) ◽  
pp. 54-58
Author(s):  
ABM Mir Mubinul Islam ◽  
Nasima Akhter ◽  
Md Zafar Imam ◽  
Mafiur Rahman ◽  
Jalal Uddin Mohammad Rumi
Keyword(s):  
Acute Appendicitis ◽  
Wound Infection ◽  
Randomized Control Trial ◽  
Local Application ◽  
Control Group ◽  
College Hospital ◽  
Group A ◽  
Study Population ◽  
Randomized Control ◽  
Group B

Background: Prevention of wound infection after appendectomy is very important for the post-operative management of the acute appendicitis patients. Objective: The purpose of the present study was to validate the efficacy of local application of metronidazole solution in the wound after closing of peritoneum in the prevention of appendectomy wound infection. Methodology: This randomized control trial was conducted in the Department of Surgery at Rajshahi Medical College Hospital, Rajshahi, Bangladesh from July 2009 to June 2011 for a period of two years. Patients admitted with features of uncomplicated and complicated acute appendicitis (Gangrenous or perforated) underwent emergency appendectomy by grid iron incision in all the units of surgery were selected as study population. The study population were divided into two groups into group A and group B. In group A (treatment group) after closure of peritoneum the exposed tissue was washed and was flooded with 100ml of metronidazole solution with 5 gm/ml concentration and was waited for one minute and in group B (control group) with the same amount of sterile saline solution. All patients were evaluated daily for evidence of wound infection such as fever, unusual wound pain with recording of pulse, temperature. Suspected wounds were checked on 3rd, 5th and 7th POD routinely after removal of dressing. Result: A total number of 200 patients were recruited for this study and was divided into two groups in equal number. Therefore, 100 cases were in group A and the rest of 100 cases were enrolled in group B. The mean age with SD of group A and B were 25.06±9.14 years and 23.82±7.51 years respectively. Uncomplicated appendicitis was found in 66 cases and 70 cases in group A and B respectively (p>0.05). In metronidazole wound wash group only 5 patients developed wound infection, however, in saline wash group 22 patients developed infection. Among the positive cultures Staphylococcus aureus was 3 cases and Escherichia coli was in 7 cases. Conclusion: In conclusion rate of wound infection is less in the group treated with the local application of metronidazole solution after appendectomy Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 54-58

scholarly journals Primerjava laparoskopske apendektomije pri enostavnem in zapletenem vnetju slepiča

2017 ◽  
Vol 86 ◽  
Author(s):  
Matjaž Križaj ◽  
Erik Štrumbelj ◽  
Stanislav Mahne
Keyword(s):  
Postoperative Complications ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Conversion Rate ◽  
Complicated Appendicitis ◽  
Early Postoperative Complications ◽  
Stump Closure ◽  
Significant Difference ◽  
Diagnostic Modalities

Background: Laparoscopic appendectomy has been gaining ground as a gold standard for the treatment of acute appendicitis. For complex inflammation there is no common opinion. A higher conversion rate, longer operative time, higher incidence of abscess formation and longer hospitalization are being reported. The aim of our study was to compare the diagnostic modalities, treatment and postoperative complications in uncomplicated and complicated appendicitis.Methods: In our institution laparoscopic appendectomy is the method of choice for the treatment of every type of appendicitis. In our retrospective analysis, all patients with acute appendicitis operated on in the years 2013 and 2014 were included. Among 273 patients, 19 were excluded due to primary open procedure and one who underwent revision surgery for other disease and had appendectomy performed. In 253 patients we observed the proportion of the postoperative complications in uncomplicated and complicated cases with respect to patients’ age, period of the year, duration of hospital stay, diagnostic modalities, drainage of the abdominal cavity, conversion rate and stump closure.Results: The analysis showed a steep increase of complicated appendicitis in elderly population, but there were no significant differences regarding period of the year (χ2 test, p = 0.158). The hospital stay was longer in complicated cases (5.94 days v. 3.049 days). When a preoperative CT scan was performed, cases were more often complicated (CT 0.654, no CT 0.229; χ2 test, p < 0.001), as was the proportion of drain insertions during surgery (0.5490 v. 0.065; χ2 test, p < 0.001). The proportion of clips for the stump closure was higher in the uncomplicated group (0.717 v. 0.521; χ2 test, p = 0.005). The rate of early postoperative complications and conversion rate revealed no significant difference.Conclusions: We have found out there is a difference in diagnostic modalities and treatment options in uncomplicated and complicated appendicitis, but no significant difference in the conversion rate and early postoperative complications. Our analysis suggests that laparoscopic appendectomy is a safe method in all types of appendicitis.

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