Outcomes of management of intestinal obstruction at an urban tertiary hospital in sub Saharan Africa: a cross-sectional study

Background Intestinal obstruction (IO) is a common cause of acute abdomen globally, it remains challenging as it increases surgical financial expenditure while also causing major morbidity. Clinically it presents with nausea, vomiting, colicky abdominal pain and cessation of bowel movements or passage flatus and stool. Diagnosis, especially in resource limited settings, can be clinical but is usually confirmed radiologically. We studied the current diagnosis, management and outcomes of IO in Mulago Hospital. Materials and methods This was a prospective study done at all the surgical units of Mulago from January to May 2014 to assess general diagnosis and management of IO. Ethical approval was got in line with Helsinki declaration, we used pretested and validated questionnaires to collect data. Informed consent was got with eligible and consenting/assenting patients that fitted the inclusion criteria of age and presenting with suspected intestinal obstruction. Uni-variate and bi-variate variables analysis was done plus measures of association. Results We enrolled 135 patients, excluded 25 and recruited 110 patient. We had more males than females i.e. 71.8% males and 28.2% females. Colicky abdominal pain, abdominal distension, and vomiting were commonest symptoms, then abdominal distension, increased bowel sounds and abdominal tenderness were the commonest signs. Most patients’ (51%) were diagnosed radiologically with a lesser number clinically diagnosed. “Dilated bowel loops” was the commonest radiological sign. Surgery was the main stay of management at 72.7% while 27.3% were conservatively managed. Postoperatively the bowels opened averagely on the 3rd post-operative day (POD) with return of bowel sounds occurring on 5th POD. Most discharges (73%) occurred by the 7th POD. Unfavourable outcomes were prolonged hospital stay followed by wound sepsis (surgical site infection) and then Mortality. Conclusion This study noted that In Mulago we mostly diagnosed patients radiologically with most surgically managed and which is similar to regional practices. Postoperatively bowel opening happening on third POD with return of bowel sounds on fifth POD. Prolonged hospital stay followed by wound sepsis and then mortality were commonest unfavorable management outcomes.

Scoliosis in Children: Impact of Goal Directed Therapies on Intra-operative and Postoperative Outcomes

Background: Scoliosis is among interventions with high postoperative complication rates due to the characteristics of the surgery where blood loss, transfusion and fluid requirements can be increased. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort there were patients who underwent scoliosis surgery and a secondary analysis to describe outcomes in these patients was realized and presented here.Objective: To describe intraoperative and postoperative outcomes in patients under 18 years old in scoliosis surgery included in the initial study and to propose improvement implementation measures.Methods: Secondary analysis of patients in scoliosis surgery. The study was approved by the Ethics Committee.Results: There were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight patients (24.1%) presented intraoperative and or postoperative complications. The most common intraoperative complication was hemorrhagic shock in 3 patients (2.6%). The most common postoperative organ failure was neurologic in seven patients (6%), respiratory in 3 patients (2.6%), cardio-circulatory in 2 patients (1.7%) and renal failure in one patient (0.9%).The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in three patients (2.6%), abdominal sepsis and septicemia in two patients (1.7%) respectively.Twelve patients (10.3%) had reoperations. Fifty-six patients (48.3%) had intraoperative transfusion.There was no in-hospital mortality.Conclusion: Integrating goal directed therapies in this surgical setting could improve postoperative outcomes

TO COMPARE THE TYPE OF WOUND INFECTION OF SINGLE DOSE VERSUS CONVENTIONAL (MULTIPLE DOSES) ANTIBIOTIC USE IN LAPAROSCOPIC CHOLECYSTECTOMY IN TERMS OF TYPE OF SSI (SUPERFICIAL INCISIONAL SSI OR DEEP INCISIONAL SSI)

Background: To compare the type of wound infection of single dose versus conventional (multiple doses) antibiotic use in laparoscopic cholecystectomy in terms of SSI Methods: This study was carried out in the department of General Surgery Indira Gandhi Medical College Shimla (H.P.) on patients admitted with radiologically proven cholelithiasis. Results: In SD group out of 03 patients who developed wound sepsis all were having Superficial incisional SSI and in C group also all patients (02) who developed wound sepsis had superficial incisional SSI. Conclusion: The type of infection wise difference in both groups was found insignificants. Keywords: Superfical, Deep, Gallstone, Wound sepsis

TO COMPARE THE EFFICACY OF SINGLE DOSE VERSUS CONVENTIONAL (MULTIPLE DOSES) ANTIBIOTIC USE IN LAPAROSCOPIC CHOLECYSTECTOMY IN TERMS OF SSI

Background: To compare the efficacy of single dose versus conventional (multiple doses) antibiotic use in laparoscopic cholecystectomy in terms of SSI Methods: This study was carried out in the department of General Surgery Indira Gandhi Medical College Shimla (H.P.) on patients admitted with radiologically proven cholelithiasis. Results: In SD group of patients out of 50 patients, 03 patients (6%) developed wound sepsis and in C group 02 patients (4%) developed wound sepsis. P value was 0.65 which is statistically insignificant. Conclusion: The wound sepsis wise difference in both groups was found insignificants. Keywords: Single dose, Conventional, Gallstone, Wound sepsis

Scoliosis in Children: Impact of Goal Directed Therapies on Intra-operative and Postoperative Outcomes

Background: Scoliosis is among interventions with high postoperative complication rates due to the characteristics of the surgery, where blood loss, transfusion and fluid requirements can be increased.A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary analysis to describe outcomes in these patients was realized and is presented here.Objective: To describe intraoperative and postoperative outcomes in patients under 18 years old in scoliosis surgery included in the initial study and to propose improvement implementation measures.Methods: Secondary analysis of patients undergoing scoliosis surgery. The study was approved by the Ethics Committee.Results: There were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight patients (24.1%) presented intraoperative and/or postoperative complications. The most common intraoperative complication was hemorrhagic shock in 3 patients (2.6%). The most common postoperative organ failure was neurologic in seven patients (6%), respiratory in 3 patients (2.6%), cardio-circulatory in 2 patients (1.7%) and renal failure in one patient (0.9%).The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in three patients (2.6%), and abdominal sepsis and septicemia in two patients (1.7%).twelve patients (10.3%) had reoperations.Fifty-six patients (48.3%) had intraoperative transfusion.There was no in-hospital mortality.Conclusion: Integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.

Pre-term Infants in Major Abdominal Surgery and Postoperative Outcome

Background: A monocentric observational study was undertaken in pediatric surgical patients in neurosurgery, abdominal and orthopedic surgery to determine predictors of postoperative outcome. In this cohort of 594 patients with a mean age of 90.86±71.80 months there were 25 pre-terms aged less than 37 weeks. A description of postoperative outcome was undertaken in these pre-term infants. Objective: The objective of this study was to describe the characteristics in pre-term patients in this initial cohort. Methods: Secondary analysis of pre-term patients included in the initial retrospective observational study. The Ethics Committee approved the study. Results: 25 pre-terms aged <37 weeks were included with a mean weight of 2.43±0.75 kg in major neonatal abdominal surgery. 9 patient presented postoperative complications among which 1 had an intra-operative cardiac arrest, 4 had postoperative respiratory failure, 2 had pulmonary sepsis, 1 had surgical wound sepsis, 1 had septicemia and 1 had multi-organ sepsis. Conclusion: In this cohort of 25 critically ill pre-terms in major neonatal abdominal surgery, the most common postoperative complications concerned the respiratory system which included respiratory failure and pulmonary sepsis. There was no in-hospital mortality.

The role of the Kazan surgical school in better understanding of sepsis

The work aims to give a clinical assessment of the scientific research of representatives of the Kazan surgical school in the 4060s of the last century on the problem of sepsis and to consider the practical significance of the results obtained in the light of modern concepts about the purulent-septic disease, as well as to study the effectiveness of the methods used to reduce mortality in wound sepsis. The representatives of the Kazan surgical school were among the first physicians in the national medical society to substantiate the key role of the local focus/foci and generalization of infection in the development of sepsis. They first laid the foundations for the prevention of generalization of infection from the primary focus as the main factor for developing sepsis. Their data on the role of bacteremia in the etiology of sepsis and the prevention of fulminant sepsis are still relevant. These achievements remain priorities for the domestic surgical school and have become part and parcel of the international guidelines 2016 on sepsis (Sepsis-3).

Antibiotic prophylaxis in cesarean sections: a tertiary care hospital based survey

Background: The objective of the study was to study the pattern of prophylactic antibiotics usage in caesarean sections in Indian settings.Methods: A cross-sectional observational study was done on women undergoing elective and emergency caesarean sections in the Department of obstetrics and gynecology who were given antibiotics according to the existing trends in the hospital.Results: Almost 72% women received prophylactic antibiotics within 30-60 minutes of skin incision while rest 28% received it before 60 minutes. In post-operative period around 80% of the women received injectable antibiotics for 48 hours, 12% for 72 hours and rest 8% received antibiotics for more than 72 hours. 90% of the patients received injections ceftriaxone 1 gm IV BD, gentamycin 80 mg IV BD metronidazole 400 mg iv TDS while 10% received injection Ampicillin 500 mg QID along with Injection Metronidazole 400 mg iv TDS and injection gentamycin 80 mg IV BD. Two percent of the cases developed wound sepsis and required change to higher antibiotics.Conclusions: In spite of recommendations by International Guidelines for single dose of prophylactic antibiotics, multiple doses are being given. There are no Indian guidelines for antibiotic prophylaxis in cesarean sections and as a result, various combinations of antibiotics are being given for variable duration leading to antibiotic resistance and increased cost of treatment.

IL-7 Immunotherapy in a Non-Immunocompromised Patient with Intractable Fungal Wound Sepsis

A non-immunocompromised patient developed life-threatening soft-tissue infection with Trichosporon asahii, Fusarium, and Saksenaea that progressed despite maximum anti-fungal therapies and aggressive debridement. IL-7 immunotherapy resulted in clinical improvement, fungal clearance, reversal of lymphopenia, and improved T-cell function. Immunoadjuvant therapies to boost host immunity may be efficacious in life-threatening fungal infections.

A clinico-epidemiological study of complicated external hernia

Background: Abdominal wall hernias are among the most commonly encountered surgical problem. Irreducibility, obstruction, and strangulation are its commonest complications which usually presents as acute emergencies. Emergency repair of complicated hernias is associated with poor prognosis and a high rate of postoperative complications even with better care, improved anesthetic management and advanced surgicaltechniques. Methods: The aim of the study was to evaluate incidence, morbidity, and mortality in complicated hernia and to compare with it non-complicated hernia. This study was conducted in the Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, from July 2018 to December 2019 on twenty-eight patients of complicated hernia and compared with similar no of uncomplicated hernia patients. Results: The mean age of the patients was 52 years with male to female ratio of 11:3 in the complicated external hernia group. The majority of the patient (60.7%) underwent herniorrhaphy, followed by hernioplasty (14.3%). Most of the patients (89.2%) survived without any post-operative morbidity, 7.1% of them developing wound sepsis while 3.5% of patients died after surgery due to septic shock. Conclusion: Complicated external hernias occur in all age groups but are more common in older age and show preponderance in males. All patients present with irreducible swelling with no cough impulse. The indirect inguinal hernia is the most common type and herniorrhaphy is the most preferred operative procedure in the complicated hernia. Wound sepsis was the most common complication. Morbidity and mortality may be attenuated with proper surgical and post-operative management. Keywords: Abdominal wall hernia; complicated hernia; herniorrhaphy; hernia