A comparative prospective study of laparoscopic guided needle assisted hernial sac ligation versus open herniotomy surgery in congenital inguinal hernia management

Background: To evaluate if significant difference exists in surgical outcome following laparoscopic guided needle assisted congenital hernial sac ligation versus conventional open Herniotomy as later is treatment of congenital hernia and laparoscopy guided emerged as newer alternative. Objective was to know whether a significant difference exists in surgical outcomes following laparoscopic guided needle assisted congenital hernial sac ligation and conventional herniotomy in terms of mean operative time, post operative pain, recurrence, local complication, cosmetic results.Methods: Patients were randomized on basis of odd and even registrations for surgery in our institute. Patients who undergone laparoscopic guided needle assisted congenital hernial sac ligation or who undergone conventional open herniotomy for congenital hernia between November 2018 to April 2020 (50 in each arm) were followed for 1, 3, 6 and 12 months to evaluate the outcomes.Results: In our study, major complication in open herniotomy group was surgical site infection (22%), hematoma (10%), intra operative bleeding (16%), seroma formation (8%) with minimum operative duration was ~60 minutes, hospital stay of 2-3 days while no such complication reported in laparoscopic guided needle assisted hernia sac ligation group being operative time of ~20 minutes, hospital stay of 1 day with better cosmetic results.Conclusions: We conclude that laparoscopic guided needle assisted hernial sac ligation is simple, safe, efficacious with its own advantage in comparison to conventional open herniotomy and should be acceptable alternative to traditional open herniotomy approach for congenital hernia.

Splenocystojejunostomy for the treatment of a symptomatic splenic pseudocyst

Pancreatic pseudocyst is a widely recognised local complication following acute pancreatitis. Typically occurring more than four weeks after acute pancreatitis, a pseudocyst is a mature, encapsulated collection found within the peripancreatic tissues manifesting as abdominal pain, structural compression, gastroparesis, sepsis and organ dysfunction. Therapeutic interventions include endoscopic transpapillary or transmural drainage, percutaneous catheter drainage and open surgery. We present our management of idiopathic chronic pancreatitis complicated by a pancreatic pseudocyst extending to the splenic capsule in a 38-year-old man. A trial of conservative management was sought, but later escalated to percutaneous fluoroscopic drainage. Despite a period of volume reduction of the pseudocyst, reaccumulation occurred. We describe successful surgical treatment via means of a splenocystojejunostomy and subsequent pain reduction.

ANALISIS PENGARUH PENGGANTIAN RUTIN PENUSUKAN KATETER INTRAVENA DAN PENGGANTIAN SET INFUSE TERHADAP TERJADINYA PLEBITIS DI RS SINT CAROLUS JAKARTA

ABSTRAKPemasangan infus adalah prosedur umum pada pasien di rumah sakit dimana komplikasi yang umum terjadi adalah plebitis. Tujuan penelitian untuk menganalisa pengaruh penggantian rutin penusukan dan penggantian set infuse terhadap kejadian phlebitis. Metoda penelitian kuntitatif, desain Kohort, sample pasien dewasa diambil secara purposif sebanyak 247 sample, dilakukan pengamatan tusukan infuse sejak pemasangan sampai pencabutan. Data dikumpulkan menggunakan lebar observasi dan VIP score (Visual infusion phlebitis score). Hasil analisa mayoritas responden perempuan 140 (56.7%), rata-rata berusia 48.9 tahun, penyakit noninfeksi 151 (61.1%), nomor kateter iv 22: 193 (78.1%), lokasi penusukan di tangan 173 (70%), pemberian cairan isotonik 181 (73.3%), pemberian terapi bolus satu jenis 89 (36%), mendapat terapi drip 142 (57.5%), lama pemasangan 4 hari 63 (25.5%), tidak ada penggantian tusukan iv 169 (68.4%), set infuse drip diganti setiap pemberian 91 (36.8%) dan skala plebitis satu 12,6%. Analisa bivariateKendal’s tau C ada hubungan pemberian terapi iv bolus (p=0.03), lama pemasangan kateter iv (p=0.00) terhadap terjadinya plebitis (p<0.05). Uji Regresi logistik didapatkan variabel independen memberikan kontribusi kejadian plebitis sebesar 24.5%. Uji probabilitas disimpulkan responden yang tidak diganti tusukan infuse rutin dan set drip secara rutin berisiko plebitis sebesar 100%. Diskusi: Hasil penelitian ini menyimpulkan pentingnya penggantian kateter intravena perifer dan penggantian set infuse untuk pemberian terapi drip secara rutin untuk mencegah terjadinya plebitis. Kesimpulan: penelitian lebih lanjut menganalisa faktor risiko plebitis diluar faktor yang telah diteliti seperti faktor tetesan dan ketrampilan perawat dalam pemasangan infuse. Kata kunci :Penggantian Kateter Intravena, Set Infus, Plebitis ABSTRACTThe insertion of peripheral intravenous catheters is a common practice in hospitals, where Phlebitis is the main local complication. This study attempts to analyze relationship of routine replacement Intravenous catheter insertion and routine replacement Intravenous infusion set to phlebitis. A quantitative-cohort design was used in this study. Purposive sampling was utilized involving 247 adult patients. The observation was conducted from insertion until intravenous catheters was retracted and the data was assessed using observation tool and VIP score (Visual infusion phlebitis score). The results found that the majority respondents were female (56.7%), average age of 48.9 years old, diagnosed with noninfectious diseases (61.1%), utilized intravenous catheter number 22 (78.1%), hand insertion location (70%), received isotones fluid (73.3%) with single bolus therapy (36%), received drip infusion (57.5%), duration of intravenous catheter of 4 days (25.5%), no intravenous replacement (68.4%), infusion drip replaced after therapy (36.8%) and a phlebitis scale of 12.6%. Kendal’s tau C statistical analysis revealed that there issignificant relationship between phlebitis and intravenous therapy (p = 0.03), duration of intravenous catheter (p = 0.00). Logistic regression test showed that independent variable contributed 24.5% to phlebitis. The probability test concluded that respondents who were not replacing Intravenous catheter insertion and Intravenous infusion setregularly may develop phlebitis risk of 100%. It is implied the importance of replacement intravenous catheter and Intravenous infusion setroutinely to prevent phlebitis. For further research, it is suggested to analyze the risk factors of phlebitis such as nurse skills for intravenous catheter insertion.Keyword: replacement Intravenous catheter insertion, infusion set, Phlebitis

Scalpel or Sheath? Outcomes Comparison Between Pre-Peritoneal Pelvic Packing and Angioembolization for Definitive Hemorrhage Control After REBOA

ABSTRACT Background: The role of angioembolization (AE) and pre-peritoneal pelvic packing (PPP) for pelvic hemorrhage control in the era of REBOA has not been well described. Our aim was to investigate outcomes of PPP and AE after REBOA. Methods: Patients who received aortic occlusion (AO) at Zone 3 (distal abdominal aorta) plus PPP and/or AE at 3 high-volume REBOA centers between February 2013 and December 2018 were identified. Outcomes were compared between 3 groups based on procedures performed: REBOA with PPP only (RPPP), REBOA with angioembolization only (RAE), and REBOA with PPP and AE (RPPPAE). Results: 58 patients underwent REBOA at Zone 3; 37 RPPP, 13 RAE, 8 RPPPAE. Mean age was 45±16 years, mean injury severity score (ISS) 35±13, mean SBP pre-AO was 71±19mmHg, and post-AO SBP was 110±34mmHg. In-hospital mortality was 28%, with the majority of deaths occurring in the intensive care unit (17%). Age, ISS, admission SBP, physiology on admission and at the time of AO, response to AO, admission hemoglobin, blood products transfused, and rate of local wound infections were not different between RPPP and RAE groups. Comparing RPPP to RAE groups, duration of AO was significantly lower in the RPPP group (45+34 vs 81+37 mins, p=0.012), while rates of AKI (14% vs 46%) and distal embolism (8% vs 31%) were higher in the RAE group (p=0.015, 0.04 respectively).There was no statistical difference in mortality between RPPP (22%) and RAE patients (39%), including on regression analysis controlling for duration of AO and ongoing CPR at the time of AO. Conclusion: Despite a longer duration of AO and higher rates of ongoing CPR at the time of AO in RAE patients, mortality rates are similar whether hemostasis is achieved after REBOA with pelvic packing or angioembolization. RPPP results in significantly lower systemic and local complication rates.

Recent advances in understanding and managing acute pancreatitis

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

Suspected Carboplatin Extravasation Reactions in Seven Dogs

ABSTRACT Carboplatin is a platinum chemotherapeutic agent commonly used in veterinary oncology that is currently classified as an irritant to local tissues when extravasated. To the authors’ knowledge, there are no reports of vesicant injuries associated with carboplatin administration reported in the veterinary literature. In this case series, seven dogs are described to have experienced injuries following a suspected carboplatin extravasation resembling vesicant injuries a median of 7 days after carboplatin administration (range 4–15 days). Wounds healed with a variety of treatments, including medical management and/or surgical debridement, a median of 25.5 days (range 7–49 days) after observation of the suspected extravasation injury. There were no obvious similarities involving carboplatin administration among patients to explain why these reactions occurred. Extravasation injury should be considered a possible local complication associated with carboplatin chemotherapy.

Recent advances in understanding and managing acute pancreatitis

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

Prognostic Indicator in Severe Acute Pancreatitis

Aim of study: - To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis. Material and Methods: This prospective study entitled “To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis” was carried out on patients hospitalized for acute pancreatitis in the surgery department at Chandulal Chandrakar Memorial Medical College and CM Hospital, Bhilai from March 2015 to October 2017.50 patients with the diagnosis of first attack of acute pancreatitis of both sexes and all age groups were selected for the study. Conclusion:- On the basis of observation and result of the study, it can be safely stated that APACHE II Scoring is quick, safe, reproducible, ongoing and cost effective. It can be done by resident or intelligent nursing staff. Give an idea regarding improving or worsening of patients. APACHE II Scoring system when complimented by high quality CECT abdomen can further refine the results and give an idea of likelihood of patients developing local complication. Thus it can also be used along with CECT abdomen for Risk Stratification of subset of patients who are likely to develop local complication who might need surgical intervention. CECT on 3rd day adds nothing to management. It has a tendency to over predict the regional complication, which are in anyway apart of natural course of history of disease (acute fluid collection). Management decision could not be based on CECT abdomen on 3rd day alone, since it is not needed to make a diagnosis of acute pancreatitis it should be abundant, thus reducing the financial burden of patients and institute. CECT abdomen done after 2nd week in the course of illness along with APACHE II Score and clinical finding are better guide for management and surgical intervention.