Evaluation of laparoscopic appendectomy proficiency in the management of acute appendicitis based on anatomy and pathologies

Background and objective: Laparoscopic appendectomy entered a controversial dilemma for choosing a perfect approach for appendectomy. Evaluation studies may resolve this controversy. This study aimed to evaluate laparoscopic appendectomy proficiency depending on anatomy and pathology. Methods: A total of 148cases managed by laparoscopic appendectomy were studied from 2014 to 2015.These cases were diagnosed clinically and by investigations. Parameters studied were operation duration, conversion rate, complications, associated pathology, rehabilitation, and histopathology. Results: By laparoscopy, the anatomical position of the appendix was easily recognized in 83.78%of cases, while the position of 16.22 %of cases was difficult because of the hidden appendix by adhesions, complications, and technical causes. The operation duration ranged between 34 and 60 minutes. Associated pathologies were demonstrated in 8% of cases. Regarding discharge from the hospital, 30% were on the same day, 50% on the first postoperative day, and 20% on the second postoperative day. Postoperative complications were 3% due to pelvic hematoma, port site infection, and bleeding. Postoperative pain was experienced in 3% of cases. The conversion rate was 4.7%. Rehabilitation was within 8-10 days. Conclusions: Laparoscopic appendectomy is safe and suitable for various anatomical positions of the inflamed appendix, suspicious, hidden, and in the presence of other pathologies with a properly placed port can play diagnostic and therapeutic roles. Significant superiority of laparoscopic appendectomy was observed in this study for the management of acute appendicitis and its pathological consequences. The conversion rate was 4.7% due to other pathologies. Keywords: Laparoscopic; Appendectomy; Anatomy; Pathology.

Symptomatic pelvic hematoma following hysterectomy: risk factors, bacterial pathogens and clinical outcome

Background Pelvic hematoma is a common finding following hysterectomy which at times may become infected causing substantial morbidity. The aim of this study was to describe the incidence, clinical manifestation and identify risk factors for infected pelvic hematoma. We also attempted to identify specific bacterial pathogens which may cause this phenomenon. Methods We conducted a retrospective cohort study at a tertiary university teaching hospital. Included were all women who underwent hysterectomy and were diagnosed with a pelvic hematoma following surgery from 2013 to 2018. In an attempt to assess possible risk factors for infected pelvic hematoma women with asymptomatic pelvic hematoma were compared to women with an infected pelvic hematoma. Results During the study period 648 women underwent hysterectomy at our medical center. Pelvic hematoma was diagnosed by imaging in 50 women (7.7%) including 41 women who underwent vaginal hysterectomy and 9 women who underwent abdominal hysterectomy. In 14 (2.2%) cases the hematoma became infected resulting in need for readmission and further treatment. Women who underwent vaginal surgery were more likely to return with infected pelvic hematoma compared to women who underwent open abdominal or laparoscopic surgery (4.5% vs. 1.1%, p < 0.05). In 8 women bacterial growth from hematoma culture was noted. Enterococcus faecalis, was the most abundant pathogen to be isolated in this sub-group. Conclusion Vaginal route of hysterectomy is a risk factor for infected pelvic hematoma following hysterectomy. Most of these infections were caused by anaerobic bacteria which may not be sufficiently covered by current antibiotic prophylactic regimens.

A CLINICAL CASE OF MANAGEMENT OF A PATIENT WITH A HEMATOMA OF THE SMALL PELVIS AFTER THE FOLLOW-UP PUNCTION

Pelvic hematoma arises up to 12% of all cases in the practice of assisted reproductive technologies as a complication after follicle puncture