Current Issue : April - June Volume : 2021 Issue Number : 2 Articles : 7 Articles
Preoperative corticosteroid use was linked to an increment in postoperative infectious complications. To determine whether corticosteroid use increases complication risks after surgical procedures, a group of patients who underwent neurosurgical procedures from 2005 to 2010 at a surgical center and took part in the National Surgical Quality improvement program was investigated. The corticosteroid use was specified as at least two weeks of parental or oral therapeutics for about amount before surgery is done. Corticosteroids played a critical role in surgical procedures since they are very important immunosuppressant drugs; they are usually used in patients to reduce inflammation, pain, and edema. In neurosurgery, corticosteroids are known to improve functional outcomes, minimize inflammation and preoperative swellings; therefore, corticosteroids are vital in the neurosurgical setting, although their risks are not clearly known. The correlation between complications and corticosteroid use before surgery was evaluated. Patients were monitored postoperatively for a duration of 30 days to point out and record any death or complications. The research is related to the NSQIP data and is exempt from any other assessment. Propensity score analysis was applied to investigate the link between preoperative corticosteroid use and postoperative complications. The findings and results were deduced using that method....
Limb salvage surgery is now the preferred procedure for bone tumor surgery. To decrease the risk of local recurrence, it is crucial to obtain adequate resection margins. The obtained margins must be evaluated postoperatively because they influence what treatment is given subsequently when margins are not adequate (e.g., surgical revision and radiotherapy). The study aims to evaluate margin assessment of tumor specimen by MRI compared to conventional histology (to establish the viability of using MRI) and assess the accuracy of a patient-specific instrument when narrow margins were aimed. The resection margins in 12 consecutive patients that were operated on for bone tumor resection were prospectively analyzed using three methods: MRI of the resection specimen, macroscopic evaluation of specimen slices, and microscopic pathological evaluation. The assessments were qualitative (R0, R1, and R2) and quantitative (distance in mm). MRI, macroscopic, and microscopic margins generated similar results for both the qualitative (all resections were R0) and quantitative assessments. The median error in safe margins was 2mm with a surgical guide (PSI) and 5mm without a surgical guide. Local recurrences were not detected after a mean follow-up period of 3.7 years (range, 2.1–5 years); however, four patients died during the study. In conclusion, MRI is a valuable tool for assessing safe margins. When specimens are not available for pathological assessment (e.g., extracorporeally irradiated autograft or autoclaved autograft), MRI could be used to evaluate margins. In particular, when tumor volume is high, MRI could also help to focus the pathological examination on areas of concern....
Lumbar hernia is a protrusion of intraperitoneal or extraperitoneal tissues through posterior abdominal wall defect and is considered to be a rare condition. We present a case of 65-year-old lady with primary spontaneous superior lumbar hernia treated laparoscopically, with the detailed operative steps and post-operative follow-up. With the growing experience in laparoscopic inguinal hernia repair, same technique, instruments and device used in transabdominal preperitoneal (TAPP) repair can be applied to treat selected cases of lumbar hernia with good outcome....
Introduction: Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis; it’s a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. Patients-Method: This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019; conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. Results: During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 3.3%; morbidity and high mortality were related to delayed consultation. Conclusion: Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management....
Introduction: Post-operative acute evisceration is defined as a total dehiscence of the abdominal wall of all the constituents of the abdominal wall. The objective is to determine hospital frequency, identify favorable factors and key etiologies, and assess the rate of morbi-mortality. Patients and Method: This is a retrospective and descriptive study carried out in the general surgery departments of the Teaching Hospitals of Point “G”, Gabriel TOURE and the pediatric surgery department of the Gabriel TOURE University Hospital in Bamako, involving 53 patients. The study ran from January 1, 2005 to December 31, 2007. Inclusion Criteria: All cases of postoperative acute evisceration operated. Non-Inclusion Criteria: All cases of evisceration of other etiologies. Results: The average age was 34.2 years with extremes of 6 and 75 years, the sex ratio was 1.12 in favor of women. The initial clinical picture was peritonitis in 26 cases or 49.1%, occlusion in 16 cases or 30.2% and tumors in 6 cases or 11.3%. The post-operative complications responsible for evisceration were: parietal suppuration 28 cases or 52.8%; digestive fistulas 15 cases or 28.3%; post-operative ascites 4 cases or 7.5%. Conclusion: Post-operative acute evisceration is a rare but serious condition due to morbidity and mortality....
Introduction: Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is the 4th most common cancer in men, the 5th in women, and the third leading cause of cancer death in men, the 5th in women. Patients and Methods: This was an analytical, prospective and descriptive study. Study Framework: Our study took place in the “A” surgery department of the Point “G” Hospital in Bamako. Study Period: August 1, 2003 to August 31, 2005. The design and preparation phase of the fact sheet lasted 1 month. The data collection phase lasted 18 months. All the patients who consulted for gastric tumor had a record. The follow-up phase of the patients lasted 6 months during which the patients were followed by appointment, by contact person or seen at home. Data entry and analysis were conducted with Epi-Info software (version 6.0). Inclusion Criteria: All patients hospitalized for gastric cancer in the “A” surgery department of the Point “G” Hospital. Result: The distribution of patients according to the evolutionary stage TNM was: Stage IV (50 cases, or 64.94%); Stage III (21 cases, or 27.27%); Stage II (6 cases, or 7.79%). In our series the average age was 59 with extremes of 20 to 85 years. The most represented age group was 46 - 65 years. Men were 60 cases (77.90%) 17 cases for women (22.10%). The sex ratio was 3.53 in favor of men. All 77 patients were recruited during the outpatient clinic, including 55 patients referred by a physician and 20 patients who came by themselves. Esogastroduodenal fibroscopy was performed in all of our patients. The tumor was localized: to the cardia in 10 cases; cardiac fundus in 2 cases; antrum in 24 cases; antro-pyloric in 28 cases; Pylorus in 1 case; great curvature in 5 cases; small curvature in 2 cases. Postoperative complications were: parietal infection in 12 cases or 17.40%; digestive fistula in 3 cases and evisceration is 1.40%. The overall three-month survival rate was 51.90% and at 6 months was 48.10%. Conclusion: Stomach cancer is the most common digestive cancer in Mali. In Africa the diagnosis is usually late and the R1 lymph node dissections remain the basic technique, despite the results obtained in the Japanese series. The results of several major series argue for their effectiveness in improving patient survival....
Background: The knowledge on pericardial disease has increased but the European Society of Cardiology in the last guidelines 2015 stated a section of perspective and unmet needs referring to the surgical management as one of these needs. Here, we present an institutional experience to contribute with other studies in explanation of questionable aspects about their surgical management. Methods: Among 127 cases (93 adults and 34 children) that were diagnosed as pericardial syndrome, we retrospectively analyzed 45 cases (40 adults and 5 children) operated for pericardial syndrome from May 2012 to June 2019. Echocardiogram was the main preoperative diagnostic tool. Surgical approach was selected according to each diagnosis. Postoperative clinical assessment, recurrence and mortality rate were the main determinants of outcome. Results: Regarding pericardial effusions, the mean preoperative medical treatment period was 17.7 ± 21.9 days and pericardial window through thoracotomy was the common approach (54.5%). In constrictive pericarditis, infection was the main etiology (40%), mean preoperative medical treatment period was 16 ± 8.8 days and complete pericardiectomy was the surgical procedure for most cases. Trans-sternal drainage was the standard approach for cardiac tamponade. No postoperative same admission recurrences were reported and 11 (24.4%) mortalities were recorded, 7 (15.5%) cases of them were diagnosed as malignant effusions. Conclusion: Decision making and surgical approach affect the outcome of surgery for pericardial syndromes. Children are more responsive to medical treatment than adults are. Primary etiology and patient’s condition are still the leading determinants of morbidity and mortality....
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