Parasitic infestation in pediatric and adolescent appendicitis: a local experience

The relationship between parasites and pediatric appendicitis is a highly debatable issue. This study aims to investigate the role of parasitic infestation in the etiology of acute pediatric appendicitis. A retrospective study including 1600 pediatric and adolescent patients who had undergone surgical therapy for a diagnosis of acute appendicitis over a period of ten years from Jan 2001 to Dec 2010. Demographic data were retrieved including the patient's age, sex, clinical data, clinical presentations, laboratory investigations, operative data and pathological findings to identify the presence and type of parasites. Patients were divided into two groups according to the presence or absence of parasites in the appendix lumen. In group I [n: 88], parasitic infestation was observed, whereas in group II [n: 1502], no parasitic infestation was present. Parasites were present in 5.5% [88 patients], and of those 88 parasitic infestations, 45 [51.1%] were Enterobaisis, 8 [9.1%] were Schistosomiasis, 23 [26.1%] were Ascariasis, 7 [8%] Trichuriasis, and 5 [5.7%] were Teania Saginata. The percentage of patients with suppurative, gangrenous or perforated appendicitis was similar in both groups with no statistical significance, irrespective of the presence or absence of parasitic infestation. The low prevalence of parasites among the appendectomy specimens did not support the notion that parasites were a major cause of appendicitis in pediatric patients

Outcome of laparoscopic cholecystectomy at a secondary level of care in Saudi Arabia

The first option for gallbladder surgery is laparoscopic Cholecystectomy. The aim of this study is to analyze the outcomes for all patients who underwent laparoscopic Cholecystectomy at a secondary level of care. Between 2005 and 2008, 968 consecutive laparoscopic cholecystectomies were performed at King Fahad Hospital. We collected and analyzed data including age, gender, body mass index [kg/m[2]], the American Society of Anesthesiologists [ASA] class, mode of admission [elective or emergency], indication for LC [chronic or acute cholecystitis [AC]], co-morbid disease, previous abdominal surgery, conversion to open Cholecystectomy, complications, operation time, and length of postoperative hospital stay. Nine hundred and sixty-eight patients had laparoscopic Cholecystectomy at the center. There were 824 females and 144 males; the age range was 15-64 [mean 32.9 +/- 12.7 years]. The operating time was 45 to 180 min [median 85 min]; the complication rate was 4.03% [39 patients]. Laparoscopic Cholecystectomy could be performed safely in the majority of patients with cholelithiasis, by an experienced surgical team at a secondary level of care

Pain after inguinal hernia repair possible role of bowel preparation

To evaluate the possible effectiveness of bowel preparation on pain after hernia repair. This was a prospective randomized study, performed at King Fahad Hospital, Hofuf, Kingdom of Saudi Arabia between January 2000 and December 2002. The group of patient was randomly divided in 2 groups. Sixty-two patients [Group I] had bowel preparation and 65 patients [Group II] had no bowel preparation. All patients in the Group 1 received lactulose 2 days before surgery and rectal enema on the day of surgery. Patients were assessed at 8 hours interval in the hospital. They were assessed for the severity of pain during the first micturation and bowel motion. The pain score in the first 24 hours was significantly lower in the Group 1 [P<0.01] as well as second 24 hours [P<0.001]. The pain in the first micturation [P<0.001] and during the first bowel motion [P<0.001] was less in Group I compared to Group II. Patients with bowel preparation before hernia repair had significantly less pain postoperatively even in the first micturation as well as the first bowel motion than those without bowel preparation

Post hemorrhoidectomy pain. A randomized controlled trial

To compare the effect of metronidazole on post conventional hemorrhoidectomy pain in patients with third and fourth degree hemorrhoids. Two hundred consecutive patients admitted in King Fahad Hospital, Hofuf, Saudi Arabia between June 2002 and May 2004 for surgical treatment of 3rd and 4th degree hemorrhoids were randomly assigned into 2 groups. In Group 1 [100 patients] pre and postoperative metronidazole was used and in Group 2 [100 patients] no medications were given. All patients received castor oil from 2 days before surgery and lactulose after surgery for 2 weeks. Patients were discharged home when free of pain. Patients in group 1 had significantly less pain than those in the second group. Hospital stay and time to first bowel motion were not significantly different between both groups and, early and late complications appear similar. Return to normal activity was significantly shorter in the metronidazole group. Prophylactic metronidazole in Milligan-Morgan hemorrhoidectomy is associated with less pain and earlier return to normal activity