Comparison of surgical site infections between laparoscopic and open cholecystectomy

Background: This study assessed the causes of infection in cholecystectomy and compared the infection rates between the open and laparoscopic cholecystectomy

Materials and Methods: This was a retrospective cohort study, performed on all patients admitted to Shariati Hospital since February 2017 for cholecystectomy. Initially, the patients were evaluated for infection risk factors, and then surgical site infection rates in these individuals were measured. Infection was assessed at the time of patients discharge [in the first few days after surgery] and again a month later, either in clinic or by phone. Information from 81 patients was collected, and SPSS software version 24 was used to analyse the data using appropriate statistical tests. Statistical significance was defined as p value < 0.05

Results: The mean age of the participants was 45.89 +/- 13.38. The relationship between surgical site infections [SSI] and age, sex, comorbidities [diabetes, hypertension, ischemic heart disease, malignancy, chronic lung disease, and chronic kidney disease], taking corticosteroids, smoking, and the emergency or elective nature of the surgery was not significant. The mean age of the patients who underwent open cholecystectomy was higher than the laparoscopic group [p = 0.005]. Similarly, the average hospitalization period for those underwent open cholecystectomy was higher [p = 0.03]. Finally, the infection rates for open cholecystectomy were 6 times higher than laparoscopic surgeries [RR: 6.11]

Conclusion: There was no significant relationship between SSIs and the risk factors assessed in this study. However, infection rates were higher in the open cholecystectomy group. More studies on the various risk factors of infection and the differences between the laparoscopic and open surgical methods are required

Surgical outcome in patients with gastrointestinal malignancies; a report from a large referral hospital, 2008-2010

A considerable portion of gastrointestinal malignancies undergoes surgery without curative resection. This study was conducted to assess surgical outcome in patients with gastrointestinal cancers. We reviewed individuals with esophagus, stomach, colon and rectum cancers admitted for surgical treatment after initial preoperative evaluations. Surgical outcome, stage of tumors and 1 and 5 years survival rate were assessed and analyzed. Two hundred and fifty five patients with esophagus, stomach and colorectal malignancies, who were admitted for surgical resection, were reviewed. Two hundred and twenty two patients were underwent surgery but tumor was not resected in 41 cases [18.6%]. Based on pathological assessment, stage of tumors was III or IV in 108 individuals [48.9%]. The proportion of tumor with advanced stage was significantly higher in patients with gastroesophageal cancers than those with colorectal malignancies [62.6% versus 31.6%],p<0.0001]. The proportion of non-resectable tumor was also significantly higher in patients with esophageal and gastric cancers [p=0.0001]. Palliative surgery was done in 26.1% of patients treated by surgical resection. The proportion of palliative surgery was significantly lower in patients with gastric cancer [p=0.001]. 1 and 5-year survival were significantly longer in colorectal cancer and those with curative surgery [p=0.001]. Survival of patients with palliative resection was the same as patient without tumor resection. Despite preoperative evaluations, there are still a considerable proportion of patients who are diagnosed as inoperable during surgery. Further researches seem to be necessary in order to provide more precise preoperative staging. Screening programs should also be considered for GI cancers in high-risk areas. It seems that palliative resection would not improve survival of patients with advanced GI malignancies

Parathyroid adenoma localization

Bilateral neck exploration is the gold standard for parathyroid adenoma localization in primary hyperparathyroidism. But surgeons do not have adequate experience for accurate surgical exploration and new methods are developed for surgery like unilateral exploration and minimally invasive surgery, thus, preoperative localization could reduces time and stress in surgical performance. 80 patients with documented primary hyperparathyroidism and with raised serum calcium and parathyroid hormone [PTH] were selected. The results of ultrasonographic localization for each patient were compared with findings of surgery and 99m technetium sestamibi scintigraphy. Also variables such as preoperative serum calcium, PTH level and adenoma weight were compared between patients who had localized and nonlocalized adenoma with ultrasonography or Sestamibi scan. The data was compared with student's t-test. In a prospective diagnostic tests' accuracy, 80 patients with primary hyperparathyroidism were enrolled. Ultrasonography images detected enlarged parathyroid glands in 61 of 80 patients [76.3%] with sensitivity of 83.5% and positive predictive value [PPV] of 89.7%. Sestamibi scintigraphy detected adenoma in 63 patients [78.8%] with sensitivity of 85% and PPV of 91.3%. There was no significant deference between ultrasonography and scintigraphy in localization of adenomas. Both ultrasonography and scintigraphy used for determining localization, and they located 73 adenomas [91.3%] with sensitivity of 97.3% and PPV of 93.5%. Ultrasonography as an accurate method for localization of enlarged parathyroid glands in primary hyperparathyroidism, is comparable in overall utility with sestamibi scintigraphy. This study suggests a strategy for initial testing with one method, followed by the alternate imaging test if the first test happen to be negative