ABSTRACT
BACKGROUND Planned elective surgery had to be postponed for a large number of patients who tested positive for Covid-19 in the preoperative period. We aimed to assess the postoperative outcomes of patients who were operated on for elective indications, following recovery from Covid-19 infection. METHODS We did a retrospective study of patients who underwent elective general surgery between 1 April 2020 and 31 March 2021, following recovery from Covid-19. The 30-day postoperative morbidity and mortality were analysed. The data relevant for the study were retrieved from the hospital’s electronic medical records. RESULTS Of the 109 patients included, 54.1% were women and the median (range) age was 49 (16–76) years; 53.2% of operations were performed for benign indications and the rest were for malignancies. Eighty-five (78%) patients underwent surgery following recovery from an asymptomatic Covid-19 infection and 23 (21.1%) patients following recovery from mild Covid-19 infection; 73.3% of the operations were performed following a planned delay of 2– 5 weeks from the diagnosis of Covid-19. The 30-day major postoperative morbidity (Clavien–Dindo grade ?3) was 6.4%, the postoperative pulmonary morbidity was 0.9%, and there was no 30-day mortality. CONCLUSIONS Elective general surgical procedures can be done safely in patients who have recovered from asymptomatic and mild Covid-19 infection, following a minimum wait period of 2 weeks.
ABSTRACT
Background: Surgical referrals for lymph node biopsies are common, majority for diagnostic purposes. The indications and the diagnostic yield vary for different sites. We conducted an audit of the lymph node biopsies done over a period of seven months.Methods: The audit included 547 patients who underwent lymph node biopsies under local anesthesia in the department of general surgery over a seven-month period. Parameters such as overall diagnostic yield of lymph node biopsies, disease specific yield of lymph node biopsies with a primary focus on tuberculosis; site specific yield of lymph node biopsies and referral pattern for the request for lymph node biopsies were analysed.Results: 324 samples (59.2%) yielded a definite diagnosis, which included haematological malignancy 102 (31.5%), infectious diseases 131 (40.5%), and 59 (18.5%) malignancy. The diagnostic yield of supraclavicular lymph nodes was found to be highest (72.45%) and the axillary group the lowest (39.8%). The referral pattern seen was 314 (57.4%) from General medicine, 149 (27.2%) from General Surgery, and 84 (15.4%) from Haematology. 130 (23.8%) samples were tested for tuberculosis; the highest yield, acquired from the cervical group (52.8%), lowest from the inguinal region (4%).Conclusions: Our audit revealed significant diagnostic yield of lymph node biopsies from the supraclavicular region. Majority of them were of infectious aetiology and referred from General Medicine. This study supports the introduction of co-ordinated problem-based referral and management pathways for the management of patients with enlarged superficial lymph nodes, supported by regular audits of practice.
ABSTRACT
Aim Structural anal sphincter damage may be secondary to obstetric anal sphincter injury, perineal trauma or anorectal surgery. We reviewed the spectrum of anal sphincter injuries and their outcomes in a tertiary care colorectal unit. Methods Data of patients who underwent anal sphincter repair between 2004 and 2008 were analyzed retrospectively. Outcomes were compared with respect to etiology, type of repair, previous attempts at repair and manometry findings. Outcomes were defined as good or poor based on patient satisfaction as the primary criteria. Results Thirty-four patients underwent anal sphincter repair. Twenty-two injuries were obstetric, eight traumatic, and four iatrogenic. All patients underwent overlap sphincteroplasty with six additional anterior levatorplasty and seven graciloplasty. Twenty-three (67.6%) patients had a good outcome while nine (26.4%) had a poor outcome. All patients who had augmentation anterior levatorplasty had a good outcome. Fifty percent of patients with a previous sphincter repair and 42.9% requiring augmentation graciloplasty had a poor outcome. Median resting and squeeze anal pressures increased from 57.5 to 70 cmH2O and 90.25 to 111 cmH2O in those with a good outcome. Conclusions Overlap sphincteroplasty has a good outcome in majority of the patients with incontinence due to a structural sphincter defect. Additional anterior levatorplasty may improve outcomes. Previous failed repairs or use of a gracilis muscle augmentation may have a worse outcome secondary to poor native sphincter muscle. Improvement in resting and squeeze pressures on anal manometry may be associated with a good outcome.