Single Dose vs Multiple Dose Prophylactic Antibiotic to Prevent Early Port-Site Infection in Elective Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment of symptomatic cholelithiasis. The need of the hour is to understand the fact that PSI is a totally different subset of infection and antibiotics are not a solution to this problem. The core issue of “prevention” is the principal solution. The study was undertaken to revalidate these well known facts with an effort to bring about a radical reform to this “social” rather than clinical problem. Material and Methods: The study comprised of 60 patients admitted for elective LC. The first thirty patients undergoing elective LC were given single dose (SD) ciprofloxacin (500 mg) within an hour between the induction and making of the first port. While the control group received ciprofloxacin (500mg) post-operatively in the ward from ward nurses (MD). Operation-room anesthetic assistant administered prophylactic antibiotics at induction of anaesthesia to all the patients. Results: Of the 30 cases that received single dose prophylactic antibiotic pre-operatively, 16.67% were males and 83.3% were females. And, of the 30 cases that received multiple dose prophylactic antibiotic pre as well as post-operatively, 10% were males and 90% were females. Analysis showed that there was no statistically significant difference across the groups in regard to the duration of preoperative hospital stay. Of the 30 cases that received single dose prophylactic antibiotic preoperatively, only one patient suffered gross contamination during the surgery. Conclusion: The rate of early PSI after administration of single dose ciprofloxacin (500 mg) intravenously at induction of anesthesia and multiple dose ciprofloxacin (500 mg given thrice or four times) intravenously post-operatively for two or three days in addition to peri-operative dose is comparable in elective laparoscopic cholecystectomy. Furthermore, hospital cost can be reduced with single dose antibiotic regimen. So single dose of ciprofloxacin 500 mg can be used safely in elective cases of laparoscopic cholecystectomy to avoid infection at port site.

Pathogenesis and management of diabetic foot--a review.

In the present article, the pathophysiology, evaluation and management guidelines of diabetic foot infections are reviewed with a view to reducing the medical morbidity, psychological distress and financial costs.

Sigmoid volvulus complicating pregnancy.

Sigmoid volvulus complicating pregnancy is an extremely rare complication with fewer than 76 cases reported in literature. We report a case of sigmoid volvulus complicating pregnancy. The sigmoid colon was resected and Hartman's colostomy was performed. The patient had a successful recovery. Aggressive resuscitation followed by early surgical intervention should be undertaken to reduce maternal and fetal morbidity and mortality.

Stump appendicitis.

A case having right lower quadrant abdominal pain in a 26-year-old female who underwent appendicectomy one year back is presented. Recurrent appendicitis was noted in appendiceal stump. Although rare, stump appendicitis should be considered in the differential diagnosis of right lower quadrant abdominal pain.

Primary liposarcoma of the omentum: a case report and review of the literature.

A case of round cell liposarcoma of omentum in a 45-year-old man is reported. The patient presented with abdominal pain, swelling and fever of 4-month duration. Abdominal ultrasonography and computed tomogram confirmed the presence of an abdominal mass, but the omental origin of the tumour was revealed only on laparotomy. In addition to the main tumour mass, multiple nodules were present in the omentum. The tumour was excised with omentum. Histopathology of the tumour revealed a round cell liposarcoma. The patient expired 9 months after operation. Eight other cases of liposarcoma of omentum reported in English literature are reviewed.

Acute appendicectomy for appendicular mass: a study of 87 patients.

OBJECTIVE: To study the feasibility of acute appendicectomy in patients with an appendicular mass. SETTING: Department of Surgery, Bankura Sammalani Medical College (BSMCH), Bankura, West Bengal, India. PATIENTS: From January 1998 to May 2001. 87 patients were diagnosed and operated for appendix mass within 24 h of admission. None of the patients had any associated complications. INTERVENTION: A McBurney's incision with Rutherford-Morrison extension was made in most patients. RESULTS: 48 patients presented with a classical appendix mass. 25 patients (28.7%) had classical features of appendix abscess, and in 14 (16.1%) a loculated collection of pus (10 to 50 ml) was found. Operative time ranged from 45 to 90 min (mean 65). Pathologic evidence of appendicitis was present in all patients. 71 patients were discharged on the seventh postoperative day. 15 patients developed minor wound infection. One patient developed band obstruction, which subsided spontaneously on conservative treatment. Rest of the patients are doing well. CONCLUSION: Low morbidity, reduced hospital stay, low cost and patient compliance favour operative management of appendicular mass by experienced surgeons thus obviating the old practice of conservative treatment followed by interval appendicectomy.

Persistent mullerian duct syndrome--a case report.

Persistent mullerian duct syndrome presents in phenotypically male subjects with unilateral cryptorchidism, inguinal herniation, and persistent mullerian remnants. Pre-operative diagnosis of this condition is difficult. Orchidopexy with excision of the persistent mullerian duct structures is usually not possible without making damage to the vas. The alternative of leaving the persistent mullerian duct structures alone and performing a staged or primary orchidopexy has been suggested. A similar case, encountered in the department of surgery, Bankura Sammilani Medical College and Hospital is being reported.