Delayed esophageal fistula following anterior cervical spine fusion

Esophageal perforation can result from either cervical spine trauma itself or follows anterior cervical spine surgical procedures in the course of management of diseases of the cervical spine. We report a case of delayed esophageal fistula in a 17-year-old patient who sustained cervical fracture affer a road traffic accident. Anterior cervical spine fusion with autogenous iliac bone graR was carried out after successful reduction of the fracture. The fistula was managed conservatively with a local honey dressing until complete closure occurred

Abdominal tuberculosis: review of 78 cases

Seventy-eight patients with abdominal tuberculosis [TB] were admitted to the medical and surgical departments at two major teaching hospitals in Jeddah during the period from January 1991 to August 2001. They were young patients with average age of 31 years. They all belonged to low socio-economic class. The majority of patients presented with non-specific symptoms which included fever, weight loss, abdominal pain, vomiting and change of bowel habit. There was a predilection for a single organ involvement. The peritoneum being the commonest site [61.50%] followed by the liver [16. 60%], mesenteric lymph nodes [10.20%], small bowel [3.80%] and colon [2.60%]. The spleen, appendix, pancreas and perineum were involved a 1.3% [one case each]. Abnormal chest x-ray suggestive of active or old tuberculosis and positive Mantaux test were present in 41% and 14.60% of patients respectively. Laparoscopy was helpful in establishing the diagnosis of peritoneal tuberculosis in 43 patients. Seven patients [8.90%] required various surgical procedures. The outcome of treatment with anti-TB chemotherapy for 6 months was successful. One patient developed post-operative abdominal fistula and two patients died. The morbidity was 1.3% and the mortality was 2.56%

Thyroid and parathyroid surgery: drain or no drain

Routine wound drainage after thyroid and parathyroid surgery was and still used on no scientific basis. We aimed to confirm whether drains following thyroid and parathyroid surgery are of any benefit. Method: A retrospective analysis of 232 patients who underwent thyroid and parathyroid surgery were reviewed. A total number of 197 patients had thyroid surgery and 35 patients had parathyroid surgery. Drains were used in 117 patients [50.4%] [group A] and no drains were used in 115 patients [49.6%] [Group B]. There was no difference between the two groups in terms of major complications that require intervention. The average drainage in group A was 60 ml [range 0-320 ml]. All patients in group B developed flaps oedema and suprasternal fullness that resolved spontaneously without intervention and one patient developed wound infection. Routine wound drainage following thyroid and parathyroid surgery is unnecessary and should be used selectively

Experience in laparoscopic cholecystectomy: Pitfalls and importance of supervision

The aim of this study is to evaluate the role of supervision by instructors during laparoscopic cholecystectomy. This is a retrospective analysis of 130 cases of symptomatic gallstones where patients underwent laparoscopic cholecystectomy between June 1992 and January 1994 at King Abdulaziz Hospital and Oncology Centre, Jeddah, Saudi Arabia. Patients with associated ductal stones were excluded. An intraoperative cholangiogram was not done in any of the cases. The female to male ratio was 3.8:1. The age of the patients ranged between 14 and 91 years [average 41.9 years]. In 91.8% of patients there was an uneventful postoperative recovery. Complications occurred in ten patients [8.2%]. One patient had injury to the common bile duct and another had a small injury to the diaphragm. A third patient developed intestinal obstruction. We strongly urge supervision during the learning period of laparoscopic cholecystectomy