ABSTRACT
Objective: To compare the impact of interrupted braided suture to continuous monofilament sutures on the development of abdominal wound dehiscence in high risk patients
Methods: Clinical judgment and the Rotterdam risk score of abdominal wound dehiscence were used to identify 140 patients at high risk for abdominal wound dehiscence. Seventy high-risk patients who had their laparotomy wounds closed by interrupted braided suture [intervention group] were compared to a similar group of patients who had continuous monofilament suture closure [control group]. Demographic, clinical and operative data of both groups were compared. The primary outcome was the occurrence of wound dehiscence either partial or complete. Secondary outcomes include development of wound infection and the 30-day mortality rate. The mean follow up period was 3 months [range 1-6 months]
Results: There were 78 males and 62 females with a mean age of 62.2+/-13.0 years. Both groups were equivalent in terms of demographics, Rotterdam risk score, type of surgery and surgical incision. Wound dehiscence occurred equally in both groups [24.3 in control vs 22.9% in intervention group, p value 0.842] but evisceration was significantly reduced by the use of interrupted sutures [4.3 vs 14.3%, p value 0.042]. The method of closure has no significant impact on infection and early mortality
Conclusion: Although method of closure did not affect the overall incidence of wound dehiscence, interrupted braided sutures significantly reduced occurrence of evisceration. This reduced the need for urgent revisional surgery but did not affect the early mortality rate. A larger randomized control trial with a longer follow up period is advised
ABSTRACT
Objectives: to study the clinicopathologic features of gastrointestinal stromal tumors [GISTs], to identify the frequency of risk categories and to predict prognostic factors for disease outcome
Methods: this is a retrospective review of gastrointestinal stromal tumor cases that conducted at department of surgery at King Hussein Medical Center between January 2007 to December 2013. A total of 42 cases of c-KIT [CD 117] positive GISTs were included in this study. Clinical data and histopathological parameters were reviewed. Categorization of risk groups was done according to the National Institute of Health
Results: there were 25 males and 17 females. The mean age of presentation was 56.8 years in males and in 51 years in females. The most common origin of GISTs was stomach in 61.9% followed by small intestine 19%, for colon and rectum 4.7% and 14.4% in others [pancreas, ovaries]. Abdominal pain was the most common presentation for 42% of cases studied. 21.4% of cases were presented with distant metastasis. Spindle cell morphology was the commonest histopathological pattern observed in [54.7%]. Risk categorization based on tumor size and cell proliferation as estimated by mitosis revealed that 59.5% of patients in our clinical settings belonged to high risk group
Conclusion: most of the cases in this group of Jordanian patients belonged to high risk group. Certain clinical and histopathological features including tumor size > 10 cm, mitotic rate >/= 10 /50HPF, tumor necrosis, mucosal ulceration and non-gastric site may be predictors for poor outcome in patients suffering from GISTs
ABSTRACT
Objectives: to analyze the results of laparoscopic peritoneal dialysis catheter insertion at King Hussein Hospital in comparison with those published in the literature
Methods: since 2007, 55 peritoneal dialysis catheters were placed laparoscopically in 49 patients. Data to be analyzed including demographic data, early and late postoperative complications, procedure related mortality, follow-up time, reasons of dropout and catheter failure and 1- and 2- year catheter survival rate have been collected. Data published in the literature were used as a control group for comparison. Statistical analysis was done using the Graph Pad software. Twosided p value <0.05 as calculated by Fisher's Exact Test when relevant is considered statistically significant
Results: over the study period of 8-years, 49 patients were included in the study with 28 [57%] females. The age range was 22-65years [median 47.9 years]. The follow up period ranged from 1 42 months. The rates of early and late catheter-related complications were comparable in both groups except for a lower rate of early exit-site/tunnel infection [0 versus 14.3%, p value 0.0053] and higher rate of cuff-extrusion [12.7 vs 1.8, p value 0.0010] in the study group. Our one-year catheter survival rate was comparable to the control group [77.8% vs 89.7%, p value 0.1180] but the two-year catheter survival rate was significantly lower [44.4%vs 76.4%, p value0.0049]
Conclusions: although our early experience in laparoscopic peritoneal dialysis catheter insertion is encouraging, a room is available for improvement and development