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 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
ABSTRACT
Objective: To present our experience in the first 100 live liver-donors done at King Hussein Medical Center with emphasis on donor postoperative complications and possible risk factors predisposing to complications
Methods: Over a period of 11 years 100 live-liver donors underwent surgery. Demographic, clinical and perioperative data of these donors were collected. Postoperative complications were registered and classified according to the Clavien-Dindo classification. Statistical analysis was used to identify potential patients' or grafts' factors associated with complications
Results: The mean age of donors was 30.71+/-7.17 and mean body mass index was 24.50+/- 2.56. Three procedures were abandoned after laparotomy. 71 underwent right hepatectomy, 12 right hepatectomy with inclusion of middle hepatic vein, 11 left hepatectomy and 3 left lateral sectorectomy. The overall complication rate was 36% with most of these being minor grade I and II [26%] complications. 9 patients developed grade III complications while one patient had grade IVa. The mortality rate was zero. Older age and higher body mass index were identified as potential risk factors for complications. Gender, graft type, estimated future liver remnant, inclusion of middle hepatic vein and preoperative biochemical profile were not found in this study to correlate with occurrence of complication
Conclusion: Strict donor selection and meticulous surgical procedure remain the only modifiable factors in donor hepatectomy. Continuous transparent clinical audit is mandatory to identify potentially preventable adverse outcomes
ABSTRACT
Parathyroid carcinoma [PTC] is an extremely rare malignancy that typically presents with severe primary hyperparathyroidism [PHPT]. More often the surgeon is confronted with the diagnosis after simple parathyroidectomy for presumed benign parathyroid adenoma. This results in unacceptably high recurrence rate ranging from 1/3-2/3 of patients. Faced with the rarity of the disease and lack of reliable preoperative diagnostic test; a high-index of preoperative and intraoperative suspicion of malignancy is warranted in patients with severe hyperparathyroidism as en-block-resection of the gland along with surrounding adherent tissue during the initial exploration offers the only potential cure of the disease. Herein, we present a 46-year-old lady who presented with severe form of PHPT, eventually proved to be caused by PTC. We will also review the literature related to this extremely rare tumor, highlighting the difficulties encountered in its management
ABSTRACT
To compare early laparoscopic cholecystectomy during index admission with delayed [interval] laparoscopic cholecystectomy in the management of acute cholecystitis at King Hussein Medical Center. Over the study period of 48 months [June 2005 to May 2009], a total of 317 patients with clinical and radiographic diagnosis of acute cholecystitis were studied. One hundred-thirty one patients underwent laparoscopic cholecystectomy during the index admission [group A] while 186 patients [Group B] underwent cholecystectomy at least six weeks after the attack. Data analyzed included patients' age, gender, duration of symptoms, white blood cell count, operative time, hospital stay, overall surgical outcomes and postoperative morbidity and mortality. Both groups were demographically and clinically comparable. Surgical outcomes were comparable in group A and B with conversion rates of 8.3% and 7.4% [p = 0.6645], and complication rates of 12.25% and 12.6% [p = 0.9352] respectively. Although delayed surgery shortens operative time significantly [60 versus 100 min, p<0.0001], the overall hospital stay is significantly reduced by early operation [5 versus 14.6 days, p<0.0001]. Although both the early and delayed approaches in management of acute calculus cholecystitis are comparable in terms of complication and conversion rates, the early approach has the advantage of offering patients a definitive treatment while reducing the overall total hospital stay and avoiding the problems of failure of delayed therapy