Routine or selective histopathology of gallbladder specimen after cholecystectomy for gallstone diseases

Objectives: To determine the incidence of incidental gallbladder cancer [IGBC] and to assess the need of routine histopathological examination of all gallbladder specimens after cholecystectomy for benign gallstone diseases Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA

Subjects: This study included all the patients who underwent elective or emergency cholecystectomy for gallstone disease at King Saud Medical City, Riyadh, Saudi Arabia between January 2012 and September 2015. Patients with preoperative suspicion of gallbladder cancer on imaging, or underwent cholecystectomy for gallbladder polyps or porcelain gallbladder were excluded from the study. Medical record of all the selected patients was reviewed and the data were collected. Interventions: Histopathological examination of gallbladder Main outcome measures: IGBC, routine histopathological examination of all gallbladder

Results: A total of 2396 patients underwent cholecystectomy for gallstones disease. All gallbladder specimens were sent for histopathological examination. IGBC was detected in nine gallbladder specimens [0.4%]. Out of 2396 patients, morphologic abnormalities were observed in 518 specimens [22.6%]. There was no reported case of IGBC with normal appearance of gallbladder specimen. Five patients underwent simple cholecystectomy for stage T1b, three patients of stage T2 tumor had further liver resection and one patient received only palliative care

Conclusions: The incidence of IGBC was 0.38%. All cases of IGBC were detected in abnormal looking thick wall gall bladder. Therefore, selective histopathology of abnormally looking specimen is recommended to reduce the cost and work load of pathologists

Impact of weekend admission on the outcome of patients with acute gastro-esophageal variceal hemorrhage

Objectives: To evaluate the impact of weekend admission on the outcome of patients with acute variceal hemorrhage [AVH] Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA Main Outcome Measures: AVH, weekend admission and clinical outcome

Subjects: Nine hundred and thirty-seven admitted during the period 1[st] January 2005 to 31[st] July 2013 and documented to have AVH. The selected patients were divided into two groups based on the admission day [weekday or weekend admission]. The data regarding patients characteristics and outcome in both the groups were retrieved from medical records and compared by using c2 test / Fisher's exact and student T- test

Results: Weekday admissions included 685 patients, while the weekend group comprised of 252 patients. The demographic, clinical and laboratory characteristics of patients admitted with AVH in both the groups were comparable. Statistically, there was no significant difference in the need for blood transfusion [46% versus 48%, p = 0.5868], and surgical intervention [5.4% versus 4.7%; p = 0.6595] between the groups. There was a little, but statistically significant delay in endoscopic intervention in the weekend group [7.56 +/- 7.8 hours versus 9 +/- 2.32; p = < 0.0001]. However, this delay did not lead to adverse outcome for patients [mortality rate 6.8% versus 5.25%; p = 0.389]

Conclusions: The weekend admissions were not associated with increased mortality in patients with AVH. Moreover, the length of hospital stay, need for blood transfusion, and rate of surgical intervention were similar in weekdays and weekend admissions

Role of postoperative antibiotics after appendectomy in non-perforated appendicitis

To determine the role of postoperative antibiotics in reducing the surgical site infections [SSIs] after open appendectomy in patients with non-perforated appendicitis [NPA]. Randomized controlled trial. The Department of Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, from January 2010 to July 2011. Three hundred and seventy seven patients, who underwent appendectomy for NPA and fulfilled the selection criteria, were randomized into two groups. The patients in group A received a single dose of pre-operative antibiotics [cefuroxime sodium and metronidazole], while the group B patients received one more dose of the same antibiotics postoperatively. Patients of both the groups were followed-up for 30 days to assess the postoperative infective complications. Group A had 195, while group B comprised of 182 patients. The groups were comparable in the baseline characteristics. Statistically there was no significant difference in rates of SSIs between both the groups [p = 0.9182]. Mean hospital stay was 2.29 +/- 0.81 and 2.35 +/- 0.48 days for group A and B respectively [p = 0.4403]. None of the patients developed intraabdominal collection. Single dose of pre-operative antibiotics [cefuroxime and metronidazole] was sufficient in reducing the SSIs after appendectomy for NPA. Postoperative antibiotics did not add an appreciable clinical benefit in these patients

Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost Gallstones

Laparoscopic Cholecystectomy [LC] is associated with a significant risk of gallbladder perforation with spillage of bile and stones into the peritoneal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Majority of these cases do not have any problem in future but sometimes the lost stones lead to serious complications. The authors present a case of lost gallstones, which resulted into an abdominal wall abscess and discharging sinus 9 years after LC. This late presentation is among the very few reports after LC. Risk factors for gallbladder perforation, various techniques to avoid spillage of stones, possible complications and their management is discussed

Outcome of primary repair in penentrating colonic injuries

To assess the outcome of primary repair in penetrating colonic injuries in terms of regional/local morbidity [suture line breakdown, intra-abdominal abscess] and mortality. Design: Prospective, interventional study. Place and Duration of Study: Surgical Unit II at Lahore General Hospital, Lahore, over a period of 3 1/2 years from June 1999 to December 2002. Patients and Out of 38 consecutive patients with penetrating colon injuries, a selective group of 25 patients [65.7%] undergoing primary repair [simple suture, resection and anastomosis without covering colostomy and right hemicolectomy] were included in this study. The morbidity and mortality variables were recorded and statistically analyzed. Majority of our patients were of younger age group [mean 25 years]. Twenty patients [80%] were male. The commonest mode of injury was firearm injury [72%]. The time interval between injury and repair was 3-11 hours [mean 7 hours]. Simple repair of colon with interrupted stitches was the commonest procedure performed [44%], followed by right hemicolectomy [32%]. Colon related complications developed in 3 patients [12%], which included two fecal fistulae and one intra-abdominal collection. One patient died of septicemia [4%]. Hospital stay ranged between 6-16 days [mean 8 days]. Primary repair is a safe method of managing penetrating colon injuries in carefully selected patients