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Introduction: Delays in non-traumatic emergency abdominal surgeries can significantly impact patient outcomes. Identifying the factors contributing to these delays is crucial for improving surgical efficiency and patient care. This study aims to prospectively analyze the determinants of delays in non-traumatic emergency abdominal surgeries and their effects on clinical outcomes. Methods: A prospective observational study was conducted on patients requiring non-traumatic emergency abdominal surgery over a one-year period. Data were collected on demographic variables, clinical characteristics, and time intervals from hospital admission to surgery. Factors such as diagnostic procedures, availability of surgical staff, operating room logistics, and preoperative optimization were analyzed. Statistical analysis was performed to identify significant predictors of surgical delays. Results: Out of 217 patients, 40% experienced significant delays (>6 hours) from admission to surgery. Key factors contributing to delays included prolonged diagnostic workup (35%), limited operating room availability (25%), and preoperative medical optimization (20%). Delays were associated with increased postoperative complications (15% in delayed group vs. 8% in non-delayed group, p<0.05) and extended hospital stay (mean of 7 days in delayed group vs. 4 days in non-delayed group, p<0.05). Discussion: The study highlights that diagnostic delays and operating room logistics are major contributors to surgical postponements. Addressing these issues through streamlined diagnostic protocols and improved operating room management can potentially reduce delays. Enhanced preoperative planning and resource allocation are also essential to mitigate the impact of delays on patient outcomes. Conclusion:Delays in non-traumatic emergency abdominal surgeries are influenced by multiple factors, including diagnostic processes, operating room availability, and preoperative medical optimization. Reducing these delays through targeted interventions can improve patient outcomes and optimize surgical care.

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Peritoneal loose bodies are rare surgical or imaging findings. In most cases, PLBs are small in size, usually from 5 to 20 mm. Giant PLBs measuring more than 50 mm are even rarer. Only a few cases of giant PLBs have been reported. The authors report a case of a giant PLB with only mild symptoms and with no preoperative diagnosis, highlighting the importance of being aware of the characteristic findings of these lesions to establish a correct diagnosis, avoiding unnecessary surgery.

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Objective To observe the effect of low-frequency electrical stimulation on the rehabilitation of pa-tients after gynecological abdominal surgery.Methods Sixty-three patients who underwent open surgery in gy-necology department of Taixing Clinical College of Bengbu Medical College from June 2021 to July 2022 were selected.The patients were randomly divided into control group(31 cases)and a low-frequency electrical stimulation group(32 cases).The low-frequency electrical stimulation group was subjected to stimulation with-in the patient′s tolerable range once a day for 30 minutes each time,and the intensity of each stimulation was adjusted based on clinical situation.The control group selected the same acupoints and pasted electrodes,connected to the treatment device but no electrical stimulation.The electrode strip was removed after 30 minutes,then re-cord the postoperative Visual Analog Scale(VAS)score as well as the time from the end of the surgery to the first discharge and defecation.Results The VAS score at 48 hours after surgery showed a low degree of pain in the low-frequency electrical stimulation group(3.6±1.2)compared to that in control group(4.5±1.4);After 72 hours of surgery,the VAS score was lower in the low-frequency electrical stimulation group(1.7±0.9)compared to the control group(3.3±1.4),indicating a lower degree of pain.The first exhaust time(26.9±6.7)h vs.(35.5±13.0)h was shorter in the low-frequency electrical stimulation group;The first bowel movement time(49.0±5.4)h vs.(64.4±13.8)h was shorter in the low-frequency electrical stimula-tion group compared to the control group.Conclusions Low frequency electro-physiological stimulation can alleviate post-operative pain and shorten exhaust and defecation time in patients undergoing gynecological open surgery.

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Presentamos el caso de un paciente masculino de 57 años con un leiomiosarcoma retroperitoneal encontrado de manera incidental. Es una patología poco común, la incidencia anual es 2.7 casos por millón de personas. De igual manera, es una enfermedad de evolución silenciosa, por lo que pasa inadvertida hasta que la masa tumoral alcanza un gran tamaño. Los leiomiosarcomas se evidencian como extensas áreas de heterogeneidad y realce heterogéneo, ocasionado por la presencia de necrosis y focos hemorrágicos. Normalmente no hay presencia de calcificaciones y hay ausencia de tejido adiposo, de esta manera que una gran masa retroperitoneal mayor a 10 cm sin contenido graso y necrosis interna variable debe sugerir la posibilidad de un leiomiosarcoma. La eliminación quirúrgica completa es el tratamiento de elección, ésta se debe realizar con márgenes negativos amplios, factor que repercute en el pronóstico, ya que estos tumores tienden a alcanzar un tamaño muy grande y, a menudo, la extirpación amplia es imposible, lo que afecta la supervivencia del paciente. Este tipo de neoplasias tienen un mal pronóstico, pues se sabe que la supervivencia a los 5 años es de aproximadamente 15%, debido a su alta tendencia a la invasión local, metástasis o diagnóstico tardío.

We present the case of a 57-year-old male patient with a retroperitoneal leiomyosarcoma found incidentally. It is a rare disease, with an annual incidence of 2.7 cases per million people. Likewise, it is a disease with a silent evolution, so it goes unnoticed until the tumor mass reaches a large size. Leiomyosarcomas appear as extensive areas of heterogeneity and heterogeneous enhancement, caused by the presence of necrosis and hemorrhagic foci. Normally, there is no presence of calcifications and there is an absence of adipose tissue, so a large retroperitoneal mass greater than 10 cm with no fat content and variable internal necrosis should suggest the possibility of a leiomyosarcoma. Complete surgical removal is the treatment of choice, and should be performed with wide negative margins, a factor that affects the prognosis, since these tumors tend to reach a very large size and wide excision is often impossible, which affects the patient's survival. This type of neoplasm has a poor prognosis, since it is known that the 5-year survival rate is approximately 15%, due to its high tendency to local invasion, metastasis or late diagnosis.

Apresentamos o caso de um paciente do sexo masculino, 57 anos, comleiomiossarcoma retroperitoneal encontrado incidentalmente. É umapatologia rara, a incidência anual é de 2,7 casos por milhão de pessoas. Da mesma forma, é umadoença de evolução silenciosa, por issopassadespercebida até que a massa tumoral atinja umtamanho grande. Os leiomiossarcomasaparecem como extensas áreas de heterogeneidade e realce heterogêneo, causadas pela presença de necrose e focos hemorrágicos. Normalmente nãohápresença de calcificações e háausência de tecido adiposo, portantouma grande massa retroperitoneal maior que 10 cm semconteúdo de gordura e necrose interna variáveldeve indicar a possibilidade de leiomiossarcoma. A remoçãocirúrgica completa é o tratamento de escolha, este deve ser realizado com amplas margens negativas, fator que afeta o prognóstico, poisesses tumores tendem a atingir tamanhomuito grande e, muitasvezes, a remoção ampla é impossível, o que prejudica a sobrevida do paciente. Esse tipo de neoplasia apresentamauprognóstico, pois sabe-se que a sobrevida em 5 anos é de aproximadamente 15%, devido à sua alta tendência à invasão local, metástaseou diagnóstico tardio.

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Background: This article summarizes the study protocol currently used to evaluate the effect of informing about the operating room environment with virtual reality (VR) glasses on patients' anxiety level and vital signs. Methods: This study was designed as a non-drug clinical, randomized controlled trial. Eligible patients will be randomly assigned to one of two groups. The population of the study will consist of 80 patients who will undergo planned abdominal surgery in the operating room unit of a state hospital affiliated to the TRNC ministry of health. Before surgery, the first group (n=40) will be informed through VR glasses, while the second group (n=40) will receive standard care. Conclusions: The outcome is anxiety level before surgery and the state of vital signs during surgery. Trial registration: International standard randomized controlled trial number NCT05899790.

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INTRODUCCIÓN: La biopsia ganglionar retroperitoneal es un procedimiento frecuentemente requerido en el estudio de neoplasias; resulta deseable optimizar su rendimiento con baja morbilidad. Este artículo describe la utilidad y complicaciones de biopsias ganglionares retroperitoneales por laparoscopia en una institución oncológica de Latinoamérica. MATERIAL Y MÉTODOS: Cohorte retrospectiva de pacientes con biopsia ganglionar retroperitoneal o mesentérica laparoscópica entre 2011 y 2021 en el Instituto Nacional de Cancerología, en Bogotá, Colombia. Se recogieron datos demográficos, quirúrgicos, complicaciones y mortalidad a 30 días, resultados histopatológicos y su rol en la clínica. RESULTADOS: Se incluyeron 41 pacientes; 73% con diagnóstico de malignidad, principalmente linfoma. La indicación fue mayormente sospecha de recaída, seguida por sospecha de enfermedad hematológica de novo. Siempre se obtuvo tejido adecuado y suficiente para diagnóstico histológico. Requirieron conversión a laparotomía cinco pacientes (12%). No hubo complicaciones Clavien-Dindo III /IV ni mortalidad a 30 días. Se presentó morbilidad grado I o II en 3 casos (7%) y un incidente intraoperatorio grado III. CONCLUSIÓN: La naturaleza invasiva y el carácter diagnóstico de la biopsia retroperitoneal laparoscópica, constituyen un desafío frecuente en la práctica del cirujano general. La planeación estratégica e individualizada y la técnica quirúrgica depurada son las claves para lograr el máximo rendimiento, con baja morbimortalidad.

INTRODUCTION: Retroperitoneal lymph node biopsy is a frequently required procedure in the study of neoplasms; it is desirable to optimize its performance with low morbidity. This paper describes the usefulness and complications of retroperitoneal lymph node biopsies by laparoscopy in a cancer institution in Latin America. MATERIAL AND METHODS: Retrospective cohort of patients with laparoscopic retroperitoneal or mesenteric lymph node biopsy between 2011 and 2021 at the National Cancer Institute, in Bogotá, Colombia. Demographic and surgical data, complications and 30-day mortality, histopathological results and their clinical role were collected. RESULTS: 41 patients were included; 73% diagnosed with malignancy, mainly lymphoma. The indication was mostly suspected relapse, followed by suspected de novo hematologic disease. Adequate and sufficient tissue was always obtained for histological diagnosis. Five patients (12%) required conversion to laparotomy. There were no Clavien-Dindo III/IV complications or 30-day mortality. Grade I or II morbidity occurred in 3 cases (7%) and a grade III intraoperative incident. CONCLUSION: The invasive nature and diagnostic character of laparoscopic retroperitoneal biopsy constitute a frequent challenge in the practice of the general surgeon. Strategic and individualized planning and a refined surgical technique are the keys to achieving maximum performance, with low morbidity and mortality.

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INTRODUCCIÓN. El quiste hidatídico puede localizarse en cualquier órgano del cuerpo. El quiste hidatídico en el páncreas (QHP)se presenta con una prevalencia menor a 1%, la localización más frecuente es la cabeza en 61% a 69%, en el cuerpo y cola en 31% a 39%. No es fácil diferenciar el quiste hidatídico pancreático de otros tumores quísticos del páncreas, por lo que esta patología debe tenerse en cuenta en el diagnóstico diferencial de lesiones quísticas pancreáticas. CASO CLÍNICO. Paciente femenino de 66 años quien desde el año 2016 se encontraba en control por una tumoración quística de la cola pancreática de 1,7 cm, diagnosticada en forma incidental. La paciente cursó asintomática y se controló en forma anual. El año 2021 la lesión alcanzó un tamaño de 4,7 cm. En este contexto se decide la resección quirúrgica por vía laparoscópica. Se resecó una pieza quirúrgica de 8 cm de longitud que incluye la cola del páncreas y el quiste. La histología describe la membrana prolígera y múltiples escólex viables. CONCLUSIÓN. La localización primaria en la cola del páncreas de un quiste hidatídico confunde el diagnóstico con un tumor quístico mucinoso. El tratamiento quirúrgico actual en los quistes distales debería ser la resección laparoscópica.

INTRODUCTION. The hydatid cyst can be located in any organ of the body. The hydatid cyst in the pancreas occurs with a prevalence of less than 1%, the most frequent location is the head in 61% to 69%, the body and tail in 31% to 39%. It is not easy to differentiate the pancreatic hydatid cyst from other cystic tumors of the pancreas, so this pathology must be taken into account in the differential diagnosis of pancreatic cystic lesions. CLINICAL CASE. The present report discusses a 66-year-old female patient who had been in control since 2016 for a 1.7 cm cystic tumor of the pancreatic tail. The patient was asymptomatic and was controlled annually. In 2021, the lesion reached a size of 4.7 cm. In this context, laparoscopic surgical resection was decided. An 8 cm long surgical specimen was resected, including the tail of the pancreas and the cyst. Histology describes prolific membrane and multiple viable scolexes. CONCLUSION. The primary location in the tail of the pancreas of a hydatid cyst confuses the diagnosis with a mucinous cystic tumor. The current surgical treatment for distal cysts should be laparoscopic resection.

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Background: Pain relief is imperative to success of a surgical procedure. Provision of adequate and effective anesthesia has been challenging. Due to its lower cost, simpler technique and higher patient acceptance spinal and epidural anesthesia are fast becoming the procedure of choice for lower limb and lower abdominal surgeries. Material: A prospective, observational study was conducted in tertiary centre teaching hospital. Total 76 cases (randomly divided in two groups) undergoing elective lower abdominal surgeries, during the study period and meeting the inclusion and exclusion criteria. Group L: Received 15ml 0.5% isobaric levobupivacaine by epidural anesthesia. Group B: Received 15ml of 0.5% isobaric bupivacaine by epidural anesthesia. Results : Majority of the cases belonged to the age group of 40 to 49 years. The age distribution was similar in the two groups. There was a female preponderance in both the groups. The distribution was similar in the two groups. Weight and height were similar in the two Groups. The onset and time to reach T6 level was similar in the two Groups. There was no statistically signi?cant difference between both the groups. When assessed according to the duration of sensory analgesia, it was observed that the duration was signi?cantly longer in cases in the levobupivacaine Group (417.26 ± 9.13 minutes) as compared to bupivacaine Group (391.37 ± 9.18 minutes). The changes in heart rate, blood pressure and respiratory rate between the two groups were clinically and statistically not signi?cant. Both levobupivacaine and bupivacaine groups did not exhibit signi?cant side effects. Conclusion: levobupivacaine can be used as a safe alternative to bupivacaine for epidural anesthesia in lower abdominal surgeries. It can be effectively concluded from the present study that Levobupivacaine has longer duration of sensory analgesia and slower onset of motor block as compared with bupivacaine.

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Objetivo: Determinar la efectividad de la colecistectomía laparoscópica de puerto único asistida por imanes bajo anestesia espinal en el tratamiento quirúrgico de la colecistopatía litiásica crónica. Material y Métodos: Estudio prospectivo de cohorte en 51 pacientes entre octubre de 2019 y febrero de 2021. 17 pacientes fueron sometidos a colecistectomía laparoscópica de puerto único asistida por imanes y 34 a colecistectomía laparoscópica convencional por un mismo equipo quirúrgico. Se aplicó la técnica quirúrgica descrita por Dominguez et al y SAGES, bajo anestesia espinal. Se realizó estadística descriptiva e inferencial, analizando el dolor postoperatorio a las 3, 6, 12, 24 y 72 h y la satisfacción de los pacientes. Resultados: Se encontró diferencia significativa en el dolor postoperatorio en el grupo de estudio a las 6 h (p = 0,022), 12 h (p = 0,039), 24 h (p = 0,025) y 72 h (p < 0,001). En la satisfacción se encuentra un RR de 3 (p = 0,001), sin diferencia significativa en el tiempo operatorio y horas de hospitalización postquirúrgicas. Conclusiones: La colecistectomía laparoscópica de puerto único asistida por imanes, bajo anestesia espinal, ha demostrado efectividad en la reducción importante del dolor postoperatorio a partir de las 6 h, y en la superación de las expectativas en los intervenidos, sin aumento significativo de tiempo operatorio ni estancia hospitalaria.

Aim: To determine the effectiveness of magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia in surgical treatment of chronic lithiasic cholecystopathy. Materials and Method: Prospective cohort study in 51 patients between October 2019 and February 2021. 17 patients underwent magnet-assisted single-port laparoscopic cholecystectomy and 34 underwent conventional laparoscopic cholecystectomy by the same surgical team. The surgical technique described by Dominguez and SAGES was used, under spinal anesthesia. Descriptive and inferential statistics were performed, analyzing postoperative pain at 3, 6, 12, 24 and 72 hours and patient satisfaction. Results: A significant difference in postoperative pain was found in the study group at 6 h (p = 0.022), 12 h (p = 0.039), 24 h (p = 0.025) and 72 h (p < 0.001). In satisfaction, there is an RR of 3 (p = 0.001), with no significant difference in operative time and postoperative hospitalization hours. Conclusions: Magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia has shown effectiveness in significantly reducing postoperative pain after 6h, associated with significantly exceeding expectations in those operated on, without a significant increase in operative time or hospital stay.

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Objetivo: Se presenta un caso de rotura esplénica atraumática. Caso Clínico: Mujer joven que estando ingresada y con reposo relativo por colección intraabdominal cercana a la colostomía presenta rotura de bazo. Se realiza esplenectomía urgente evidenciando gran hemoperitoneo y rotura esplénica. Discusión y conclusiones: El diagnóstico de rotura esplénica atraumática debe tenerse en cuenta en los pacientes con dolor abdominal de aparición súbita ya que un retraso en el diagnóstico puede conducir a un aumento de la tasa de mortalidad.

Objective: A case of idiopathic atraumatic splenic rupture is presented. Clinical case: A young woman was admitted to hospital with relative rest due to an intra-abdominal collection near the colostomy and presented with a ruptured spleen. An urgent splenectomy was performed, revealing large haemoperitoneum and splenic rupture. Discussion and conclusions: the diagnosis of atraumatic splenic rupture should be taken into account in patients with sudden onset abdominal pain, as a delay in diagnosis may lead to an increased mortality rate.

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Introducción: El situs inversus totalis es una condición congénita en la cual los órganos torácicos y abdominales se encuentran en posición contraria a la posición habitual. En la literatura quirúrgica internacional se encuentran publicados no más de 55 casos de colecistectomía en pacientes con situs inversus totalis. La resolución laparoscópica de una paciente en nuestra Institución nos permite revisar esta particular condición patológica. Caso Clínico: Paciente femenino de 43 años de edad hospitalizada por una colecistitis aguda la cual es resuelta por vía laparoscópica sin incidentes. Material y Método: Se resume la literatura actual mediante una extensa revisión en PubMed de los reportes más relevantes. Considerando que todos los artículos publicados son casos clínicos o pequeñas series de casos, se presentan los resultados de esta revisión en tablas con estadística descriptiva básica. Discusión: Se discuten las características generales de estos pacientes, la presentación clínica, diagnóstico y técnica quirúrgica. Conclusión: La colecistectomía laparoscópica constituye el estándar de oro en pacientes con situs inversus y patología biliar, la cual debe ser realizada por un cirujano experimentado acomodando los trocares apropiadamente, debido a las dificultades técnicas que se encuentran en estos pacientes por las anomalías anatómicas propias de esta condición. El diagnóstico radiológico actual permite la planificación del abordaje y del procedimiento quirúrgico apropiado para cada paciente.

Introduction: Situs inversus totalis is a congenital condition in which the thoracic and abdominal organs are in the opposite position from normal anatomy. We found no more than 55 cases of cholecystectomy in patients with situs inversus totalis published in the international surgical literature. The laparoscopic resolution of a patient in our Institution allows us to review this particular pathological condition. Clinical Case: A 43-year-old female patient was admitted for acute cholecystitis and was resolved laparoscopically without any incidents. Material and Method: We summarized the current literature through an extensive PubMed review of the most relevant reports. Considering that all published articles are clinical cases or small case series, we present the results of this review in a table with basic descriptive statistics. Discussion: We discuss the general characteristics of these patients, clinical presentation, diagnosis, and surgical technique. Conclusions: Laparoscopic cholecystectomy is the gold standard in patients with situs inversus and biliary pathology, which must be performed by an experienced surgeon, properly accommodating the trocars due to the technical difficulties in these patients secondary to anatomical anomalies typical of this condition. Current radiological diagnosis allows planning the appropriate approach and surgical procedure for each patient.

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Background: Through the age’s man sought for methods of binding wounds to promote healing. In olden days various things were used by surgeons but the secret to achieve a good wound healing lies in meticulous tissue dissection followed by selection of suture material, methods of wound closure and postoperative complications. Staplers were originally developed to address the perceived problem of patency i.e., security against leaks of blood or bowel contents in anastomosis in particular but now. It is widely accepted that both sutures and staples can achieve the basic goals of skin wound closure. Methods: Patients admitted under various surgical units from December 2020 to June 2022 at Mamata Medical College and Hospital, Khammam. A study was carried out with 50 patients undergoing laparotomy electively and emergency. Results: Skin approximation was much faster with staple as compared to sutures. Post-operative SSI was more common with skin suture group as compared with staples. Cosmetic appearance of the scar was found to be superior in staple group in comparison to conventional suturing group. Conclusions: The results of the study indicate that skin closure by stapler can be preferred over conventional skin suture.

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Objetivo: Reporte de caso clínico de una presentación poco común de apendicitis aguda sin reporte en la literatura actual. Material y Método: revisión de expediente clínico en hospital general regional 196 del instituto mexicano del seguro social. Resultados: Masculino de 47 años con dolor abdominal en epigastrio. Clínicamente se palpa defecto hemiario, encontrando apéndice vermiforme edematosa en saco herniario. Discusión: La presentación de apendicitis aguda en sacos hemiarios epigástricos es extremadamente rara encontrando, solamente, un reporte de caso en la literatura.

Objective: Clinical case report of an uncommon presentation of acute appendicitis with no report in the current literature. Material and Method: review of the clinical record at Hospital General Regional 196 of the Mexican Social Security Institute. Results: 47 year old male with abdominal pain in epigastrium clinically palpated hernial defect, finding edematous vermiform appendix in hernial sac. Discussion: The presentation of acute appendicitis in epigastric hernial sac is extremely rare finding only one case report in the literature.

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Objetivo: Realizar caracterización clínica-epidemiológica de quiste de colédoco en la población infantil atendida en el Hospital Materno Infantil. Material y Método: Estudio transversal, retrospectivo, descriptivo. La población del estudio consistió en los expedientes con diagnóstico de quiste de colédoco (QC) en el servicio de cirugía pediátrica. Criterios de inclusión: desde el nacimiento hasta los 18 años, operados en este hospital, diagnóstico clínico e imagenológico. Análisis estadístico: base de datos Epi Info.12.0, usando medidas de frecuencia, como la media y varianza. Resultados: Un total de 12 pacientes, la relación entre mujer hombre fue de 3:1, con predominio en mujeres. El grupo etario con mayor frecuencia fue el preescolar con 41,7%. El síntoma más frecuente fue el dolor abdominal con 83,3%; el tipo de QC más frecuente fue el tipo I con 75%, todos fueron resecados y la reconstitución de tránsito más utilizada fue la hepaticoyeyuno anastomosis en Y de Roux (HYYR) con 83,3%. Discusión: El grupo etario, el sexo y el tipo de QC en este estudio, coincide con la literatura citada. El ultrasonido puede ser suficiente para el diagnóstico de QC, la colangiopancreatografia por resonancia magnética permite identificar el subtipo de quiste y planificar la intervención quirúrgica. Conclusión: en nuestro hospital hay poca experiencia en la realización de hepaticoduodeno anastomosis (HD) y ninguna experiencia en la realización de HD y HYYR laparoscópicas, por lo cual, se plantea la necesidad de mejorar las opciones terapéuticas según estándares internaciones. Además, tomando este estudio como base, se deben realizar investigaciones posteriores con mayor complejidad metodológica.

Objective: To perform a clinical-epidemiological characterization of choledochal cyst in the pediatric population attended at the Hospital Materno Infantil. Material and Methods: Cross-sectional, retrospective, descriptive study. The study population consisted of records with a diagnosis of choledochal cyst (CC) in the pediatric surgery service. Inclusion criteria: from birth to 18 years of age, operated in this hospital, clinical and imaging diagnosis. Statistical analysis: Epi Info.12.0 database, using frequency measures, such as mean and variance. Results: A total of 12 patients, female to male ratio was 3:1, with female predominance. The age group with the highest frequency was preschool with 41.7%. The most frequent symptom was abdominal pain with 83.3%, the most frequent type of CC was type I with 75%, all of them were resected and the most frequent reconstruction was Roux-en-Y hepaticojejunostomy (HJ) with 83.3%. Discussion: The age group, sex and type of CC in this study coincides with the literature cited. Ultrasound may be sufficient for the diagnosis of CC, magnetic resonance cholangiopancreatography allows identification of the subtype of cyst and planning of surgical intervention. Conclusion: In our hospital there is little experience in performing hepaticoduodenostomy (HD) and no experience in performing laparoscopic HD and HJ, therefore, there is a need to improve the therapeutic options according to international standards. Furthermore, taking this study as a basis, further research with greater methodological complexity should be carried out.

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Background: In gastrointestinal surgery after resection of bowel loops, anastomosis of the bowel loops forms the main part of the surgery. The evolution of mechanical sutures by stapler devices is a technological advancement which helps anastomosis of bowel loops with less tissue injury and decreased time duration of procedure. Objective of current study was to compare the hand sewn anastomosis with stapler anastomosis in various types of elective gastrointestinal surgeries. Methods: A retrospective comparative study was conducted in department of general surgery at New Civil Hospital, Surat. The study included 50 patients of either gender and different age groups. Results: Out of 50 patients, 7 patients had Benign Gastric Outlet Obstruction (GOO), 18 patients had Post corrosive esophageal stricture, 5 patients had obstruction, 6 patients had post ileostomy status, 5 patients had carcinoma of ascending colon, 1 patient had carcinoma of caecum, 4 patients had ileo-caecal growth, 3 patients had carcinoma of descending colon, and 1 patient had sigmoid colon growth. In stapler anastomosis group Mean Total operative time was (156.20±45.21) mins whereas in handsewn anastomosis group Mean Total operative time was (188.40±48.32) mins with p value of 0.019. Conclusions: In this study, one distinct advantage of staplers was the consistent reduction in operating time. However, no significant difference was found between the stapler and hand-sewn groups with respect to other parameters such as restoration of intestinal function, postoperative hospital stay, and postoperative complications like leakage, fistula or stricture formation.

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Background: Despite recent advances in preoperative management, postoperative respiratory morbidity is still a common problem especially following upper abdominal surgery. Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications, which are de?ned as pulmonary abnormalities occurring in postoperative period which produce clinically signi?cant, identi?able disease or dysfunction that adversely affects the patients' clinical course. Decline in lung function was signi?cantly more in smokers than non- smokers. To study the risks of postoperative complications in smokers and non smokers, by a pre-operative medical evaluation of the patients done by performing pulmonary function test both pre and post operatively and studing changes on them to predict and reduce morbidity, mortality and length of hospital stay in patients. Aim: To see the impact of smoking in patients undergoing upper abdominal surgeries using pre and post- operative lung function in patients. Methods: We performed a randomly controlled prospective hospital study for 2 years, including eighty patients. Patients ? 60 years of age were taken randomly of both the sexes which were of ASA status 2 to 3, smokers or nonsmokers , planned for elective, non-laparoscopic, upper abdominal surgeries( cholecystectomy or gastrectomy). The selected individuals were subjected to spirometry preoperatively. After surgery and proper recovery from the anesthesia Spirometry was again carried out in the post-operative period on the ?rst and second post-operative days as was done pre-operatively and the changes in their lung functioning tests were noted. Results: In our study FVC, FEV1 and FEV1/FVC were studied preoperatively and on the ?rst and second post operative day following upper abdominal surgeries. There is signi?cant fall in FVC, FEV1 and FEV1/FVC i.e lung fuction tests on the ?rst and second post operative day following upper abdominal surgeries in smokers than in nonsmokers. Conclusion: Following upper abdominal surgeries, there is fall in FVC, FEV1 and FEV1/FVC fall being more in smokers than nonsmokers. Lung spirometry allows patients with pulmonary abnormality to be objectively screened and could be useful for predicting operative risk related to abnormal pulmonary function and reduce morbidity, mortality and length of hospital stay in patients. Hence, it is reasonable to comment, that smokers should be advised to stop smoking as early in the preoperative period as possible.

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OBJECTIVE@#To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with electroacupuncture (EA) on rehabilitation after abdominal surgery.@*METHODS@#A total of 320 patients undergoing abdominal surgery were randomly divided into a combination group (80 cases), a TEAS group (80 cases, 1 case discontinued), an EA group (80 cases, 1 case discontinued) and a control group (80 cases, 1 case discontinued). The patients in the control group received enhance recovery after surgery (ERAS) standardized perioperative management. On the basis of the treatment in the control group, the TEAS group was treated with TEAS at Liangmen (ST 21) and Daheng (SP 15); the EA group was treated with EA at Neiguan (PC 6), Hegu (LI 4), Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39); the combination group was treated with TEAS combined with EA, with continuous wave, 2-5 Hz in frequency, and the intensity was tolerable to the patients, 30 min each time, once a day, from the first day after surgery, until the anus resumed spontaneous defecation and the oral intake of solid food was tolerated. The gastrointestinal-2 (GI-2) time, first exhaust time, first defecation time, first tolerance of oral intake of solid food time, time of first get out of bed and hospital stay were observed in all the groups; the pain visual analogue scale (VAS) score and incidence rates of nausea and vomiting 1, 2, 3 days after surgery were compared in all the groups; after treatment, the acceptability of each treatment was evaluated by patients in each group.@*RESULTS@#Compared with the control group, the GI-2 time, first exhaust time, first defecation time, first tolerance of oral intake of solid food time were shortened (P<0.05), the VAS scores 2, 3 days after surgery were decreased (P<0.05) in the combination group, the TEAS group and the EA group; those in the combination group were shorter and lower than the TEAS group and the EA group (P<0.05). Compared with the control group, the time of hospital stay in the combination group, the TEAS group and the EA group were shortened (P<0.05), and that in the combination group was shorter than the TEAS group (P<0.05).@*CONCLUSION@#TEAS combined with EA can accelerate the recovery of gastrointestinal function in patients after abdominal surgery, relieve postoperative pain, and shorten hospital stay.

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Background@#Surgical Apgar Score (SAS) is a simple, inexpensive, and readily available ten-point scoring system using patient's parameters which include surgical blood loss, lowest recorded mean arterial pressure (MAP) and lowest intraoperative heart rate in predicting 30-day post-operative morbidities. This study determined the reliability of SAS in predicting immediate post-operative extubation and immediate intensive care unit (ICU) admission among patients who underwent major abdominal surgeries in a tertiary hospital in Iloilo City.@*Methods@#A descriptive retrospective cross- sectional study conducted in a tertiary hospital in Iloilo City included patients aged 19 and above who underwent major abdominal surgery from January 1, 2017 to December 31, 2019, and met the study's inclusion criteria. Purposive sampling was utilized. Demographics, clinical data, intraoperative data, management as well as treatment course, post- operative course and patient outcome were extracted, and data collected were utilized for data processing and analysis. Frequency count, mean and standard deviation were utilized for descriptive statistics; T-test and One-way Analysis of Variance (ANOVA) were utilized to determine statistical difference among groups. Logistic regression analysis was employed to assess association between SAS and immediate extubation and post- op ICU admission. Statistical Package of the Social Sciences (SPSS) software version 23.0 was utilized for statistical computations. A probability level of p<0.05 was utilized to determine statistical significance.@*Results@#The study consisted of 221 patients predominantly female 64.3 % (n=142) with the mean age of 55.80 17.53. Mean SAS was 6.79 $ 1.3 with a total of 13 (5.9%) patients who were classified as high risk (SAS 0-4), 152 (68.8%) patients as medium risk (SAS 5-7) and 56 (25.3%) patients as low risk with SAS 8-10. On logistic regression analysis, mean arterial pressure (MAP), lowest heart rate and estimated blood loss were significantly associated with decision to do immediate post-operative extubation and immediate ICU admission (p<0.001). Those with higher MAP were 1.19 times more likely to be extubated (OR 1.199, CI: 1.078-1.334, p<0.001) and higher estimated blood loss more likely to be admitted in the ICU (OR 1.006, CI: 1.004-1.009, p<0.001). Lastly, those with higher heart rates were 1.2 times more likely to be admitted in the ICU post-operatively. Low-Risk SAS (Score of 8-10) is predictive of immediate post-operative extubation with 97.7% sensitivity and 75.6% specificity. High Risk SAS (score of 0-4) is predictive of immediate post-operative ICU admission with a sensitivity of 76.1% and 98.3% specificity.@*Conclusion@#SAS is a reliable and valid predictive tool in determining immediate post- operative extubation and ICU admission among patients undergoing major abdominal surgeries. Multicentric, longitudinal and prospective studies are further required to confirm results.Keywords: Surgical Apgar Score (SAS), extubation, intensive care, critical care, abdominal surgery

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Objective:To summarize the best evidence of pulmonary rehabilitation in adult patients undergoing upper abdominal surgery and provide evidence-based basis for clinical intervention.Methods:Systematically searched clinical decisions, guidelines, expert consensus, evidence summary, systematic review and randomized controlled trial studies on pulmonary rehabilitation for patients undergoing upper abdominal surgery in UpToDate, Cochrane Library, Web of Science, PubMed, Embase, CINAHL, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, National Comprehensive Cancer Network, Guidelines International Network, Medlive, British Thoracic Society, European Respiratory Society, American Association for Cardiovascular and Pulmonary Rehabilitation, Canadian Thoracic Society, American Thoracic Society, WanFang Database, China National Knowledge Infrastructure, VIP Database, and China Biology Medicine. The retrieval time limit was from March 11, 2012 to March 11, 2022. Evidence was extracted, summarized and recommended after strict evaluation of literature quality.Results:A total of 19 pieces of literature were eligible for inclusion. They were 2 clinical decisions, 4 expert consensuses, 4 systematic evaluations, and 9 randomized controlled studies.The best evidence included 22 recommendations in 7 dimensions, namely pulmonary rehabilitation team, patient assessment, sports training, respiratory muscle training, drug rehabilitation, health education and quality control.Conclusions:Summary of the best evidence of pulmonary rehabilitation in patients undergoing upper abdominal surgery can provide evidence-based guidance for clinical intervention, but medical staff should also develop personalized training programs according to the actual situation of patients when applying the evidence.

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Objective:To study the duration of invasive mechanical ventilation (MV) and its influencing factors after neonatal abdominal surgery under general anesthesia in neonatal intensive care unit (NICU).Methods:From January 2018 to December 2020, neonates received abdominal surgery under general anesthesia and needed endotracheal intubation and MV after surgery in NICU of our hospital were retrospectively studied. According to MV duration, the neonates were assigned into <72 h group and ≥72 h group. Multivariate logistic regression was used to analyze the risk factors of postoperative MV duration.Results:A total of 113 neonates were enrolled, including 57 male (50.4%) and 56 female (49.6%). The gestational age was (35.7±3.6) weeks, the birth weight was (2 497±933) g, the average operation age was 9.9(3.6, 22.2) d and the average hospital stay was 22.0(12.0,37.0) d. Congenital intestinal obstruction (37/113, 32.7%) was the most common diagnoses on discharge, followed by neonatal necrotizing enterocolitis(28/113,24.8%) and gastrointestinal perforation (18/113,15.0%). The duration of operation was 80.0 (55.8,117.3) min. All neonates needed MV with endotracheal intubation. The duration of postoperative respiratory support was 30.0(7.0,84.5) h. 48 neonates (42.5%) had endotracheal intubation removed within 24 h after surgery. Multivariate logistic regression analysis showed that preoperative respiratory support ( P=0.004), congenital heart disease( P=0.013) and intravenous midazolam ( P=0.032) were independent risk factors for prolonged postoperative MV. Conclusions:The need of preoperative respiratory support, congential heart disease and intravenous midazolam were independent risk factors for the duration of postoperative MV after neonatal abdominal surgery under general anesthesia.