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

Management of complicated gallstone disease during pregnancy

Controversy still exists regarding the optimal management of complicated gallstrones during pregnancy owin to the possible risks for the fetus. Generally the management of such problems during pregnancy is conservative, however, endoscopic retrograde cholangiopancreatography [ERCP] and/ or operative intervention may be required in some patients. Aim of Study: The aim is to evaluate the management of complicated gallstone disease with particular reference to the indications, timing and risks of ERCP and operative intervention during pregnancy and its effect on fetus outcome. Patients and methods: This retrospective study was conducted on 32 pregnant women, who were admitted with complication of cholelithiasis at Riyadh Medical complex [RMC] through the emergency during the period of March 1998-October 2002. Their files were evaluated for age, hematological, radiological, fetus assessment, management, fetus outcome and how ERCP and surgery were performed. Among the 32 pregnant women studies, 22 responded satisfactorily to conservative treatment. They had laparoscopic cholecystectomy [LC] after delivery. Ten patients needed further treatment, two were operated for acute cholecystitic [AC] and recurrent biliary colic [BC]. Eight patients had ERCP for obstructive jaundice and recurrent pancreatitis following which two had LC cholecystectomy. All patients remained well until delivery. Majority of gallstone complications during pregnancy can be managed conservatively. Surgery can be deferred until delivery. few patients who needed ERCP and/ or surgery can be managed safely during second and third trimester