Ten years Siriraj’s experience of wound infection rate at the third post-operative day or the day of discharge in appendicitis pediatric patients.

Objective: Primary: To find the wound infection rate at the third postoperative day 3 or the day of discharge from Siriraj Hospital, Bangkok, Thailand. Secondary: To find factors that might cause postoperative wound infection: age, body weight, mean time of the first wound dressing, duration of abdominal pain before operation, pre-diagnosis antibiotic administration, duration of anesthesia and operation, and type of suture material. Methods: Retrospective reviews of medical records of the division of pediatric surgery diagnosed appendicitis from 1997-2006 were used to form the study group. Data collected included personal profile, abdominal pain before diagnosed appendicitis, medication used before being diagnosed, type and duration of preoperative antibiotics, operative time, time in operating room, length of stay, time of the first dressing after operation, and wound infection were collected. Data were collected to be analyzed for descriptive and analytic method between the wound infection group and the no wound infection group and between the complicated (ruptured or gangrenous) appendicitis and the non complicated (acute or acute suppurative) appendicitis groups. Results: There were 433 patients. Appendectomy wounds were opened in the third operative day or the day of discharge in 109 patients. Two wound separations, 1 wound infection and 8 wounds that had discharge were found. The average time of first wound dressing after operation was 64.31 hours. Three out of 4 wound infections were diagnosed after discharge from the hospital. The average time in the operating room was longer in the wound infection group compared with the uninfected group (P = 0.042). Patients with complicated appendicitis had more incidence of wound infection than patients with non complicated appendicitis (P = 0.015). Compared between the non complicated and the complicated appendicitis group, the age and bodyweight of the complicated group were lower than the other group (P = 0.009 and 0.05, respectively). Patients with complicated appendicitis had a longer duration of abdominal pain before being diagnosed with appendicitis and a longer length of stay (LOS) (P <0.001). Conclusion: Wound infection is rarely diagnosed at the third operative day or the day of discharge. Complications from wound dressing, including wound separation and psychological problems, were more common than the wound infection that was detected at that time. Patients with the wound infection spent a longer time in the operating room. The patients with complicated appendicitis were younger and had a lower bodyweight. They had a longer duration of abdominal pain before admission, had a longer length of hospital stay, and had more incidence of wound infection compared with the non complicated group.

Treatment of hemangioma and vascular malformation by Nd-YAG laser.

Objective: To review the results of Nd-YAG laser therapy in patients with hemangioma and vascular malformation in the aspects of size, colour, complications and parent satisfaction. Methods: Retrospective reviews of 9 patients who had received Nd-YAG laser therapy from 23.8.2006-15.11.2006 were carried out. Patients were treated with CW-Nd YAG laser by a transcutaneous with ice technique, a contact technique, or an interstitial technique depending on the lesions. Data were collected by patient and parent interview or sonography measurement for voluminous lesion. Results: There were 9 patients. In the patients with vascular malformation (n=6), five cases showed increased faintness of the lesions‘ colour. There were two voluminous venous malformations; both showed marked regression (>50%) of lesions after laser treatment. In patients with voluminous hemangioma (n=2), one showed moderate (50%) regression within two months of laser treatment. The other showed no regression within one month; however, no progression of lesion was detected. There was one patient with eruptive angioma. Complete laser coagulation was done by the laser contact technique without recurrent bleeding. There was scar development after laser treatment in two venous malformation patients treated by the transcutaneous laser therapy. There was no scar complication in treated hemangioma patients. Hypopigmentation was found in both venous malformation patients treated by the laser contact technique. Conclusion: Nd-YAG laser therapy is a treatment alternative in hemangioma and vascular malformation. Hemangioma regressed or stopped growth after laser treatment. All venous malformations showed improvement of colour (fainter). However, a scar complication from laser therapy could be encountered, especially if the skin cooling preparation technique was not done properly. Voluminous reduction can be expected in 100% of cases. Laser treatment by contact technique is an effective method for destruction of protruding venous malformations and eruptive angioma.

Laparoscopic cholecystectomy versus open cholecystectomy in children.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is well accepted as the standard cholecystectomy only in adult patients. However, the advantages of LC over open cholecystectomy have never been proved in pediatric patients because the number of pediatric cholecystectomies is limited as well as the faster ability of pediatric patients to resume their normal activity. MATERIAL AND METHOD: Retrospective study of 42 pediatric cholecystectomies (laparoscopic cholecystectomy (n = 8) (LCs), open cholecystectomy alone (n = 8) (OCs) and open cholecystectomy concomitant with splenectomy (n = 26)(OCs + S)) done in Siriraj University Hospital, Bangkok, Thailand between 1992 and 2000 was conducted. RESULTS: Statistical comparison revealed that LC was superior to OC in regard to diet resumption. LCs resumed soft diet on 1.38 days, whereas OCs and OCs + S could resume soft diet on 3.38 and 3.35 days respectively. The average length of hospitalization following LCs was significantly shorter than OCs' and OCs + S' ones (3.00 vs 8.38 and 4.85 days respectively). There was no morbidity and mortality in LCs, whereas two OCs and three OCs + S had complications. CONCLUSION: In this preliminary study, laparoscopic cholecystectomy is a preferred method of cholecystectomy in children because it has a shorter post-operative interval of diet resumption and shortens hospitalization with minimal morbidity. However, this study has a limited number of patients and further study is still required to conclude the benefits of LC.