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OBJECTIVE: To determine the outcome of hepato-pancreato-biliary patients who were operated upon during the pandemic under a safety protocol devised to minimise the risk of coronavirus disease-2019 infection in patients and staff during the perioperative period. METHODS: The retrospective study was conducted at the Hepato-Pancreatico-Biliary (HPB) Unit of Bahria International Hospital Orchard, Lahore, Pakistan, in February 2021, and comprised data of all patients who were discussed in the multidisciplinary meeting of the Unit between May 1 and December 31, 2020. The coronavirus disease-2019 screening protocol was a negative polymerase chain reaction test just before admission and a second negative test 24-48 hours pre-surgery. All patients had computed tomography scan of chest to rule out atypical pneumonia due to coronavirus disease-2019 infection. Surgery was deferred for positive patients for at least 2 weeks until their test was negative. Surgeries were carried out with full personal protective equipment. Further testing was carried out if clinically indicated. Data was collected of 30-day coronavirus disease-2019-related morbidity and mortality. Data was analysed using SPSS 20. RESULTS: Of the 44 patients, 29(65.9%) were males and 15(34.1%) were females. Overall, 32(72.7%) patients were aged >40 years, 8(18.2%) were aged 20-40 years and 4(9%) were aged <20 years. Of the total, 7(15.09%) patients were found to be positive for coronavirus disease-2019 during preoperative screening. Among them, 5(71.4%) had successful surgery post-recovery, 1(14.3%) died without surgery due to pulmonary complications related to coronavirus disease-2019 and 1(14.3%) patient was lost to follow-up. Among the 42(95.5%) patients who underwent any procedure, 2(4.7%) patients turned positive for coronavirus disease-2019 in the postoperative period. There was 1(2.4%) mortality in the 30-day post-operative period which was not related to coronavirus disease-2019. Complications were seen in 5(11.90%) patients. Three (9.3%) out of 32 staff members were found to be asymptomatic carriers. CONCLUSIONS: Hepato-pancreatico-biliary surgery could be safely carried out during coronavirus disease-2019 pandemic if strict safety protocols were followed.
Subject(s)
Biliary Tract Surgical Procedures , COVID-19 , Female , Humans , Male , Biliary Tract Surgical Procedures/methods , COVID-19/epidemiology , Pancreas , Pandemics , Retrospective Studies , Young Adult , AdultABSTRACT
Appropriate risk stratification and careful follow-up are mandated in elderly patients with comorbidities. Herein, we report a case presenting 5 months after the nonoperative management of acute cholecystitis during the height of the COVID-19 pandemic.
ABSTRACT
ABSTRACT Objective: To determine the effectiveness of the haemorrhoidal artery ligation via palpatory method among patients with grade II and III hemorrhoids. Study Design: Observational prospective study. Place and Duration of Study: The study was conducted at Combined Military Hospital Multan where with hemorrhoids were operated between May to Nov2018. Methodology: A total of 121 patients participated in this study. Patients included in the study were aged between 20-60 years of age with grade II and III hemorrhoids. Patients were selected from out-patient department. They were explained the purpose of the study and those who consented to participate in the study were enrolled through a written consent form. Digital rectal examination was done under spinal anesthesia followed by proctoscopy and hemorrhoids were identified. Split proctoscope was passed and hemorrhoids were isolated one by one. Haemorrhoidal artery was palpated sutured with vicral 3/0. Follow up at 3weeks and 8 weeks. Results: Male respondents accounted for 50(41.3%) whereas their female counterparts comprised 71(58.7%). The mean age of the male and female respondents was 43.76 ± 10.08 and 44.52 ± 10.59 years respectively. Out of 121 patients that underwent haemorrhoidal artery ligation, only 33(27.3%) had post-operative complications. Most of the patients had rectal bleeding followed by post-operative defecation pain, anal fissure, fistula in ano and recurrence Conclusion: In conclusion, palpatory method is painless, less invasive, has less complications and is safe alternative to open hemorrhoidectomy where Doppler guided haemorrhoidal ligation equipment is not available.