Antibiotic Treatment Has No Influence on Anal Fistula Formation and Recurrent Perianal Abscess After Incision and Drainage of Cryptogenic Perianal Abscess: A Randomized Single-Blind Prospective Study.

BACKGROUND: Anal fistula commonly appears after incision and drainage of perianal abscess. Theoretically, fistula develops as a consequence of infection process. Antibiotic treatment was suggested to decrease the possibility of fistula development. OBJECTIVE: We hypothesized that antibiotic treatment has no influence on development of anal fistula after surgical treatment of perianal abscess. DESIGN: A single blind randomized prospective study. SETTING AND PATIENTS: Patients with primary cryptogenic abscess were eligible to participate. Patients were divided in two groups. Patients in Group I received amoxicillin 875mg/clavulanic acid 125mg during 7 days after surgery and Group II patients received no antibiotics. Study database included demographics, clinical and laboratory data. MAIN OUTCOME MEASURES: Patients were examined in our outpatient clinic 2 weeks, four months and 1 year after surgery and telephone questionnaire performed 6 month after surgery. Primary Outcome was formation of anal fistula. Secondary Outcome was recurrent perianal abscess. RESULTS: Overall 98 patients completed the study. Groups were not different on inclusion. Anal fistula was diagnosed in 16 (16.3%) patients in Group I (treatment group) and 10 (10.2%) patients in the Group II (control group) (p = 0.67). Nine patients (9.2%) developed recurrent perianal abscess, 4 in the treatment group, and 5 in the control group (p = 0.73). LIMITATIONS: Relatively small number of patients treated in single Medical Center. CONCLUSION: Antibiotic therapy has no influence on anal fistula or recurrent perianal abscess formation after incision and drainage of perianal abscess. See Video Abstract.

Should Advanced Age Preclude Surgical Treatment of Gastrointestinal Stromal Tumor?

Introduction: Surgical resection is a gold standard treatment for gastrointestinal stromal tumors (GISTs). It can be performed by minimally invasive surgery approach in most of the patients. It has been shown that advanced age is not a clear poor prognostic factor in patients who underwent surgery for GIST. We hypothesized that elderly patients undergo elective surgery less often compared to younger population. We aim to evaluate the safety, efficacy and oncological results of GIST treatment in the elderly population in our Medical Center. Materials and Methods: All patients who underwent surgery for GIST in Shamir Medical Center from January 1, 2016, to July 31, 2023, were included in the study. The patients were divided into 2 groups. Group 1 included patients younger than 75 years, while patients older than 75 years were included in Group 2. The groups were compared according to demographics, clinical and surgical parameters, complications, and pathology results. Results: Overall, 49 patients were included in the study. Group 1 included 28 patients and Group 2 included 21 patients. Group 2 patients more often underwent emergency surgery (52.4% versus 14.3%, P < .05) and had increased open surgery rate (19% versus 0%, P < .05). No difference between the groups was noted in surgical parameters, complications, and length of hospital stay. Tumor size, number of mitoses, level of ki67%, and involvement of surgical margins were not significantly different. However, in Group 2 patients, tumor size was larger and there was a trend toward higher rate of ki67 > 5%. Conclusion: Elderly patients with GIST are less frequently undergoing electively surgery and relatively often undergo open surgery. Frequency of complications is similar in elderly patients compares to younger patients group.

Laparoscopic Completion Total Gastrectomy for Remnant Gastric Cancer Compared to Laparoscopic Total Gastrectomy in Short- and Medium-Term Results.

Introduction: The incidence of remnant gastric cancer is increasing in recent years. The advantages of minimally invasive surgery for gastric cancer are well established. However, laparoscopic completion total gastrectomy for remnant gastric cancer harbors difficulties due to adhesions, changed configuration of the anatomical organs, and changes on the lymphatic flow. We aim to investigate the feasibility, safety, and the short-term outcomes of laparoscopic completion total gastrectomy compared to laparoscopic total gastrectomy. Materials and Methods: All patients who underwent total gastrectomy from January 2018 to December 2021 at Shamir Medical Center were included in the study. Patients were divided into two groups-completion gastrectomy and total gastrectomy. The groups were compared for demographics, operative, and clinical outcomes. Results: Overall, 22 patients were included in the study. Eight were completion gastrectomy following subtotal gastrectomy for malignancy and 14 were primary total gastrectomy. All operations were performed by minimal invasive surgery technique. Average age was 64 years, with no differences in gender. Two major intraoperative complications were noted in completion group (25% versus 0%, P = .12). Both length of surgery (3:03 versus 3:40, P = .049) and length of stay (7 days versus 9 days, P = .5) were shorter in completion group. There were fewer postoperative complications (12.5% versus 28.5%, P = .61). Average number of harvested lymph nodes was significantly lower in completion group (10 versus 33, P = .002). Conclusion: Laparoscopic completion total gastrectomy for remnant gastric cancer is safe and feasible having comparable oncological surrogate's parameters and recurrence profile. Clinical Registration Number: 0015-22-ASF.

Clinical Presentation of Acute Cholecystitis during the COVID-19 Outbreak.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare systems worldwide. The fear of seeking medical attention to avoid the possibility of being infected may have altered the course of some diseases. OBJECTIVES: To describe our experience with the management of patients with acute cholecystitis during the pandemic at our medical center. METHODS: We compared patients treated for acute cholecystitis between 1 March and 31 August 2020 (Group I) to patients admitted with the same diagnosis during the same months in 2019 (Group II). We evaluated demographics, presenting symptoms, laboratory and imaging findings at presentation, the disease's clinical course, management, and outcome. RESULTS: Group I consisted of 101 patients and group II included 94 patients. No differences were noted for age (66 years, IQR 48-78 vs. 66 years, IQR 47-76; P = 0.50) and sex (57.4% vs. 51.1% females; P = 0.39) between the two groups. The delay between symptom onset and hospital admission was longer for Group I patients (3 days, IQR 2-7 vs. 2 days, IQR 1-3; P = 0.002). Moderate to severe disease was more commonly encountered in Group I (59.4% vs. 37.2%, P = 0.003). Group I patients more often failed conservative management (36% vs. 6%, P = 0.001) and had a higher conversion rate to open surgery (15.4% vs. 0%, P = 0.025). CONCLUSIONS: Patients presenting with acute cholecystitis during the COVID-19 pandemic more often presented late to the emergency department and more showed adverse outcomes.

Angiography in patients with pelvic fractures and contrast extravasation on CT following high-energy trauma.

INTRODUCTION: Pelvic fracture may be accompanied by severe bleeding. Computed tomography (CT) is a gold standard diagnostic tool in stable trauma patients. Contrast extravasation detected on CT of pelvis is a sign of hemorrhage, but its significance is not clear. We aimed to evaluate the need for angiography in patients with pelvic fracture and CT revealed contrast extravasation. We tried to identify parameters that might help to choose patients who will benefit from therapeutic angiography. METHODS: Electronic medical records of patients with pelvic fracture admitted to Level II Trauma Center during 10 years were retrospectively reviewed. Patients who had contrast extravasation on CT were included. Data base consisted of demographics, injury severity, initial physiologic parameters, laboratory data, results of CT and angiography. RESULTS: Forty out of 396 patients had contrast extravasation detected by CT. Twelve patients underwent angiography and 4 of them benefited from embolization. The sensitivity of contrast extravasation in evaluating the need for embolization was 1.0 (95% CI 0.398, 1.0), positive predictive value was 0.1 (95% CI 0.028, 0.237), and the negative predictive value was 1.0 (95% CI 0.990, 1.0). CONCLUSION: The role of angiography in stable patients with pelvic fracture and CT identified contrast extravasation remains questionable. Most of these patients are not in need of angioembolization.