Comparison of treatment methods of appendiceal mass and abscess: A prospective Cohort Study.

BACKGROUND: The aim of our prospective study is to compare and analyze the results of two treatment methods of appendiceal mass and abscess: emergency surgery and conservative treatment with and without interval surgery. MATERIALS AND METHODS: 74 Patients with the diagnosis of appendiceal mass or abscess were enrolled in this study. The patients were assigned into two groups: the emergency surgery group and the conservative management group. The conservative management group was subdivided into two groups: interval surgery group and the ambulatory follow-up observation group without interval surgery. Several clinical characteristics were determined and compared between the groups. Among patients who underwent surgery, the surgical methods, operation time, postoperative hospitalization period, and post-surgical complications were analyzed. In the ambulatory follow-up observation group, recurrence of appendicitis was assessed. RESULTS: Comparison of the emergency surgery group and interval surgery group revealed that the interval surgery group was characterized by shorter operation time (P = 0.008), a smallernumber of postoperative complications (P = 0.02) and also shorter postoperative hospital stay (P = 0.009). In the ambulatory follow-up observation group, recurrence of appendicitis developed in 3 (13%) patients. US or CT-guided PCD was performed in all 3 patients on the conservative treatment stage. Comparing the interval surgery and recurrent appendicitis groups revealed statistically significant difference: operation time (P = 0.04) as well as postoperative hospital stay (P = 0.04) were shorter in recurrent appendicitis group. In 3 (4.1%) patients, the cause of the appendiceal mass was caecal cancer (2 cases) and Crohn's disease. CONCLUSION: Conservative treatment without interval surgery seems to be the preferred method for treatment of appendiceal mass and abscess. Patients can be operated on only in case of recurrence of appendicitis. US or CT PCD of appendiceal abscess presents the risk-factor for the development of recurrence of appendicitis. CT and colonoscopy within 4-6 weeks after completing the conservative treatment is recommended to be performed in all patients.

Gallbladder agenesis: A case report and review of the literature.

INTRODUCTION: Gallbladder agenesis is a rare congenital abnormality with an incidence of 10-65 per 100,000. Approximately half of these patients are surgically operated on because of the symptoms similar to biliary colic, and correct diagnosis is established intra-operatively. We present a clinical case of gallbladder agenesis from our practice. PRESENTATION OF CASE: A 49 (forty-nine) - year- old women was admitted in the Emergency Department of our clinic. Symptoms were similar to the biliary colic. Ultrasonography showed hyperechogenic acoustic shadow on the projection of the gallbladder which was considered as constricted gallbladder and cholecystolithiasis was diagnosed. Laparoscopic cholecystectomy was considered. During laparoscopy gallbladder could not be found. Surgical operation was completed without conversion. Postoperative treatment included analgesics and antispasmodics. Pre-operative symptoms disappeared. One month later magnetic resonance cholangiopancreatography (MRCP) confirmed gallbladder agenesis diagnosis. Health condition of the patient is satisfactory, without any complications after a year of surgery. DISCUSSION: Gallbladder agenesis presented with symptoms similar to biliary colic can be diagnosed without surgical intervention. Conservative treatment consists of antispasmodic drugs. CONCLUSION: If the shrunken gallbladder is detected on the ultrasound, additional radiological examinations are required. MRCP is considered as a test of choice among the radiological investigations. If gallbladder agenesis is identified on laparoscopy, there is no need for further conversion. For postoperative follow up examination MRCP investigation is recommended.

Open retromuscular mesh repair versus onlay technique of incisional hernia: A randomized controlled trial.

INTRODUCTION: The aim of this prospective randomized clinical study was to compare and analyze the results of two methods of treatment of incisional hernia: open retromuscular mesh repair and onlay technique. METHODS: 180 patients who underwent open elective surgery for middle primary incisional hernia were randomized into two groups. The retomuscular mesh repair was used in the first group and the onlay technique - in the second group. Several preoperative and intraoperative factors, also wound complications (wound infection, hematoma, seroma) and hernia recurrence rate were determined and compared between the groups. RESULTS: The operative time was significantly longer in the retromuscular group compared with the onlay group (P < 0.001). In the retromuscular group 17 (22.1%) wound complications were observed, in the onlay group-39 (50.0%) wound complications. The difference was statistically significance (P < 0.001). Seroma was the most frequent postoperative wound complication, ranging from 16.9% to 41.0% among the groups, respectively (P = 0.0013). No significantly difference has been found between groups by wound infection and hematoma. 2 (2.6%) case of hernia recurrence was marked in retromuscular group and 4 (5.1%) case of hernia recurrence - in onlay group. But there was no statistically significantly difference between the two groups. CONCLUSION: Our research shows no significant difference in frequency of hernia recurrence between retromuscular mesh repair and onlay technique for treatment of incisional hernia. The usage of the retromuscular mesh repair is associated with significantly less wound complications than onlay technique. That can be considered as an advantage of retromuscular method, which makes it more preferential than onlay method.

Management of Appendiceal Mass and Abscess. An 11-Year Experience.

The aim of our study is to compare the results of emergency surgery versus conservative treatment with interval surgery in patients diagnosed with appendiceal mass and abscess. A retrospective review of 48 patients with appendiceal mass and abscess treated from January 2002 to January 2013 at General Surgery Department of Kipshidze Central University Hospital was performed. Patients with emergency surgery were compared to patients treated by nonoperative management with interval surgery. Demographics, clinical profile, and operative outcomes were studied. The emergency surgery group included 25 patients, and the interval surgery group included 23 patients. The clinical characteristics of the emergency surgery and interval surgery groups were not statistically different. In the emergency surgery group, an open appendectomy was performed on 17 patients, and colonic resections (ileocecectomy or right hemicolectomy) were performed on 8 patients. In the interval surgery group, an open appendectomy was performed on 21 patients, and colonic resections were performed on 2 patients. There were no statistical differences in types of surgery, postoperative complications, operation time without colonic resections, and postoperative hospitalization period among these 2 groups. Operation time with colonic resections was of greater duration in the emergency surgery group than in the interval surgery group (P = 0.04). Both treatment methods for appendiceal mass and abscess have the same results. The surgeon must consider clinical symptoms and results of investigations in each particular case when choosing an appropriate treatment method. Prospective randomized controlled trials are required for comparing the results of all 3 treatment methods of appendiceal mass.

Standard polypropylene mesh vs lightweight mesh for Lichtenstein repair of primary inguinal hernia: a randomized controlled trial.

PURPOSE: The aim of the present clinical study was to compare early and late outcomes after inguinal hernia repair with the heavyweight mesh (HW) and lightweight mesh (LW) during a 3 year follow-up period. METHODS: 226 patients were randomized into LW and HW mesh groups, both of which underwent unilateral primary inguinal hernia repair via the Lichtenstein technique. Wound complications (infection, hematoma, seroma), hernia recurrence, pain and feeling of foreign body in inguinal area were determined in patients. Pain was measured by visual analogue scale. RESULTS: No statistical difference has been found between LW and HW groups by wound complication (P = 0.80). One case of hernia recurrence has been mentioned in both groups one year after hernioplasty. But there was no detectable difference between the two groups. No significant difference has been found between LW and HW groups by frequency of chronic pain 7 days, 1 and 3 months, 1, 2, and 3 years after surgery. As for the feeling of foreign body in groin it is similar in both groups after 1 and 3 months. Level of feeling of foreign body was significantly lower in LW group 1, 2, and 3 years after surgery, than in HW group (P = 0.03, P = 0.02, P = 0.02, respectively). CONCLUSION: Our research shows no significant difference in wound complications, hernia recurrence and chronic pain after Lichtenstein hernioplasty, by using of LW and HW meshes. The usage of the LW mesh was associated with less feeling of foreign body than that of the HW mesh, what can be considered as prevalence of LW mesh hernioplasty.

Mucocele of the appendix: case report and review of literature.

Appendiceal mucocele is a rare disease. Sometimes it is discovered accidentally and sometimes it resembles acute appendicitis. Correct diagnosis before surgery is very important for the selection of adequate surgical treatment to avoid intraoperative and postoperative complications. Ultrasonography, and particularly computed tomography, should be used extensively for this purpose. If mucocele is treated incorrectly pseudomyxoma peritonei, which is characterized by malignant process, may develop. We present a case of a 54-year-old man who was admitted to the emergency department with the signs of acute appendicitis. Open surgery was performed. At the time of surgery, a cystic mass of the appendix with dimensions 7 × 4 ×3 cm, with inflamed walls, but without perforation was discovered in the right iliac fossa. No discharge was found in the peritoneal cavity. Diagnosis of mucocele was suspected. Only appendectomy was performed because no pathologic process was found in the base of the appendix and lymph nodes were not increased in size. Hystopathologic diagnosis was mucinous cystadenoma. After 2 years, the patient is feeling well.