Endoscopic-Assisted Percutaneous Sigmoidopexy: New Highlights on Technique and Outcomes.

Background: Sigmoid volvulus is primarily a disease of the elderly. Case Presentation: We describe a case of recurrent sigmoid volvulus in an elderly woman who refused surgery due to the high risk posed by general anesthesia and surgical intervention. She underwent endoscopic-assisted percutaneous sigmoidopexy using only three 2-shot anchor sets. No radiographic observation was necessary during the procedure. Some puncture sites were secured using endoscopic clips. Conclusion: Endoscopic-assisted percutaneous sigmoidopexy is increasingly used as an effective alternative to surgical sigmoidopexy when surgery under general anesthesia poses a high risk. Despite clinical improvement and resolution of the recurrent volvulus, after sigmoidopexy patients may continue to experience motility dysfunction and diffuse dilation of the colon for a few weeks, which may correlate with the episodes of obstruction experienced prior to fixation.

Successful Surgical Management of an Invasive Adenocarcinoma Within a Duplicated Gallbladder by an Extensive Hepatic Resection: A Case Report.

Identifying a duplicated gallbladder is a rather rare entity, but a well-described phenomenon within the current literature. Although this finding has been described in numerous case reports, management remains poorly defined and the diagnosis is often difficult. We present a case of a patient with a suspected duplicated gallbladder versus a choledochocele that was diagnosed later on with adenocarcinoma within a duplicated gallbladder during surgical management requiring extended hepatic resection for curative intent. This case emphasizes the importance of radiological techniques in diagnosing such rare cases and the surgical approach of managing adenocarcinoma in the presence of this rare anatomical malformation.

The impact of partial and complete lockdown during the COVID-19 pandemic on acute surgical services: a retrospective cohort study.

PURPOSE: The burden of the coronavirus disease of 2019 (COVID-19) pandemic on the healthcare sector has been overwhelming, leading to drastic changes in access to healthcare for the public. We aimed to establish the impact of implemented government partial and complete lockdown policies on the volume of surgical patient admissions at a tertiary referral center during the pandemic. METHODS: A database was retrospectively created from records of patients admitted to the surgical ward through the emergency department. Three 6-week periods were examined: The complete lockdown period (CLP), which included a ban on the use of cars with the exception of health service providers and essential sector workers; A pre-COVID period (PCP) 1 year earlier (no lockdown); and a partial lockdown period (PLP) that involved a comprehensive curfew and implementing social distancing regulations and wear of personal protective equipment (e.g., masks) in public places. RESULTS: The number of patients admitted to the surgery ward was significantly higher in the PCP cohort compared to the CLP and PLP cohorts (p = 0.009), with a 42.1% and 37% decline in patients' admissions, respectively. Admission rates for patients with biliary pathologies and vascular thrombotic events increased. 30-day mortality rates did not differ significantly between the three periods (p = 0.378). CONCLUSIONS: While COVID-19 lockdown regulations had a significant impact on patient admission rates, surgical outcomes were not affected and the standards of care were maintained. Future protocols should strive to improve access to healthcare to avoid complications caused by delayed diagnosis and treatment.

Compliance with safety measures and risk of COVID-19 transmission among healthcare workers.

AIM: This study aimed to determine the compliance of healthcare workers (HCWs) with the hospital safety measures and the prevalence of hospital-acquired COVID-19 infection among them. METHODOLOGY: HCWs at King Abdullah University Hospital (KAUH) assigned for COVID-19 patients between 18 March and 10 June 2020 were tested for past infection using total anti-SARS-CoV-2 immunoglobulin assay, demographic data and compliance with safety measures were assessed using a questionnaire. RESULTS: A total of 340 HCWs participated in the study, 260 were close direct care. Three HCWs tested positive for total anti-SARS-CoV-2 immunoglobulin. Close direct care were more compliant with personal protective guidelines than those providing direct care. CONCLUSION: HCWs compliance with personal protective guidelines might explain the low prevalence of COVID-19 infection in hospital settings.

Impact of the COVID-19 pandemic on the management of chronic limb-threatening ischemia in Northern Jordan: Case series and literature review.

INTRODUCTION: The novel COVID-19 pandemic has imposed unprecedented restrictions on healthcare services worldwide. In developing nations such as Jordan, appreciable impacts on healthcare delivery ensued owing to limited resources. As a result, managing chronic limb-threatening ischemia (CLTI) has been modified to accommodate altercations in the system. This study assessed the impact of the COVID-19 pandemic on managing patients with critical limb-threatening ischemia (CLTI) during the lockdown. METHODS: Objectives were accomplished by retrieving records of clinical data and perioperative results for patients diagnosed with CLTI at King Abdullah University Hospital between March 17 and June 1, 2020. Patients' demographics, Rutherford classification, type of intervention, and intervention variables during the outbreak were retrospectively analyzed (pandemic Group A) and compared with patients from the same period last year (control Group B). RESULTS: A total of 96 patients with CLTI were included in the study; Groups A and B consisted of 28 and 68 patients, respectively. The mean ages for Groups A and B were 62.8 and 60.2 years, respectively. Conservative management was applied to 53.6% (P < 0.01) of Group A patients, whereas endovascular revascularization was the primary approach in Group B (39.7%, P < 0.01). After the intervention, the majority of patients in Group A were classified as category six on the Rutherford classification system (46.4%, P < 0.01), whereas the majority in group B were classified as category five (55.9%, P < 0.01). CONCLUSIONS: The more unsatisfactory outcome of CLTI during the pandemic entails substantial measures to ensure conscientious virtual encounters and ambulatory community-based services during current and future pandemics. The endovascular-first policy should be endorsed in future pandemics as it is better at reducing aerosol transmission than standard surgical intervention. Moreover, endovascular procedures are minimally invasive and associated with favorable outcomes when medical optimization and hospital beds are limited.