Frequency of wound infection in children undergoing appendectomy for acute versus perforated appendicitis.

Objective: To find out the frequency of wound infection in children undergoing appendectomy for acute vs perforated appendicitis. Study Design: Observational and Cross-sectional study. Setting: Department of Surgery at Children’s Hospital and the Institute of Child Health Lahore. Period: January 2018 to July 2018. Material & Methods: Data was collected by using Random sampling technique. Patients of both genders were included. Diabetic children were excluded. Questionnaire was developed with the help of experts, literature review and data collection. Results: A sum of 120 patients were included with mean age of 9 + 1.94 SD minimum was 7 and maximum was 13. Some patients have acute appendicitis 20(16.67%) and 100 (80.33) perforated appendix undergone appendectomy. Conclusion: The findings of the study indicated that there is less wound infection in acute appendix but more wound infection observed in perforated appendix after appendectomy.

Acute Appendicitis in Pre-School Children

Background: Appendicitis is an emergent condition in young children which can cause serious illness. Aim: To identify features related with appendicitis in pre-school children. Study design: Retrospective study Place and duration of study: Department of Paediatric Surgery, Bolan Medical College Hospital Quetta from 1st April 2020 to 31st March 2021. Methodology: Fifty two children between 5-15 years were admitted for appendectomy. All demographic and clinical information including earlier diagnosis, symptoms, biochemical, histopathological as well as radiological imaging were properly documented. The operational technique was open appendecectomy. Results: There were 61.53% boys and 38.46% girls with mean age 8±0.8 years. Abdominal pain was presented in 90.3% while nausea in 82.7% with nausea/vomiting children. There were 51.9% children having perforated appendix with majority between 8-10 years of age. Misdiagnosis was common in 44.2% patients. Conclusion: Appendicitis in pre-school children is difficult and challenging to diagnose which requires careful diagnosis. Key words: Appendectomy, Pre-schoolers, Perforated, Misdiagnosis

COMPARISION OF SURGICAL SITE INFECTION BETWEEN OPEN APPENDECTOMY AND LAPAROSCOPIC APPENDECTOMY

Appendectomy is most common surgical procedure in emergency surgery. Inamed appendix can be removed laparoscopically (laparoscopic appendectomy) or openly (open appendectomy). Surgical site infection is representative of health care associated infection in which it may effect on patients' morbidity and mortality. The aim of the study is to compare laparoscopic appendectomy and open appendectomy in terms of surgical site infection. The frequency of 60 patients who underwent appendectomy open appendectomy-40;laparoscopic appendectomy-20 between September 2019- march2020 which were retrospectively reviewed for demographic and pathological characteristic, recovery of bowel movements, length of hospital stay and post-operative complications. The frequency of purulent/gangrenous or perforated appendix were Laparoscopic appendectomy-10% and in open appendectomy 20%. The time of rst atus after surgery were 2.9 days and in open appendectomy were 2.97 days in laparoscopic appendectomy. Length of hospital stay were relatively short in laparoscopic appendectomy group and in open appendectomy group The frequency of overall surgical site infection were not that difference between the two groups laparoscopic appendectomy -15% open appendectomy group were22%But that of supercial surgical site infection was signicantly lower in laparoscopic appendectomy group5% open appendectomy group 15%.

Risk of Developing Perforations and Abscesses for Patients With Appendicitis, With Regards to Duration of Symptoms. A Retrospective Cohort Study.

ObjectiveSome studies have supported delayed appendectomy citing that the risk of perforation does not increase until beyond 24-48 hours of hospitalization. This retrospective cohort study looked at the relationship of duration of symptoms and the prevalence of perforated appendicitis. To evaluate if a delayed approach would be justifiable.MethodsBetween 1st of January 2018 and 30th of March 2020, there were N=1274 patients, 40 years or younger, suspected of appendicitis at the National University Hospital of Iceland. n=658 had appendicitis and n=105 of them had a perforated appendix. ResultsRelative risk for perforations depending on duration of symptoms were; 6.4, 14.7, 20.2 and 27.1 for 24-48, 48-72, 72-96, and over 96 hours, respectively, compared to 0-24 hours (p < 0.001). There was also a significant correlation with increased duration of symptoms and prolonged hospital stay for patients with appendicitis (p < 0.0001 and rho = 0.36). ConclusionThis indicates that perforations are dependent on the duration of the symptomatic period, and it is probably beneficial to react early and not postpone the workup or treatment past 24 hours.

Management of wound infection after appendectomy: are parenteral antibiotics useful?

This study investigated the use of antibiotics in the treatment of wound infections after appendectomy. The subjects were 72 patients with post-operative wound infections at a district general hospital in Jordan. All patients received daily antiseptic dressings with povidone-iodine 10% in alcohol. The patients were randomized in a single-blind trial to receive either no antibiotics or parenteral antibiotics metronidazole and cefoxitin. There was no significant effect of antibiotic use in patients with early inflamed or severely inflamed appendicitis. However, for patients with perforated appendicitis the mean length of hospital stay and the mean frequency of change of dressings were significantly reduced. We conclude that antibiotics do not offer any advantage in post-appendectomy wound infections except for cases of perforated appendix

Complications of appendicitis in a tertiary care centre

Background: Acute appendicitis is the most common surgical emergency. An appendicectomy is considered the gold standard of treatment for acute appendicitis because of the potential risk of disease progression to perforation, gangrene and peritonitis. The aim of this study was to determine the incidence of complications in patients diagnosed with acute appendicitis.Methods: A total number of 70 patients were studied with various symptoms of acute appendicitis and their complications, all patients were presented to PESIMSR, Kuppam from December 2016 to June 2018. Clinical assessment , investigations like WBC counts, X-ray erect abdomen, USG abdomen and pelvis and management were recorded. The incidence of complications were studied. The cases of appendicular mass was treated conservatively, except for those who do not respond to antibiotics.Results: During this study period, among 70 patients aged between 5-45 years, male were 53 and female patients were 17 and 11 patients belong to pediatric age group and 59 patients aged more than 18 years. The commonest complication was postoperative surgical site infection (20%) found in perforated appendix patients in our study. Around 76% of the patients developed complications. Among the female patients diagnosed with acute appendicitis, appendicular perforation being the most common complication and it was the postoperative surgical site infections in males.Conclusions: Acute appendicitis is the most common surgical emergency. Open appendicectomy is the most commonly done procedure in our hospital. The commonest complication is postoperative surgical site infection (20%) found in perforated appendix patients in our study.

Association of Wound Infection with Various Surgical Technique Applied for Appendectomy in Diabetic and Hypertensive Patients

Background: Perforated appendix in diabetic as well as hypertensive patients is associated with elevated risks of postoperative infectious complications such as wound infection and intra-abdominal abscess. Objective: To identify better appendectomy procedure for diabetic and hypertensive patients. Study Design: Randomized Controlled Trial Place and Duration of Study: Department of Surgery, Unit l, Bahawal Victoria Hospital Bahawalpur from 10th October 2020 to 9th April 2021. Methodology: Ninety eight patients meeting the criteria of perforated appendix were divided in two groups; one group consisted of 49 patients who were managed by open surgical procedure. Second group was consisted of 49 patients who were managed by laparoscopic surgical procedure. Patient outcomes in-terms of wound infections, operative time and duration of surgery was assessed. Results: Mean age of patients was 25.49±6.03 years. There were 17 hypertensive while 15 diabetic patients. Wound infection was seen in 21% and 28% open surgery diabetic and hypertensive patients respectively in comparison to 10%and 8% in laparoscopic appendectomy diabetic and hypertensive patients respectively (p<0.001). Conclusion: Laparoscopic appendectomy (LA) is associated with significantly lower rates of post-operative wound infections and shorter hospital stay in comparison to open appendectomy in diabetic and hypertensive patients of perforated appendicitis. Key Words: Perforated appendix, laparoscopic, open appendectomy

Compare the Incidence of Surgical Site Infection after Appendectomy Wound Irrigation with Normal Saline and Imipenem Solutions

Objective: To compare the incidence of surgical site infection after appendectomy wound irrigation with regular saline solution and imipenem solution. Study Design: Comparative randomized control trial Place and Duration of Study: Department of Surgery Unit-1, Sandeman Provincial Hospital Quetta from 1st September 2020 to 30th April 2021. Methodology: Eighty patients of both genders were presented in this study. Patients detailed demographics age, sex and body mass index were recorded after taking informed written consent. Patients underwent for appendectomy wound irrigation were included. Patients were equally divided into two equal groups, I and II. Group I had 40 patients and received imipenem and group II irrigated with saline solution with 40 patients. Outcomes were surgical site infection, deep abscess formation was observed post-operatively. Results: The mean age of the patients in group I was 26.11±2.03 years with mean BMI 23.61±3.32 kg/m2 and in group II mean age was 25.14±3.12 years with mean BMI 22.14±4.88 kg/m2. In group I, 32 (80%) patients had inflamed appendix, perforated appendix was in 7 (17.5%) and gangrenous appendix in 1 (2.5%) while in group II inflamed appendix in 34 (85%), perforated appendix in 4 (10%) and gangrenous appendix 2 (5%). Surgical site infection in group I was 3 (7.5%) and abscess formation in 2 (5%) cases while in group II SSI in 6 (15%) and abscess formation in 3 (7.5%) cases. Conclusion: Imipenem irrigation after appendectomy reduces wound infection. Healthcare costs and patient suffering due to infection can be reduced. Keywords: Imipenem solution, Wound irrigation with saline, Appendectomy wound infection