Recurrence and long-term outcome after open cystectomy with omentoplasty for hepatic hydatid disease in an endemic area

BACKGROUND/PURPOSE

Surgery is the cornerstone in the treatment of echinococcosis. The purpose of this study is to report the long-term results of partial cystectomy and omentoplasty in the management of hepatic hydatid disease.

MATERIAL AND METHODS

In a retrospective survey over the past 20 years (1982-2001) there were 36 patients (13 men and 23 women, with a mean age of 50 years) with hepatic echinococcosis, treated by partial cystectomy and omentoplasty. All patient data were carefully studied and short-term as well as long-term results were assessed. The cystic lesion was single in all but two cases (5.6%), located in the right lobe of the liver (69.4%), the left lobe (25%) or both lobes (5.6%). The mean size of the cyst was 12 cm in diameter (range 3 to 25 cm). The follow-up was achieved at regular intervals and recently in all, including computed tomography and specific immunological test ELIZA. It has completed a mean 12-year period (range 2 to 21 years) and in 75% of cases up to 10 years.

RESULTS

The mean hospital stay was 23 days (range 9 to 51 days). The morbitity was 8/36 (22%) due mainly to septic complications. The 30-day mortality was 1/36 (2.7%). The residual cavity remained for a mean of 8 months (range 4 to 18 months), while fistula formation was seen in 1/36 (2.7%). There was cure in 29 cases (80.6%) without any serological or imaging evidence of residual disease. However, recurrence was documented in 7 cases (19.4%) requiring further treatment.

CONCLUSIONS

Following the experience of the authors, partial cystectomy and omentoplasty may be an acceptable alternative to more radical procedures, especially in high risk cases and in developing countries.

Recurrence and long-term outcome after open cystectomy with omentoplasty for hepatic hydatid disease in an endemic area

BACKGROUND/PURPOSE

Surgery is the cornerstone in the treatment of echinococcosis. The purpose of this study is to report the long-term results of partial cystectomy and omentoplasty in the management of hepatic hydatid disease.

MATERIAL AND METHODS

In a retrospective survey over the past 20 years (1982-2001) there were 36 patients (13 men and 23 women, with a mean age of 50 years) with hepatic echinococcosis, treated by partial cystectomy and omentoplasty. All patient data were carefully studied and short-term as well as long-term results were assessed. The cystic lesion was single in all but two cases (5.6%), located in the right lobe of the liver (69.4%), the left lobe (25%) or both lobes (5.6%). The mean size of the cyst was 12 cm in diameter (range 3 to 25 cm). The follow-up was achieved at regular intervals and recently in all, including computed tomography and specific immunological test ELIZA. It has completed a mean 12-year period (range 2 to 21 years) and in 75% of cases up to 10 years.

RESULTS

The mean hospital stay was 23 days (range 9 to 51 days). The morbitity was 8/36 (22%) due mainly to septic complications. The 30-day mortality was 1/36 (2.7%). The residual cavity remained for a mean of 8 months (range 4 to 18 months), while fistula formation was seen in 1/36 (2.7%). There was cure in 29 cases (80.6%) without any serological or imaging evidence of residual disease. However, recurrence was documented in 7 cases (19.4%) requiring further treatment.

CONCLUSIONS

Following the experience of the authors, partial cystectomy and omentoplasty may be an acceptable alternative to more radical procedures, especially in high risk cases and in developing countries.

Comparison between modern mesh and conventional non-mesh methods of inguinal hernia repair

BACKGROUND

The objectives of the study were to compare the tension-free mesh repair with non-meash conventional repair of groin hernia.

METHODS

In the past two years in 299 consecutive unselected patients 339 inguinal hernia repairs were carried out. They randomly allocated to undergo either a non-meash modified Bassini's repair (n=164) or a tension-free mesh repair (n=175). The latter group consisted of laparoscopic TAPP repair (n=46) and open onlay patch repair (n=64) or plug and patch repair (n=65). Operation time, postoperative pain and complications, hospital stay, return to work and recurrence were assessed. Statistical analysis was made using the "t"-Student test.

RESULTS

The characteristics of the patients in each group and the operation time did not differ significantly. The planned procedure was completed in all and no death occurred. The analgesic requirements (none 2.5 vs 56.4%, opiods 77 vs 23.6%), complication rate (9.4 vs 4.3%), hospital stay (4.2 vs 1.8 days), return to work (17.2 vs 7.3 days) and recurrence rate (5.5 vs 1.2%) in non-mesh group were more than in the mesh group. All differences were statistically significant (p<0.05). Among the three subgroups of mesh group no statistically significant differences (p>0.05) were found.

CONCLUSIONS

The tension-free mesh repair either open or laparoscopic provides excellent results with better short-term outcome and lower recurrence rate than non-mesh modified Bassini's repair.

Helicobacter pylori infection in patients undergoing appendectomy

AIMS

Helicobacter pylori has been found in the upper gastrointestinal tract; it is incriminated as aetiological factor in various pathological conditions. This prospective study assesses the presence of this microorganism in the appendix flora and the possible role of its infection in the pathogenesis of acute appendicitis.

METHODS

H. pylori was investigated in 46 consecutive patients undergoing emergent appendectomy for presumed acute appendicitis. Blood sample for serological test of H. pylori infection was drawn before operation. The removed appendix specimen was stained for H. pylori; confirmation was made by PCR (Polymerase Chain Reaction) analysis. The intensity of inflammation was determined pathologically grading from no inflammation to gangrenous appendicitis. Statistical analysis was made using the chi-square test.

RESULTS

Seropositivity for H. pylori infection was found in 18 patients (39%), but the microbe was detected in just two appendix specimens (4%). In all seropositive patients acute appendicitis was confirmed by the pathology study; serous (33%) and purulent or gangrenous (67%). The latter incidence in the seronegative patients was 50%. There were found eight specimens (17%) negative for inflammation dealing all with seronegative patients.

CONCLUSIONS

It seems that H. pylori colonizes the appendix in small proportion and is unlikely to be associated in direct correlation with acute appendicitis. However, seropositive patients with acute inflammation are likely to suffer from purulent or gangrenous form.

Complete dehiscence of the abdominal wound and incriminating factors

OBJECTIVE

To find out the causes of abdominal wound dehiscence.

DESIGN

Retrospective study.

SETTING

University hospital, Greece.

SUBJECTS

Abdominal wound dehiscence occurred in 89 cases out of 19,206 major abdominal operations including 4671 emergencies during the past 15 years (0.5%).

INTERVENTIONS

In the study group 14 local and systemic risk factors were analysed and compared with those in a control group of 89 patients who had similar procedures without dehiscence.

MAIN OUTCOME MEASURES

Statistical analysis using the chi square test.

RESULTS

Significant factors (p < 0.05) included age over 65 years, emergency operation, cancer, haemodynamic instability, intra-abdominal sepsis, wound infection, hypoalbuminaemia, ascites, obesity, and steroids. Risk factors that were not significant included sex, anaemia, diabetes mellitus and pulmonary disease. Overall morbidity and mortality were 30% and 16%, respectively. The mortality and the possibility of dehiscence seem to correlate directly with the number of risk factors.

CONCLUSION

Patients with these risk factors require more attention and special care to minimise the risk of its occurrence.