Assessment of needlestick injuries and hepatitis B and C infection among surgeons

BackgroundSpecialist surgeons are at high risk of exposure to hepatitis viruses through occupational exposure to blood or body fluids. Protective measures against occupational exposure to the hepatitis B virus (HBV) and hepatitis C virus (HCV) must be taken in order to prevent infection in surgeons. We aimed to determine the needlestick injuries, and markers HBV and HCV in Iranian surgeons.MethodsThis study was cross-sectional research, performed in Baqyatallah, Shohada, Rasoul Akram, Sina, Taleghani, and Emam Hossein hospitals (all university hospitals) of Tehran, Iran. Overall 318 eligible surgeons were included. Anonymous questionnaires were used containing data about demographic characteristics, self-reported blood and needlestick contacts, occasional exposures, risk behaviors and vaccination. Also, the blood samples were taken and tested for hepatitis B surface antigen (HBsAg), antibody against Hepatitis B surface antigen (antiHBs) and HCV antibody (HCVAb). Fisher exact test and Kruskal Wallis test were used to analyze the data.ResultsThe mean age of the surgeons was 47.76 ± 8.95 years and 177 of them (55.66%) were male. The average number of needle–sticks was 28.28 ± 16.58 during the surgeons’ working life. Among them, 5 cases (1.59%) were positive for HBsAg and 2 cases (0.66%) were positive for HCVAb. ConclusionIn spite of the high needlestick rate in Iranian surgeons, prevalence of hepatitis B and C is not very high among them. A high degree of vigilance and a careful surgical technique is the only means available to prevent the transmission of the viruses.

An experimental rat model of hilar splenic vessel ligation versus splenectomy for spleen trauma

BACKGROUND

The most prevalent method of treating splenic injury is by splenectomy. This method is followed by postoperative complications. Therefore, less invasive procedures such as splenic angioembolization are introduced. This technique needs appropriate training, a high-tech setting and could be followed by complications. Thus, not all surgeons agree to do this procedure. Splenic hilar ligation of main vessels is a non-invasive procedure which has similarities to a splenectomy with unknown results.

OBJECTIVES

We aim to evaluate and compare splenectomy and hilar ligation.

METHODS

Thirty rats were divided into splenectomy and splenic hilar ligation groups. An identical grade 3-spleen injury was performed on all rats. After 6 weeks blood samples were obtained and hematologic and immunologic aspects were measured in their serum. Giemsa stained peripheral blood smears were obtained from the ligation group.

RESULTS

Comparing the above-mentioned variables before and after the surgery in each groups showed statistical significance in all aspects except IgM, C4 and platelets levels in ligation group (P value: 0.213, 0.059 and 0.649 respectively). Analysis revealed significant deference in postoperative WBC, IgM and C4 levels between splenectomy and ligation group (P value: < 0.001, < 0.001 and 0.026 respectively).

CONCLUSION

Splenic hilar ligation of main vessels is an easy way of treating splenic injury in hemodynamically stable patients with less postoperative complications. Therefore, it can be performed by all surgeons in all kind of medical centers. Spleen remains viable and continues its role although some aspects of its function become interrupted.

Obstructed Defecation Syndrome After Delivery Trauma

Background:

Obstructed defecation syndrome (ODS) occurs in about 7% of adults; it seems that the etiology of pelvic floor disorders is multifactorial. Pregnancy and childbirth damage to the pelvic nerve and muscles are proposed causes for this condition. The precise role of vaginal delivery (VD) is not clearly defined, although in recent studies association of pelvic floor disorder with Operative vaginal delivery and episiotomy has been proposed.

Objectives:

In this prospective study, we assessed the outcome of stapled transanal rectal resection (STARR) in females with one of the two modes of delivery (VD or caesarean section (C/S).

Patients and Methods:

We used Longo’s ODS score for the assessment of the severity of pelvic floor malfunction. Stapled Trans Anal Rectal Resection (STARR) procedure was performed using two circular staplers. Follow-up was done 12 months after the discharge. To assess the role of episiotomy in patient with VD, we divided them into two subgroups; females who had VD with episiotomy (Vd + epi) and females who had VD alone. Data were analyzed using SPSS version 20 software. P values less than 0.05 were considered statistically significant.

Results:

In 30 consecutive females undergoing STARR for the treatment of ODS, who enrolled in this prospective study, 19 (63.3%) had Vaginal Delivery VD and 11 (36.7%) had Cesarean Section (C/S). The ODS score before the surgery was higher in females who had C/S, although there was no significant difference between VD and C/S groups in terms of the percentage of the ODS score improvement after the STARR surgery.

Conclusions:

Higher ODS score in females who had C/S showed that C/S could not protect the pelvic organ from pregnancy and delivery trauma. It seems that episiotomy has a protective effect during VD; it can reduce the severity of trauma in pelvic organs during childbearing.

Comparison of Colonic J-pouch and Straight Coloanal anastomosis after Low Anterior Resection

Background

The tendency towards sphincter preserving for low rectal cancers with low anterior resection, has led to the technique of straight coloanal anastomosis (SCAA) or colonic J-pouch anal anastomosis (CPAA).

Objectives

The aim of our study was to compare functional outcomes, complication rates and quality of life (QoL) after LAR with either a straight or colonic J pouch anastomosis.

Patients and Methods

In 88 patients with rectal tumors located in lower third, who were candidate for LAR with coloanal anastomosis. They were divided for reconstruction using either SCAA (n= 47) or CPAA (n= 41) from January 2007 to May 2009. Functional results were assessed after closure of temporary loop ileostomy, 6 months postoperatively. Quality of life (QoL) was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30.

Results

The two groups were matched for gender, age, and preoperative chemotherapy and radiotherapy. There were no significant differences between the SCAA and CPAA groups relative to anastomotic leakage. Among patients with CPAA, the mean of 24 hours bowel movements, daytime bowel movements, incontinence scores, and incidence of urgency were significantly lower than those in the SCAA group. Also, patients with a CPAA had a significantly better quality of life.

Conclusions

CPAA provided not only better functional results than SCAA, but also improved quality of life, thus may be the better choice.

Laparoscopic cholecystectomy versus small incision cholecystectomy in symptomatic gallstones disease

OBJECTIVE

To compare the results and outcomes of the laparoscopic cholecystectomy (LC) with the small incision cholecystectomy (SIC).

STUDY DESIGN

Observational study.

PLACE AND DURATION OF STUDY

Baqiyatallah Hospital, Tehran, Iran, from February 2008 to March 2009.

METHODOLOGY

Patients with symptomatic gallstones that were referred and enrolled in the study for LC or SIC. Operation, anaesthesia, analgesics and postoperative care were standardized. The patients were assessed for operation time, postoperative pain, nausea, vomiting, hospital stay, return to work time and complications in the postoperative period on day 1, 1 week, 1 month and 6 months, postoperatively.

RESULTS

Of 144 patients, 81 underwent LC and 63 underwent SIC. Both groups were matched for age, gender, BMI, clinical findings and ASA grading. The mean duration of operation was 74 and 62 minutes in the LC and SIC groups, respectively (p = 0.0059). Duration of hospital stay and return to regular activities were shorter after LC compared to SIC. Pain scores, nausea and vomiting were the same in both groups, although the frequency of intra-operative complications were greater in LC compared to SIC.

CONCLUSION

Outcome and complications of SIC were comparable with those of LC.

Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy

Background

Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time.

Objectives

The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method.

Materials and Methods

In this randomised controlled clinical trial, male patients with unilateral inguinal hernia were randomized into two groups: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis.

Results

All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery).

Conclusions

Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.

Thoracoscopic Sympathicotomy vs Sympathectomy in Primary Hyperhidrosis

Background

Primary hyperhidrosis (P.H.H.) is characterized by excessive sweating in certain parts of body. It’s estimated prevalence is 0%-6.1% in different populations. In Asian population its prevalence is around 3%. In 57% of cases, there is a positive family history.

Objectives

To evaluate and compare the early and late satisfaction, outcomes and complications of thoracoscopic sympathectomy and sympathicotomy in the treatment of primary hyperhidrosis.

Materials and Methods

From April 2007 to January 2011, we prospectively treated 60 primary hyperhidrosis patients via thoracoscopic surgery. The first 30 patients underwent sympathectomy and the next 30 patients underwent sympathicotomy. We evaluated early and late satisfactions, outcomes and complications on the first visit (5-8days) following surgery and 12 months after surgery, for all patients.

Results

The mean operative time was 66.3 minutes in sympathicotomy group and 110.8 minutes in sympathectomy group (P < 0.001). There were no significant differences between the two groups in overall early and late satisfaction, gustatory sweating, pompholyx and post-operative pain. There was comparatively less early and late compensatory sweating (C.S.), and other adverse influences of C.S. in the sympathicotomy group.

Conclusions

Because of shorter operative time, less C.S. and less adverse influence of C.S., sympathicotomy seems a better treatment for primary hyperhidrosis, compared with sympathectomy.

Milligan-Morgan Hemorrhoidectomy vs Stapled Hemorrhoidopexy

BACKGROUND

The stapled hemorrhoidopexy (SH) is a procedure for prolapse and hemorrhoids . At first SH seemed to be a good alternative for the Milligan Morgan (MM) hemorrhoidectomy and preliminary results in early 2000 confirmed it. However, further studies and evaluation of long-term results showed poorer outcomes.

OBJECTIVES

This study aimed to evaluate and compare the results of these 2 surgical procedures in terms of recovery, improvement of symptoms and incidence of complications.

MATERIALS AND METHODS

This study was conducted from April 2008 to August 2010. A total of 80 patients were divided into 2 groups of 40 each. In the SH group, there were 24 males (60%) and 16 females (40%) with a mean age of 48 ± 12.5 yrs. In the MM group, there were 30 males (75%) and 10 females (25%) with a mean age of 50.6 ± 17.3 yrs. Patients with grade 3 and 4 prolapsed hemorrhoids were entered in the study. Data were entered using SPSS software and analyzed using t-test and Chi-square test.

RESULTS

The two groups had no significant difference in terms of age or sex. Duration of surgery was 35 ± 7 minutes in the SH and 23.6 ± 13.5 minutes in the MM group. This difference was statistically significant (P = 0.000). Post-operative pain and complete pain relief was slightly lower in the MM group (not significant). Hospital stay was significantly longer in the MM group (P = 0.003). Return to work was similar in both groups. Three patients in the SH group (7.5%) and 2 in the MM group (5%) had hemorrhoid recurrence.

CONCLUSIONS

Both techniques are efficient treatment methods for grade III and IV hemorrhoids and are associated with greater than 95% recovery rate. Overall, outcomes are the same in both techniques. Lower postoperative pain was the only advantage of SH over MM technique.