Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections : a prospective multicentre study (WISS Study)

Background: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. Methods: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Results: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p <0.0001). The multivariate logistic regression model was highly significant (p <0.0001, R-2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. Conclusions: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.Peer reviewe

Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study.Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%.Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.</p

Total endoscopic excision of branchial cyst in a child aged 3 years

AbstractThis is the case report of a three-year-old female Arab child who presented with a neck swelling since one year of age. Physical examination was suggestive of a 6 × 4 cm swelling in the right lateral neck, which was dumbbell shaped, deep to sternocleidomastoid muscle on either side of the muscle. Ultrasound scan revealed a large cyst with internal echoes in the right carotid space anteriorly. The cyst was dissected endoscopically by an axillary approach and complete excision was achieved, thus avoiding the need for a large incision in the neck. No complications noted after treatment. The lowest age at which branchial cyst excision was carried out endoscopically was 18 years as per the available literature. Hence this case seems to be the first ever endoscopic branchial cyst excision in the pediatric age group

A retrospective analysis of 200 axillary route thyroidectomy cases

Background: Thyroid disorders are common in women. The surgical solution available in most places is open thyroidectomy, which can ultimately lead to unsightly scar formation. This can be cosmetically unappealing, especially for women. The endoscopic thyroidectomy is a very good alternative to the traditional open thyroidectomy. It gives excellent cosmetic outcomes, especially when done with an axillary approach, without compromising safety. Methodology: This is a retrospective study conducted on 200 patients who underwent endoscopic thyroidectomy at Sunrise Group of Hospitals, Kochi and Dubai, from July 2013 to March 2016. The procedures performed were total thyroidectomy and hemithyroidectomy. The operation time, thyroid gland/nodule size, duration of hospital stay, and complications were considered for the outcome assessment. Results: A total of 200 endoscopic thyroidectomies were done. The mean age was 38 years, and the mean size of the thyroid was 9.19 ± 3.45 cm. The average time for hemithyroidectomy was 90 ± 12 min, and average time for total thyroidectomy was 150 ± 10 min. Forty-two patients underwent endoscopic hemithyroidectomy, whereas 158 patients underwent endoscopic total thyroidectomy. The histopathological reports revealed that there were 70 adenomas, 41 colloid nodules, 30 thyrotoxicosis, 27 thyroiditis, 26 carcinoma, and 6 Hurthle cell neoplasm cases. Complications, such as permanent hypoparathyroidism, nerve injury, and mortality, were not seen in the study population. Conclusion: Endoscopic thyroidectomy offers excellent cosmetic outcomes with no additional untoward effects. This procedure can be utilized for thyroids as large as 12 cm. All pathologies, including malignancies, can be safely dealt by expert endoscopic surgeon

Effectiveness of Minimally Invasive Hybrid Surgery for Ileal Interposition (MIHSII) for the Resolution of Type 2 Diabetes

Aim. To evaluate the effectiveness of minimally invasive hybrid surgery for ileal interposition (MIHSII), a novel procedure for type 2 diabetes (T2DM) in patients with a body mass index (BMI) &lt;30 kg⁄m2. Materials and methods. MIHSII is an innovative technique in which sleeve gastrectomy is performed laparoscopically, followed by extracorporeal ileal interposition performed through a 5-cm midline incision. The procedure was performed on 31 T2DM patients, 17 males and 14 females. Their BMI values ranged from 21.8 kg/m2 to 29.8 kg/m2, with a mean BMI of 26.61 ± 2.61 kg/m2. The average duration of diabetes 8.14 ± 4.89 (range = 1-20) years. Most of the patients exhibited poorly controlled diabetes despite the use of oral hypoglycemic agents (OHAs) and/or insulin. Results. The mean preoperative glycosylated hemoglobin (HbA1c) for the population was 8.86%. The mean HbA1c 1 year after surgery was 6.80%. The difference between the mean preoperative and 1-year postoperative HbA1c values was significant, at P &lt; .05 (group 1: BMI = 18.5-24.99 kg/m2, t = 2.83, and P = .022; group 2: BMI = 25-29.99 kg/m2, t = 4.23, and P = .001). The resolution rate of diabetes was 80.48%; 48.57% experienced complete resolution, and 31.91% experienced partial resolution. The remaining 19.52% of patients exhibited a significant reduction in HbA1c, although the HbA1c levels did not fall below 6.5%, even with medications. Conclusion. MIHSII is an innovative technique of metabolic surgery and is a cost-effective and minimal procedure for the resolution of T2DM in patients with BMI &lt;30 kg/m2. </jats:p

Prospective observational study on acute appendicitis worldwide ({POSAW})

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45\%) women and 2354 (55\%) men, with a median age of 29 years. Nine hundred and seven (21.2\%) patients underwent an abdominal CT scan, 1856 (43.3\%) patients an US, and 285 (6.7\%) patients both CT scan and US. A total of 4097 (95.7\%) patients underwent surgery; 1809 (42.2\%) underwent open appendectomy and 2215 (51.7\%) had laparoscopic appendectomy. One hundred eighty-five (4.3\%) patients were managed conservatively. Major complications occurred in 199 patients (4.6\%). The overall mortality rate was 0.28\%. Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low