surgery
Sadq Kadem; Sabah Abdulsahb Mohamd; Zainab Taher Ibrahim
Abstract
Open thyroidectomy; is the gold standard surgical procedure for thyroid diseases, but the incision scar in the anterior aspect of the neck due to this approach cannot be avoided and may results in a permanent cosmetic defect. Therefore, there is a need to improve postoperative quality of life, including ...
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Open thyroidectomy; is the gold standard surgical procedure for thyroid diseases, but the incision scar in the anterior aspect of the neck due to this approach cannot be avoided and may results in a permanent cosmetic defect. Therefore, there is a need to improve postoperative quality of life, including cosmetics. Recently, transoral endoscopic thyroidectomy has been developed; it is a natural orifice thyroid surgery, minimally invasive and completely scar free. This study aimed to describe the outcome, patient’s satisfaction, and complications after hemithyroidectomy for benign thyroid nodules by transoral endoscopic vestibular approach in comparison with open approach. This study was conducted in Al-Shiffa General hospital, Basrah, Iraq from August 2017 to June 2019 and was approved by a local ethical committee.Fifty patients with benign thyroid nodules who are candidate for hemithyroidectomy were included in the study; they were divided into two groups according to the method for thyroidectomy which was either conventional open or transoral endoscopic thyroidectomy vestibular approach based on the patients’ preferences. All operations were performed by the same surgical team. The results of this study showed that 24 (48%) of them operated upon by transoral endoscopic thyroidectomy vestibular approach, while the remaining 26 (52%) patients have been operated upon by open thyroidectomy approach. Transoral endoscopic thyroidectomy vestibular approach reported significant longer operative time, has comparable rate of complications with an excellent cosmetic outcome and better postoperative patients’ satisfaction in comparison to open thyroidectomy.In conclusion, transoral endoscopic thyroidectomy vestibular approach is a safe and feasible procedure with an excellent cosmetic outcome and better patients’ satisfaction. At present, it is a relatively time-consuming procedure and, therefore, candidate patients with a strong motivation for scar free surgery are recommended.
Yaqoob Ayoob Yaqoob; Husham Salman Abdulkareem; Mohammed Khalaf Raheem; Sadq Ghaleb Kadem
Abstract
In healthy individuals, the bile is usually sterile, however, in cases of cholecystolithiasis and/or choledocholithiasis, it could be colonized with bacteria (bactibilia) and may lead to surgical site infection after cholecystectomy. In our hospital, the local regimen is to use antibiotics prophylaxis ...
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In healthy individuals, the bile is usually sterile, however, in cases of cholecystolithiasis and/or choledocholithiasis, it could be colonized with bacteria (bactibilia) and may lead to surgical site infection after cholecystectomy. In our hospital, the local regimen is to use antibiotics prophylaxis only for patients with high-risk factors, while in case of low-risk patients, the antibiotics used as postoperative treatment; this local regimen has no demonstrated bacteriological or epidemiological basis.
The aim of this study is to determine the nature of bacteria in bile and their antimicrobial susceptibility in low-risk patients and the relationship between bactibilia and the presence of some predisposing factors as well as developing postoperative infectious complications.
This study was conducted in Al-shiffa General hospital, Basrah, Iraq from April 2018 to May 2019. Forty-three patients with uncomplicated symptomatic gallstones who were candidates for elective laparoscopic cholecystectomy and have no risk factors for infection were included in the study.
Under fully aseptic technique, a sterile laparoscopic needle connected to a sterile 10ml disposable syringe used to aspirate 5–7ml of bile from the fundus of gallbladder for culture and antibiotic sensitivity. In this study culture assessment of bile demonstrate that, 20 patients (46.51%) have infected bile; Klebsiella spp. 7(35%) and Pseudomonas spp. 7 (35%) are the most frequent causative agents. Factors like gender, age, duration of complaint and number of stones were found not significantly increase the risk of infection. Antibiotics sensitivity revealed maximum sensitivity to Meropenem (100%), Amikacin (90%) and less sensitivity to the most commonly used Ceftazidime. No cases of superficial or deep-seated surgical site infections were reported.
In conclusion, bile infection reported in a significant rate in low risk patients for infection subjected to elective laparoscopic cholecystectomy. Klebsiella spp. and Pseudomonas spp. are the most common isolate which shows high sensitivity to Meropenem and Amikacin and less sensitivity to third generation Cephalosporine; so we recommend the use of Amikacin as a prophylactic antibiotic instead of third generation Cephalosporine.
Keywords: Bile infection, Cholecyctectomy, elective surgery, laparoscopy, low risk patients