International Surgery Volume 109: Issue 1

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The International College of Surgeons is celebrating its 90^th Anniversary of existence this year. The College

Objective

This study aimed to assess the necessity of invaginating the appendiceal stump in laparoscopic appendectomy for patients with acute nonperforated appendicitis.

Summary of background data

Laparoscopic appendectomy has become the preferred method over open appendectomy for acute appendicitis, offering benefits such as shorter intraoperative times and reduced wound sepsis. However, the necessity of invaginating the appendiceal stump, aimed at preventing stump leakage and intrabdominal infection, remains unclear.

Methods

This retrospective observational study was conducted at Nippon Medical School Musashikosugi Hospital from 2009 to 2018 and involved patients aged ≥15 years diagnosed with acute nonperforated appendicitis who underwent emergency surgery without preoperative intra-abdominal abscess. Patients were divided into 2 groups: open appendectomy with stump invagination (Group O) and laparoscopic appendectomy without stump invagination (Group L). The primary outcomes were incidences of appendiceal stump leakage and postoperative intra-abdominal abscess.

Results

The study involved 119 patients in Group O and 175 in Group L. Both groups were comparable in age, sex, body mass index, blood examination results, operating time, and drain insertion rate. Group L presented more cases of gangrenous appendicitis with severe inflammation but had shorter postoperative stays compared with Group O. The incidence of postoperative intra-abdominal abscess was 2% (2 cases) in Group O and 2% (4 cases) in Group L with no significant difference. No cases of stump leakage were observed in either group.

Conclusions

Invaginating the appendiceal stump in laparoscopic appendectomy for nonperforated appendicitis may be unnecessary as its omission does not increase short-term postoperative complications.

Objective

This study is to explore the application value of fractional administration of compound polyethylene glycol electrolyte powder combined with simethicone for bowel preparation before colonoscopy in elderly patients.

Methods

The objects are 60 elderly patients who underwent colonoscopy in our hospital in 2021. The patients were randomly divided into the control group and the observation group, with 30 cases in each group. The control group took two doses of polyethylene glycol electrolyte powder eight hours apart for intestinal preparation. On this basis, the observation group was given simethicone for bowel preparation. Adverse reactions, intestinal cleanliness, air bubbles in the intestines, lens clarity, time of entering the lens, amount of saline flushing, and lesion detection were compared between the two groups.

Results

There was no significant difference in adverse reactions, bowel cleanliness score, detection rate of ≥0.5 cm polyps, and adenomas between the two groups (P > 0.05), but the air bubbles and lens clarity, the time of entering the lens, amount of saline flushing, detection rate of <0.5 cm polyps of the observation group was significantly better than that of the control group (P < 0.05).

Conclusion

It is safe and effective for elderly patients to take compound polyethylene glycol electrolyte powder combined with simethicone for intestinal preparation.

Background

Whereas a potential connection between epilepsy and frailty has been proposed in past research, the causal nature of this relationship requires additional study.

Objective

This research was designed to evaluate the bidirectional causality between epilepsy and frailty index (FI) through 2-sample Mendelian randomization (MR).

Methods

In this study, we applied genome-wide association studies to perform forward and reverse MR within a 2-sample context to explore the potential bidirectional causality between FI and epilepsy. The main analysis approach was the inverse variance weighted (IVW) used to assess the potential influence of causal relationships and to carry out sensitivity checks.

Results

MR analysis revealed a positive correlation between FI and the heightened risk of epilepsy [OR_IVW = 1.2126, 95% confidence interval (CI): 1.0143–1.4497, P = 0.0343]. This correlation persists in MR analysis that excluded aberrant single nucleotide polymorphisms (OR_IVW = 1.1862, 95% CI: 1.0236–1.3746, P = 0.0232). Reverse MR analysis corroborated a significant positive relationship between epilepsy and FI (OR_IVW = 1.0896, 95% CI: 1.0242–1.1592, P = 0.0066), which was confirmed in subsequent replication analysis (OR_IVW = 1.0975, 95% CI: 1.0532–1.1436, P = 9.69e-06). Sensitivity analysis further supported the hypothesis of a causal link between FI and epilepsy.

Conclusion

There is an evident bidirectional causal relationship between FI and epilepsy.

Inadequacy of anterior-only fixation for reducible three-column injury of the subaxial cervical spine: case report

Yu-ying WuM.D.,

Po-Yuan ChenM.D.,

Kang LuPhD., and

I-Fan LinM.D.