Parastomal hernia repairs: A nationwide cohort study in the Republic of Ireland.

BACKGROUND: In the context of improving colorectal cancer outcomes, post-survivorship quality of life has become an important outcome measure. Parastomal hernias and their associated morbidity remain largely under-reported and under-appreciated. Despite their burden, conservative management is common. This study aims to provide a national overview on the current trends in parastomal hernia repairs (PHRs). METHODS: All PHRs performed in public hospitals across the country between 1/2017 to 7/2022 were identified retrospectively from the National Quality Assurance and Improvement System (NQAIS) database. Anonymised patient characteristics and quality indices were extracted for statistical analysis. RESULTS: A total of 565 PHRs, 64.1 % elective and the remainder emergent, were identified across 27 hospitals. The 8 national colorectal units performed 67.3 % of all repairs. While 42.3 % of PHRs were standalone procedures, reversal of Hartmann's procedure was the commonest simultaneous procedure in the remainder. The median age, ASA and Charlson Co-Morbidity Index were 64 years (19), 3(1) and 3(10) respectively. Mean length of stay (LOS) was 16.25 days (SD = 29.84). Linear regression analysis associated ASA (95 % CI 0.58-16.08, p < 0.035) and emergency admissions (95 % CI 5.86-25.55, P < 0.002) with a significantly longer LOS, with the latter also associated with more frequent emergency re-admissions (95 % CI 0.18-0.82, p < 0.002). CONCLUSION: Patients undergoing emergency PHR were older and significantly more comorbid. Consequently, these patients were subjected to longer hospital stays, more frequent readmissions and overall higher hospital costs. Multidisciplinary perioperative optimisation and standardised referral pathways should underpin the shift towards elective PHRs.

Risk factors and outcomes in acute perforated gallbladder: A retrospective cohort study.

BACKGROUND: Acute gallbladder perforation is a rare complication of biliary diseases with an estimated incidence of 2% of all gallbladder diseases. It carries a higher risk of morbidity and mortality. This study examines the risk factors and outcome of patients admitted with acute and subacute gallbladder perforation (AGBP) to a tertiary hospital in the Eastern Province of Saudi Arabia. METHODS: A retrospective study was performed including all patients with biliary diseases who were operated on from Jan. 2016 until Dec. 2020. The patients were divided: the first group included patients with AGBP and the second group included patients with other biliary diagnoses. We excluded patients with chronic perforation, traumatic or malignant perforation. RESULTS: A total of 587 patients were eligible for this study. The incidence of AGBP was 2.7% and its morbidity was 6.3% with no mortality reported. AGBP was significantly associated with male gender, older age, in patients with two or more associated comorbidities; diabetes mellitus, hypertension and dyslipidemia. Ultrasonography was not diagnostic while AGBP was confirmed by computed tomography in 42.9%. AGBP was associated with a significant higher risk of conversion to open cholecystectomy and partial or subtotal cholecystectomy. The multivariate linear regression analysis revealed that the length of hospital stays increased by 70% in patients with AGBP. CONCLUSION: Acute perforated gallbladder is predominant in elderly male patients with multiple comorbidities, especially diabetes mellitus, hypertension, and dyslipidemia. CT has a higher sensitivity to detect or suspect AGBP. Laparoscopic cholecystectomy is a safe management approach.

Non O1 Vibrio cholerae as a cause of bacteremic lower limb cellulitis: A case report.

INTRODUCTION: Self-limiting gastroenteritis and wound infections in immunocompetent patients are most of the cases involved with Non-O1, non-O139 Vibrio cholerae which its microorganism occasionally accountable for intestinal and extra-intestinal infections. Cellulitis is an infection of the skin and underlying soft tissue mostly affected by bacteria. Diabetic foot ulcer is the most costly and devastating complication of diabetes mellitus. CASE PRESENTATION: This following case describes a bacteremic soft tissue infection in a diabetic patient who is 54-year-old male with 6 years of type 2 diabetes mellitus. The patient was treated with surgical debridement of the foot ulcer, calf fasciotomy and medical therapy then he discharged. The next day readmitted with deteriorating of his condition the whole right leg to the level of the knee became ischemic and black with evidence of wet gangrene. A Guillotine above knee amputation was done. DISCUSSION: Upon review of literature, we only found few cases have been reported of cellulitis due to V. cholerae. A degree of hepatic impairment or immunocompromised state like Diabetes Mellitus, chronic infections, malignancies, and peripheral vascular disease are seen in the majority of non-gastrointestinal V. cholerae infections which suggests that it should be included in the differential diagnosis of bacteremic skin and soft tissue infections in patients with underlying illnesses. CONCLUSION: Cholerae should be included in the differential diagnosis of any bacteremic skin and soft tissue infections especially in elderly, comorbid and immune-compromised patients. Well-timed, proper antibiotic and surgical treatments are important in management of the infection to decrease morbidity and mortality.