Perioperative hypothermia in colorectal surgeries: are we doing enough to prevent it?

OBJECTIVE: To determine the incidence of hypothermia in patients undergoing colorectal surgery, and to identify factors that increase vulnerability to perioperative hypothermia. METHODS: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised medical records from May 2012 to June 2017 related to all patients aged >16 years of either gender who underwent colorectal procedures. Analysis about predictors of perioperative hypothermia was done using Stata 12. RESULTS: Of the 100 patients, 69(69%) were males. The overall mean age was 50.2±16.7 years. Majority cases had elective presentation 72(72%). Incidence of perioperative hypothermia was noted in 74(74%) patients. Postoperative morbidity was 16(16%), while mortality was 4(4%). Elective presentation and hypothermia before surgery were significantly associated with occurrence of intraoperative hypothermia (odds ratio: 4.5 and 1.3 respectively). CONCLUSIONS: Perioperative incidence of hypothermia was found to be quite high despite appropriate measures. Factors responsible need to be explored and rectified.

Template operative note, a better documentation.

Operative notes are a valuable part of patient's medical record, and carry the medico-legal significance. One way of improving it is to introduce the template form operative notes. Only few studies have been done worldwide to compare both the forms of operative notes. This cross-sectional study was conducted in the department of General Surgery, AKUH. This included the patients who underwent Laparoscopic cholecystectomy (Complying with inclusion criteria) from August 2013 till March 2014. Out of 24 patients, 19 were females. The completeness of data in template group was significantly better than traditional group (79.2% vs. 8.3%). There was no significant difference among the residents of different level (writing the notes) and the completeness of data in both the groups. Similarly the timing of day did not affect significantly on the completeness.

Telesurgery prospects in delivering healthcare in remote areas.

Feasibility and safety of performing remote surgery was first established by performing surgeries on pigs in later part of the 20th century. The first tele-robotic remote surgical system was set up in Canada in 2003 between two hospitals 400 kilometres away. The current review was planned to have a look at the current state of robotic surgery and its use in telesurgery. Literature search was conducted for articles related to "Robotic Surgery" and "Tele-Surgery". Our search included articles published in English literature, including case studies and review articles. We searched Google Scholar and PubMed to search relevant articles. Introduction of haptic feedback technology added significantly to safety robotic surgery. Tele-surgery, also called tele-robotics, combines the advantages of robotic surgery, including magnified view, augmented reality and improved ergonomics and dexterity, and provision of surgical care in remote areas and difficult-to-reach locations like spacecrafts and ships. Challenges, like cost, availability and legislations, remain to be addressed.

Experience of managing complicated diverticulitis of colon: a retrospective case series from South Asian country.

OBJECTIVE: To assess the morbidity and mortality associated with complicated diverticulitis in Pakistan. METHODS: The retrospective case series was conducted at an urban tertiary care university hospital of Karachi, Pakistan, comprising data from December 1989 to November 2010. International Classification of Diseases codes for diverticular disease and diverticulitis with abscess, fistula, stricture, bowel obstruction and perforation were obtained from the medical record department. SPSS 19 was used for statistical analysis. RESULTS: A total of 60 (1.9%) cases with complicated diverticulitis were located from among 3170 records reviewed. Mean age was 62.7 +/- 13 years with male-to-female ratio being 36:24. In 37 (62%) patients, the diagnosis was established on computed tomography scan of the abdomen, followed by barium enema in 12 (20%) and colonoscopy in 11 (18%). Post-operative morbidity was observed in 24 (40%) and 7 (16%) expired within 28 days of surgery. Post-operative intra-abdominal sepsis, wound dehiscence and incisional hernia were significantly associated with generalised peritonitis (p < 0.05), while admission to intensive care unit was associated with age over 60 years and faecal peritonitis. Post-operative mortality was significantly associated with high American Society of Anaesthesiologists-score III and IV and age above 60 years. CONCLUSION: Complicated diverticulitis carries significant morbidity and mortality in Pakistani population. Since the trend is on the rise, therefore we propose a prospective multi-centre cohort study to understand the spectrum of disease, management and identification of risk factors to achieve the best possible outcomes in patients with complicated diverticulitis.