International Symposium on recent advances in surgery.

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Splenectomy for hematological disorders in the Eastern Province of Saudi Arabia.

Splenomegaly is a common clinical disorder in the Kingdom of Saudi Arabia. Its aetiology is variable and includes portal hypertension due to schistosomal periportal hepatic fibrosis, haemoglobinopathies and lymphoproliferative disorders. At King Fahd Hospital of the University, Al-Khobar in the Eastern Province of the Kingdom, splenectomy is performed frequently for various reasons on patients drawn from all the Provinces. This is a report of 104 patients (age range eight months to 65 years) who underwent splenectomy between 1982 and 1987. We reviewed the indications, operative findings, outcome, and complications of the procedure. Patients with hypersplenism formed the largest group (50%) subjected to splenectomy followed by those suffering from the haemoglobinopathies. Chest infection as the most common complication and it mainly affected patients with portal hypertension. Post-operative septicaemia occurred in four cases within six months from the date of splenectomy.

Wound infection following biliary surgery. A prospective surgery.

Biliary surgery in general, with cholecystectomy in particular, is probably the commonest major elective abdominal operation worldwide. A prospective study has been completed on 141 biliary operations in which intra-operative bile swabs were taken, and other risk factors for wound infection sought. Patients' characteristics were: males 51, females 90 (1:1.8); mean age 42.4 +/- 16 years; mean Quetelet index for adults was 32 +/- 5. The operations were: emergencies 10, simple-cholecystectomies 112, and choledochotomies (including other concomitant procedures) 29. The observed wound infection rates were: overall 7.8%, simple cholecystectomy 3.6% and choledochotomies 24.1%, figures which agree closely with the national and international literature. The infected patients consumed, on average, 7 days more in hospital than the uninfected ones. We found three major risk factors for wound infection: patients aged 40 years or older (over 4-fold), choledochotomy (over 6-fold), and microbiologically proven wound co-ntamination (9-fold). We conclude that, given the consistently low (less than 4%), incidence of wound infection following simple cholecystectomy, routine antibiotic prophylaxis in this subset is probably unjustified.

Arteriovenous fistula for hemodialysis. A report of 112 consecutive cases.

Arterio-venous fistula of Brescia was created in 112 consecutive patients during a five year period from May 1983 at King Fahd University Hospital of King Faisal University, Al-Khobar, Saudi Arabia. These fistulae were created for hemodialysis in patients with chronic renal failure. There were 67 males and 45 females. The youngest patient was 13 years and the oldest 75 years. Complications were negligible (0.85%), even-though 31% were diabetics and 24% had sickle cell hemoglobinopathy. The arteriovenous fistula failed in 6 patients and the patency rate was 94.6%. The minimum follow up was three months and the maximum fifty-two months. The end-to-side anastomosis gave better results. For long term dialysis arterio-venous fistula of Brescia should remain as the first choice.