Search Results (5)

Introduction: Postoperative pain in laparoscopic cholecystectomy is not well studied. Peritoneal lavage is performed in cases of acute or complicated cholecystitis, whereas it is uncommon in cases considered clean surgeries; paradoxically, this latter group reports more pain. Objective: To evaluate the association between peritoneal lavage and postoperative pain levels in patients undergoing laparoscopic cholecystectomy. Methods: Prospective cohort study on 110 patients with gallbladder pathology scheduled for elective laparoscopic cholecystectomy. Groups: with peritoneal lavage (n1 = 55) and without peritoneal lavage (n2 = 55). Pain was evaluated at 6, 12, and 24 h using the visual analog scale (VAS). Numeric variables were described as means or medians. Categorical variables were described as absolute frequencies and percentages. The association between peritoneal lavage and postoperative pain levels was analyzed using Linear Quantile Mixed Models (LQMMs) with the ‘lqmm’ package in R. Results: Pain assessment shows that the median pain scale scores were significantly lower at 6, 12, and 24 postoperative hours (p < 0.001) in patients who received peritoneal lavage. The adjusted median differences ranged from −1.6 to −1.7 points on the VAS across all evaluated time points, indicating consistently lower postoperative pain scores in the lavage group. Conclusions: Peritoneal lavage with saline solution during laparoscopic cholecystectomy was associated with lower postoperative pain scores during the first 24 postoperative hours. Full article

Background and Clinical Significance: Pelvic inflammatory disease represents a multifaceted sexually transmitted disease affecting women of reproductive age, beginning in adolescence. Clinical presentation ranges from asymptomatic patients to acute abdominal pain in the setting of tubo-ovarian abscesses; however, presentation as primary peritonitis with seemingly intact fallopian tubes is exceptional. Primary peritonitis in the absence of other comorbid conditions (e.g., liver cirrhosis and nephrotic syndrome) in healthy, immunocompetent women is rare and typically occurs without an identifiable intra-abdominal source. The diagnosis can be challenging due to its mild-to-moderate, nonspecific symptoms. Case Presentation: We report the case of a 21-year-old immunocompetent woman who presented with lower abdominal and left iliac fossa pain with hyperleukocytosis. Laparoscopic exploration confirmed the diagnosis of primary peritonitis. Following diagnosis, she underwent peritoneal lavage and was started on empiric broad-spectrum parenteral antibiotic therapy. Cervico-vaginal cultures established the diagnosis of PID following identification of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma parvum. The clinical course was favorable. Conclusions: An early multidisciplinary approach, including consultation with an infectious disease specialist and clinical pharmacologist, is recommended in cases of peritonitis with an unclear source. PID may present as primary peritonitis and this clinical scenario should be considered in sexually active young women with unexplained peritoneal infection when no gastrointestinal or gynecologic source is evident intraoperatively. Full article

Acute appendicitis remains one of the most common surgical emergencies, with a lifetime incidence of approximately 7–8% in the USA and Europe. Despite the widespread adoption of the laparoscopic approach and advances made in perioperative care, post-operative infections—particularly intra-abdominal abscesses—continue to pose a substantial clinical challenge, with an overall probability that ranges from 5 to 15%. Nowadays, it is essential not only to improve patient outcomes by reducing these complications but also to promote responsible antibiotic use. This review provides an in-depth examination of post-appendectomy infections in adults, synthesizing research from the past decade. It explores the various risks involved, including those related to the patient, the disease itself, and the surgical techniques employed. There is particular emphasis on the impact of surgical approach, closure methods, timing of surgery, and intraoperative decisions such as drain placement, peritoneal lavage, and routine bacterial cultures. Part of the discussion is about emerging data regarding the use of antiseptic solutions and specimen retrieval techniques. Additionally, the review examines current approaches to managing postoperative intra-abdominal abscesses. It assesses when antibiotics are necessary, evaluates image-guided percutaneous drainage, and considers laparoscopic re-intervention as a possible solution. While recent studies offer valuable insights, the heterogeneity of available evidence highlights the pressing need for high-quality, standardized research. Ultimately, a deeper understanding of infection pathways and preventative strategies is vital—not only for reducing morbidity and hospital readmissions, but also for safeguarding the long-term efficacy of antibiotics and delivering safer, more effective surgical care. Full article

Background: Several studies have suggested that laparoscopic peritoneal lavage for the treatment of diverticulitis might be associated with an increased event rate. The WSES (World Society of Emergency Surgery) guidelines recommend performing laparoscopic peritoneal lavage only in highly selected patients; however, selection criteria remain poorly described. This study, based on a single-center retrospective cohort of patients presenting with acute diverticulitis and undergoing surgery, aimed to assess the complication and long-term outcomes of the lavage group and to report our experience with the treatment of acute diverticulitis. Methods: Operative management of acute sigmoid diverticulitis was involved, in particular, laparoscopic peritoneal lavage, primary resection, and the Hartmann procedure. Results: Six-month follow-ups showed the occurrence of Clavien–Dindo complications in ≥2 in 21.9% of patients in the sigmoidectomy group versus 61.1% of patients in the lavage group (p = 0.0028). Among the 11 patients with complications after laparoscopic lavage, 9 required a second surgery. After a comparison between the patients with complications and those without who were managed with laparoscopic lavage, descriptive differences were found regarding the BMI (95% CI, 21.7–24.3 vs. 95% CI, 24.7–31.3, p = 0.0419). In analysis, a BMI of ≥27 kg/m² (OR, 16 p = 0.049) was associated with short- and long-term complications in the lavage group. There was no evidence for an association between complications and a BMI of ≥27 kg/m² in the primary resection (OR, 1.61 p = 1) or the Hartmann procedure group (OR, 4.25 p = 0.1438). Perforated colonic diverticulitis treated with laparoscopic peritoneal lavage was associated with a high morbidity rate. Conclusions: The choice of surgical strategy for acute diverticular pathology is complex, influenced by various conditions. BMI could be a prognostic factor for long-term outcomes, including recurrent diverticulitis and the occurrence of abscesses. Full article

Background and aims: In the treatment of post-cholecystectomy bile leaks, endoscopic naso-biliary drainage (ENBD) or biliary stenting using plastic stents is the standard of care. Fully covered self-expandable metal stent (FCSEMS) placement across the sphincter of Oddi is considered a salvage therapy for refractory cases, but pancreatitis and migration are the major concerns. Intraductal placement of a dumbbell-shaped FCSEMS (D-SEMS) could avoid these drawbacks of FCMSESs. In this retrospective study, we investigated the usefulness of intraductal placement of the D-SEMS for post-cholecystectomy bile leaks. Methods: Six patients who underwent intraductal placement of the D-SEMS for post-cholecystectomy bile leaks were enrolled. This method was performed as initial treatment in three patients and as salvage treatment in three ENBD refractory cases. Results: Technical and clinical successes were obtained in 6 (100%) patients and 5 (83%) patients, respectively. One clinically unsuccessful patient required laparoscopic peritoneal lavage. The early adverse event was one case of mild pancreatitis (17%). The median duration of the D-SEMS indwelling was 61 days (42–606 days) with no migration cases, all of which were successfully removed. The median follow-up after index ERCP was 761 (range: 161–1392) days with no cases of recurrent bile leaks. Conclusions: Intraductal placement of the D-SEMS for post-cholecystectomy bile leaks might be safe and effective even in refractory cases. Full article