OA Surgery http://www.oapublishinglondon.com/oa-surgery OA Surgery Omental cysts in children: Report of two cases. http://www.oapublishinglondon.com/article/1085 Omental cysts are the least common variety of intraabdominal cystic lesions encountered in children. They are often identified incidentally, although they may also cause acute abdominal pain. We describe here two girls with omental cysts with very unusual clinical presentations. 07/12/2020 12:59:45 pm Ileoileal intussusception due to Meckel¬ís diverticulum: An uncommon aetiology. http://www.oapublishinglondon.com/article/1086 Introduction: Intussusception is a major cause of acute intestinal obstruction in children. Most of the cases of intussception (90%) are considered idiopathic and only about 6% of cases have a pathological lead point. Majority of the pediatric cases (95%), are ileocolic type and MD is considered a rare cause. Case Report: We are presenting an unusual case of ileoileal intussusception due to inverted Meckel’s diverticulum in an 18 month old male child. Discussion: The classic clinical triad of intussusception is colicky abdominal pain, vomiting and bloody (Red currant jelly) stools, however, it is found in only 20% of patients. Contrast enemas have diagnostic as well as significant therapeutic value, having reduction rates between 70-90%. Surgical intervention is indicated if intussusception is not reduced by an enema or if features of bowel ischemia, perforation, shock and peritonitis are evident. Delay in seeking medical advice or delay in diagnosis may lead to ischemic necrosis and perforation of involved bowel. 07/12/2020 12:59:45 pm Complex wounds treated with MatriStem xenograft material: case series and cost analysis. http://www.oapublishinglondon.com/article/1087 Introduction: Complex wounds remain challenging to treat and heal, and those that involve additional risk factors such as immunosuppression, tobacco abuse, Crohn’s disease, diabetes, and obesity pose increased risks of delayed healing, non-healing, reoperation and reinfection. Treatment of wounds is often costly, involving materials, personnel, and procedures. MatriStem (Acell Inc., Columbia, MD) is a regenerative extracellular matrix (ECM) material derived from porcine bladder that has shown efficacy in facilitating the healing of complex wounds. In this analysis, ten diverse cases of complex wounds treated with periodic MatriStem application at a single institution are examined, and the materials costs of treatment are calculated. These costs are compared to comparable wound care materials costs at the same institution using what has to date been the conventional wound treatment protocol: negative pressure wound therapy (NPWT). Case Series: We present ten cases of complex wounds treated with MatriStem xenograft material in repeat applications until the wound was maximally healed. In each case presented, the original surgery involved placement of a MatriStem graft, and the costs of this graft are represented based upon hospital contracted pricing. In subsequent weeks, patients were treated with bedside or in-office additional MatriStem material, either in the form of ground powder, or in the form of single-layer wound sheets. The costs of these materials are also depicted, based upon the payment schedule from our facility. An analysis of the cost of care is provided and compared to weekly costs of care in the same institution when conventional methods using NPWT is utilized. Results: Using weekly MatriStem applications, each patient achieved healing of the wound without infection or complication, and the median treatment time was 11 weeks. The average cost of materials per week for healing these wounds using MatriStem is $152 per week. The costs of materials for NPWT calculated from the same contracted pricing agreements by the same institution are $501 per week. MatriStem wound treatment is less costly for this diverse set of ten wounds on a weekly basis than treatment with NPWT. This holds true even when the cost of the initial graft is included in the analysis. Further discussion illuminates why labor, transportation, and miscellaneous supply costs are also lower for MatriStem treatment when compared to NPWT. Discussion: Treating complex wounds is a challenging and costly process. The use of MatriStem (Acell Corporation) has proven effective in achieving and accelerating wound healing in other studies. In this study, treatment of a diverse array of complex wounds resulted in successful clinical healing of the wounds without complications, re-infection, or reoperation. Patients undergoing wound care with MatriStem report satisfaction with reduced need for visits, eliminating the need for wearing or carrying a NPWT device, elimination of the need for dressing changes, and reduced interactions with both the medical personnel and the wound itself. The costs of materials for the treatment of these wounds is substantially less on a per-week basis than the costs at the same institution when NPWT is utilized. 07/12/2020 12:59:45 pm Metastatic transitional cell cancer of the gall bladder presenting as acute cholecystitis: a rare phenomenon. http://www.oapublishinglondon.com/article/1088 Metastatic involvement of the gallbladder is extremely uncommon.  We present a first-in-literature report on a 79-year-old male who presented with acute cholecystitis secondary to metastatic transitional cell carcinoma from the urinary bladder to the gall bladder. 07/12/2020 12:59:45 pm Cardiac damage after vascular surgery procedures: A silent killer. http://www.oapublishinglondon.com/article/1215 Introduction:Perioperative myocardial ischemia remains a major cardiovascular complication after non cardiac, and especially vascular, surgery. In this review, we try to identify the real significance of asymptomatic cardiac damage after vascular surgery and make conclusions regarding the proper perioperative management. Discussion:The mechanism of perioperative myocardial ischemia can be explained through the reactions of the heart functioning under conditions of stress. Regarding preoperative assessment of the patients, there is a large number of clinical risk indices available, although some of them have been proved useful for vascular patients in specific. A large number of studies and randomized trials have underlined the high incidence of asymptomatic myocardial damage after vascular procedures and its association with postoperative mortality. However, the results of studies so far show a high diversity regarding the impact of certain risk factors, such as the gender and the age of the patient. Conclusions:Perioperative myocardial ischemia deserves the classification as a ‘silent killer’. Cautious preoperative cardiac assessment and proper perioperative management could lead to optimal results. 07/12/2020 12:59:45 pm Predictors of mortality following pancreaticoduodenectomy for periampullary cancer. http://www.oapublishinglondon.com/article/1216 Background:Pancreaticoduodenectomy is associated with significant postoperative morbidity and mortality. Identifying the preoperative factors that increase the risk of postoperative morbidity might improve patient selection and risk stratification, and may lead to better outcomes.        Methods:Using the American College of Surgeons-National Surgical Quality Improvement Project's (ACS-NSQIP) participant-use file, we identified all patients that underwent pancreaticoduodenectomy (Whipple, WP) for periampullary cancer at the 240 participating hospitals. Demographic, clinical, and intraoperative variables and 30-day morbidity and mortality were collected in standardized fashion.             Results:From the 2005 to 2008 databases, we identified 3072 patients that underwent pancreaticoduodenectomy. The 30 day mortality following WP was 3% (92/3072). Pre-operative factors leading to increased risk of mortality included: Age > 55yrs (OR 2.65, p=0.005), NIDDM (OR 1.7, p=0.0423), dyspnea at rest (OR 7.14, p=0.013) and with moderate exercise (OR 2.4, p=0.0037), COPD (OR 2.8, p=0057), ascites (OR 4.3, p=0.0411), CHF (OR 33.8, p<0.0001), hypertension (OR 1.8, p=0.0076), acute renal failure (OR 16.53, p=0.0123); Albumin < 2.5, elevated BUN, PTT and INR. Perioperative and postoperative factors that increase the risk of mortality were operative time, organ space infection, pneumonia, septic shock, unplanned intubation, renal failure, and myocardial infarction. Conclusion:Recognizing the risk factors preoperatively may help guide physicians in the management of these patients. Optimizing patient selection and risk stratification is crucial in these patients and will likely lead to improved outcomes and quality of life. 07/12/2020 12:59:45 pm Isolated heterotopic pancreas of the ileum in an adult: A case report and review of literature. http://www.oapublishinglondon.com/article/1339 The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF and HTML files will be uploaded when the corrections to the proof are returned by the corresponding author. 07/12/2020 12:59:45 pm Partial abdominal cocoon in an elderly man. http://www.oapublishinglondon.com/article/1340 The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF and HTML files will be uploaded when the corrections to the proof are returned by the corresponding author. 07/12/2020 12:59:45 pm