Search

Objective Method Results Conclusion This paper evaluates the accuracy of C‐reactive protein (CRP), leukocyte count, and neutrophil‐to‐lymphocyte ratio (NLR) for diagnosing tubo‐ovarian abscess (TOA) and assessing the cost‐effectiveness of different treatment regimens for pelvic inflammatory disease (PID), with and without TOA.A retrospective cohort study was conducted between January 1, 2003, and December 30, 2021, including women aged 13–80 years diagnosed with PID. The analysis focused on the incremental cost‐effectiveness ratio of different treatment regimens.C‐reactive protein, leukocyte count, and NLR were found to be statistically significant markers for diagnosing TOA. Out of 907 PID cases, 705 achieved clinical cure with initial treatment. The most cost‐effective treatment for mild PID without TOA was ceftriaxone combined with azithromycin, which was considered less costly and more effective in the cost‐effectiveness analysis. For severe PID with TOA, ampicillin combined with gentamicin and clindamycin was more cost‐effective compared to ampicillin with sulbactam plus doxycycline, given a willingness‐to‐pay threshold of US$213.57 for a 4.2% increase in cure rate.The study's findings support the use of CRP, leukocyte count, and NLR as diagnostic tools for TOA. Ceftriaxone combined with azithromycin is recommended as the first‐line treatment for mild PID at our institution due to its cost‐effectiveness. For TOA, ampicillin combined with gentamicin and clindamycin is a cost‐effective option if the healthcare system's willingness to pay exceeds US$213.57 for a 4.2% increase in cure rate, contributing valuable insights for PID treatment strategies from a hospital's perspective. The average time of hospital admission for TOA was 3 days. After discharge, patients received oral doxycycline until completing 14 days of treatment. [ABSTRACT FROM AUTHOR]

The term gossypiboma denotes a cotton foreign body retained inside the patient during surgery, a rare surgical complication. The symptoms following this entity are non-specific, such as pain, palpable mass and fever, which make clinical diagnosis difficult. The computerized tomography (CT) scan is the most useful method for diagnosis; however, sometimes the preoperative diagnosis remains uncertain even after the imaging exam. In that case, laparoscopy arises as a valuable diagnostic tool, as well as a prompt treatment option. However, when diagnosis is made years after the original surgery, the laparoscopic approach becomes harder. Our patient presented without clear symptoms, remaining asymptomatic for 34 years. The CT scan presumptive diagnosis was a gastrointestinal stromal tumour, and laparoscopy was performed providing an accurate diagnosis and treatment in the same surgical time. [ABSTRACT FROM AUTHOR]

Aim: Hernia registries report that guidelines are not always implemented by general surgeons and suggest that the success rate of this procedure is higher in hernia specialty centers. There are many definitions of hernia centers, but their objectives consist of improving healthcare by homogenizing the clinical practice. We performed a systematic review and meta-analysis to analyze hernia centers' definitions and compare hernia centers with non-specialized centers. Material and Methods: Cochrane Central, Scopus, Scielo, and PubMed were systematically searched for studies defining a hernia center or comparing hernia centers and non-specialized centers. Outcomes assessed were recurrence, surgical site events, hospital length of stay (LOS), and operative time. We performed subgroup analyses of hernia type. Statistical analysis was performed with R Studio. Results: 3,260 studies were screened and 88 were thoroughly reviewed. Thirteen studies were included. Five studies defined a hernia center and eight studies, comprising 141,366 patients, compared a hernia center with a non-specialized center. Generally, the definitions were similar in decision-making and educational requirements but differed in structural aspects and the steps required for the certification. We found lower recurrence rates for hernia centers for both inguinal (1.08% versus 5.11%; RR 0.21; 95% CI 0.19 to 0.23; p < 0.001) and ventral hernia (3.2% vs. 8.9%; RR 0.425; 95% CI 0.28 to 0.64; p < 0.001). Hernia centers also presented lower surgical site infection for both ventral (4.3% vs. 11.9%; RR 0.435; 95% CI 0.21 to 0.90; p = 0.026) and inguinal (0.1% vs. 0.52%; RR 0.15; 95% CI 0.02 to 0.99; p = 0.49) repair. Conclusion: Our systematic review and meta-analysis support that a hernia center establishment improves postoperative outcomes data. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42024522263, PROSPERO CRD42024522263., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 da Silveira, Rasador, Lima, Nogueira, Sanha, Kasakewitch, Cavazzola, Sreeramoju and Malcher.)