V-005 A CASE SERIES DEMONSTRATING APPLICABILITY OF LAPAROSCOPIC MANAGEMENT OF STRANGULATED OR INCARCERATED HERNIAS IN EMERGENCY GENERAL SURGERY

Aims

Acute small bowel obstruction secondary to strangulated hernias is a presentation often encountered during the acute surgical take. Despite the widespread use of a minimally invasive approach for elective hernia surgery, there is a significant reduction in use of laparoscopy in the emergency setting. We aim to describe a case series on the applicability of laparoscopy in the management of emergency strangulated or incarcerated hernias.

Materials

We describe 4 cases of patients who presented with acutely strangulated or incarcerated hernias as an emergency to a single centre in the United Kingdom. The cases demonstrated include inguinal, femoral, obturator and spigelian hernias, each presenting as an acute emergency with concomitant small bowel obstruction.

Results

The patients underwent emergency surgery using a laparoscopic approach for repair of strangulated or incarcerated hernias and assessment of obstructed small bowel. Where indicated, small bowel resection and primary anastomosis was undertaken when viability of affected segment of bowel was compromised. All procedures were completed laparoscopically, with no recurrence occurring in these patients during the follow-up period.

Conclusion

Minimally invasive surgery is an important tool in the armamentarium of the acute care surgeon. A laparoscopic approach will reduce the insult of intervention in already physiologically deplete patients. This case series demonstrates the feasibility of laparoscopy in the management of strangulated or incarcerated hernias in the emergent setting, requiring advanced laparoscopic skill as demonstrated in this video.

355 Comparison of Outcomes in Surgical and Endoscopic Transgastric Cystgastrostomy for Severe Acute Pancreatitis

Aim

The heterogeneous nature of severe acute pancreatitis (SAP) renders decisions related to complications challenging. A select group of patients may be suitable for surgical (S-CG), which can be performed open or laparoscopic, or endoscopic (E-CG) transgastric cystgastrostomy (TCG) of symptomatic or infected retrogastric pancreatic collections (walled-off pancreatic necrosis (WOPN) or pseudocyst). There is limited data comparing outcomes between these approaches.

Method

Retrospective analysis of all patients that underwent S-CG or E-CG was performed from a single, high-volume benign pancreatic centre between 2012 – 2021 inclusive. Patient demographics, clinical characteristics, and outcomes of these 3 groups was compared. One-way analysis of variance tests was used to compare categorical data.

Results

47 patients underwent TCG: 20 S-CG (12 open and 8 laparoscopic), and 27 E-CG. There was no statistical difference between S-CG and E-CG for age, body mass index (BMI), aetiology, organ failure and type or position of collection. S-CG patients had less burden of pre-existing co-morbidities (APACHE-II and Charlson-Co-morbidity-Index (CCI)) (p<0.05). S-CG patients had shorter length of stay, emergency readmission and reintervention (p<0.05). Those who underwent E-CG had higher burden of intervention due to persistent/recurrent pancreatic collections, with 33% mortality rate (p <0.05).

Conclusions

S-CG, in a select group of patients, provides a single-staged intervention for drainage of transgastric pancreatic collections, especially when they predominantly contain solid necrosis and patient is suitable for general anaesthetic. Outcomes are favourable for S-CG, but multidisciplinary approach is critical to delineate the most appropriate approach for each individual patient.

Postoperative Pain and Paresthesia in Labral Repairs of the Shoulder: Location Does Matter

Background:

Favorable outcomes have been reported regarding postoperative shoulder pain and function after repair of anteroinferior (Bankart) glenohumeral labral tears. However, the outcomes of patients after repair of isolated superior labral anterior-posterior (SLAP) tears are a contentious topic. The authors have also anecdotally noted that patients evaluated with labral tears complained of numbness and tingling in their ipsilateral hand.

Purpose:

To determine if there is a difference in the temporal outcomes of shoulder pain and hand paresthesia in patients with SLAP tears versus Bankart tears after arthroscopic repair.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Included were 66 consecutive patients who underwent arthroscopic labral repair at a single institution between August 2018 and February 2021. The prevalence and magnitude of shoulder pain as well as numbness and tingling of the hand were assessed using questions from the L’Insalata Shoulder Questionnaire and the Boston Carpal Tunnel Questionnaire preoperatively and at 1 week, 6 weeks, 12 weeks, and 6 months after surgery.

Results:

Preoperatively, patients with SLAP lesions reported a higher prevalence of shoulder pain during sleep compared with those with Bankart tears (P < .05). Postoperatively, patients who underwent SLAP repair reported a larger proportion and more severe magnitude of shoulder pain during rest, overhead activities, and sleep compared with those who underwent Bankart repair (P < .05). Only patients who underwent Bankart repair reported improvements in the prevalence and magnitude of their shoulder pain during rest, overhead activities, and sleep by 6 months postoperatively compared with preoperative levels (P < .05). Preoperatively, 30% of patients with Bankart repairs and 40% of patients with SLAP repairs reported hand tingling, while 35% and 50%, respectively, reported hand numbness. The prevalence and magnitude of hand tingling and numbness were not significantly different between groups at any time point.

Conclusion:

Study results indicated that patients who underwent SLAP repair experienced worse shoulder pain outcomes compared with those who underwent Bankart repair using the same anchor and surgical technique. Only patients who underwent Bankart repair reported improvements in their hand numbness after surgery. Therefore, labral tear location does matter with respect to shoulder pain and hand numbness.

In vitro modeling of dental water line contamination and decontamination

The contamination of dental unit water lines (DUWL) is an emerging concern in dentistry. The aim of this study was to use an in vitro DUWL to model microbial contamination and evaluate the decontamination efficacy of tetraacetylethylenediamine (TAED) solutions. A DUWL biofilm model used to simulate clinical conditions was used to generate a range of biofilms in DUWL. Three distinct biofilms were generated: (1) biofilm from water, (2) biofilm from a mix of water + contaminating human commensal bacteria, (3) biofilm from water with contaminating oral bacteria added after biofilm formed. The contaminating oral species used were Streptococcus oralis, Enterococcus faecalis and Staphylococcus aureus. Decontamination by simple water flushing or flushing with TAED was evaluated (2, 5 and 10 min intervals). The DUWL tubes were split and samples were plated onto a range of media, incubated and bacteria enumerated. Water flushing did not reduce the number of microorganisms detected. Bacteria were not detected from any of the TAED sampling points for any of the biofilm types tested. Interestingly, if contamination was introduced to new DUWL along with the waterborne species a biofilm was formed containing only the waterborne species. If however, an existing biofilm was present before the introduction of "contaminating" bacteria then these could be detected in the biofilm. This implies that if the DUWL are new or satisfactorily cleaned on a regular basis then the associated cross-contamination aspects are reduced. In conclusion, TAED provides effective control for DUWL biofilms.