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Are prophylactic antibiotics justified in pediatric patients with inguinal hernia repair?

Author: Ali E. Joda
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 24-29
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: There are different studies highlighting the role of using prophylactic antibiotics in clean surgeries, but still there is conflicting evidence regarding whether prophylactic antibiotics are beneficial or not in preventing post-operative surgical site infection. Aim: This study aims to evaluate the use of peri-operative prophylactic antibiotics in preventing or reducing surgical site infection in the elective open repair of pediatric inguinal hernia. Patients and method: Over a ten-month period a total 150 pediatric patients underwent elective surgical repair for inguinal hernia were enrolled in this randomized prospective study, they were categorized into two equal Groups alternating at the time of operation. The patients in group A (Control) were followed a standard regimen of giving pre-operative parenteral antibiotic (in the ward or at the beginning of anesthesia) & then post-operative oral antibiotics for five days duration, while the patients in group B (Case) underwent the same surgery, but neither preoperative nor post-operative antibiotics were given. A written informed consent from the parents or child guardian was obtained after explanation. The rate of surgical site infection was compared between the two groups. A p value of less than 0.05 was considered to be significant statistically. Results: The total infection rate in both (case and control groups) was 3.33%, the rate of postoperative wound infection in "case group" was 4 % compared to that in "control group" which was 2.67 %. This noticed variance was statistically insignificant (P value by Chi-Square Test = 0.9883, Two –tailed p value using paired samples- t test was = 0.6578). 80% of the infections were mild (grade 1 & 2) & 60% was noticed in the 3rd post-operative day. Conclusion: This study pointed out that peri-operative prophylactic antibiotics are not justified routinely in pediatric inguinal herniotomy as there is no significant increased risk of postoperative wound infection in "group B" compared to "group A" (p value = 0.6578 using paired samples t- test), & this low risk of wound infection does not warrant the economic burden of their usage in such clean surgical operations.


Article
12.GOMCO CLAMP CIRCUMCISION IN NEONATES AND INFANTS: A PRELIMINARY EXPERIENCE IN IRAQ

Author: Ali E. Joda علي عكاب جوده
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2017 Volume: 15 Issue: 2 Pages: 188-197
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Circumcision and its complications are one of the most common cases that pediatric surgeons facing in their practice. There are many techniques that have been described to perform it either by the free hand operative methods or with the use of special devices.Objective: To evaluate the results of using Gomco clamp for circumcision as a preliminary experience in Iraq.Methods: A total of 120 babies were subjected to circumcision by this device during the period from April 2014 - November 2015; their age ranges from 7 days - 11 months and they were divided into 3 groups: neonates, infants 1-3 months, infants 4-11 month. By using three different sizes of the clamp, the procedure was performed under local anesthesia in the majority of cases in a form of subcutaneous ring block with aid of sedatives while general anesthesia was given to those cases of coincidental circumcision with other operations. The outcomes of the procedure were assessed after one-month period of follow up.Results: 12.5% of cases were neonates; the average duration of the procedure was 20 minutes. A total complication rate of 9.16% was recorded (11 cases out of 120. The lowest rate of complication (6.6%) was seen in neonates, while the group of infants older than 4 months had the highest complication rate (10%). The most frequent complication recorded was bleeding (36.3% of all complication rate) followed by excess skin, infection, meatitis, epidermal inclusion cyst, no other complications were recorded.Conclusion: Circumcision by Gomco clamp is a safe and simple method with good functional and cosmetic results if performed during neonatal period and early infancy. Choosing the suitable size of the clamp, adequate training and good postoperative care will minimize most of the complications.Keywords: Circumcision, Gomco clamp, neonate, infant, complications.Citation: Ali E. Joda. Gomco clamp circumcision in neonates and infants: a preliminary experience in Iraq. Iraqi JMS. 2017; Vol. 15(2): 188-197. doi: 10.22578/IJMS.15.2.12

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