BACKGROUND: Organisms blamed in acute appendicitis are right predictable and very susceptible to a wide range of broad-spectrum antibiotics. AIM: The aim of the study was to assess the clinical benefit of the routine intra-operative swab during an appendectomy in guiding antibiotic selection. METHODS: Four hundred and thirty patients underwent appendectomy halved into two groups, each 215. In Group 1, an intra-operative swab was routinely obtained for culture/sensitivity. The results of which were reviewed for helping direct antibiotic selection. No intra-operative swabs were obtained in Group 2. Both groups were given single-dose cefotaxime and metronidazole preoperatively intravenously at the time of induction of anesthesia. RESULTS: In swab group, 63/215 cultures (29.3%) revealed pathogens, while (70.7%) were negative or revealed isolated colonic commensals. Most cultures were negative or isolated colonic commensals. Fifty-two/63 cultures (82.54%) were sensitive to both cefotaxime and metronidazole, and only 11/63 (17.46%) reported resistant organisms to cefotaxime but not to metronidazole. Most pathogens were sensitive to empirical antibiotics. Twenty-two/215 patients (10.23%) developed infective complications, most (63.6%) had their cultures from the infected wound yielded different micro-organisms. Only 8/215 (3.72%) in the swab group needed a change in the empirical antibiotics for treating infective complications. In the non-swab group, 19/215 patients (8.83%) developed infective complications. Only 6/215 patients (2.8%) needed a change in the empirical antibiotics for treating infective complications. Collectively, only 14/430 patients (3.25%) required a change in the empirical antibiotics for treating infected wounds. CONCLUSIONS: Routine peritoneal swabs for culture/sensitivity during appendicectomy are of no clinical value. Such practice is considered a waste of laboratory resources and money. A single prophylactic dose of antibiotics has significant role in preventing surgical site infection.

BACKGROUND: The serious complications of total and near-total thyroidectomy vary from hypocalcemia to recurrent laryngeal nerve injury to tension hematoma. Post-operative hypocalcemia is common and has an incidence of 1.3–83% in some studies. AIM: The aim of the study is to evaluate the immediate post-operative sequence of serum-ionized calcium next to entire or close entire thyroidectomy to describe the incidence degree of hypocalcemia. METHOD: One hundred and seventy-four (174) patients who underwent total and near-total thyroidectomy were investigated for serum-ionized calcium level preoperatively and on post-operative day (POD) 1 and 2, searching for difference in serum-ionized calcium level preoperatively. RESULTS: There was a significant difference between pre-operative serum-ionized calcium (Ca++) level and that in POD1. The mean pre-operative ionized Ca was 1.23 ± 0.47 mmol/l, while mean ionized Ca on POD1 was 1.175 ± 0.11 mmol/l proposing decrease in mean of ionized Ca++ in POD1 (p = 0.0001). There was also a significant difference between pre-operative serum-ionized Ca++ level and that in POD2. The mean pre-operative ionized Ca was 1.23 ± 0.47 mmol/l, while the mean of ionized calcium on POD2 was 1.177 ± 0.1 mmol/l suggesting decrease in mean concentration of Ca++ in POD2 (p = 0.0001). CONCLUSION: Significant number of patients who undergo near-total and total thyroidectomy develop decrease in the serum concentration of calcium postoperatively.

BACKGROUND: Open appendectomy is the treatment of choice for perforated appendicitis. Perforated appendicitis is associated with a 15–20% risk of developing post-operative wound infection, which the later associated with increased morbidity as increasing post-operative pain, longer hospital stay, suppurative wounds, patient dissatisfaction and increase cost of treatment. Some literatures revealed inconsistent results related to the incidence of surgical site infection (SSI) between delayed primary closures (DPC) and primary closure (PC) in open appendectomy for perforated appendicitis. AIM: The objective of the study is to define the best practice of wound management in patients operated on for perforated appendicitis. PATIENTS AND METHODS: One hundred and twenty patients having perforated appendicitis underwent open appendectomy enrolled in the study. The patients were randomly grouped according to the method of managing the surgical incisions into two groups; patients with their incisions closed primarily (PC) and those with their incisions left open to be frequently dressed for 5 days with Betadine-soaked gauze packing till it become clean then closed (DPC). An infected wound was assigned as such if purulent discharge yielded from the incision site. Results to be addressed were the incidence of SSI and the hospitalization length. RESULTS: Out of the total 120 patients, 19.17 % developed SSI following closure of the incision. Patients managed by PC revealed higher rate of SSI than DPC group (32.8% vs. 5.1%, p < 0.001) and longer hospitalization (8.3 vs. 6.4 days, with a p < 5%). CONCLUSION: DPC is preferred policy over PC when managing an open appendicectomy wounds for perforated appendicitis, as the former is associated with low incidence of wound infection and shorter hospitalization.