Submited on: 06 Mar 2013 08:44:20 AM GMT
Published on: 06 Mar 2013 11:33:55 AM GMT
 

  • What are the main claims of the paper and how important are they?

    This is an interesting case of necrotising fascitis and pericarditis after an appendectomy as it stands.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    There are a number of case reports of necrotizing fascitis after appendectomy in the literature. The pericarditis as a complication of appendectomy is somewhat novel.


  • Are the claims properly placed in the context of the previous literature?

    There is very little mention of the prior reports of appendectomy complicated by necrotizing fascitis.


  • Do the results support the claims? If not, what other evidence is required?

    There should be a thorough literature literature documented to support the novelty of the case.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Methodology is vaild, however, a larger literature search would be helpful.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    As above.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    NA


  • Other Comments:

    None other than above

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Significant

  • How to cite:  Anonymous.Pericarditis & Necrotising Fascitis: Unusual Complications Following a Laparoscopic Appendectomy; A Case Report[Review of the article 'Pericarditis & Necrotising fascitis: Unusual Complications following a laparoscopic appendectomy; A Case Report ' by Syed S].WebmedCentral 2013;4(3):WMCRW002651
1 2 3 4 5 6 7 8 9
Report abuse
 

  • What are the main claims of the paper and how important are they?

    Main claims of the paper are to describe rare complications after laparoscopic appendectomy. These are important to know as it is one of the commonest laparoscopic procedures performed.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    These claims are novel and not described frequently in literature.


  • Are the claims properly placed in the context of the previous literature?

    The claiims are not properly placed in the context of previous literature


  • Do the results support the claims? If not, what other evidence is required?

    The results do not support the claims. The diagnosis of necrotising fascitis mandates necrosis of the fascia along with the subcutaneous tissue and overlying skin. There is no such description in the case presented. Pericarditis cannot be diagnosed with ECG alone in abscence of chest pain.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    NA


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    1. Why preoperative ultrasonography of abdomen was not done?

    2. The port palcement has not been specified as there are different port placements described for ther procedure.

    3. The status of the appendix needs to be described in detail and whether there was any intraperitoneal collection?

    4. Was the specimen retrieved after putting it in a endobag? If not, was the port site contaminated while removing the appendix?

    4. Did the patient have any co-morbidities?

    5. If the authors suspected necrotising fascitis they should have obtained a bacterial culture and selected antibiotics according to the sensitivity pattern.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No


  • Other Comments:

    This appears to be case of port site infection without necrotising fascitis

    The claim of pericarditis is not well supported

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I have performed over 2000 laparoscopic procedures

  • How to cite:  Patle N M.Pericarditis and Necrotising Fascitis: Unusual complications following laparoscopic appendectomy; A case report[Review of the article 'Pericarditis & Necrotising fascitis: Unusual Complications following a laparoscopic appendectomy; A Case Report ' by Syed S].WebmedCentral 2013;4(3):WMCRW002631
1 2 3 4 5 6 7 8 9
Report abuse
 
First of all , there are some things you need to know nowadays in UK no laparoscopy is done by closed approach , it is understood that open access is used for port insertion, no one needs to mention that because latest guidelines are used in all hospitals based on evidence based practised. Another thing you need to know is that a lady with no previous medical illnesses coming first time to the hospital means that there were no comorbidities. The port site placements - A 3-port technique was used: umbilical port for camera and specimen removal, a suprapubic port and right upper quadrant port. USG abdomen is done to rule out gynaecological pathology if suspected In UK appendicitis is a clinical diagnosis and in this hospital USG IS NOT CONSIDERED reliable in diagnosing appendicitis Saddle shape in ECG is diagnostic of pericarditis and you dont find it elsewhere usually. I agree there was no chest pain but there was upper abdomen pain infact upper and lower both and pericarditis can have unusual presentation of upper abdomen pain, We had requested an echo but the patient was eager to go home on analgesia and had requested to arrange that on outpatient basis .However the date she got was weeks later when it was expected to be normal The diagnosis of necrotising fascitis was suspected on the basis of skin appearances and confirmed by CT images. i am sorry for not having any pictures with me as i moved on to another hospital The slight free fluid found in pelvis at the time of operation did not yield any growth when it was cultured, All antibiotics are given in UK on basis of culture and senstivety but in this case the clinical skin changes lead to emperical treatment and the good response of the patient was evidence of its success thank you
Responded by Dr. Sumaira N Syed on 27 Mar 2013 12:42:40 PM

  • What are the main claims of the paper and how important are they?

    To report two unusual complications associated with laparoscopic appecdectomy


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    No


  • Do the results support the claims? If not, what other evidence is required?

    No


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    No


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    I am little disappointed with the approach of the surgeon. I would like to mention few points that disturbed me as below:

     

    1. What was the approach taken to create the pneumoperitoneum-open or closed

    2. Was there any haemorrhage during gaining the access as it can complicate the port site

    3. How much duration required to complete the surgery

    4. How long patient was hospitalized initially?

    5. How come prior to discharge patient had no symptoms at all? difficult to understand.

    6. Which antibiotics were selected & why?

    7. How long patient was followed up?


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No


  • Other Comments:

    No

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I have performed more than 600 laparoscopic procedures without similar complications.

  • How to cite:  Belekar D M.Pericarditis & Necrotising Fascitis: Unusual Complications Following a Laparoscopic Appendectomy-A Case Report[Review of the article 'Pericarditis & Necrotising fascitis: Unusual Complications following a laparoscopic appendectomy; A Case Report ' by Syed S].WebmedCentral 2013;4(3):WMCRW002602
1 2 3 4 5 6 7 8 9
Report abuse
 
Thanks for reviewing, I can understand that you want a more detailed description of points which I felt are understood. In Uk no one uses closed technique, it is always open nowadays. When I say uncomplicated lap appendicectomy operation it means the surgery did not involve complications like prolonged bleeding at port sites or anywhere else The duration in uncomplicated cases is usually 1-2 hr.s and this case took 1 hour. She stayed for 2 days ,was good and happy to go home on 3rd day post operatively
Responded by Dr. Sumaira N Syed on 14 Mar 2013 07:43:25 AM

  • What are the main claims of the paper and how important are they?

    occurence of rare complications of laparoscopic appendicectomy such as necrotising fascitis and pericarditis


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    it is indeed a rare complication in case of laparoscopic appendicectomy


  • Are the claims properly placed in the context of the previous literature?

    NA


  • Do the results support the claims? If not, what other evidence is required?

    NA


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    NA


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    The author has not described the technique used to gain abdominal access. This is very important because when using an open technique in patients(more so in obese patients) there is a possibility of creating various false planes where the infection can spread. Also if the entry port is bigger than the trocar, CO2 gas tends to leak in intramuscular plane and hence infection can spread in this plane when there in significant intraabdominal infection. the author also failed to comment if the appendix specimen was extracted in specimen bag. The mentioned complication should not occur if the specimen is removed in extraction bag.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    NA


  • Other Comments:

    NA

  • Competing interests:
    none
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I have performed over 150 laparoscopic appendicectomy over last 3 yrs.

  • How to cite:  YV K P.Pericarditis & Necrotising fascitis: Unusual Complications following a laparoscopic appendectomy; A Case Report [Review of the article 'Pericarditis & Necrotising fascitis: Unusual Complications following a laparoscopic appendectomy; A Case Report ' by Syed S].WebmedCentral 2013;4(3):WMCRW002570
1 2 3 4 5 6 7 8 9
Report abuse
 
The technique was the standard lap appendicectomy, no port site gas leak was noted during surgery, trocar sizes and port site incisions matched appropriately,the appendix had not perforated,there was no peritoneal contamination appendix base was cauterised,the appendix removed from umblical port,histopatholology did not show any unexpected pathology,it was an inflammed appendix as expected,no perforation at all,I agree that baseline Ecg preoperatively would have added benefit but this was a 35 yr old female ,fit and healthy who never had any chest pain, there is no recommendation to do an Ecg preoperatively in patients presenting as acute appendicitis at the age of 35 ,being a female her pregnancy test was done which was negative,the surgery was a standard laparoscopic surgery in a 35 yr old lady with weight about 62 kg not at all obese There is no recommendation in UK to give prophylactic antibiotics in cases of suspected appendicitis Histolopathology confirmed an inflammed gangrenous appendix which had not perforated
Responded by Dr. Sumaira N Syed on 14 Mar 2013 09:54:42 AM
Review on
Posted by Dr. Vijay Ramachandran on 06 Mar 2013 01:08:08 PM GMT

  • What are the main claims of the paper and how important are they?

    The paper claims to highlight some rare complications following Lap.Appendectomy.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The claims are novel to the extent that there has been only two papers which have dealt with the issue of Necrotising Fasciitis after Lap.Appendicectomy viz. 

    1.http://www.ncbi.nlm.nih.gov/pubmed/22778196

    2.http://www.ncbi.nlm.nih.gov/pubmed/18492384

    There are no prior reports till date of pericarditis following the procedure.

     


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    No.I would have loved to read about the status of the appendix which was removed,degree of peritoneal contamination,method of securing the base of the appendix,antibiotic prophylaxis employed,whether endo bag was used for retrieval,reason for ileus, whether an ECG was done prior to her surgery (which if normal,would have lend credence to the diagnosis of pericarditis as a postoperative complication) etc.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    NA


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Yes.The paper will definitely benefit from better writing of the manuscript and attention to detail.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No


  • Other Comments:

    None

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I have performed more than 1000 Lap. Appendectomies till date without any such complication.

  • How to cite:  Ramachandran V .Review on [Review of the article 'Pericarditis & Necrotising fascitis: Unusual Complications following a laparoscopic appendectomy; A Case Report ' by Syed S].WebmedCentral 2013;4(3):WMCRW002569
1 2 3 4 5 6 7 8 9
Report abuse
 
thanks a lot for the review, The technique was the standard lap appendicectomy, no port site gas leak was noted during surgery and there was no excessive bleeding, trocar sizes and port site incisions matched appropriately,the appendix had not perforated althoughit was partly gangrenous ,there was no peritoneal contamination appendix base was cauterised,the appendix removed from umblical port,histopatholology did not show any unexpected pathology,it was an inflammed appendix as expected,no perforation at all,I agree that baseline Ecg preoperatively would have added benefited but this was a 35 yr old female ,fit and healthy who never had any chest pain, there is no recommendation to do an Ecg preoperatively in patients presenting as acute appendicitis at the age of 35 ,being a female her pregnancy test was done which was negative,the surgery was a standard laparoscopic surgery in a 35 yr old lady with weight about 62 kg not at all obese, No antibiotic prophylaxis is recommended in UK for cases of suspected appendicitis
Responded by Dr. Sumaira N Syed on 14 Mar 2013 09:51:43 AM