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Purpose: To measure SSI rates among gastrointestinal surgeries and to identify the associated risk factors. Patients and methods: We conducted a multicenter retrospective surveillance-based study of adults undergoing gastric, colon and small bowel (SB) procedures from January to December 2016. Univariate and multivariate analyses performed to determine the predictive variables in each surgery. Results: 71 patients out of 2099 developed SSI; 0.8%, 19.8%, and 10.8% following gastric, colon, and SB surgeries respectively. In gastric surgery risk factors identified by univariate analysis were age, duration, wound class, risk index, emergency and scope use (P0.05). Logistic regression analysis revealed that laparoscopic approach was the only significant predictor with inverse relationship with SSI rate versus open gastric surgery (P0.05). Prolonged duration was the significant risk factors for developing SSI in colon surgery and emergency was a significant risk for development of SSI in SB surgery. Gram negative bacilli were the main causative pathogens; with high percentage of MDROs. Conclusion: Variances in SSI rates and risk factors among gastric, colon and SB surgery were detected. The use of endoscope in gastric surgeries exhibited a protective effect against development of SSI. The reduction of SSI rate can be achieved by targeted preventive interventions for the identified risk factors.

Background: Elizabethkingia meningoseptica is frequently found in hospital environments and usually associated with healthcare-associated infections (HAIs), particularly in patients in the intensive care units (ICU). The current study report an outbreak of E. meningoseptica infection/colonization in the pediatric intensive care unit, highlighted the infection control methods used to stem the spread. Methods: During a period of 7 months, May - November 2015, 4 patients were infected/ colonized by E. meningoseptica. Infection control measures were re-emphasized after each case and environmental swabs were cultured to detect possible source. Results: Four patients were colonized/ infected with E. meningoseptica, their mean age 22 months. The average time patients spent in ICU between admission and isolation of E. meningoseptica was 27.5 + 19.2 days. All patients were mechanically ventilated. 25% E. meningoseptica isolated from blood causing healthcare associated Central Line Associated Blood Stream Infection (CLABSI) while it was isolated from endotracheal tube (ETT) secretion in 75 % as healthcare associated colonization. The 4 isolates confirmed as identical using pulsed field gel electrophoresis (PFGE). Conclusion: Intensive infection control measures including healthcare workers education, emphasizing hand hygiene, comprehensive cleaning and disinfection of equipment and environmental surfaces are recommended to prevent spread of the bacterium.

OBJECTIVE: The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS: Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS: The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS: Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.

OBJECTIVE: The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS: Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS: The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS: Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.

OBJECTIVE: The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS: Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS: The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS: Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.

OBJECTIVE: The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS: Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS: The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS: Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.

OBJECTIVE: The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS: Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS: The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS: Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.

OBJECTIVE: The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS: Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS: The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS: Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.