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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.
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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.
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Are the claims properly placed in the context of the previous literature?
The claiims are not properly placed in the context of previous literature
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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.
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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
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
NA
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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.
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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
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Other Comments:
This appears to be case of port site infection without necrotising fascitis
The claim of pericarditis is not well supported
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Competing interests:
No
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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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
Responded by Dr. Sumaira N Syed on 27 Mar 2013 12:42:40 PM
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What are the main claims of the paper and how important are they?
To report two unusual complications associated with laparoscopic appecdectomy
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
Yes
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Are the claims properly placed in the context of the previous literature?
No
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Do the results support the claims? If not, what other evidence is required?
No
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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
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
No
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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?
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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
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Other Comments:
No
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Competing interests:
None
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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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
Responded by Dr. Sumaira N Syed on 14 Mar 2013 07:43:25 AM
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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
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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
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Are the claims properly placed in the context of the previous literature?
NA
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Do the results support the claims? If not, what other evidence is required?
NA
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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
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
NA
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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.
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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
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Other Comments:
NA
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Competing interests:
none
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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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
Responded by Dr. Sumaira N Syed on 14 Mar 2013 09:54:42 AM
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What are the main claims of the paper and how important are they?
The paper claims to highlight some rare complications following Lap.Appendectomy.
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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.
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Are the claims properly placed in the context of the previous literature?
Yes
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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.
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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
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
NA
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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.
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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
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Other Comments:
None
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Competing interests:
None
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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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
Responded by Dr. Sumaira N Syed on 14 Mar 2013 09:51:43 AM
This is an interesting case of necrotising fascitis and pericarditis after an appendectomy as it stands.
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.
There is very little mention of the prior reports of appendectomy complicated by necrotizing fascitis.
There should be a thorough literature literature documented to support the novelty of the case.
NA
Methodology is vaild, however, a larger literature search would be helpful.
As above.
NA
None other than above
None
No
No
None
Significant