Management of common bile duct stones after cholecystectomy

Non-surgical management was attempted as the first line of treatment in 39 patients presenting with stone [s] in the common bile duct after cholecystectomy. Of these, 12 patients presented with a T-tube. Endoscopic sphincterotomy was successful in 31 patients [79.5%] to achieve clearance of the common bile duct. In patients with the T-tube still in place, and in whom endoscopic sphincterotomy has failed, attempts at removal of the stones via the T-tube tract were successful in 3 out of 4 patients. Surgical intervention was indicated in only 6 cases [15%]: 5 patients after failure of non-surgical management and the sixth patient was operated upon to deal with bleeding after sphincterotomy

Marsupialization of the wound in the management of the difficult anal fistula

Marsupialization of the perineal wound was done in 25 cases of difficult anal fistula. The results were compared to 24 cases managed without marsupialization. The study showed that this simple technique when performed after adequate surgery for anal fistula led to a 40% reduction in the mean hospital stay [from 10 days to 16 days] and a 20% reduction in the mean wound healing time [from 7.5% weeks to 6 weeks]. The procedure was not followed by an increase in the complications whether local or systemic. The author recommends its application to all difficult anal fistula wounds after dealing properly with the fistula track[s]

On-table colonic lavage in emergency large bowel surgery: is it always feasible?

A series of 42 patients who required emergency surgery for distal colonic lesions were admitted to this study. Out of these patients, 24 were operated upon with primary bowel resection and immediate anastomosis after intraoperative colonic irrigation and 18 had primary resection with delayed anastomosis. The overall results proved on- table lavage to be an affective method that enables primary colonic anastomosis and less hospital stay, without a significant increase in complication rates. However, the study concluded that the best results were obtained in patients presented with colonic bleeding, next in those with intestinal obstruction, then in the group presented with peritonitis. Thus, the technique is not considered to be an absolute one and cases should be selected according to the presenting lesion in addition to other factors as age and general condition of the patient