Clinical impacts of oral gastrografin follow through in adhesive small bowel obstruction [ASBO]. [a prospective randomized study]

Many studies have shown that Gastrografin can be used for diagnosis of adhesive small bowel obstruction [ASBO] and for assessing the need for surgical intervention .However; several the studies have reported conflicting results. Therefore the aim of this study is to assess the diagnostic and therapeutic effect of Gastrografin in ASBO. Altogether 110 patients with ASBO were randomized into control and Gastrografin groups. In the Gastrografin group, 100 ml of the dye was administered through a nasogastric tube. Obstruction was considered complete if the contrast failed to reach the colon on the 24-hour film. Patients with Gastrografin in the colon within 24 hours after dye administration were considered as partially obstructed and were submitted to non operative treatment. The patients were operated on if they developed signs of strangulation or failed to improve within 48 hours. The overall operative rate 14.5% in Gastrografin group versus 34.5% in control group: P = 0.04 .The time from admission to resolution of symptoms was significantly lower in Gastrografin group [19.5 vs. 42.6 hours: P = 0.001] and the length of hospital stay shorter in Gastrografin group [3.8 vs. 6.9 days 0.002] and in non operative patients [3.1 vs. 5.1 days]. Sensitivity, specificity, positive predictive value and negative predictive value for Gastrogrqfin follow-through as an indicator for operative treatment of ASBO were 87.5%, 100%, 100%, and 97.9% respectively. Oral Gastrografin helps in the management of ASBO. Oral Gastrografin is safe and reduces the operative rate and time of resolution as well as hospital stay

Early oral feeding in patients undergoing elective colonic anastomosis

Recent evidence seems to indicate that immediate postoperative feeding if feasible is safe after either laparoscopic surgery or laparotomy. This study is done to assess the safety, outcome of early oral feeding and shows factors affecting early postoperative feeding after colorectal procedures. Between June 2005 and April 2008, 120 consecutive patients underwent elective colonic anastomosis were then randomized into 2 groups. Early feeding group began fluid on the first postoperative day and regular feeding group were managed in the traditional way- nothing by mouth until the resolution of the ileus. The majority of patients [75%] tolerated the early feeding. The time to first passage of flatus [3.3 +/- 0.9 d vs. 4.2 +/- 1.2 d] and stool [4.1 +/- 1.2 d vs 4.9 +/- 1.2 d] were significantly sooner in group 1. Hospital stay is significantly shorter in early feeding group [4.2 +/- 0.2 d vs. 6.9 +/- 0.5 d]. Operative time and amount of blood loss had a significant impact on tolerability of early feeding while age, gender, type of operation, and previous abdominal operation had no significant impact. Early oral feeding after colorectal surgery is safe, tolerated by the majority of patients. Operative time and amount of blood loss has impact on the tolerability of early feeding

Clinical impacts of oral gastrografin follow through in adhesive small bowel obstruction [SBO]

Many published studies have shown that Gastrografin can be used for diagnosis post operative acute small bowel obstruction [ASBO] and assessing the need for surgical intervention. However, the studies have reported conflicting results hence the aim of our study to test this hypothesis. Altogather 100 patients with 117 episodes of ASBO were randomized into control and gastrografin groups in a double blinded fashion. Eight episodes in eight patients were excluded due to protocol violation. In Gastrografin group, 100 ml of the dye administered through a nasogastric tube and complete-obstruction has been considered if the contrast failed to reach the colon on the 24-hour film .Patients were operated on only if they developed signs of strangulation or failed to improve within 48 hours. Gasrografin group showed a significant decrease of both the time between admission and operation [P = 0.001] and that of hospital stay [P = 0.000]. The need for surgery was reduced but statistically insignificant [P = 0.225]. Oral Gastrografin helps in the management of ASBO

Rubber band ligation for 550 patients of symptomatic haemorrhoids out of 2200 patients retrospective study

This retrospective study was conducted to elucidate the results of the treatment for symptomatic haemorrhoids using rubber band ligation [RBL] method. Method: a retrospective study for 550 patients who came to the colorectal unit from June 1998 to June 2006, data was retrieved from archived files. Forty four patients with haemorrhoid had liver cirrhosis.RBL was performed using the Mc Gown applicator on an outpatients basis. The patients were asked to return to out-patient clinic for follow up at 2 week, 1, 6, months and through telephone call every 6 month for 2 years]. After RBL 496 patients [90.18%] were cured with no difference in outcome for first, second or third degree haemorrhoids [P value = 0.31]. symptomatic recurrence was detected in 16.03% after 2 years then repeated RBL or surgery were done for them. A total of 88 patients [16%] had 155 complications from RBL which required no hospitalization. Complications were registered; pain in 10.37%, rectal bleeding in 8.36% and vaso-vagal symptoms in 7.81%. RBL is a safe and successful method for treating symptomatic haemorrhoids, even in cirrhotic patients

Comparative study between biofeedback retraining and botulinum neurotoxin in treatment of anismus patients

Anismus is a significant cause of chronic constipation. This study came to revive the results of biofeedback BFB retraining and botulinum toxin A BTX- A injection in treatment of anismus patients. Forty eight patients with history of constipation underwent anorectal manometry, balloon expulsion, defecography, and electromyography. All patients had a non relaxing puoborectalis muscle. The patients were randomized into 2 groups. Group I patients receive biofeedback, two times per week for one month. Group II patients were injected with BTX- A. Follow up was conducted weekly in the first month then monthly for one year. In BFB training group 3 patients quite before the end of sessions with no improvement, initial improvement was recorded in 12 patients [50%] while long term success was recorded in 6 patients [25%]. In BTX-A group, initial improvement recorded in 17 patients [70.83%] with long term improvement in 8 patients [33.3%] There is a significant difference between BTX-A group and BFB group as regarding the initial success, but this significant difference disappeared at the end of follow up. Biofeedback retraining has therapeutic effect on patients suffering from anismus also, BTX-A injection is successful for temporary treatment of anismus and need repeated injection. Initial improvement is better after BTX-A injection

Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study

Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy [LC] feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy [OC] versus LC in compensated cirrhosis. A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group [55 patients] and LC group [55 patients]. There was no operative mortatity. In LC group 4[7.33%] patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group [96.13+17.35m vs. 76.13+15.12] P<0.05, associated with significantly higher intraoperative bleeding in OC group [P<0.01], necessitatating blood transfusions to 7 [12.72%] patients in OC group. The time to resume diet was 18.36+8.18h in LC group which significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group [6+1.74 days vs. 1.87+1.11 days] P<0.01 with low postoperative morbidity. LC in cirrhotic is still complicated and highly difficult which associates with significant morbidity compared with that pf patients without cirrhosis. However, it offers lower morbidity, shorter operative time, early resume dieting with less need for blood transfusion and reducing hospital stay than OC.