ABSTRACT
Introduction: Laparoscopy has revolutionised Surgerywith its widespread acceptance as predominantly minimallyinvasive to intraabdominal surgical procedures. Creationof pneumoperitoneum is indispensable primary step ofthe procedure as it allows creation of operative field. Itcan be achieved by various techniques viz Classical openmethod as described by Hasson. The aim of the study wasto ascertain safety of direct trocar insertion in creation ofpneumoperitoneum in laparoscopic surgeries and adopt thesame as an alternative to veress technique.Material and methods: A total of 576 patients were includedin the study, Group A comprised of patients in whom wecreated pneumoperitoneum by classical veress needleinsertion and included 327 patients. Group B comprised of249 patients in whom we created pneumoperitoneum by directtrocar insertion method.Results: The mean age of patients was 47.54 years SD 11 witha male female ratio of 1:1.56. Laparoscopic cholecystectomy(52.08%) was most frequent followed by laparoscopicappendectomy (13.02%). Group A patients witnessed omentalemphysema (7.95%) as commonest complication followed bypreperitoneal insufflation(5.19%) while as the most commoncomplication in group B was omental emphysema (0.81%).Port site infection (4.28%) and subcutaneous emphysema(3.36%) predominated in group A and port site infection(1.2%) and seroma formation (1.2%) were common in groupB.Conclusion: There are many methods to createpneumoperitoneum. The closed technique modified to directtrocar insertion versus classical method by Veress werecompared in patients undergoing laparocopic proceduresat SMHS hospital for a period of one and a half year. Theresults are fascinating as the modified technique overshadowsits classical version in terms of feasibility, efficacy andconsumption of time.
ABSTRACT
Background: Chronic anal fissure is a familiar entity in surgical outdoor departments of hospitals in our valley. The muslim women are usually reluctant to expose their anal canal related pathologies to male surgeons, letting anal fissures to reach the chronic stage. Under this background, the present study was conducted to look for the feasibility of lateral anal sphincterotomy in the management of chronic anal fissure in our patients.Methods: This prospective study was carried out over a period of 3 years in the unit 2nd of department of surgery at SMHS (Shri Maharaja Harisingh) hospital, an associated hospital of Government Medical College Srinagar. During this period, 59 patients presented to the outpatient department with typical chronic anal fissures and were included in this study.Results: Fifty-nine patients, diagnosed on clinical evaluation as chronic anal fissure were included in this study. The age varied from 19 to 58 years with mean age of 36.38±7.14 (SD= 7.14) years. There was a female predominance, with a female to male ratio of 2.1:1. Fifty-two (88.1%) patients had posterior midline fissure and 7 (11.8%) patients had an anterior anal fissure. Thirty-one patients were not satisfied with the conservative treatment and insisted for surgical management. All 31 patients were managed by open lateral anal sphincterotomy.Conclusions: Lateral anal sphincterotomy (LAS) is a safe and effective method of management for chronic refractory anal fissures. The complications are minimal and negligible.