ABSTRACT
Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Although lateral internal sphincterotomy [LIS] is an effective treatment of chronic fissure in ano, it has the potential to cause serious complications, the most distressing of which is incontinence to flatus and fecal soiling. We proposed fissurectomy [F] as an alternative surgical treatment. Experimental and Comparative Study. This study was conducted at Surgical Department, Ghulam Mohammad Mahar Medical College Sukkur. One hundred twenty four patients, divided into two groups. Sixty patients underwent fissurectomy and 64 underwent lateral internal sphincterotomy. After a median follow-up of 18 months, we compared the results of the two procedures. In addition to frequent visits on a predetermined basis, a telephone inquiry into fissure recurrence and continence status was made. All patients in either group were pain-free and without bleeding within one week. In both groups, urinary retention was noted in two patients. Incontinence to flatus occurred in four patients [6.2%] in the LIS group, but no incontinence was noted in the F group. There were two patients [3.1%] with fissure recurrence in the LIS group, but no one in F group. No patient in either group was afflicted with anal stenosis or perianal infections. All wounds healed within 6 to 8 weeks. 58 patients [96.6%] in the F group and 56 [87.5%] in the LIS group reported satisfactory results. In surgical treatment of chronic anal fissures not responding to conservative management, fissurectomy may be a sphincter-sparing alternative and perhaps a preferable surgical technique
ABSTRACT
To see the results and complication rate of Laparoscopic cholecystectomy at Sukkur. Prospective Study. This study was conducted at Ghulam Mohammad Mahar medical College Hospital Sukkur and Sukkur Blood Bank Hospital from December 2004 to December 2009. The study comprises of 550 case. All were admitted from OPD of both hospitals. All patients had routine investigations, Liver function tests and ultrasound abdomen. The patients who underwent laparoscopic cholecystectomy whether successful or converted were included in study. The procedure was carried out by standard four port technique. Clinical examination, investigations, operative time, postoperative complications, reasons for conversion and hospital stay were recorded on proforma and results were drawn. The male patients were 100 and female patients were 450, male to female ratio was 1:4.5. Mean age of patients were 47.63 years ranging from 25 years to 75 years there were 127 [23.09%] obese, 72 [13.90] controlled hypertensive. Anatomical obstacle noted in 40 [7.27%] patients. Adhesions in 52 [9.45%] and acute cholecystitis in 22 [3.75%] patients. Overall conversion rate was 4%. In total of 22 patients which were converted, causes were slipped clip, 2 hemorrhage from falciform ligament 1, severe hemorrhage 3, unclear anatomy 6, common bile duct injury 4, intra abdominal adhesions 4, gangrene gall bladder 1, and advance carcinoma 1. mean hospital stay was 1.8, ranges from 1 day to 10 days. Laparoscopic cholecystectomy has a gold standard procedure. It is safe and effective and becoming cost effective day by day. Incidence of complication is low, morbidity and mortality are low. The pain free postoperative period and early ambulation lead to saving of value able working hours