ABSTRACT
Background: Diverting temporary stoma is created to protect the primary bowel pathology and distal anastomosis. Once that primary pathology has been overcome or distal anastomosis gets healed, closure of temporary stomas can be carried out. Invention of stapling devices for intestinal anastomosis provided another dimension than hand sewn method to the stoma closure techniques. In this study, we have compared two methods of loop stoma closure-hand sewn method versus stapler method.Methods: This is prospective comparative study in which 50 cases of loop ileostomy/colostomy were taken. 25 patients underwent ileostomy/colostomy closure by hand sewn anastomosis (group A). Another 25 patients underwent ileostomy/colostomy closure by stapler anastomosis (group B). Time taken for operation, initiation of oral intake, anastomotic leak, post-operative wound infection and total hospital stay duration were compared between these two groups to conclude about which method is superior and in the best interest of patient and surgeon.Results: Mean operation time 105.96 minutes (group A) and 72.84 minutes (group B). Mean time to start oral intake 5.36 days (group A), 3.6 days (group B). 16% patients (4/25) group A and 4% patients (1/25) group B developed anastomotic leak. 28% patients (7/25) group A and 8% patients (2/25) group B had post-operative wound infection. Mean hospital stay 10.4 days in group A and 7.84 days in group B.Conclusions: Stapler method provides significant benefits in terms of less operative time, early oral intake and less hospital stay. Overall stapler method for stoma closure is more efficient and cost effective.
ABSTRACT
Introduction: Urinary tract infection among indoor patientswho underwent urethral catheterization is one of the mostcommon nosocomial infections. Infection in catheterizedpatients is a result of biofilm formation along catheter thatascends into urinary bladder along the internal and externalcatheter surfaces. Acquisition of new bacteriuria while acatheter remains in situ is 3 to 7% each day. The aim andobjective of this study was to estimate the rate of CAUTIin catheterized indoor patients with their demographicdistribution and clinical presentation.Material and methods: We conducted prospective studyof 200 cases of indoor patients with age <80 years whounderwent catheterization for various surgical indication fromSeptember 2017 to October 2019. After taking informed andwritten consent of patients, we studied CAUTI by culture andsensitivity testing of patient’s urine, graphs were obtained andresult analyzed.Results: We had studied 200 indoor patients in which 32had CAUTI(16%),out of which 68% patients were female,major age group in CAUTI was 60-79 years(44%). 88%CAUTI were asymptomatic. Mean duration of catheterizationin CAUTI was 6.2 days.7 type of organism were isolatedfrom 32 patients of CAUTI, Escherichia coli was mostfrequently isolated microorganism (26%), Candida albicanswas second common organism(20%). Out of 32 patientsof CAUTI 29(90%) were unimicrobial and 3(10%) werepolymicrobial.Conlusions: According to this study Urinary tract infectionin catheterized patients was major cause of nosocomialinfection. Major patients of CAUTI were asymptomatic butthey were big reservoir of cross infection. So we shoulddevelop standard infection control programs, implement themand monitor to control CAUTI.
ABSTRACT
Background: Echinococcosis is caused by parasite called Echinococcus granulosus and Echinococcus multilocularis. The modern treatment of hydatid cyst of the liver varies from surgical intervention to percutaneous drainage or medical therapy.Methods: This clinical study was done on 50 patients who had liver hydatid disease admitted in Sir T Hospital, Bhavnagar from August 2013 to February 2016. Patients were divided into two groups consisting of 25 cases in each. Group A: managed by open surgery. Group B: managed by laparoscopic surgery. All patients followed up for 6 months after surgery.Results: The mean operative time in Group A was 65.2 minutes (range 35-100 minutes) while in Group B it was 76.32 minutes (range 50-100 minutes). Group B patients were mobilised early and resumed duty very fast then Group A. The mean duration of stay in hospital was 12.4 days (range 4-20 days) in Group A and 6.2 days (range 4-12 days) in Group B. Wound infection seen in 16% in Group A and 0% in Group B. General complication rate was 32% in Group A and 8% in Group B. No recurrence noticed in either group during follow up.Conclusions: Overall laparoscopic management of liver hydatid cyst is cost effective in terms of early mobilization, early discharge and early resumption of work along with cosmetic benefit.