ABSTRACT
Background & Objectives: Aorto-bi-femoral bypass is one of the most important surgical strategies in vascular surgical practice. The procedure is employed in surgical revascularization for both stenotic and aneurysmal diseases involving the aorto-iliac segment. The present study was carried out to analyze our recent experiences with this procedure for aorto-iliac occlusive diseases (AIOD) at the National Institute of Cardiovascular Diseases (NICVD). Materials and Methods: Over a period of 3 years (April 2008 to March 2011), a total of 47 patients underwent aorto-bi-femoral or aorto-bisiliac bypass grafting for AIOD using a Y-graft prosthesis. The mean age of the patients was 46.4 years (range 25-75 years). Thirty eight of the patients were male and the remaining 9 were female. A retroperitoneal approach was used in 27 patients. In the remaining 20 patients, the operation was done using a transperitoneal approach. A Gelatin-coated Dacron Y-graft prosthesis was used in 43 (5 of which were silver-coated prosthesis) patients while PTFE (Polytetrafluoroethylene) prosthesis was used in the remaining 4 patients. The operation was carried out under epidural anesthesia with sedation in most cases. Results: The operation was well-tolerated in all patients. There was no intraoperative mortality in this series. Two patients died in the immediate post-operative period- one due to myocardial infarction and the other due to acute renal shut-down leading to renal failure accounting for a mortality rate of 4.3%. Wound infection and lymphorrhoea at the groin incision site were the two main immediate post-operative complications. There was no incidence of graft infection in this series. Twelve patients were available for post-operative follow-up up to 2 years. Out of them, 5 patients returned with occluded grafts 8-23 months after the operation. Three of these patients underwent graft excision with re-do Y-graft bypass. The remaining two were treated with extra-anatomic bypass (Axillobifemoral). Conclusions: Aorto-bi-femoral bypass is an effective surgical strategy for occlusive diseases involving the abdominal aorta and the iliac arteries. The procedure is well-tolerated with a low incidence of early post-procedural complications and graft failure. However, poor adherence of the patients to follow-up remains a significant obstacle for evaluating the long-term outcome of this procedure.
ABSTRACT
This study was carried out to determine whether primary fistulotomy should be performed at the time of incision and drainage of anorectal abscesses and what% age of patients would develop fistula-in-ano or recurrent abscess. The record of 77 patients was reviewed who underwent incision and drainage of anorectal abscesses. Out of 77 patients, thirteen [16%] developed recurrent abscesses and 26 [34%] developed persistent fistulain-ano, with combined recurrence rate of 51%. This supports the policy of fistulotomy in the second sitting especially to prevent any complications and also of the fact that 59% would not need it
Subject(s)
Humans , Male , Female , Abscess , Rectal Diseases , Anus DiseasesABSTRACT
Fifty eight total thyroidectomies were performed from October 1994 to April 1996 using capsular dissection technique. Fifty five operations were carried out for benign and 3 for malignant disease. None of the patients developed recurrent laryngeal nerve damage or permanent hypocalcaemia. This paper addresses total thyroidectomy with reference to the risk of postoperative complications which in the past were considered major deterrents for not performing this percedure for benign diseases