Maximal anal dilatation for treatment of haemorrhoids

A prospective study to assess the short and long term results following maximal anal dilatation for treatment of haemorrhoids was carried out in King Abdulaziz university hospital, Jeddah. A regular regimen of using anal dilators after maximal dilatation was not used in this study. The series comprised 522 patients treated over a period of 5 years between January 1980 and January 1985. Follow-up at 6 months was available in 470 patients; 57% were cured, 32% improved, 6% unchanged, 2% were worse and 3% had further treatment. Follow-up at 4 or more years was available in 107 patients: 51% were cured, 26% improved, 9% unchanged, 5% were worse and 9% had further treatment. The outcome at 6 months and 4 years was good in most of the patients and comparable with that obtained by other surgical procedures for treatment of haemorrhoids. This indicates that anal dilatation is a satisfactory procedure for treatment of haemorrhoids in our patients. The results are also comparable with those from other anal dilatation studies and indicate that our abandoning the use of anal dilators after maximal dilatation does not seem to have influenced the results

Source of infection in postcholecystectomy wound sepsis

A prospective bacteriological study was carried out on 212 patients undergoing elective cholecystectomy to identify and compare bacteria from bile and septic wounds. Bacteria were isolated from the bile in 43 patients [20%]: 28 patients [13%] developed post-operative wound sepsis. Of 28 patients 20 [71%] with wound infection had positive bile culture. Of those 20 patients, 16 [80%] with wound sepsis and positive bile culture were found to have the same organisms in both bile and wound. Escherichia coli was the commonest organism isolated from both bile and septic wounds. Anaerobic organisms were isolated from the bile of two patients and from infected wound in only one patient. Cholecystectomy with duct exploration was associated with an incidence of wound infection as compared with cholecystectomy alone. A non-functioning gall bladder and operative cholangiography were not demonstrable risks in our series. The sensitivity of organisms recovered from bile to various antibiotics was assessed. The use of prophylactic antibiotics preferably as per-operative single doses in elective cholecystectomy is recommended