ABSTRACT
Introduction: The type of suture material for skin closure is also reported to influence post-operative wound complications. However, several other studies have failed to demonstrate significant differences between different types of suture material. Materials and Methods: This study was conducted at M. S. Ramaiah hospitals, Bengaluru - 560 054, Karnataka, India, where 100 patients underwent abdominal skin closure with either staples or conventional vertical mattress suturing with Ethilon. Results: The present 1 year observational study was conducted in the Department of Surgery, M. S. Ramaiah Hospitals, Bengaluru - 560 054, Karnataka, during the year December 2014-November 2015. Data obtained was tabulated and analyzed in tables. Conclusion: The use of skin staples in low tension incision is easy, associated with low incidence of wound complications, provides good cosmetic outcome and also takes considerably less time for skin closure and thus recommend its use more frequently especially for closure of long and multiple incisions.
ABSTRACT
Introduction: Laparoscopic cholecystectomy, a minimal-access approach surgery for the removal of the gallbladder which offers many advantages that include a marked reduction in hospital stay and decreased cost. Materials and Methods: This was an open-label and prospective study on the Indian population. The study was conducted in 50 patients of cholecystectomy who underwent laparoscopic cholecystectomy under constant intraperitoneal pressure (14 mmHg) in M.S. Ramaiah Hospitals, Karnataka, Bengaluru. The study was designed to evaluate the complications of laparoscopic cholecystectomy especially the changes in liver enzymes. Results: Bilirubin (total) pre-operative was 0.510 ± 0.286 mg/dl, increased 24 h after surgery to 0.684 ± 0.239 mg/dl by 134% (P = 0.000). Bilirubin (direct) increased by 168% from 0.221 ± 0.129 mg/dl to 0.372 ± 0.203 mg/dl. Gamma-glutamyl transferase (GGT) increased from 45.13 ± 19.14 U/l to 46.37 ± 19.08, (P = 0.046). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was found to be significantly elevated from 22.68 ± 7.031 U/l to 32.74 ± 7.731 U/l (P = 0.000) and from 33.61 ± 10.40 U/l to 56.10 ± 15.08 U/l (P = 0.000), respectively. Alkaline phosphatase did not show any elevation, pre-operative values were 72.62 ± 14.36 U/l, and after 24 h was 71.81 ± 12.60 U/l (P = 0.350). Conclusion: This study demonstrated that bilirubin (direct and total), AST, ALT, and GGT elevations could occur after laparoscopic cholecystectomy. When analyzed together with the data collected from previous studies, these changes may be attributed to the reduction of portal venous flow under high pressures of a pneumoperitoneum.
ABSTRACT
Introduction: Pneumothorax is the presence of air in the pleural space and can be due to a number of causes. Although most pneumothoraces can be managed successfully with tube thoracotomy, patients with recurring pneumothoraces should be considered for operative intervention. Methodology: All patients presenting to M. S. Ramaiah Medical College and Hospitals and diagnosed with pneumothorax during a period of 5-year were included in the study. These patients were clinically evaluated and were investigated using chest radiography/computerized tomography scan of thorax and then subjected to appropriate therapy. Fisher exact test has been used to find the significance of study parameters on a categorical scale between two or more groups. 95% confidence interval has been computed to find the significant features. A statistical analysis was done using IBM SPSS 20 statistical software. Results: The mean age of presentation in our study was 35.23 years. The majority of patients presented with chest pain (87.1%). The second most common symptom was found to be dyspnea (64.5%) followed by a cough (54.8%). Pneumothorax is usually unilateral and in our study 91.4% of cases presented with unilateral pneumothorax with 51.4% being right pneumothorax. Bilateral pneumothorax was found to be 8.6%. 62.8% of patients were diagnosed to have a spontaneous pneumothorax. The two main causes of secondary spontaneous pneumothorax were tuberculosis and pneumonia. Traumatic pneumothorax accounted for 28.5% of cases with road traffic accidents (80%) as the single largest cause. Conclusion: Primary spontaneous pneumothorax is the largest cause of pneumothorax. The most common symptom that patients present with is pleuritic chest pain. Chest radiographs are the imaging modality of choice for pneumothorax. Insertion of chest drains is the treatment of choice for pneumothoraces presenting for the 1st time. Exploratory thoracotomy and decortication are the treatment of choice for recurrent pneumothorax.