ABSTRACT
Background: Chronic anal fissure is a familiar entity in surgical outdoor departments of hospitals in our valley. The muslim women are usually reluctant to expose their anal canal related pathologies to male surgeons, letting anal fissures to reach the chronic stage. Under this background, the present study was conducted to look for the feasibility of lateral anal sphincterotomy in the management of chronic anal fissure in our patients.Methods: This prospective study was carried out over a period of 3 years in the unit 2nd of department of surgery at SMHS (Shri Maharaja Harisingh) hospital, an associated hospital of Government Medical College Srinagar. During this period, 59 patients presented to the outpatient department with typical chronic anal fissures and were included in this study.Results: Fifty-nine patients, diagnosed on clinical evaluation as chronic anal fissure were included in this study. The age varied from 19 to 58 years with mean age of 36.38±7.14 (SD= 7.14) years. There was a female predominance, with a female to male ratio of 2.1:1. Fifty-two (88.1%) patients had posterior midline fissure and 7 (11.8%) patients had an anterior anal fissure. Thirty-one patients were not satisfied with the conservative treatment and insisted for surgical management. All 31 patients were managed by open lateral anal sphincterotomy.Conclusions: Lateral anal sphincterotomy (LAS) is a safe and effective method of management for chronic refractory anal fissures. The complications are minimal and negligible.
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Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy.
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Background: Although a rare entity, alveolar hydatid disease is associated with significant morbidity. This disease presents a diagnostic challenge because of its low prevalence, unfamiliarity and nonspecific presentation. Aim: To look about the clinical profile, diagnosis and management of these patients.Methods: This prospective study was conducted in the department of surgery at SMHS (Shri Maharaja Harisingh) hospital. All patients with a diagnosis of alveolar hydatid disease of liver during this time period were enrolled in the study.Results: Eight patients in our study were females and 5 patients were males. The age ranged from 21 to 56 years with mean age of 42.07±8.88 years (SD =8.88). The most common presentation in our study was pain abdomen (38%). The most common finding on physical examination was hepatomegaly (30.76%). CT (computerized tomography) scan abdomen gave an impression of alveolar hydatid disease in 5 patients, a suspicion of malignancy in 3 patients and tuberculosis in one patient, and a possibility of liver abscess in one patient. Results of tru cut biopsy were suggestive of alveolar hydatid disease in 4 out of 6 patients. Twelve patients were operated on elective basis (liver radical resection in 8 patients, while “laparotomy and only tumor biopsy” in 4 unresectable patients) and one patient on emergency basis, and all were subjected to histopathological examination. ABZ (albendazole) was given orally at a dosage of 10-15 mg/kg per day.Conclusions: Alveolar hydatid is a rare disease with atypical (unfamiliar) and nonspecific clinical features and atypical radiological features. Also, the disease is associated with significant morbidity, hence a high index of suspicion is needed along with supplementary imaging studies for timely intervention to prevent further complications arising from the disease.
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Introduction: Neglected cases of hemorrhoids presentingwith complications like strangulation are not uncommon,as observed in our tertiary care hospital. Under the abovebackground we conducted the present study to look into theprofile and management of the patients with complicated(especially strangulated) prolapsed hemorrhoids attending toour tertiary care hospital.Material and methods: This prospective hospital based studywas conducted in unit-II of department of general surgery inShri Maharaja Harisingh (SMHS) hospital Srinagar over aperiod of 5 years from January 2013 to December 2017. Allpatients with complicated prolapsed internal hemorrhoids(strangulation with infection, ulceration, gangrene, and/or necrosis) were enrolled in this study. Patients presentingwith features suggestive of complicated prolapsed internalhemorrhoids were subjected to clinical history, local inspectionand examination to confirm the diagnosis, and were managedappropriately.Results: During the study period of 5 years, 31 patients ofcomplicated (strangulated) prolapsed internal hemorrhoidswere enrolled. The age of our patients ranged from forty-fourto seventy-two years with mean age of 59.12±6.56 (SD=6.56)years. In our study 20 patients (64.5%) were from rural areaand 11 patients (35.5%) were from urban background. Mostcommon presentation in our study was strangulated prolapsedinternal hemorrhoid with pain, ulceration and infection.Conclusion: Patients with grade 3 and 4 internal hemorrhoids,patients having difficult access to health care facilities, andpatients having poor compliance to conservative treatment,should be offered surgical intervention at the earliest beforethe complications arise. Complicated prolapsed internalhemorrhoids can be managed initially conservatively (byprone position, bed rest, saline compresses, hot baths, icepacks, soothing topical applications, laxatives, antibiotics, sitzbath with antiseptic solutions)
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Introduction: Management of infected wounds is notalways simple and easy. Vacuum-assisted closure (VAC) isa wound healing therapy that utilizes a dressing system thatcontinuously or intermittently applies a negative pressure tothe wound surface. Our aim was to assess the Feasibility andadvantages of simplified version of otherwise costly VAC, orsimple suction drainage in selected cases.Material and methods: This prospective study was conductedin the unit 2nd of department of surgery at SMHS hospital, anassociated hospital GMC Srinagar, over a period of 3 yearsfrom January 2014 to December 2016. During this period, 32patients were subjected to vacuum suction treatment and wereincluded in this study.Results: Wall suction (VAC) was used in 26 patients. MiniVac drain (USG guided) was used in 5 cases. In one patient ofscalp infection conventional large size suction drain was used.The time taken for the wounds to become healthy was 3 to7(average 3.5) days of VAC dressing or suction drainage. Noantibiotics were given during suction drainage in 21 patients.Need for grafting by split skin grafting method was felt in only2 patients. Mild discomfort (abnormal sensation) was reportedin 21 patients. Hospital stay for patients managed by suctiontherapy ranged from12 hours (breast abcess) to 16 days withan average of 7 days. The total cost incurred in the patientsundergoing VAC for a period of 15 days per patient was Rs.800 ($ 12).Conclusion: VAC seems to have revolutionary potential inthe management of the difficult to treat infected wounds asfar as its safety, speed and cost-effectiveness are considered.