Results of primary closure in the management of gangrenous and viable sigmoid volvulus

To compare the outcome of primary repair, both in viable and gangrenous cases of Sigmoid Volvulus. Retrospective study conducted from August 2001 to April 2006. District Headquarter Hospital, Bannu, North West Frontier Province. All patients admitted with large gut obstruction due to Sigmoid Volvulus. After initial investigations and resuscitation, the patients were shifted to the operation theatre where the vascular status of the sigmoid colon was noted, and resection and primary anastomosis was done in all the cases. Patients were allowed orally after 3-5 days, when their bowel sounds returned and they were able to pass flatus and/ or faeces. All patients were discharged home after recovery, and were followed up for a minimum of four months. The outcome of both the gangrenous and the viable gut patients was compared in terms of anastomotic leakage, wound infection, hospital stay and long term complications. The findings were entered onto a proforma and the results compiled and analyzed. Amongst the total 83 patients, there were 72 [86.7%] males and 11[13.3%] females, with an age range of 35-80 years [mean 55 years]. All patients presented with the typical symptoms of intestinal obstruction. Local and systemic signs of toxicity were more common in the gangrenous group. Postoperatively 17 [53.12%] patients in the gangrenous group and 9 [17.64%] cases in the viable group developed paralytic ileus; 2 [6.25%] patients in the gangrenous group developed anastomotic leakage leading to peritonitis; 2 [6.25%] patients in the gangrenous group and one [1.96%] in the viable group developed intra abdominal abscess; eight patients in the gangrenous group and five in the viable group developed wound infection, two of these patients late on developed incisional hernia. The mean hospital stay in the gangrenous group was 10 days as compared to eight days in the viable group. The difference in the outcome of primary anastomosis in both the viable and non viable groups was insignificant. Primary anastomosis can be safely done for acute sigmoid volvulus in both gangrenous and viable gut

Penetrating colonic injuries: management by primary repair

To assess the out come of primary repair in Penetrating Colonic Injuries. Prospective, interventional study from August 2001 to February 2004. Setting: This study was conducted at DHQ Hospital, Bannu. All patients who sustained colonic injury either by gunshot or stab injury were included in the study. Only those patients were included who were hemodynamically stable, did not have life threatening co-existing injuries and on operation were found to have mild to moderate peritoneal fecal contamination. All patients were operated after initial resuscitation and colonic injuries found were repaired primarily without fecal diversion. During the immediate and early postoperative period, these patients were observed for any complications like peritonitis, wound infection, peri-anastomotic abscess, pelvic, sub-diaphragmatic or interloop abscesses and colocutaneous fistulae. Patients were discharged home after they passed stools and their postoperative period remained uneventful for few days. Out of the 35 patients, majority were young males [80%]. The commonest mode of injury was fire arm, seen in 80% of the cases. The time interval between injury and repair was 4-12 hours [mean 6 hours]. Simple repair with interrupted suture was the commonest procedure performed, followed by right hemicolectomy. Twelve [34%] patients developed complications in the form of wound infection, intra abdominal abscesses and fecal fistulae. The total hospital stay was 7-21 days with the mean [9 +/- 2 days]. Primary anastomosis is safe and has excellent results in Penetrating Colonic Injuries

Experience of day care surgery at Peshawar

To evaluate the results of Day Care Surgery in our set-up. Retrospective study from Jan. 2003 to May 2005. Surgical 'C' Unit of Khyber Teaching Hospital, Peshawar. A total of 190 patients who underwent Day Care Surgery were included in this study. All patients were evaluated and counselled before hand, and asked to come on a given date. On the day of surgery they were shifted to the Operation Theatre, operated, kept under observation and sent home the same day with the advice to contact the concerned surgeon in case of any problem or complication. The patients were followed-up on the 3rd and 7th days, and examined for evidence of any local or distant complication. The patients were once again followed within a months time. Out of 190 patients, there were 131 male and 59 female patients, with an age range of two months to 65 years. All patients went home following surgery the same day except two, who were apprehensive and had to he kept for night. Twelve made telephone calls and were given advice. Five patients were readmitted with vomiting. two with severe pain and two with reactionary hemorrhage, and were discharged home the next day. One patient with hernia repair was readmitted after two days with scrotal oedema and treated. Day Care Surgery in uncomplicated cases is safe and cost effective. Majority of the patients were satisfied with this approach of early discharge