Medical therapy versus lateral internal anal sphincterotomy

Background: Anal fissure is painful condition, with reduced quality of life for patients

Objective: To evaluate the efficacy of medical therapy versus lateral internal sphincterotomy for the treatment of patients with acute and chronic anal fissure

Patients and Methods: This was a comparative prospective study of 122 patients of acute and chronic anal fissure, conducted at Bahawal Victoria Hospital Bahawalpur, during a period of 2 years from 1[st] July, 2011 to 30[th] June, 2013. Medical therapy [Group A] was advised to 122 patients [32 patients with acute anal fissure and 90 patients with chronic anal fissure] with pain killer, stool softener, high fibre diet and 0.2% glyceryltrinitrate ointment applied at fissure site, thrice a day for eight weeks. The lateral internal sphincterotomy [Group B] was done in 47 patients. Patients with inflammatory bowel disease, pregnant women and patients taking nitrates for other condition were excluded. The patients were followed up, to assess fissure healing, complications and compliance for 6 months

Results: 29 [90.63%] patients with acute anal fissure and 46 [51.11%] patients with chronic anal fissure were cured by medical therapy and 45 [95.74%] out of 47 patients who did not respond to medical therapy were cured with lateral internal anal sphincterotomy [LIAS]. Headache was the main complaint in medical group while postoperative anal itching [10.64%], fecal soiling of clothes [8.51%] and transient flatus incontinence 3 [6.38%] were main complaints and one [2.13%] patient of permanent fecal incontinence was seen in group B

Conclusion: As the medical therapy is simple, achieves satisfactory healing rates, the authors suggested this as the first line of treatment for anal fissures as it could be prescribed by the general practitioner in the absence of any additional anal pathology. Patients unresponsive to medical therapy can then be referred for lateral internal sphincterotomy

Effect of perioperative risk factors and co-morbid diseases on post operative complications in perforated peptic ulcer patients

Background: Perforated peptic ulcer is a serious complication of peptic ulcers. Emergency operations for perforated peptic ulcer are associated with a high incidence of postoperative complications

Objective: The objective of this study was to determine the effect of perioperative risk factors and co morbid diseases on postoperative morbidity in perforated peptic ulcer patients

Patients and Methods: This was a prospective study on 102 patients who were operated for perforated peptic ulcer in surgical ward of Bahawal Victoria Hospital, Bahawlpur, from 1[st] January, 2011 to 31[st] December, 2012. All patients of peptic ulcer perforation were included in this study. Perforations due to malignancy or marginal ulcers were excluded. Data was collected using a preformed questionnaire. Variables included in the questionnaire were; patient's demographic data [age, sex], duration of illness, previous history of Peptic Ulcer Disease, NSAID use, alcohol use and cigarette smoking, associated medical co morbid illness, preoperative shock status at admission, interval between ulcer perforation and operation, operating time, site of perforation, size of perforation, type of surgical procedure and postoperative complications. Data was analyzed using SPSS computer software version 16.0

Results: A total of 102 patients were included. Males to females ratio was 4.6:1]. The incidence of disease was high in age group of 31-40 years 30.4% followed by age group of 41-50 years 28.4%. Analysis showed that age above 60 years [P=0.02], the presence of preoperative shock [p=0.00], history of smoking [p=0.038], interval between perforation and operation [P=0.00], spillage more than 500 ml [p=0.00], type of operation [p=0.022], an operating time over 120 minutes [p=0.00] were significantly associated with postoperative morbidity. The most frequent underlying diseases were chronic cough [pulmonary disease] which was present in 15% patients, hypertension 10%, diabetes mellitus 10% and heart disease 10%

Conclusion: Age more than 60 years, the presence of preoperative shock, smoking, H/O NSAID intake, operation after 24 hours of perforation, operation time more than 2 hours, size of perforation and spillage more than 500ml were significant risk factors for morbidity from a perforated peptic ulcer

Surgically induced astigmatism after phacoemulsification with clear corneal 5.2 mm incision; temporal vs superior approach

The purpose of this study was to compare the amount of surgically induced astigmatism [SIA] by a sutureless clear corneal incision of 5.2 mm while using a superior and temporal approach. It was carried out at the department of Ophthalmology Nishtar Medical College and Hospital Multan. The sample size was 150 eyes of 130 patients. Clear corneal incision was used in all the patients. The patients were divided into two groups Group-1 included 75 eyes of 61 patients who underwent surgery via temporal approach. Group-2 included 75 eyes of 69 patients in whom superior approach was used. Keratometry was performed preoperatively, on first post operative day, after 1 week and 6 weeks. Surgically induced astigmatism was calculated by comparing pre operative and post operation keratometric readings at 6 wks. The surgically induced astigmatism in Group-1 [Temporal approach] ranged from 0.4-1.3D, mean 0.95 D whereas for Group-2 [Superior approach] range was 1.0-2.9D and mean was 1.98D. For a suture less clear corneal incision temporal approach results in considerably lesser degree of surgically induced astigmatism

Efficacy of SRKT biometry formula

To evaluate the predictive accuracy of SRKT formula in biometry. Two hundred eyes which underwent cataract extraction by phacoemulsification and implantation of a posterior-chamber intraocular lens were included in the study. Depending upon the axial length the patients were divided in four groups. Group-l: Axial length<22 mm, n=28 eyes [14%].Group-2: Axial Length 22.00-24.5 mm, n=136 [68%]. Group-3: Axial Length 24.6-26 mm, n=25 eyes [12.5%]. Group-4: Axial Length > 26 mm, n=11 eyes [5.5%]. In all patients SRKT formula was used to calculate the power of intraocular lens. Group-I: The mean deviation in refraction was 0.42D with SRKT and 0.56D with RCOphth guidelines. Group-2: The mean deviation in refraction was 0.62D with SRKT and 0.59D with RCO guidelines. Group-3: The mean deviation in refraction was 0.43D with SRKT and 0.41D with RCOphth guidelines. Group-4: The mean deviation in refraction was 0.42D with SRKT [RCOphth recommends the same formula for this length of eye ball]. When the overall mean deviation [of all four groups] was calculated, it was 0.56D for SRKT [range 0 to 2.81D] and was 0.52 D if RCOphth guidelines had been followed. Postoperative BCVA of 6/12 or better was achieved in 197 eyes [98%]. SRKT formula performed credibly in average-length eyes as well as in the long eyes. For short eyes results would have been better if Hoffer Q formula had been used

Comparison of functional and cosmetic outcome in merseline mesh and silicone band used as a frontalis sling in ptosis surgery

The idea to use merseline mesh and silicone band in ptosis surgery and to find an effective, durable, simple, flexible and easily avaible material having less complications and best cosmetic results. Both the silicone band and merseline mesh were used as brow suspension in the form of rhomboid. Most of the cases [85%] were operated under local anaesthesia. Thirty four [Silicone band 18, merseline mesh 16] had good results i.e. within 1 mm of normal and 15% [Silicone band 02, merseline mesh 04] had fair results i.e. they were 2 mm under corrected. Both the materials were effective, inexpensive and provided good results with no recurrence but using silicone band showed better results with lesser complications