single layer sero-submucosal suture [interrupted or continuous] for gastro-intestinal anastomosis [particularly in children]

The routine method of doing intestinal anastomosis entails two-layer technique. An inner all layer inverting stitch and an outer sero-muscular stitch adding to more inversion of the bowel margin near the anastomotic line. This will narrow the bowel lumen and may delay recovery and sometimes leads to some sort of acute or sub-acute bowel obstruction if excessive inversion is made particularly in children who have an already naturally narrow intestinal lumen. For this reason a single layer extra-mucosal [sero-submucosal] bowel anastomosis was tried in this study on 72 patients. A good No. of them were children 19%. This has been found to be safe. The stitches were passed through the bowel wall including the structurally important sub-mucosa but excluding the mucosa. They were then tied tight enough to approximate and coapt the tissues but not to strangle them. Fine non-absorbable suture material 3/0 for adult and 5/0 for children on an eyeless needle was used in all parts of the GIT except when Gastro-enterostomy anastomosis was indicated where fine absorbable suture was preferred. This method of anastomosis had been found to be associated with no or minimal leakage not presenting clinically, with early return of bowel function and with no obstructive symptoms since only small mucosal ridge is formed resulting in no or minimal narrowing of the lumen

Precautions to avoid injuring the superior laryngeal nerve [SLN] and its external and internal branches during thyroidectomy

The aim of this study is to find out the best operative measures and precautions to be undertaken to avoid injury and to safeguard the superior laryngeal nerve and its branches particularly its external laryngeal branch which is near and intimate to vascular pedicle of the superior pole of the thyroid gland during the operation of Thyroidectomy. This is in order to minimize the incidence of the serious disabilities associated with their injury particularly those of voice changes after Thyroidectomy. 30 patients with definite indications for Thyroidectomy were included into this study. From the operative findings of this series, it has been found that [the best operative precautions to be taken in consideration are either to identify the external laryngeal nerve which is most desirable but not always easy and sometimes time consuming or to dissect carefully the individual branches and tributaries of the distal 1.5cm to 2 cm of the superior thyroid pedicle and to tie and divide them right on the surface of the upper pole, and to avoid altogether the traditional method of mass clamping and ligation whether high or low of the superior thyroid pedicle during thyroidectomy since according to the operative findings in this study mass ligature is not without danger to the external laryngeal nerve, and to the superior laryngeal nerve if high ligature is adopted]. Lekacos et al 1987 [20] reported three cases of superior laryngeal nerve injury after 54 classical high ligations of the superior thyroid artery [STA]

Day case repair of moderate sized adult inguinal hernia under local anaesthesia Sohag Teaching Hospital

This work aimed to study the intraoperative and the immediate postoperative course and progress of 50 patients presenting with inguinal hernias repaired under local anesthesia. Two techniques for achieving local anesthesia were described. Half of the cases had regional nerve block and the other half had local infiltration technique. The results of the two techniques were compared. The results of this study were in favor of local anesthesia being not only safe and adequate but also superior and economic than spinal and general anesthesia. On comparing the two techniques of local anesthetics, the local infiltration technique was found to be more advantageous than regional nerve block technique