ABSTRACT
To observe the prevalence of anal fissure, and outcome of open lateral internal sphincterotomy in terms of symptomatic relief, fissure healing and complications of procedure in female population. Cross sectional, Prospective interventional. Surgical Unit DHQ [Teaching] Hospital Rawalpindi, Women Medical Complex Sialkot over a period of seven years from 2003 to 2010. Female Patients with chronic anal fissure with history of failed conservative treatment were included in the study after taking informed consent. All patients were evaluated and managed by consultant General Surgeon and were subjected to open lateral internal sphincterotomy [LIS]. Two hundred and seventy three female patients of mean age of 39.5 years with chronic anal fissure and history of failed / noncompliance to conservative treatment were enrolled in this study. All patients underwent open lateral internal anal sphincterotomy. Post operatively had excellent recovery, were ambulant on same day. Minor complications were noted in 44 patients [0.16%]. Moderate pain at operation site was the commonest complication seen in 32 patients [0.11%]. No major complication like permanent incontinence of flatus and feces or recurrence was reported in any of the patients. Lateral internal sphincterotomy remains an effective treatment for chronic anal fissure in the hands of experienced surgeon with highest patient satisfaction, and should be considered as the first line therapy in chronic and resistant / recurrent acute anal fissures
ABSTRACT
To analyze the role of damage control in surgery in severely injured and polytrauma patients. Descriptive study. Surgical unit of District Headquarter [teaching] Hospital, Rawalpindi. January 2000 to December 2007. This study included 28 severely injured patients who presented in the accident and emergency department of District Headquarters [teaching] Hospital, Rawalpindi. These patients were unstable because of life threatening hemorrhage following some blunt or penetrating trauma. After immediate shifting to operation theater, resuscitation and operative intervention was done simultaneously. Different procedures of damage control surgery like abdominal packing for hepatic and pelvic trauma, major vascular ligation for vascular injuries of neck and extremities were adopted in phase I. In phase II patients were managed in ITC for coagulopathy and hypothermia. Definitive treatment was done in Phase III after 24-72 hours once patients got stable. Total 28 patients included in the study. In 18 patients abdominal packing for hepatic injury [n=11] and pelvic fractures [n=7] was done. Major vascular ligations in n=11 and temporary intestinal clamping in n=1 patient. Planned re-exploration after 24-72 hours in n=16 and unplanned re-exploration within 24 hours in n=5 patients was done. Complications included ongoing hemorrhage [n=5], coagulopathy [n=2], controlled biliary fistula [n=1], abdominal compartment syndrome [n=1], cerebral ischemia [n=1] and gangrene of abdominal wall [n=1]. Two patients died