ABSTRACT
Background: Since the introduction of male sterilization by surgery on deferens, several techniques have emerged to improve the results in terms of time, invasiveness, post operative infection, complications and success rate. Introduction: Vasectomy was introduced by Sharp in 1897. No scalpel vasectomy was introduced in China by Dr. Li Shun-Qiang in 1974. Intact fascial sheath helps in restoration of vas lumen and fascial sheath interposition prevents recanalization of vas by prevention of meeting of epithelialization from cut end of vas. Material and methods: The study was performed at PGIMS, Rohtak by performing surgery and follow-up up to one year of 326 subjects of no scalpel vasectomy. Clients were allocated in two groups. Group - A (155) with fascial sheath interposition and Group - B (171) without fascial sheath interposition. Surgeries were performed as a routine surgical procedure after full preparation of client including consent. Results: Majority of clients (56.1%) in Group - A were in age group 31-40 years followed by 22-30. years (28.4%), 41-50 years (14.8%) and 0.7% in age group more than 50 years. in Group - B, majority were also in age group 21-30 years (63.7%), followed by 31-40 years (29.8%), 41-50 years(5.9%) and 0.6% were of above 50 years. In Group - A, fascial sheath interposition was not possible in 17.2% clients due to non separation of sheath from vas. Sperm granuloma formation was observed in 8.6% in Group - A and 5.6% in Group-B. In comparison of 100% success rate in Group - A failure rate of 1.8% was observed in Group - B. Conclusion: The present study supports the existing literature that fascial sheath interposition adds a little more to the operating time of vasectomy, increases chances of wound infection and granuloma but has a less failure rate of vasectomy.
ABSTRACT
Traumatic rupture of diaphragm though not rare, presents as complication of penetrating and blunt injuries of chest and abdomen. Preoperative diagnosis of diaphragmatic injury is difficult because of the complex shape of the thin diaphragmatic muscle, the horizontal in-plane orientation of one diaphragmatic dome, and the often associated traumatic abnormalities in the lung bases. Failure to detect this underlying injury is associated with significant morbidity and mortality because of delayed visceral herniation, strangulation or both. We report a case of left-sided post traumatic rupture of diaphragm presenting as tension hydropneumothroax following a road traffic accident. It was managed as tension hydropneumothorax during initial resuscitation by intercostal tube drainage. Lack of improvement in the clinical condition led to the suspicion of diaphragmatic rupture. The patient was managed successfully by operative repair of diaphragm and manual reduction of hernial contents