ABSTRACT
Objective: To determine the role of omental graft in the outcome of vesicovaginal fistula [VVF] repair
Place and Duration of study: Department of Obstetrics and Gynecology Unit 1, Bahawal Victoria Hospital / Quaid-e- Azam Medical College Bahawalpur, from June 1997 till December 2016
Methodology: All patients with VVF were included in this study. All had uncontrolled continuous loss of urine. In all cases examination under anesthesia was done. Transabdominal approach was used in all patients. Adequate dissection of bladder from anterior vaginal wall was achieved and fistula repaired. Omental pedicle graft was interposed between bladder and vagina. The distal part of the omentum was stitched to the distal limits of the space between bladder and vagina. Bladder drainage with three way Foley catheter was maintained for 21 days
Results: Of the total 144 patients with VVF, 43 [29.8%] developed this complaint after obstructed labor, 23 [15.9%] following cesarean hysterectomy, 6 [4.1%] after cesarean section, 44 [30.5%] after total abdominal hysterectomy [TAH], 6 [4.1%] after vaginal hysterectomy, 3[2%] after post coital trauma, 19 [13.2%] after failed earlier repair. Of the total, 140 [97.2%] fistulae healed successfully with the technique of pedicled omental graft. Failure rate was 2.7%
Conclusion: Successful management of VVF largely depends upon the judicious use of omental graft with minimal recurrence rate
ABSTRACT
Objective: To find the success rate of calcium dobesilate and norethisterone in treatment of menorrhagia of dysfunctional uterine bleeding [DUB] origin
Study design: Descriptive case series
Place and Duration of study: Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital / Quaid-e-Azam Medical College Bahawalpur, from December 2013 to December 2016
Methodology: Patients with dysfunctional uterine bleeding were included in this study. They were divided into two groups. Group A was given calcium dobesilate and Group B was given norethisterone for menorrhagia of DUB. The outcome in terms of resolution of symptoms was noted at follow up on 8,10 and 12 weeks in outpatient department
Results: A total of 600 patients of 19 year to 35 year of age were enrolled. The success rate in terms of cessation of bleeding was 83.3% in group A. This was observed within 3-5 days of starting treatment and patients remained symptoms free for the next 10-12 weeks after discontinuation of the medicine. Success rate of 98% was observed in group B however on withdrawal of medicine bleeding started again. More side effects were also observed in group B
Conclusions: Arrest of bleeding in patients with menorrhagia of DUB was more frequently noted in group B where norethisterone was used, however, it recurred on withdrawal of medicine. More side effects were also observed in group B. In group A though success rate was low but no withdrawal bleeding occurred after cessation of medicine
ABSTRACT
To compare continuous suturing technique with interrupted method for the procedure of Episiotomy. A comparative study. Gynaecology Unit 2, Bhawal Victoria Hospital Bahawalpur, from January 2008 to December 2009. Patients were randomized into two groups; One group [C] was repaired with continuous, non-locking sutures involving the vagina, perineum and subcutaneous tissues for skin. The other group [I] with the same match had continuous locking sutures of vagina, interrupted sutures in the perineal muscles and interrupted transcutaneous sutures for skin. The threads used for stitching were identical in both the groups. The participants were asked about pain during defecation, urination, in sitting position and during movement, the use of analgesics on the 2[nd], 10[th] day and 3 months postpartum. A total of 547 women underwent vaginal deliveries with episiotomies. Less repair time [one minute - p=0.017] was noted in continuous technique group and suture material consumed was also less [RR 3.2, 95% CI: 2.6-4.0]. The comparison of pain on the 2[nd], 10[th] day and 3 months after delivery showed no significant difference between two techniques [RR 1.08, 95% CI:0.74-1.57, RR, 0.96, 95% CI: 0.59-1.55 and RR, 0.68, 95% CI:0.19-2.46 respectively]. There was no difference between the severity of pain in short and long term period in both the techniques. Repair with continuous suturing was quicker and less suture material was used in comparison with interrupted suturing.