Correlation of Clinical Findings with Radiological and Intraoperative Findings in Cases of Intestinal Obstruction

Intestinal obstruction accounts for 15% of all patients presenting to emergency department with complaints of acute abdominal pain. Recognising obstruction early, aggressive preoperative treatment, skilled surgical techniques and intensive postoperative management improves outcome. We wanted to correlate the clinical findings with radiological and intra-operative findings in cases of intestinal obstruction.METHODS50 cases of intestinal obstruction chosen by simple random technique, were studied in the department of general surgery at MMIMSR, Mullana, Ambala. Intraoperative findings were compared with x-ray, USG abdomen and CT abdomen findings.RESULTSAdhesions and bands (26%) were found to be the most common cause of intestinal obstruction. Most common finding on plain x-ray abdomen was the presence of dilated gut loops (82%). USG abdomen has limited diagnostic value in cases of intestinal obstruction with most common finding reported in USG abdomen being that of small bowel obstruction (62%). Out of 49 patients who underwent CT scan abdomen and surgery, CT findings matched with intraoperative in 45 patients (91.84%) and the most common finding was adhesions and bands (22.4%).CONCLUSIONSX-ray abdomen and USG abdomen have limitations and are diagnostic only in a handful of cases. CT abdomen provides much more elaborate information and helps the surgeon to understand the pathology. Preoperative CT also helps prevent laparotomies in scenarios where surgeon with preoperative knowledge can opt for laparoscopic approach, thereby reducing postoperative stay in the hospital and complication. So, understanding of the imaging modalities and knowing when to use them and what to look for can save precious time of the patient and also that of the surgeon allowing for early diagnosis and better plan of treatment.

Comparative Study of Conventional Three Ports with Single Port Laparoscopic Inguinal Hernia Repair in a Tertiary Care Hospital

Introduction: Inguinal hernia repair is the most frequentlyperformed surgical procedure worldwide. Advances inlaparoscopic techniques have ushered an opportunity toimprove and improvise many surgical procedures. Singleincision laparoscopic surgery (SILS) was developed withthe aim of reducing the invasiveness of conventionallaparoscopy, and has been successfully performed by manysurgeons. Aim of the study was to asses the safety andfeasibility of single por laparoscopic approach for inguinalhernia repair.Material and methods: This study was conducted on 50patients presenting to Acharya sri chander college of MedicalSciences and Hospital, Sidhra, Jammu ASCOMS over aperiod of one year from November 2011 to October 2012 withuncomplicated inguinal hernia in whom 25 patients underwentsingle port laparoscopic TAPP(SPL-TAPP) hernia repairand 25 underwent conventional three port transabdominalpreperitoneal hernia repair.Results: No significant differences were noted among patientdemographics. The age group ranged from 20-60 years. Themean Age, weight and height in SPL-TAPP were 44.4, 59.46and 157.2 cm respectively. Mean operative time, hospital stayin single port TAPP was significantly lower as compared toconventional surgery. Moreover postoperative complicationswere also lesser in SPL-TAPP with almost no reoccurances.Conclusion: Single port TAPP offers to be safe andefficacious with minimum reoccurances and shorter hospitalstay

Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries

Various adjuvant are being used with local anesthetics for prolongation of intra operative and postoperative analgesia in epidural block for lower limb surgeries. Dexmedetomidine, the highly selective alpha2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. The aim of the present study was to compare the hemodynamic, sedative and analgesia potentiating effects of epidurally administered dexmedetomidine when combined with ropivacaine. The study was conducted in prospective, randomized double-blind manner in which 100 patients of American Society of Anesthesiologist Grade I and II in the age group of 20-65 years of either sex under going lower limb surgeries were included after taking informed consent. The patients were randomly allocated into two groups of 50 each. Epidural anesthesia was given with 150 mg of 0.75% ropivacaine in Group A [n = 50] and 150 mg of 0.75% ropivacaine with dexmedetomidine [1 microg/kg] in Group B [n = 50]. Two groups were compared with respect to hemodynamic changes, block characteristics which included time to onset of analgesia at T10, maximum sensory analgesic level, time to maximum sensory and motor block, time to regression at S1 dermatome and time to the first dose of rescue analgesia for 24 h. At the end of study, data was compiled and analyzed statistically using Chi-square test, Fisher's exact test and Student t-test. P < 0.05 was considered to be significant and P< 0.001 as highly significant. Significant difference was observed in relation to the duration of sensory block [375.20 +/- 15.97 min in Group A and 535.18 +/- 19.85 min in Group B [P - 0.000]], duration of motor block [259.80 +/- 15.48 min in Group A and 385.92 +/- 17.71 min in Group B [P - 0.000]], duration of post-operative analgesia [312.64 +/- 16.21 min in Group A and 496.56 +/- 16.08 min in Group B [P < 0.001]] and consequently low doses of rescue analgesia in Group B [1.44 +/- 0.501] as compared to Group A [2.56 +/- 0.67]. Sedation score was significantly more in Group B in the post-operative period. Epidural Dexmedetomidine as an adjuvant to Ropivacaine is associated with prolonged sensory and motor block, hemodynamic stability, prolonged postoperative analgesia and reduced demand for rescue analgesics when compared to plain Ropivacaine