ABSTRACT
Study Design: Prospective, randomized
Place:Surgical-3 Jinnah Hospital/ Allama Iqbal MedicalCollege, Lahore
Duration: Two years,January2009-December 2011
Methods: Patientsbetween 10-50 years, waiting for ileal stomareversal were re-investigated and were prepared onout door basis. Admissions were done one daybefore operation of stoma reversal. All operationswere undertaken on elective lists by the same gradeof surgeons. Patients were randomly allocated oneof the two groups. Each group consisted of 60patients. Group-1 patients were allowed to take clearliquids 4 hours after surgery and fluid diet wasgiven on first postoperative day and weredischarged from hospital 24 hours after operation.Patients of group-2 were kept NPO for 4 days withnasogatric tube in situ. Clear fluids were allowed on4th postoperative day. Fluid diet was permitted on 5thpostoperative day and were discharged fromhospital on 6-7th postoperative day
Inclusioncriteria: Loop ileostomy
Exclusion criteria: Endileostomy, Extremes of age
Results: Sample size ofthe research was 120 patients with random divisionin two groups. Group-1 consisted of 60 patientsundergoing protocol of short stay hospitalizationwhereas 60 patients of group-2 were managed withconventional method of intravenous fluid and nil bymouth for 4-5 day. The demographic characteristicsof group-1 and group-2 were similar. Theindications of constructing of ileostomy wereabdominal tuberculosis, typhoid perforation,obstetrical trauma, firearm injury, iatrogenicintestinal injury during adhenolysis and strangulatedhernia with gangrenous intestine. The indicationswere almost identical in both groups. Majority ofpatients of group-1[70%] were able to go home onfirst postoperative day with total hospital stay of 2days. In group-2, 66.6% of the total patients hadhospital stay of 8 days with p value of .674 [p=.674]which is insignificant statistically. Similarly thestatistics of postoperative complications weresimilar with p value of .805 [p=.805] which is againnot significant
Conclusion: Short stayhospitalization is safe and feasible in majority of thepatients undergoing ileostomy reversal
ABSTRACT
The aim of this study was to compare the efficacy and morbidity of two surgical procedures, firm cutting seton and loose seton / fistulotomy in the management of suprasphincteric and high trans-sphincteric fistula in ano. Jinnah Hospital / Allama Iqbal Medical college, Lahore. June 1999 to January 2008. This is a prospective, randomized study of 50 consecutive patients [25 in each group] suffering from suprasphincteric and high trans-sphincteric fistula in ano. Patients were randomly allocated one of the two methods of treatment. In firm cutting seton, seton was repeatedly tightened with the interval of 15 days till the thread came out whereas loose seton / fistulotomy was a two staged surgical procedure. Follow up was made for 12months to record the fistula recurrence, anal incontinence, duration of complete wound healing and number of hospitalizations. Comparison was made using standard statistical methods. Chi-square and Fisher's Exact test was applied for comparison. There was no significant statistical difference between the groups in age, sex and type of fistula. Patient treated with loose seton / fistulotomy required more than one hospitalization, more off work and more expenditures as compared to firm cutting seton method. The rate of anal incontinence was more in patients treated with loose seton / fistulotomy. Recurrence rate was almost the same in both groups. Both techniques are equally effective in eradication of fistula but the rate of postoperative anal incontinence and duration of complete healing of the wound is more in patients treated with loose seton / fistulotomy