ABSTRACT
Background: Fistula-in-ano is one of the common ano-rectal disorder which causes appreciable morbidity and inconvenience to the patient. Different surgical techniques have been described in literature from time to time. Open fistulectomy though considered as the standard treatment for fistula in-ano, fistulectomy with primary closure has its merits of short hospital stay, early wound healing and lower costs. The objectives of this study was to compare the period of stay, period of healing, time period to return to daily activities and cost factor between open fistulectomy and primary closure technique.Methods: Patients admitted in all surgical units of NIMRA Hospital, were included in the study without bias on a serial basis. This is a study comprising 50 patients over a period of 12 months from Febrauary 2019 to January 2020.Results: The patients were divided into two equal and comparable groups. Patients who underwent open fistulectomy were classified under Group I and those who underwent fistulectomy with primary closure were classified as Group II. The patient’s characteristics of the two groups were well matched.Conclusions: In patients treated by classical method because of long time taken to heal, number of hospital visits for dressings were more and more antibiotics were prescribed when compared to cases treated by excision of fistula tract and primary closure. From this study it can be concluded that fistulectomy with primary closure is ideal for low anal fistulaures.
ABSTRACT
Background: Abdominal tuberculosis includes tuberculous infection of gastrointestinal tract, mesentery, lymph nodes and omentum, peritoneum and solid organs like liver and spleen. The initial clinical presentations are nonspecific and no single laboratory investigation is pathognomonic. Bacterial culture and tissue histopathology though confirmatory are time consuming, and immunological tests though rewarding is expensive. Moreover, abdominal tuberculosis with an acute abdomen presents as an enormous challenge to the surgeon.Methods: This one-year prospective observational study of 25 patients who presented with intestinal tuberculosis at the Department of General Surgery, NIMRA Medical College from February 2019 to January 2020. The causes of intestinal tuberculosis were determined along with clinical profile and were monitored for outcome based on the morbidity and mortality.Results: Among the 25 patients, all had intestinal tuberculosis on the basis of operative findings and histopatholoigcal reports. Age of the patients ranged between 9 to 70 years; majority (75%) were in the age group of 20 to 40 years. Female to male ratio was 1.7:1. The commonest operative findings were hyperplastic ileocaecal tuberculosis (16%), followed by strictures (20%), and perforations (24%). The overall mortality was 8% due to sepsis and septic shock.Conclusions: Intestinal tuberculosis is a common problem presenting to general surgical units in the developing countries, often in an acute form. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis, in order to minimize complications.