ABSTRACT
Introduction: Crude morbidity and mortality rates are limited indicators of quality of care, and can be misleading when the results of emergency surgery are compared between different units and hospitals. Scoring systems that group patients based on the severity of illness before treatment can allow a meaningful analysis of morbidity and mortality rates. Risk-adjusted comparisons can then be made between surgeons and hospitals. The aim of the study: To evaluate the efficacy of POSSUM scoring as a risk assessment tool in predicting morbidity and mortality for patients undergoing emergency laparotomy for hollow viscus perforation. Materials and methods: Totally 100 patients who underwent emergency laparotomy from January 2015 to September 2015 at Madras Medical College and Hospital were studied. Data were collected prospectively on a pro forma prepared for the study. All patients had their physiological score recorded on admission. Results: In our study, using POSSUM score the morbidity prediction ranges from 91 – 100% morbidity rates seen in 21 patients and 31 – 40% morbidity rates seen in 22 patients. But the morbidity was observed in 63 patients out of 100. On comparing the predicted and the observed morbidity, the prediction using POSSUM and the observed morbidity was found similar. Conclusion: From our study, it has been evaluated that POSSUM scoring in patients with perforation peritonitis is a significant tool to evaluate the mortality and morbidity outcomes of the patients.
ABSTRACT
Introduction: Fistula in ano is the benign anorectal condition, but became a major problem for surgeons to cure the disease. For proper treatment of fistula in ano, a thorough knowledge of Anorectal anatomy and etiopathogenesis of the anorectal abscess is required. More than 90% cases of perianal abscess and anal fistulas occur due to cryptoglandular infections in the intersphincteric plane. Less than 10% occurs due to the complications of Crohn's disease, malignancy, Tuberculosis, and Radiation Exposure. The aim of the study: To study the different modalities of treatment for fistula in ano (Fistulotomy/ Fistulectomy/ Fibrin Glue Injection/ LIFT procedure). Materials and methods: Patients who met inclusion and exclusion criteria for the study selected and all patients discussed the nature of the disease and possible complications (recurrence, anal incontinence, and anal stricture) expected after surgery was explained. Written consent for the study and surgery was obtained. In proforma, thorough history, signs and symptoms, we identified internal opening and external opening by thorough digital rectal examination and proctoscopic examination under the adequate light were noted. Results: In our study, out of those 15 cases of Fistulectomy, 4 cases developed intraoperative bleeding, 3 cases developed sphincter injury and 3 cases had prolonged surgery more than 1 hour. Of 10 cases with Fistulotomy, 3patients developed intraoperative bleeding, 2 developed sphincter injury and 2cases had prolonged surgery more than 1 hour. Cases proceeded with Fibrin Glue Injection did not develop any obvious intraoperative complication. Manivannan Dhanraj, Nachiappan Meenakshisundaram, Vinodh Duraisami, Vinayak Rengan. Comparison of various techniques in the management of fistula in ano. IAIM, 2018; 5(5): 14-20. Page 15 Conclusion: Fistulectomy has a moderate degree of intraoperative and postoperative complications with a moderate chance for stricture and incontinence and less chance for recurrence. Moreover few cases required second sitting for the completion of treatment.