Comparison of hernioplasty under local anesthesia v/s spinal anesthesia.

Background: Hernia is a common surgical problem which requires good surgical skill as well as good knowledge about anatomy and various repair of hernia. Hernia is a protrusion of a viscous of part of viscous through a normal or abnormal opening in the wall of its containing cavity. Inguinal hernioplasty can be done under general anesthesia, spinal/epidural and local anesthesia. The choice of anesthesia depends upon a variety of factors viz patient's acceptance, surgeon’s wishes, safety feasibility and cost etc. Recently there has been revival in the use of local anesthetic technique for hernioplasty. Aim: To study comparison of local anesthesia v/s spinal anesthesia for per-operative and post- operative outcome measures. Material and methods: We have done comparative study of total 100 patients (50 patients under local anesthesia and 50 patients under spinal anesthesia), with follow up period of 60 days. The present study included male patients of uncomplicated inguinal hernia with ASA grade 1 to 3. Patients were selected without bias of type (Direct/Indirect) and extent. All patients were explained about both the methods of anesthesia for hernioplasty, those who willing for local anesthesia were selected for this group and similarly spinal anesthesia group selected (total 100,50 in each group). Results: All patients were explained about both the methods of anesthesia for hernioplasty, those who willing for local anesthesia were selected for this group and similarly spinal anesthesia group selected (Total 100, 50 in each group). In local anesthesia group 7(14%) patients had intra- operative discomfort in form of pain. 64% of patients of local had mild pain and 38% had moderate pain. None of the patients belonged to serve pain group. In spinal anesthesia, 6% of patient had serve pain, 22% patients had mild pain and 72% patients had moderate degree of pain. Local anesthesia was associated with less post-operative complication, in our study no patient devlope complication like nausea, vomiting, urinary retention, or headache. Conclusion: hernioplasty under local anesthesia was an acceptable alternative to spinal anesthesia for hernioplasty especially with regard to operative condition, patient’s surgeon’s satisfaction, post- operative pain relief, complications and cost efectiveness.

Study of management of 25 cases of fistula- in-ano.

Background: Fistula-in-ano forms a good majority of treatable benign lesions of the rectum and anal canal. 90% or so of these cases are end results of crypto glandular infections. Despite the easy of diagnosis, establishing a cure is problematic on two accounts. Firstly, many patients tend to let their ailment nag them rather than being subject to examination, mostly owing to the site of this disease. The more important second factor is that a significant percent of these diseases persist or recur when the right modality of surgery is not adopted or when the post-operative care is inadequate. Aim and objectives: To know the usefulnessof investigative procedures in early and accurate diagnosis of fistula in ano. To study the efficacy of different modalities of surgical approach with reference to post-operative hospital stay and complication like pain, bleeding and sphincter incontinence and outcome in respect to persistence /recurrence of fistulae. Material and methods: A total of 25 patients with clinically diagnosed fistula in ano were included in the study. Clinical history was obtained in all the patients. Clinical examination including per rectal examination and proctoscopy was done in all the patients. All the patients were processed by routine investigations, ECG, ches X -ray etc. prior to surgery. Patients were followed up to a period of 1 year. Results: 6 patients i.e. 24% had similar illness out of them two previously operated for fistula with recurrence, and four patients with similar illness and resolved without treatment. In this study, 72% of patients had low level of fistula and another 28% of patients had an internal opening situated above the ano rectal ring. Patients with low level fistula were treated with fistulotomy and fistulectomy and patients with high level fistula were treated with seton placement. In this study 60 % of patients underwent fistulotomy, 12 % of patients fistulectomy and another 28% seton placement. Patients with low level fistula were treated with fistulotomy and fistulectomy and patients with high level fistula were treated with seton placement. Conclusion: Fistula-in-ano is an important, commonest disease due to crypto glandular infection (anal glands) and has a complication of ano rectal abscess. It is curable disease by the treatment of surgery and higher antibiotics, local antibiotics with good post-operative wound management, like sits bath for twice a day without closing the wound.

A study of 50 cases in different modalities of treatment of chronic pancreatitis.

Background: Chronic pancreatitis was defined by features consistent with irreversible pancreatic inflammation, i.e., clinical, structural or functional abnormality of the pancreas. The presence of pancreatic calculi or ductal irregularity/parenchymal atrophy was determined at imaging using ultrasonography, CT scan, MRI, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS). Material and methods: The profile of 50 patients with chronic pancreatitis seen in the Genral Surgery, Gastro surgery Department of Civil Hospital, Ahmedabad, from May 2007 to September 2009 were included. The diagnosis of chronic pancreatitis was based on clinical, biochemical (serumamylase, serum criteria and anti-diabtic treatment requirement) and imaging. Various treatment modalities like conservative, endotherapy and surgical were evaluated. Results: Out of 50 patients, 33 underwent surgery, 11 underwent endotherapy, 6 underwent external drainage via pigtail catheterization and 14 were kept on medical therapy that later on underwent surgery due to partial or no relief of abdominal pain. The indication for surgery was in these 33 patients and the surgical procedures were performed. 15 (10%) patients had postoperative complications; major among these being wound dehiscence (n=2), pancreatic fistula (n=1), gastrointestinal bleed (n=1) and intra abdominal bleed (n=1). There were four postoperative death (3 post whipple’s and 1 post triple bypass). Conclusion: Idiopathic pancreatitis is the most common form of chronic pancreatitis seen at our hospital, and in general, the majority of these subjects showed a good response to endotherapy and surgery of chronic pancreatitis. Pancreatic endotherapy is effective as short-term intervention, can be used at an early stage and has limited indications.