ABSTRACT
Background: Aim of this study is to examine the efficacy of Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth predictor modification (P-POSSUM) equations in predicting morbidity and mortality in patients undergoing emergency laparotomy, to study the morbidity and mortality patterns in patients undergoing emergency laparotomy at Malla Reddy Institute of Medical Sciences, Hyderabad. Methods: The study was conducted for a period of 2 years from February 2018 to February 2020. 100 Patients undergoing emergency laparotomy were studied in the Department of General surgery MRIMS, Hyderabad. POSSUM and P-POSSUM scores are used to predict mortality and morbidity. The ratio of observed to expected deaths (O:E ratio) was calculated for each analysis. Results: The study included total 100 patients, 83 men and 17 women. Observed mortality rate was compared to mortality rate with POSSUM, the O:E ratio was 0.62, and there was no significant difference between the observed and predicted values (χ²=10.79, 9 degree of freedom (df) p=0.148). Observed morbidity rates were compared to morbidity rates predicted by POSSUM, there was no significant difference between the observed and predicted values (χ²=9.89, 9 df, p=0.195) and the overall O:E ratio was 0.91. P-POSSUM predicted mortality equally well when the linear method of analysis was used, with an O:E ratio of 0.65 and no significant difference between the observed and predicted values (χ²= 5.33, 9 df, p= 0.617).Conclusion: POSSUM and P-POSSUM scoring is an accurate predictor of mortality and morbidity following emergency laparotomy and is a valid means of assessing adequacy of care provided to the patient.
ABSTRACT
Background: Anal fissure is a linear tear in the lining of the anal canal below the dentate line. Among the conservative modalities glyceryl trinitrate (GTN) is emerging as first line of treatment since it breaks the vicious cycle and relaxes the sphincter. Surgery was considered as the first line of treatment if conservative measures such as bulk laxatives, stool softeners and local anaesthetics fail. Aim of this study was to study the aetiology and predisposing factors, age and sex distribution, clinical presentation, position of fissure, complications associated with medical and surgical management and comparison of efficacy of topical GTN (0.2%) and lateral anal sphincterotomy.Methods: The study was based on analysis of 60 patients who were treated for chronic fissure in ano at Malla Reddy Institute of Medical Sciences, Hyderabad from January 2018 to February 2020. Patients were divided into 2 groups. One group was managed by topical application of the ointment and other group was managed by surgery (lateral anal sphincterotomy). Statistical tool (software) used to analyse the data was SPSS 13.0 software.Results: Around 33.33% patients who were managed medically by 0.2% glyceryl trinitrate did not have relief of symptoms. Patients under surgical management had more relief of symptoms (86.6%). Almost all patients treated with glyceryl trinitrate had some form of headache. During the immediate post-operative period 13.3% patients treated with surgery had pain.Conclusions: It can be concluded that open lateral anal sphincterotomy is superior to topical 0.2% GTN with high rate of healing and very low rate of complications.