ABSTRACT
Objective: to compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's haemorrhoidectomy at Allied Hospital
Study Design: simple comparative study
Place of Study: Surgical Unit 1, Allied Hospital Faisalabad
Duration of Study: January 2011 to September 2012
Sample size: 50 patients
Material and Methods: fifty patients of 3rd and 4th degree hemorrhoids were selected for admission from the outpatient department. Patients with additional anal disease [e.g. fissure, abscess, fistula, ano-rectal cancer etc.] were excluded. Two groups of twenty five each were made. Group A for stapled haemorrhoidectomy and Group B for Milligan- Morgan haemorrhoidectomy [MMH]. The operative time was measured in minutes. Postoperative pain was assessed through visual analogue scale [VAS]. Bleeding was measured as mild, moderate and profuse. Other postoperative complications during hospital stay like urinary retention, anal stenosis etc. were noted. T-test, chi-square test and repeated measured analysis of variance were applied to compare the variables
Results: a majority of patients[combined in both groups] had third degree haemorrhoids. The mean length of operative time was found statistically insignificant between stapled and open groups [34 vs 36 minutes]. In Group A 23 [92%] patients were discharged in 24 hrs while 2 [8%] patients were discharged after 24 hrs. In Group B 9 [36%] patients were discharged in 24 hrs and 16 [64%] patients were discharged after 24 hrs. In group A 19 [76%] patients were having mild bleeding, 5 [20%] moderate bleeding and 1 [4%] profuse bleeding. In Group B 7 [28%] patients were having mild, 16 [64%] moderate and 2 [8%] profuse bleeding. In Group A 15 [60%] patients were having mild pain, 7 [28%] moderate and 3 [12%] severe pain on visual analogue scale. In Group B 4 [16%] patients were having mild pain, 15 [60%] moderate and 6 [24%] severe pain. The proportion of postoperative anal stenosis, prolapsed recurrence, persistent pain, recurrent bleeding and urinary retention was higher in MMH than stapled haemorrhoidectomy group
Conclusion: there was a significant difference between stapled haemorrhoidectomy and Milligan Morgan's for bleeding, pain and hospital stay. However the mean length of operative time was insignificantly different
ABSTRACT
Amoebic liver abscess is a common infection in third world countries like ours due to poor sanitary arrangements. It presents with severe pain and high grade fever and if not diagnosed and treated promptly, may lead to complications and mortality. To estimate the incidence, need for aspiration and treatment outcome. Case series study. At respective consultations centers in Faisalabad. From 1[st], January, 2007 to 31[st] December 2008. All patients suspected of the diagnosis of liver abscess whether presenting to physicians or surgeon were referred for ultrasonography for the confirmation of the diagnosis. Basic biodata, coexisting medical or surgical diseases and relevant investigation were recorded, and patient was assessed for the need to aspirate the abscess. After initial treatment patients were reassessed for the need to aspirate the abscess on third, tenth and twentieth day both clinically and ultrasonically. We had 188 cases in the study. There were 128 [68%] males and 60 [32%] females. Majority, 156 [76.6%], of the abscesses were single, 40 [21%] had double and 4 [2%] had three abscesses. 166 [83%] were situated in the right lobe, 28[15%] in the left lobe and 4 [2%] had abscess in both lobes. 16 [9%] were aspirated at presentation due to their size or position. Only 4 [2%] were aspirated at first follow-up on third day due to non resolution of pain or fever or increase in size. All the patients who were not lost from follow up responded to standard treatment of metronidazole. Amoebic liver abscess is a common diagnosis in our setup. Patients presents with right upper quadrant pain and fever. Clinical background and ultrasonogram give a reasonable suggestion about amoebic etiology. If initial aspiration is not indicated due to size larger than 5cm. or proximity to surface or nonresolution of symptoms or lesion in left lobe, conservative treatment with oral or intravenous metronidazole is successful