Study of post cholecystectomy biliary leakage and its management

Background: Cholecystectomy is one of the most frequently performed surgeries. The surgery is associated with many avoidable complications and hence requires a serious and cautious approach. Aim: The aim of this study was to know the outcome of post cholecystectomy biliary leaks and its management methods. Materials and methods: 10 cases of biliary leaks were studied from 100 open cholecystectomies and 100 laparoscopic cholecystectomies from 2013 January to 2014 January. Pre-operative workup with ultrasound abdomen, LFT and other biochemical investigations were done and diagnosis was established. The outcome of surgery and its most common post-operative complication - biliary leak was studied with following parameters: Post-operative diagnosis, Surgery - Lap or Open, Incision, Method of approach – Fundus or Classical method, CBD exploration, Intra-operative findings, Drains used, Post-operative symptoms, Amount of collections, Removal of drains, USG – Sub hepatic collections, ERCP etc. Results: In the present study of 10 cases, fundus first method was done in 3 cases of open cholecystectomies and none in laparoscopic cholecystectomies. Classical procedure was done in 7 cases out of which 3 cases were done in laparoscopy method and 16 cases in open method. Intraoperative detection of bile duct injury is noted in 3 cases of open cholecystectomies and non in laparoscopic method. In the present study, 56 % of the patients were treated conservatively who required no therapy and surgical placement of the drain itself was sufficient. P. Krishna Kishore, B. Manju Sruthi, G. Obulesu. Study of post cholecystectomy biliary leakage and its management. IAIM, 2016; 3(9): 222-227. Page 223 Conclusion: Pain abdomen, Jaundice, Nausea and Vomiting are the major complaints in case of bile leaks and fistulas. Pathologically, chronic cholecystitis is commonest cause of leaks after surgery mainly because of fibrosis at calots triangle. Incidence of Post-operative bile leaks is almost the same in open and laparoscopic cholecystectomy. Routine placement of drains is must because it permits post operative evacuation of serosanguineous exudates and monitoring of bleeding or leakage of bile. Abdominal collections, bilomas or sub-hepatic abscess are reported less with the placement of drains

Comparative study between stapler and open hemorrhoidectomy in the management of grade III/ IV hemorrhoids

Background: The rectum serves the function of a temporary reservoir for faeces and unfortunately when hemorrhoids raise their ugly heads, the natural process of eliminating waste from the body causes discomfort to the patient. Aim: The aim of my dissertation topic was to compare stapler hemorrhoidectomy (MIPH) with open hemorrhoidectomy in the management of 3rd / 4th degree hemorrhoids with reference to complications like pain, retention of urine, bleeding and anal incontinence, comforts to the patient, comforts to the surgeon, Intra operative complications, hospital stay, cost of surgery. Materials and methods: Inclusion criteria were primary III and IV degree hemorrhoids. Exclusion criteria were patients with associated co-morbid conditions, associated gastrointestinal diseases, recurrent hemorrhoids. Parts of a PPH 03 stapler device: Icon hea, Anvi, Shaft of instrument, Handle with safety lock. Results: Most of the patients belong to age group 41-50 and above 67% of the patients are between the age group of 41-60. About 83% of patients where males; females accounted for only 17%. The average post-operative stay for patients who underwent stapler hemorrhoidectomy was 3 days, whereas for open hemorrhoidectomy 4.6 day. Out of 100 patients only 60 cases came for follow up. The period extended from 2 months to 30 months. Stenosis was more common after open P. Krishna Kishore, B. Manju Sruthi, G. Obulesu. Comparative study between stapler and open hemorrhoidectomy in the management of grade III/ IV hemorrhoids. IAIM, 2016; 3(9): 218-221. Page 219 hemorrhoidectomy whereas recurrence was more common after stapler hemorrhoidectomy. Conclusion: Hemorrhoids is a common problem worldwide, a penalty paid by human beings for their erect posture. Lack of fiber in diet and chronic constipation are the root causes for this problem. The common mode of presentation is painless bleeding, prolapsing pile mass and pain when complicate.