Intestinal Stoma Experience Of 100 Cases At Tertiary Care Hospital

Introduction :An intestinal stoma is an opening of the intestine on anterior abdominal wall made surgically. Stomas are used to divert the fecal stream away from distal bowel in order to allow a distal anastomosis to heal as well as to relieve obstruction in emergency situation. Aims & Objectives : 1) to identify indications for commonly performed stomas 2) to study complications associated with stomas. Methods: This is a retrospective study was carried out in a surgical unit of A tertiary teaching Hospital, Ahmedabad from January 2016 to December 2018. Data was collected retrospectively from medical records and meticulous history taking including age, gender, indication, type of stoma, type of surgery, careful clinical examination, appropriate operative findings and follow up of the cases were noted. The results were analyzed and compared with other studies. Results: A total of 100 patients were evaluated age ranged between 12- 85 years (50.5 ± 29.01 years) Male to female ratio was 7:3. Of the 100 patients 88 were admitted in emergency while 12 in out-patient department. The most common type of stoma made was loop ileostomy (62%) followed by sigmoid colostomy (13%) and transverse loop colostomy (9%). Main indication for a stoma formation was enteric perforation (35%) followed by Koch’s abdomen (16%). Of the various complications encountered with intestinal stoma, peristomal skin irritation (45%) was the most consistent complication followed by laparotomy wound infection (22%). Conclusions: In Spite of vast exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone

A Comparative Study Of Open Haemorrhoidectomy And Stapled Haemorrhoidopexy

ntroduction:Haemorrhoidsor‘Piles’isafrequentlyobserveddiseaseinsurgicalpractice.Variousnon‐surgicalandsurgicaltreatmentsareavailable.Openhaemorrhoidectomy(Milligan‐Morgan)isawidelyusedprocedure.Arecentnoveltechniquecalled‘Stapledhaemorrhoidectomy’,firstdescribedandperformedbyItaliansurgeonAntonioLongoisgainingworldwiderecognitionforitsbenefits.Aim:TocompareStapledhaemorrhoidectomywithopen(MiliganMorgan)haemorrhoidectomyintermsofpost‐operativepain,resumptionofdailyactivity,hospitalstay,post‐operativebleeding,urinaryretentionandanalincontinence.StudyDesign:Prospective,comparativestudyfromAugust2017toAugust2018.MaterialsandMethods:Atotalof80patientsbetweentheagegroupof20and70years,diagnosedtohavegradeIIIorIVhaemorrhoidswereincludedinthestudy,dividedinto2groups,Group1undergoingOpenhaemorrhoidectomy(40patients)andGroup2undergoingStapledhaemorrhoidectomy(40patients).Postoperativelypatientsofbothgroupswerereviewedatthetimeofdischarge.Allpatientsweregivenaquestionnaireanddatacollectedverballyandanalysedstatistically.ComparativeanalysisbetweenthetwogroupsweredonebasedonIndependentstudents‘t’test.Results:ThemeanageofpatientsinOpenhaemorrhoidectomy(OH)groupwas42.2andStaplerhaemorrhoidectomy(SH)groupwas38.5.86.6%weremalesand13.4%werefemalesinOHgroup,90%weremalesand10%werefemalesinSHgroup.Post‐operativebleedinginbothOHandSHgrouphadanincidenceof2%.Post‐operativeurinaryretentionwasseenin4%and8%inOHandSHgrouprespectively.Inbothgroups,post‐operativeanalincontinencewasnotseen.BasedonIndependentsample‘t’testthepost‐operativepain,Post‐operativehospitalstayanddurationofresumptionofdailyactivitywaslessinSHgroupcomparedtoOHgroupandstatisticallysignificantwithp<0.001.However,complicationslikepost‐operativebleeding,urinaryretentionandanalincontinencearealmostsameinboththegroupsConclusion:StapledHaemorrhoidectomyislesspainfulwithshorterdurationofhospitalstayandresumptionofdailyactivityisfasterthantheopenhaemorrhoidectomy.However,longtermfollow‐upisrequiredtoknowtherecurrencerateinstapledhaemorrhoidectomy.

A Study Management Ofacute Pancreatitis; Role Ofrecent Criteria In Prognosis And Management Of Acute Pancreatitis

AbstractAim :To compare APACHE-II scoring, C-Reactive Protein (CRP), Interleukin-6 (IL-6) estimation and Contrast Enhanced Computed Tomography in assessing the severity of acute pancreatitis and prognosis of the condition. .To determine the role of these investigations and the most accurate investigation for the detection of severity of acute pancreatitis and prognosis at 72 hours. Method:The present study was conducted at the Department of General Surgery, V.S. General Hospital, Ahmedabad. The Study population consisted of first50 cases of acute pancreatitis fulfilling the inclusion criteria. It was a prospective study. Results: Apache II scoring done at admission predicted severe pancreatitis in 8 cases out of 10 cases which turned out to be severe on Atlantic classification. So, there was 2 false negative cases in severe group. Apache II score at admission predicted 38patients as mild pancreatitis thus giving false positive result in 2 cases. Pearson Chi-square test of significance was applied for the analysis of the data. This clinical scoring done at admission had a sensitivity of 80%,specificity of 95%, positive predictive value of 80%, negative predictive value of 95% and accuracy of 92%. Serum CRP level of the patients at admission predicted 7 as severe pancreatitis out of 10 actual cases of severe pancreatitis thus giving false negative result in 3 cases. This biochemical assay labeled 26 cases as mild at admission thus giving false positive rate in 14 cases. Statistical analysis of the data yielded a p value of 0.07 (Pearson Chi-square test) indicating that the data was statistically insignificant. Estimation of serum CRP level at admission had sensitivity of 70%, specificity of 65%, PPV of 33.33%, NPV of 89.65% and accuracy of 66%. Serum IL-6 level of the patients at admission predicted 8 as severe pancreatitis out of 10 actual cases of severe pancreatic thus giving false negativeresult in 2 cases. This biochemical assay labelled 36 cases as mild at admission thus giving false positive rate in 4 cases. Estimation of serum IL-6 level at admission had sensitivity of 80%, specificity of 90%, PPV of 66.67%, NPV of 94.74% and accuracy of 88%. Conclusion: .Evaluation of the different prognostic indications for the detection of severity at admission showed that Apache II score as well as serum IL-6 were the best indicators of severity. However, due to the complex nature of the calculation, the Apache II score might prove to be cumbersome. Whereas serum IL-6 being costly and not being easily available in the setup is its main drawback.

Comparison of percutaneous ultrasound guided needed aspiration and open surgical drainage in management of puerperal breast abscess.

, less morbidity and will allow the patient to carry on breast feeding. Aims & Objective: The aim of this study is to compare the management of puerperal breast abscess by percutaneous ultrasound guided needle aspiration versus open surgical drainage with special attention to resolution and complications. Material and Methods: In this interventional study, 70 puerperal breast abscess cases were randomly divided and undergone either percutaneous ultrasound guided niddle aspiration (Group A) or open surgical drainage (Group B) and results were compared. Results: Failure rate for aspiration therapy was17.14% with 06 patients requiring conversion to open surgical drainage after aspiration and were excluded from study. The resolution time was less in aspiration group. Painful and cumbersome daily changes of dressing, mammry fistula in 3 patients with ugly scar were the main drawback of open surgical drainage as compared to aspiration. However, there was high failure rate of aspiration therapy in abscesses presenting later than 5 days (45.83%) and those with >5 cm size (55.55%) on ultrasonography. Conclusion: Percutaneous ultrasound guided needle aspiration has acceptable failure rate and is an effective alternative to open surgical drainage of puerperal breast abscess especially for those present early and of small size.

Splenogonadal fusion - A review of rare anomaly.

Splenogonadal fusion is a rare congenital malformation that involves an abnormal connection between the spleen and the gonad or mesonephric derivatives. It manifests itself as a mass consisting of splenic and testicular or ovarian tissue. Splenogonadal fusion has been classified into two types; continuous, where there is a direct connection between spleen and gonad; and discontinuous, where ectopic splenic tissue is attached to the gonad, but there is no connection to the spleen. Many cases had an associated other anomalies either genital or systemic. Knowledge about the existence of such an uncommon entity is essential even to be suspected preoperatively as the appearance at exploration can be misleading as a malignant mass and often results in unnecessary gonadal removal.

Crossed testicular ectopia- A review.

Crossed testicular ectopia, an extremely rare anomaly, is a deviation of testicular descent resulting in unilateral location of both testis, the etiology of which is not exactly known till yet. In most cases, the patient comes to the hospital because of cryptorchism on one side, and inguinal hernia on the other side, so the patients are usually very young. It is often not diagnosed until surgical exploration. This manuscript illustrates this condition with possible etiology, clinical features, diagnosis and management reported in the literature.

Comparison between total and subtotal thyroidectomy in Graves’ disease.

Objective: To compare the results of total thyroidectomy and subtotal thyroidectomy amongst the surgically treated patients with Graves’ Disease. Material and Method: This study includes 50 patients of Graves’ disease out of which 27 patients underwent for total thyroidectomy and 23 underwent for subtotal thyroidectomy. Comparison done in regards to postoperative complication between total and subtotal thyroidectomy in terms of advantages and disadvantages. Results: Incidence of transient or permanent recurrent laryngeal nerve palsy and hypocalcemia were high amongst the patients operated for total than subtotal thyroidectomy. Thyroid function tests were normal in all patients after total thyroidectomy with hormone replacement therapy and 17.39% of patients had hypothyroidism after subtotal thyroidectomy. Recurrence rate was nil and 21.73% respectively in total and subtotal thyroidectomy. One patient of subtotal thyroidectomy had occult carcinoma in histopatholical examination which required revision of surgery. Conclusion: Total thyroidectomy is superior to subtotal thyroidectomy based on the considerable surgical risk and lack of recurrence in total thyroidectomy as well as the risk of occult carcinoma and questionable ability of the subtotal thyroidectomy to maintain the euthyoid state.