ABSTRACT
Haemorrhoids are nowadays a very common anorectal disease in the community. It may be attributed to increased consumption of more refined and junk food by the present generation of people. We have been seeing symptomatic haemorrhoids as early as late teenagers, and early 20's. Well, there are plenty of treatment options available, among them, in our hospital we have been doing Ferguson's closed haemorrhoidectomy, but pain and urinary retention are frequently seen and sometimes troublesome requiring removal of per-anal pack overnight/Foley’s catheterization. And also, in those patients with tight sphincters, because of straining to pass the stools for the first time, the wound margins used to give away, converting into an open haemorrhoidectomy. Aim of this study was to assess the effect of sphincterotomy in patients undergoing closed haemorrhoidectomy, in terms of immediate post-operative pain and urinary retention.METHODSPatients who came with symptomatic haemorrhoids to our hospital during the period January 2018 to August 2019 were assessed and patients requiring haemorrhoidectomy were included in the study according to inclusion and exclusion criteria. Patients included in the study were randomly divided into 2 groups (without/with sphincterotomy) till target of 50 was achieved. Post-operative outcomes of pain and incidence of urinary retention was compared among the 2 groups.RESULTSOn analysing the data regarding severity of pain and incidence of urinary retention between the 2 groups, there was significant difference (p value <0.001) in perceiving pain on all the days of assessment, and incidence of urinary retention was significantly low in sphincterotomy group (p value 0.001).CONCLUSIONSDoing internal sphincterotomy at the base of haemorrhoidectomy wound significantly reduces the immediate post-operative pain and urinary retention following closed haemorrhoidectomy. So, when sphincter tone is high, it's better and safer to do sphincterotomy to alleviate immediate post-operative pain and urinary retention.
ABSTRACT
Small intestinal anastomosis is a common GI procedure. Anastomotic leaks increase morbidity, mortality and hospital stay in patients undergoing bowel anastomosis. Understanding the risk factors associated with anastomotic leak not only helps to reduce the incidence of leaks but also to identify the patients who are candidates for creation of stomas. The aim of the study is to define the risk factors associated with anastomotic leak following small bowel anastomosis.METHODSA total of 74 patients who underwent small bowel anastomosis in our study period between September 2016 and December 2019 in Karuna Medical College, Palakkad, were prospectively followed up and divided into two groups, leak and non-leak group depending on occurrence of anastomotic leak. Many host and disease related factors known to influence the outcome of anastomosis were recorded in both groups and compared.RESULTSOut of 74 patients, 40 were males and 34 females. 10 patients were aged more than 60 years. 26 of them had perforation and peritoneal contamination. Out of 74, 67 were emergency surgeries and 7 were elective surgeries. 14 patients were anaemic, 19 were hyponatraemic and 12 were hypoalbunemic. In total, 13 patients developed anastomotic leak. Overall mortality and morbidity was 6.7% (5 patients) and morbidity was 40.5% (30 patients). Mortality in anastomotic leak group was 23% (3 patients).CONCLUSIONSHypoalbuminemia (P value- 0.016) and presence of peritoneal contamination (P value= 0.004) were found to significantly increase the risk of anastomotic leak in the present study. In the presence these risk factors, it is better to consider the patient for diverting stoma in emergency setting and consider improving patient nutritional status in elective setting.