ABSTRACT
Abdominal wound dehiscence is a common complication of emergency laparotomy in Indian setup. Factors as relates to burst abdomen and they recommended certain surgical measures. These measures included control of nausea and vomiting, decompression of distended abdomen, choice of appropriate sutures, control of infection and use abdominal drains. Wound dehiscence is related to the technique of closure of abdomen and the suture used. it is interned to study the closure of abdomen with non-absorbable (Polypropylene, Nylon) versus delayed-absorbable (Polydiaxanone)in cases operated at V.S. Hospital , Ahmedabad with respect to the effectiveness of these different suture materials in our setup.METHODS AND MATERIALS:Thepresent clinical Prospective comparative study was carried out at the surgery department of V.S. hospital from June2014 to Jan 2017. Patients underwent both elective and emergency laparotomy through midline vertical incisions. First 50 cases of midline laparotomy closure were studied with these three suture materials; Polydiaxanone (PDS), Nylon and Polypropylene (PPL) with/without retention suture. The patients were followed regularly after surgery up to 6 months.RESULT:Wound infection is the most important single factor in the development of burst abdomen and incisional hernia.61The incidence of wound infection was in Polypropylene (Prolene)(12.5%), in Polydiaxanone (PDS) (20%) and in Loop Nylon(12.5%) .The incidence of wound infection was related to type of surgery . As in over study infections were higher in emergency surgery then planned surgery, it was 10% in PDS group,12.5% in PPL group and 12.5% in loop nylon group. And in planned surgery only one case had wound infection, which was in nylon group. CONCLUSION:continuous suture technique using no.1 loop Polydiaxanone (PDS) had comparatively higher incidence of wound infection, and also report a case of burst abdomen, but had low incidence of scar pain for closure of midline laparotomyincision, No.1 Polypropylene had high incidence of stitch granuloma and Loop nylon no.1 had a low incidence of infection and stitch granuloma but high incidence of scar pain.. Burst abdomen had high incidence in high risk patient irrespective of suture material used, however this incidence can be reduced by prophylactic retention.
ABSTRACT
Background ,Abdominal wound dehiscence is a common complication of emergency laparotomy in Indian setup.Factors as relates to burst abdomen and they recommended certain surgical measures. These measures included control of nausea and vomiting, decompression of distended abdomen, choice of appropriate sutures, control ofinfection and use abdominal drains.Wound dehiscence is related to the technique of closure of abdomen and the suture used. it is interned to study the closure of abdomen with non-absorbable (Polypropylene, Nylon) versus delayed-absorbable (Polydiaxanone)in cases operated at V.S. Hospital , Ahmedabad with respect to the effectiveness of these different suture materials in our setup.METHODS AND MATERIALS:The present clinical Prospective comparative study was carried out at the surgery department of V.S. hospital from June2014 to Jan 2017. Patients underwent both elective and emergency laparotomy through midline vertical incisions. First 50 cases of midline laparotomy closure were studied with these three suture materials; Polydiaxanone (PDS), Nylon and Polypropylene (PPL) with/without retention suture. The patients were followed regularly after surgery up to 6 months.RESULT:Wound infection is the most important single factor in the development of burst abdomen and incisional hernia.61The incidence of wound infection was in Polypropylene (Prolene)(12.5%), in Polydiaxanone (PDS) (20%) and in Loop Nylon(12.5%) .The incidence of wound infection was related to type of surgery . As in over study infections were higher in emergency surgery then planned surgery, it was 10% in PDS group,12.5% in PPL group and 12.5% in loop nylon group. And in planned surgery only one case had wound infection, which was in nylon group.CONCLUSION:continuous suture technique using no.1 loop Polydiaxanone(PDS) had comparatively higher incidence of wound infection, and also report a case of burst abdomen, but had low incidence of scar pain for closure of midline laparotomy incision, No.1 Polypropylene had high incidence of stitch granuloma and Loop nylon no.1 had a low incidence of infection and stitch granuloma but high incidence of scar pain.. Burst abdomen had high incidence in high risk patient irrespective of suture material used, however this incidence can be reduced by prophylactic retention suturing
ABSTRACT
Abstracts: Background: To study the different modes of clinical presentation and study clinical outcome in various causes of large bowel obstruction in adults and to accomplish the operative management and to anticipate the postoperative complications and their management. Methodology: This is a prospective observational study of large bowel obstruction in adults and was carried out in 2012-2014. Results: A total 50 cases of large bowel obstruction were studied. Maximum patients11(44%) cases belonged to age group 51-60yrs. Obstipation is seen in50(100%), pain in 44(88%), distension in 50(100%), tenderness in 44(88%), constipation in 50(100%),rigidity in 14(28%). In present study, malignancy was the commonest (24 cases – 48%) cause of large bowel obstruction. There were 10 cases (20%) of stricture, 8 cases (16%) of volvulus, two case (4%) of endometriosis and two case (4%) of intussusception causing large bowel obstruction. Pseudo-obstruction comprised 4 cases.20 cases (43.5%)were operated for resection anastomosis of pathological part to relieve obstruction, while 18 cases (39.1%) were operated for temporary colostomy due to lack of definitive procedure either due to unresectable mass or gross contamination of bowel loop. Rest of the cases 8(17.3%) were operated for end colostomy or ilestomy. Wound infection was the commonest complication observed in 10 cases.6 patients died due to septicaemia.Pleural effusion was present in 4 patients.Skin excoriation around colostomy occurred in 6 cases. Mortality of the study was 6 (12%) cases. Conclusion : Old age (51-60) was the most common age group affected by large bowel obstruction.Colorectal carcinoma was the leading cause of large bowel obstruction . In our study. Distention and constipation were predominent symptoms.. Plain X-ray erect abdomen is the single most important diagnostic tool for diagnosing obstruction and its level of obstruction.CT SCAN abdomen confirmed the type and site of obstruction and spread of tumor in cases of large bowel malignancy.Early recognition and timely intervention is important to prevent the bowel from going for gangrenous changes.
ABSTRACT
Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative technique, post-operative wound problems continue to be a major threat. Clean sound healing of laparotomy wound after any intra-abdominal procedure is a cardinal index of good surgical repair. Post- operative wound problems delays recovery and often increase stay and may produce lasting sequel and require extra resources for investigations, management and nursing care, therefore its prevention is relevant to quality patient care, therefore its prevention is relevant to quality patient care.Post-operative wound problems seldom causes death, yet it does prove to be an economic burden on patient and on health system and induce psychological trauma to the surgeon as it robs his hours of dedicated work on operating table and good carrier. Considering wound problems is quite common in developing countries like India the present study was taken up to find out the incidence of Post-operative wound problems and factors that influence its occurrence. Present study aimed to discover the sound, ideal method for the abdominal wound closure with regard to the problems associated with laparotomy wound.
ABSTRACT
Background: Preparation for surgery has traditionally included the routine removal of body hair from the intended surgical wound site. Hair is removed as its presence can interfere with the exposure of the incision and subsequent wound, the suturing of the incision and the application of adhesive drapes and wound dressings. Hair is also perceived to be associated with a lack of cleanliness and hair removal is thought to reduce the risk of surgical site infections (SSIs). SSIs are experienced by around 10% of patients in the UK each year and can result in delayed wound healing, increased hospital stays, unnecessary pain and in extreme cases the death of the patient. Three methods of hair removal are currently used: shaving, clipping and chemical depilation. When a surgical operation is to be conducted through a hair bearing part of the body, hair removal is often performed. Aims & Objective: This study aimed to evaluate the relationship of two methods (shaving and depilation cream) of preoperative hair removal to adequacy of hair removal, skin injury and reaction during hair removal, postoperative wound infection in a developing country where razor shaving is very popular. Material and Methods: Consecutive consenting patients scheduled to have such operations were randomized into two groups. One group had hair removal by shaving with a razor blade while the other had hair removed by depilatory cream. Adequacy of hair removal and presence of skin injuries and/or reactions were noted preoperatively. Details of the procedures were recorded and patients were then assessed for postoperative wound infection. Results: A total 215 patients were studied. Of the 103 patients who had hair removal by depilatory cream, hair was completely removed in 93 (91%) compared to 69 (62%) of the 112 patients who had razor hair shaving. Skin injuries were noted in 32 (29%) of the razor group and 4 (4%) of patients who had depilatory cream. 18 patients (8%) had postoperative wound infection including 3 (3%) in the depilatory cream group and 15 (13%) of the razor group. A significant association was found between preoperative skin injuries and postoperative wound infections. Conclusion: Preoperative hair removal with razor shaving predisposes to skin injuries which in turn significantly influence postoperative wound infection rates. Such injuries and resultant wound infection are fewer when depilatory cream is used for hair removal.