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Introduction: Appendicitis is the most common causeof surgical abdomen in all age groups with a lifetime riskof 6%. The role of laparoscopic appendicectomy remainscontroversial as many researchers have suggested thatoverall morbidity is primarily a function of the degree of theappendicitis rather than the operative approach. The presentstudy was designed to compare the outcome of laparoscopicappendicectomy versus open appendicectomy in a tertiarycare hospital.Material and methods: This was a randomized controlledstudy on 100 cases of acute appendicitis operated inRohilkhand Medical College, Bareilly in a period of one year.The patients were randomly assigned to two groups of 50 eachoperated by open and three port laparoscopic surgery.Results: Abdominal pain (100%) was the commonestpresenting complaint. Retrocaecal anatomical position (76%in open, 70% in lap. appendicectomy) of the appendix wasthe commonest operative finding. Wound infection rate (8%)was insignificantly higher in open appendicectomy. Therewas significantly less operative time, postoperative painbetter cosmesis and early return to normal daily activity inlaparoscopic as compared to open appendicectomy.Conclusion: Laparoscopic appendicectomy is better ascompared to open appendicectomy in terms of post-operativecomplications, post-operative pain, hospital stay, early returnto normal activity, and subjective cosmesis.
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Introduction: Laparoscopic cholecystectomy today hasbeen rapidly embraced worldwide as the procedure of choicefor cholecystectomy. Conventionally, titanium clips areused to ligate the cystic duct. Recently, various methods ofsuture ligation of the cystic duct both intra corporeal andextra corporeal have been described during laparoscopiccholecystectomy. Only limited number of studies have beencarried out prospectively to compare the various methods. Thepresent study was thus designed to compare clip occlusionversus extra corporeal suture ligation (Roeder knot) of thecystic duct in laparoscopic cholecystectomy.Material and methods: This study was a single blindedrandomized controlled trial conducted on 150 adult patientsundergoing laparoscopic cholecystectomy. They wererandomized into two groups of 75 each to compare theprocedures of clip occlusion versus extracorporeal sutureligation (Roeder knot) of the cystic duct with respect to theoperative time, complications, associated morbidity, operativecost and hospital stay.Results: There was no significant (p>0.05) differencein duration of surgery between the groups (Clipligation=40.44±4.63 minutes, suture ligation=43.32±4.44minutes). Bile leakage due to slippage of ligature was presentin 2 (2.7%) patients with clip ligation as compared to 0% insuture ligation. This difference was found to be statisticallysignificant (p=0.03). Obstructive jaundice due to accidentalligation of CBD was present in 2 (2.7%) patients with clipligation as compared to 0% in suture ligation. This differencewas also found to be statistically significant. (p=0.03). Thecost of Clip ligation (Rs.369.07±8.08) was higher than sutureligation (Rs.300.00±0.00).Conclusion: The results of this study indicate thatextracorporeal (Roeder’s knot) is a safe, cost effectivealternative with a low complication rate as compared totitanium clip ligation of the cystic duct in laparoscopiccholecystectomy
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Background: Due to the injudicious and indiscriminate use of Anti-Microbial Agents (AMAs) among hospitalized patients especially in ICUs, it is extremely imperative to monitor and refine the prescribing pattern of antibiotics regularly. Hence an effective surveillance team consisting of a physician, a pharmacologist and a microbiologist should develop and implement an antimicrobial stewardship program based on the local antibiogam to increase the therapeutic benefits and curb the menace of Anti-Microbial Resistance (AMR). Aims:-To study the prescribing pattern of Anti-Microbial Agents and to evaluate the antimicrobial sensitivity pattern of common bacterial isolates in Medical ICU (MICU) of a tertiary care hospital. Methods: After taking approval from the Institutional ethical committee, this prospective observational study was conducted in the department of Pharmacology and Microbiology over a period of six months. Patient records were reviewed and analyzed to assess the prescribing pattern of antibiotics and Culture-sensitivity reports of various specimen from MICU were collected to determine the antibiotic sensitivity pattern. Results: Ceftriaxone (26%) was the most commonly prescribed drug followed by Metronidazole (16%). Fixed drug combinations such as Piperacillin+Tazobactam (14%), Amoxicillin + clavulanic acid (10%) and Cefoperazone + Sulbactam (8%) were also frequently used. The most predominant organism isolated was Klebseilla species (25%) followed by Acenitobacter species (19.4%). Colistin /Imipenem and Vancomycin/Linezolid depicted100% sensitivity for Gram-Negative (GNIs) and Gram-Positive Isolates (GPIs) respectively. Conclusions: The need of the hour is to preserve the power of the almost exhausted antimicrobial armamentarium against the rampantly emerging multidrug resistant organisms.