Résumé
Background: Ileal perforation is a surgical emergency. It has very high morbidity and also mortality. As patients are commonly presented with peritonitis and fecal contamination, wound infection rate is very high. Wound infection is major issue in such condition, where related complications are frequently seen. If wound infection is controlled then many complication related to it could be prevented. And it finally affects the morbidity of patient. Aims & Objective: To compare a role of negative pressure closure versus simple closure of laparotomy wound in ileal perforation. Material and Methods: 60 cases, in period of Nov 2012 to June 2013 at SMIMER hospital, Surat presented with ileal perforation were included in the study. After a surgical treatment of all cases, they were divided in two groups. One group A was closed with Negative pressure closure (By putting subcutaneous Negative Suction Drain) at the time of laparotomy wound closure and other group B with simple closure. And the outcome compared in the form of wound infection, hospital stay, second surgery and morbidity. Total 10 cases were expired within 3 day after surgery, excluded from study (6 from group A and 4 from group B). Results: In study average rate of wound infection (SSI-Surgical Site Infection) was 25% (8/24) in group A and 57.7% (15/26) in group B. Average hospital stay for group A was 12 day and 18 day for group B. Second surgery needed in 4 cases in group A and for 8 cases in group B. Second surgery was in form of secondary suturing of wound or wound dehiscence and burst abdomen repair. Mortality in group A was 6 and in group B was 4 but it was not related to SSI because all death occurred within 3 days after surgery mainly due delay presentation and to poor general condition pre-operatively. Overall morbidity was less with Negative pressure closure in compare to simple closure and it highly affects the morbidity and somehow mortality also. Conclusion: One of the common complications of typhoid is typhoid ulcer and perforation. There is more chance of wound infection in such laparotomy wound because of highly contamination of the peritoneal fluid with fecal material. Such wound constantly leads to serous discharge and bacterial colonization. But negative pressure closure removes that collection and avoids wound infection. And it helps in reducing hospital stay and morbidity.
Résumé
Background: Haemorrhoids is a common disease affecting people of all ages and both sexes. Though there is no confusion on the treatment of 3rd and 4th degree haemorrhoids, there is still confusion regarding the ideal treatment for 1st and 2nd degree haemorrhoids. Aims & Objective: To compare the safety, efficacy, advantages and disadvantages of Rubber Band Ligation and Micronized Flavonoids in the treatment of internal haemorrhoids. Material and Methods: Two hundred patients of haemorrhoids were treated, One hundred cases with Rubber Band Ligation and rest hundred with Daflon 500 mg. The outcome measured in term of relief from bleeding and duration of treatment. Results: 82% of patients on Daflon and 60% of patients undergoing Rubber Band Ligation were completely cured (P<0.01) on the 7th day but on follow up there is no statistical significance. Conclusion: Daflon gives rapid relief from symptoms of haemorrhoids as compared to Rubber Band Ligation but the long duration and higher cost of treatment patient acceptability and compliance is less.
Résumé
Background: Surgical site infections (SSI) formerly termed surgical wound infection, are one of the most frequent post-operative infectious complication. Patients with SSI had longer and costlier hospitalization than patients who didn't have such infection. Laparoscopic surgery as a minimally invasive surgery have good outcome regarding SSI as compared to open procedure. Aims & Objective: To compare infection rate after laparoscopic versus open surgery. Material and Methods: A retrospective analysis of large number of cases in SMIMER Hospital was conducted. Patients who underwent laparoscopic (n=4500) or open (n=1500) appendicectomy, cholecystectomy, anti-reflux surgery, or gastric bypass from 2009 to 2012 were included in the analysis. The main outcome measure was inpatient diagnosis of SSI (Surgical Site Infection) after laparoscopic and open surgery. Results: During 36 month of study period total of 6000 patient underwent one of four selected procedure. Overall, the incidence of SSI was significantly lower in laparoscopic (100 of 4500, 2.0%) than in open (150 of 1500, 10%) surgery (P<0.01). Largely, laparoscopic techniques offer a protective effect against SSI. Patient treated with laparoscopy were 76% less likely to experience SSI. Odds Ratio (OR), 0.30; 95% Confidence Interval (CI), 0.28-0.34. Conclusion: Patient treated with laparoscopic procedure is less likely to experience SSI. After stratification by severity of illness, wound classification & admission status, laparoscopic techniques shows a protective effect against SSI.