Anterior or posterior gastro-jejunostomy with truncal vagotomy for duodenal ulcer--are they functionally different?

Truncal vagotomy with gastrojejunostomy (GJ) is the standard treatment for chronic cicatrizing duodenal ulcer with gastric outlet obstruction. We tried to determine if a significant functional difference exists in the early and late outcomes following anterior and posterior types of GJ to treat this condition. The case records of 106 patients who underwent truncal vagotomy and GJ at our institute from 1 January 1995 to 31 December 1999 were studied retrospectively. Patients were followed up with a personal interview. Perioperative and long-term parameters were compared in the anterior and posterior G.I. groups. Sixty-five patients (61.32%) were followed up; 31 in the anterior group and 34 in the posterior group. The median follow-up was 5 years (range 2.5-7.5 years). Except for a significant difference in length of afferent loop (p < 0.0001), there were no significant differences in the duration of hospital stay, nasogastric aspirates on postoperative days 1, 2, 3 and 4 and the day the nasogastric tube was removed. Early postoperative complications were uncommon and not different in the two groups and long-term outcomes were similar. The Anterior GJ, being technically easier and needing less operative time, may be advocated in all cases of chronic duodenal ulcer, with gastric outlet obstruction requiring truncal vagotomy and drainage.

A unique case of metastatic penile basal cell carcinoma.

Basal cell carcinoma rarely arises in the penis and metastasizes infrequently. This article presents probably the first case report of a metastatic penile basal cell carcinoma.

Clinical aspects of adhesive intestinal obstruction.

BACKGROUND: Mechanical intestinal obstruction remains one of the commonest surgical emergencies. With hernias being electively repaired and obstructive hernias becoming less common, adhesive obstruction has emerged as the leading cause of intestinal obstruction in the west. This study was designed to analyse any such changes in the pattern of intestinal obstruction in the population of Pondicherry of Tamilnadu of South India. METHODS: Data were collected from the compiled case records at JIPMER, Pondicherry, both retrospectively and prospectively from 1984 to 1992 about the clinical aspects of intestinal obstruction and analysed. RESULTS: There were 572 patients admitted with a diagnosis of intestinal obstruction in this period. Obstructed external hernia occurred in 219 patients and adhesive obstruction in 176 patients. Fourteen percent of the patients with adhesive obstruction had appendicectomy as the index laparotomy in the past. Majority of the patients presented within 10 years of the index laparotomy. Adhesive obstruction was managed mainly by conservative treatment in 109 cases. There were 25 patients with recurrent obstruction; most of them were conservatively managed. CONCLUSIONS: Obstructed external hernias were the commonest cause of intestinal obstruction. Increasing the patient awareness will help to decrease the incidence of obstructed hernias significantly. Adhesive obstruction deserves a conservative approach with judicious application of surgical intervention. A careful approach is required to avoid the increased morbidity and mortality associated with delay in the diagnosis of gangrenous obstructions.

Gastrojejunocolic fistula following surgery for peptic ulcer.

This article aims to emphasize that gastrojejunocolic fistula following peptic ulcer surgery, though uncommon in the post vagotomy era, still continues to occur. We stress the changing trends in its epidemiology, aetiopathogenesis and treatment. The case records of 12 patients with gastrojejunocolic fistula (seen over a 15 year period) were reviewed. Details regarding clinical presentation, investigations and treatment were analyzed and the results compared with previous published series. All the 12 patients in this study had a short loop posterior retrocolic gastrojejunostomy as part of the primary peptic ulcer surgery. Diarrhoea and profound weight loss was present in all of them. Incompleteness of vagotomy was proved in all the six patients investigated for the same. The fistula was demonstrated in all of them on barium enema, while it was seen on upper GI endoscopy in 4. Eight patients were treated by a one stage resection and repair of fistula. A three stage procedure was performed in two.

Malignant granular cell tumour. A case report and review of literature.

A rare case of malignant granular cell tumour of the anterior abdominal wall in a woman of 30 years is reported and and the relevent literature is briefly reviewed.

A study on laboratory diagnosis of liver abscess in Pondicherry.

A study was carried out to evaluate the role of laboratory investigations for diagnosis of liver abscess from the year 1976 to 1981. Bacteriological, parasitological, serological, haematological, histopathological studies and liver function tests were carried out in 240 confirmed cases of liver abscess during the study period. Out of 219 cases, pus culture for pyogenic bacteria was positive in 68 cases (including 27 cases of secondary bacterial infection of amoebic liver abscess) and sterile in 151 cases. Ent histolytica was demonstrated in pus of 24 cases. The diagnostic titre of 1:128 and above was detected in 137 sera by isohaemagglutination test. The liver function tests were of limited value. Albumin globulin ratio was altered in 91.25% cases and there was moderate increase in the levels of alkaline phosphatase. Histopathological studies demonstrated Ent histolitica in 2 cases only. Changes characteristic of pyogenic liver abscess were observed in 6 cases. Rest showed no specific changes.