Comparison of Single Layer Versus Double Layer Continuous Anastomotic Technique for Small Bowel Resection and Anastomosis.

Small intestinal resection and anastomosis is an important surgical procedure. Aims and Objectives : To study efficacy and safety of single layer intestinal anastomosis using non absorbable suture material against conventional double layer anastomosis. Single layer anastomosis will decrease surgery time and minimize incorporation of foreign body [sutures]. Materials and Methods : Present study carried out in Pravara rural hospital, Loni. It is a prospective study of 50 patients who underwent elective and emergency resection and anastomosis of small intestine from May 2004 to Oct 2006. Observations : Majority of patients were in the age group of 40-50 yrs and children. Intestinal obstruction with gangrene was the most common indication for anastomosis. Significant difference was found in recovery and complications between two methods after applying Z-test. Discussion : Forty seven patients required resection and anastomosis and 3 patients operated for ileostomy closure. Single layer anastomosis has superior results as compared to double layer anastomosis of small intestine. Conclusion : Arithmetical means of these endpoints suggest that single layer method offers same or better results than double layer method.

Road Traffic Accidents - Throwing Care and Caution to the Wind.

It was observed, for last ten years, that the Road Traffic Accidents causing morbidity and mortality has increased significantly in rural area. The economic growth in this area along with development of SHIRDI and SHANI- SHINGANAPUR was noted. Objectives: We were interested to know the incidence of trauma and any remediable factors that could be suggested and implemented. The aim was to document the predominant mechanism of injury and to determine temporal relationship between the final outcome, types of injury, and time taken since injury to hospitalization. Methods: The study, carried out in rural area, hospital based included 2,154 patients of polytrauma, who were admitted, diagnosed and treated out of a total number of 4,638 patients of polytrauma who visited the causality of the hospital. Proforma was designed and data recorded and analyzed. Results: Predominantly young male population was affected by trauma. There was a gross delay in arrival to the hospital in considerable number of patients. Mortality was 32.66% when patients reached hospital within two hours of injury. Mortality increased to 51.51% when patients reached the hospital after eight hours of injury! Conclusions: In majority of patients the mechanism of injury was the result of motor vehicle accident. The patients who have multi-system involvement have poorer outcome to our country due to accidents amounts to Rs.5000 crores annually2. In a developing country like India, public health facilities are scarce. Only 0.9% of GDP is spent on public medical services6. In higher income countries, RTA are already among the top ten leading causes of disease burden in 1998 as measured in DALY (Disability–Adjusted Life Years). According to a WHO / World Bank report, “The Global Burden of Disease’’, deaths from non communicable diseases are expected to climb from 28.1 million a year in 1990 to 49.7 million by 2020 and RTA being the main cause of this rise. On an average in the industrialized countries and also in many developing countries, one hospital bed in ten is occupied by trauma victim7. Member countries of South East Asia region, during the past two decades, are passing through significant Urbanization, Motorization, Industrialization and changes in the socio - economic values of societies. Injuries on roads, at homes and in the work place have increased due to lack of safety related policies and programmes. Children saved today from nutritional and infectious diseases are killed and/or maimed by injuries tomorrow. In fact RTA injuries are ranked as number one cause of burden of diseases among children in 2000. This heavy burden at such an early age has long – term implication on the qualities of life and economy of the nation8.