Dynamic Intestinal Obstruction – Study Of Fifty Cases.

Abstracts: Background: Acute intestinal obstruction is one of the commonest surgical emergencies accounting for nearly 30% of all acute abdominal emergencies. It is vital to distinguish strangulated from non-strangulated intestinal obstruction because former is associated with increase morbidity and mortality and is a surgical emergency. Success in the treatment of dynamic intestinal obstruction depends largely upon early diagnosis and skillful management of both the patho physiological effects of dynamic intestinal obstruction and the cause itself. Methodology: The present study includes fifty operated cases of dynamic intestinal obstruction of varied etiology admitted at our institution during the period of July 2008 to October 2010. Patients below the age of 10 years and Patients who were treated conservatively were not included in this study. The patients were followed up for a period varying from 3 months to 1 year postoperatively. Results: In present study post operative adhesions and bands were the commonest causes (40%) of dynamic intestinal obstruction. The most commonly performed surgery was adhesiolysis which consisted of division of band or adhesion causing obstruction. The majority of patients in the present study were in their third, fifth and sixth decades of life. The percentage of patients developing complications were much higher in strangulated obstruction. The overall mortality of 12% in the present series compares favourably with other series conducted in recent years. Conclusion: Both morbidity and mortality were higher in cases of strangulated obstruction when compared with simple luminal obstruction. Hence, an aggressive policy should be adopted to reach at an early diagnosis and treat accordingly, thereby preventing the potential complication of strangulation.

Comparative study of laparoscopic versus open surgery in 42 cases of liver hydatid cyst.

Background: Hydatid disease is endemic mainly in the Mediterranean countries, the Middle East, South America, India, Northern china and other sheep rearing areas. Liver is the commonest site of affection (55-70 %) followed by lung (18-35%). In the last decade, laparoscopic treatment of hepatic hydatid disease has been increasingly popular and has undergone a revolution parallel to the progress in laparoscopic surgery. This study presented our experience with 42 cases of liver hydatid cyst comparing laparoscopic approach and open approach for surgery during a period of one and a half years at our institute. Objectives: The main objective of the present study was to study retrospectively, the merits of laparoscopy over that of open approach for surgery during a period of one and a half years at our institute. Objectives: The main objective of the present study was to study retrospectively, the merits of laparoscopy over that of open surgery in treatment of hydatid cyst of liver. Material and methods: This study comprised of 42 patients who diagnosed to have liver hydatid cyst treated during the period of January 2013 to June 2014 at our Hospitals. They were treated either by laparoscopic approach or by open method for liver hydatid cyst. Patients not fitting into inclusion criteria were excluded from study. Predefined proforma was filled up and results were analyzed. Results: Conversion to open surgery occurred in two cases (4.84 %). The mean cyst diameter was 6.62 cm (range, 2–15 cm) in group 1 and 7.23 cm (range, 2-18 cm)in group 2 (p = 0.699). The mean operative time was 90 min (range, 70-110 min) in group 1 and 110 min (range,90-130 min) in group 2 (p\0.001). The general complication rate and abdominal wound complication rate were respectively 0 % and 0 % in group 1 (p = 0.023) compared with 5.23 and 8.72 % in group 2 (p =0.015). The mean hospital stay was 6.42 days (range, 1-21 days) in group 1 and 11.7 days (range, 4–80 days) in group 2 (p = 0.001). The mean follow-up period was 24.2 months (range,6-32 months) in group 1 and 28.4 months (range, 6-40 months) in group 2. No recurrences were observed in either group during this period. Conclusions: Laparoscopic surgery provides a safe and efficacious approach for almost all types of hepatic hydatid cysts. Large, prospective, randomized trials are needed to confirm its superiority.

Comparative Study of Monopolar Cautery and Bipolar Vessel Sealing System in Laparoscopic Appendectomy.

Background: Laparoscopic appendectomy has gradually become widespread especially in the last decade. Although laparoscopic techniques are similar, different instruments, such as endoscopic stapler, endoscopic clip, monopolar hook cautery, harmonic scalpel, and vessel sealing instrument, can be used in appendiceal mesentery dissection 1, 2. BVS is an effective and safe system to be used at the dissection of appendiceal mesentery and haemostasis and is definitely effective in decreasing the operation period. Objectives: The main objective of the present study was to studyretrospectively, the effects of using monopolar cautery and vessel sealing system on the operation period in the appendix mesentery dissection. Methods: Hundred patients, operated laparoscopically for acute appendicitis in between June 2010 and June 2011, are evaluated retrospectively. Monopolar cautery was used in 50 patients and bipolar vessel sealer was used in 50 patients. No intraoperative or postoperative complication was seen in any of the patients. None of the patients required conversion to open surgery due to dissection problems of the appendiceal mesentery. Results and Interpretation: The mean duration of operation was 51.08 min in the monopolar cautery group whereas 36.68 minutes in the bipolar vessel sealing system group. Conclusion: Bipolar vessel sealeris safer and time saving as compared toMonopolar cauteryin laparoscopic appendectomy.

The Surgical Management of Dermato Fibro Sarcoma Protuberance.

Background: Dermatofibrosarcoma protuberance is relatively uncommon low to intermediate grade malignant neoplasm with characteristic cytogenetic features. It constitutes less than 0.1% of all malignant neoplasms. Although metastasized rarely, it is locally aggressive tumour with high recurrence rate. It is a one of the rare type of law grade sarcomas that occur s anywhere in the body, usually arise from trunks and extremities. It rarely arises from abdominal wall. Objectives: The main objective of the present study was to study the outcome of surgical treatment of dermatofibrosarcoma protuberance. Methods: This study included 4 patients all retrospective and prospective from September 2008 to December 2013. They were subjected to detailed history taking and examination with relevant investigations and were subjected to surgery. They were followed up for at least 36-month period to assess for any recurrence. Results and Interpretation: Out of 4 patients, all were males. Mean age of presentation was 32 years. Site distribution was 25% trunk, 50% extremities and 25% neck. All patients underwent wide local excision. At the end of follow-up period of up to 3 years after surgery Overall recurrence rate was nil. Because of the potential of local recurrence, therapy for DFSP should be directed toward adequate local excision of the primary lesion. Minimal resection should include a surrounding margin, comprising 3-cm margin of normal skin and removal of underlying deep fascia. Compromising on margins invites higher chances of local recurrence. Conclusion: DFSP behaves like a locally infiltrating neoplasm. Despite their locally aggressive behaviour, distant metastasis occurs with extreme rarity. Because of this, it is reasonable that therapy should be directed towards adequate local excision of the primary lesion. Compromising on margins always invites higher chances of local recurrence.