Tube loop seton drainage treatment of recurrent extrasphircteric perianal fistulae

Tube loop drainage treatment of multiply recurring high-spreading extrasphincteric perianal fistulae in 23 patients is reported in this study. The drainage loop seton makes the rinsing of the wound possible following fistulectomy and also the bi-directional drainage of the wound discharge. Strangulation of the wound and an early closure of the fistula and hence the development of recurrence are prevented by means of controlled formation of scarred tissue. The sphincteral musculature of the anus is also protected from damage. Thirty-five recurring fistulae of the studied 23 patients were treated successfully by this method. The results have shown that two fistulae recurred, no one of the studied patients developed incontinence and that the use of tube loop seton has advantage over the pull-out method as regards cases of high-spreading multiply recurring extrasphincteric perianal fistulae

One stage resection of acute sigmoid volvulus

In a descriptive prospective study, 20 patients with sigmoid volvulus and two with ileosigmoid knotting had primary resection of the redundant sigmoid colon with an immediate anastomosis after intraoperative antegrade colonic irrigation. Tube caecostomy was established in the two patients who required resection of both small bowel and sigmoid colon and in a further five patients in whom the integrity of the colorectal anastomosis was suspected. There was no clinical anastomosis leak and no mortality in any of the patients. Superficial wound infection occurred in three patients. The duration of hospital stay ranged from 10 to 14 days. The result showed that the procedure was associated with an acceptable morbidity and a short hospital stay. Also, it suggested that the resection of acute sigmoid volvulus and primary anastomosis after antegrade intraoperative colonic lavage safely provided that the patient is reasonably fit

Comparative study of emergency operative procedures for bleeding duodenal ulcer

In a series of 62 emergency operations in pateints with bleeding duodenal ulcer, vagotomy with pyloroplasty and underrunning of the bleeding points was performed in 30 cases with two deaths [6.9%], partial [Billorth II] gestrectomy in 21 cases with two deaths [9.4%] and vagotomy with antercomy in 11 cases with one death only [9%]. A patient was more likely to be treated by partial gastrectomy if a giant ulcer with an internal diameter >/= 2 cm was found. The results suggest that while vagotomy and pyloroplasty combined with a direct attack on the bleeding point is an acceptable standard emergency operation for bleeding duodenal ulce, gastric resection proved to be a satisfactory alternative procedure and should be considered in the technically difficult case with a very large ulcer. A giant ulcer was present in 23.8 percent of cases coming to surgery

Diagnostic peritoneal lavage as an adjunct to decision making in the acute abdomen

The current study suggests that peritoneal lavage can be useful in evaluating patients with abdominal pain but does not suggest this procedure as a routine in all patients. When the diagnosis proves to be particularly difficult or the patient is in a morbid or confused state precluding accurate clinical evaluation, the procedure can be performed with minimal risk and sufficient accuracy in making the decision whether to operate or not

Evaluation of a single session ligation treatment for bleeding second and third degree hemorrhoids

In this prospective study single session RBL was found to be a safe and effective technique in the treatment of bleeding hemorrhoids. Although it was associated with some complications, non of them were with significant discomfort long term results were good in more than 90 percent of the patients. Single session RBL is recommended as the treatment of choice in the outpatient management of those with second and third degree hemorrhoids