RESUMO
Intestinal obstruction is one of the most common intra-abdominal problems dealt by general surgeons. The morbidity and mortality are much higher than many diseases. If diagnosed & treated early, the recovery time, morbidity & mortality are much less. Hence the need for the study. METHODSWe have analysed 216 cases of intestinal obstruction done by a single surgeon in one hospital in the last three decades. Differences in the selection, surgical skill, capability, & post-operative care management are excluded by including a single surgeon’s (1st Author) operated cases. Only operated cases are included in the study. Conservatively managed patients are not included in this study. RESULTSFemales are more affected 56%, than 44% males. If Pelvic pathology cases are excluded – both sexes are equally affected. Small intestine was affected in 88 % of patients. Anastomotic leak occurred in 8 patients (3.7%). Burst abdomen occurred in 4 patients - 1.85%. Re-exploration was done in 13 patients (6.0%). LAMA & death together accounted for 6 cases (2.8%). Success rate of all operations was 97.2%. CONCLUSIONSFemale sex is more commonly effected. Adhesion & bands are major causes of small bowel obstruction. Anastomotic leak is common in strangulated bowels with associated with septic shock. PGA (Vicryl) & PDS are better than catgut in decreasing the leak rate. Mortality rate is more in anastomotic leak patients.
RESUMO
Fistula in ano is a common perianal disease of the mankind. It is secondary to mainly cryptoglandular infections & abscess. Persistence of chronic infection will lead to fistula formation.1 Management of high-level fistulas is complicated due to incontinence, which is troublesome; hence, many procedures have been tried by many surgeons, but without any supremacy over others. Immediate reconstruction of divided sphincter muscle will give good result.2 We have done fistulectomy & repair of the external anal sphincter & followed for the last two decades with no incontinence & minimal recurrences.METHODS192 cases of fistula in ano for the last 20 years operated by a single surgeon (1st author) were studied & were followed up to now. The differences, in the selection of cases, surgical skill & post-operative management are excluded in the study by including cases done by a single surgeon (first author) only. 136 males & 56 females were operated. Intersphincteric 45.8%, trans-sphincteric 49%, high level fistulas 5.2%, trans-sphincteric & high fistulas with considerable external sphincter loss (54 cases) were repaired with 1–0 Vicryl. Fistula in ano is associated with haemorrhoids in 24/192 & ano rectal abscess (20/192). Fistulotomy done in 16/192, simple & subcutaneous tracts - fistulectomy done in 65%. Curetting of the high tracts done in 16/192.RESULTSMales are predominantly affected 70.8%. This is more common in 3rd, 4th & 5th decades (80.1%). Single external opening was seen in (90%). Posterior & lateral fistula tracts are more commonly seen in (89.6%). Non-specific pyogenic infective pathology is seen 99%. Recurrences- 6/192. Time taken to heal is 3–6 weeks. Incontinence is not seen in any case. No recurrence or incontinence seen in primary sphincter repair of 54 cases.CONCLUSIONSPrimary sphincter repair is simple & best procedure with minimal or no recurrence & decreases the healing time. It is more suitable & advised in fistulas with considerable external sphincter loss.