Antibiotics and early post operative complications of closed hemorrhoidectomy: a retrospective matched pair study.

OBJECTIVE: The purpose of the present study was to compare early post-operative complications and length of hospital stay of hemorrhoidectomy patients between those who had and had not received metronidazole perioperatively. RESEARCH DESIGN: Retrospective, matched pair case-control study. MATERIAL AND METHOD: Medical records of all hemorrhoidal patients hospitalized between January 2000 and December 2005 were reviewed. Hemorrhoidectomy patients who had and had not received metronidazole perioperatively during this period were matched based on demographic data. Demographic data including bodyweight and number of hemorrhoidectomies of both groups were collected. Length of hospital stay and immediate post-operative complications (bleeding, urinary retention, and wound dehiscence at 2nd and 4th week), the total dosages of pethidine, acetaminophen, and NSAIDs were analyzed and compared by the McNemar and the Wilcoxon Signed Rank Test. RESULTS: Of 1,184 patients who completed the follow-up protocol, 88 patients (male: female = 31:57) who had received metronidazole could be matched by gender, age, NSAIDs used, number of hemorrhoids resected and operation in the same period with 88 patients (male:female = 31:57) who had not. There were six (6.8%) and seven (8%) patients with urinary retention in the metronidazole group and non-antibiotic group respectively. One patient in each group (1.1%) experienced bleeding that ceased spontaneously. The length of hospital stay was 1.14 +/- 0.35 (ranged 1-2) and 1.11 +/- 0.35 (ranged 1-3) days in the metronidazole and the non-antibiotic group respectively, showing no significant difference (p = 0.683). There was no significant difference in the total dosages of pethidine given postoperatively, which was 1.06 +/- 0.83 and 1.03 +/- 0.78 mg/kg in the metronidazole and the non-antibiotic group respectively (p = 0.747). At the 2nd week, there were two wound dehiscences (2.25%) in each group. At the 4th week, no more new wound dehiscence was detected and all were completely healed without stricture. CONCLUSION: There was no benefit of metronidazole on closed hemorrhoidectomy with respect to post-operative complications, length of hospital stay, and total analgesics used.

Closed lateral internal sphincterotomy using endoshere cut scissors.

BACKGROUND: Internal sphincterotomy remains the gold standard for treatment of chronic anal fissure but it is associated with immediate wound bleeding and hematoma, which is usually corrected by a pressure dressing for half an hour. OBJECTIVE: This procedure was the initial study to decrease intra-operative and immediate postoperative wound bleeding, hematoma, and duration of pressure by using Endoshere cut scissors for closed lateral internal sphincterotomy. MATERIAL AND METHOD: Closed lateral internal sphincterotomy was performed on patients with chronic anal fissures by using Endoshere cut scissors in standard technique. The Fansler's proctoscope (diameter 1.5 cm) was inserted into the anal canal to permit adequate exposure of the anal fissure after local anesthetized with 0.5% xylocaine with adrenaline 1-2 cc. at left lateral region. The intersphincteric groove was identified, and then the small stab incision was made on the lateral side. The surgeon used the forceps to expose the internal sphincter then sphincterotomy was carried out with Endoshere cut scissors. After the operation was finished, no pressure dressing was applied to the sphincterotomy wound. RESULTS: Closed lateral internal sphincterotomy was performed on 10 patients by using Endoshere cut scissors. The present results showed that no intra-operative and immediate postoperative wound bleeding, hematoma occurred. No pressure dressing was required. CONCLUSION: The authors' early results showed that Endoshere cut scissors are usefulfor closed lateral internal sphincterotomy. There was no intra-operative and immediate postoperative wound bleeding and hematoma. The pressure dressing is unnecessary. The long term results should be further studied in a randomized control trial.

Management and outcome of severe acute pancreatitis.

BACKGROUND: The treatment of severe acute pancreatitis (SAP) varies among several institutes. It has been evolving from routine surgical management to conservative management in the early stages. The surgical management has a role in the later stages of the disease. OBJECTIVE: The purpose of the present study was to review the management and outcome of the patients with SAP at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: Two hundred and ten patients with a diagnosis of acute pancreatitis at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from December 2001 to April 2005 were studied by retrospective chart review. RESULTS: Forty patients were diagnosed with SAP, 27 men and 13 women. SAP was most commonly caused by alcohol abuse (47.5%) and biliary tract disease (37.5%). Eighteen patients (45%) had pancreatic necrosis. Among them, seven patients (38.9%) had infected necrosis, and the rest had sterile necrosis. All patients with infected pancreatic necrosis underwent open pancreatic necrosectomy, and three of 7 died. Four of 11 patients with sterile necrosis died. The overall mortality was 25%. CONCLUSION: Patients with SAP have high morbidity and mortality rates. The patients with infected pancreatic necrosis may require surgical management, whereas those with sterile necrosis or SAP without local complications can be managed with conservative treatment and/or intervention. Post-operative complications might occur, thus require long term follow-up.