comparative study of different treatments of hemorrhoids

Hemorrhoid is a common anal problem in our country that is currently treated by many different methods. Three modalities were assessed in a randomized prospective trial in which 848 patients with a second-degree hemorrhoid were treated by rubber band ligation [470 patients], injection sclerotherapy [280 patients], or cryosurgery [98 patients]. The effectiveness of each method was assessed clinically at 3, 6, 9, and 12 months after initial treatment, and determined by improvement in presenting symptoms. All patients complained of rectal bleeding and prolapse of the hemorrhoid on defecation, but only 69% had anal pain and 14% suffered from pruritus ani. Rubber band ligation was found to be superior to the other methods, and displayed statistical significance when compared to injection sclerotherapy and cryosurgery

Jeddah experience in the management of high anal fistula

Twenty-six [26] transsphincteric anal fistulae with secondary high extensions and sixteen [16] suprasphincteric anal fistulae with secondary high extensions have been treated successfully over a period of 3 years. The operative technique depends on exploration of the intersphincteric plane with removal of the primary source of the infection, together with excision of the primary tract, and drainage of the secondary high extensions. The patients have been followed for 2 years without recurrence. Continence for flatus and liquid feces was 92.1% and 96.15%, respectively, in the transsphincteric and 75% and 93.75%, respectively, in the suprasphincteric group but the continence for solid feces was 100% in both. Thus, the so-called excision technique for treatment of high fistula is safe and results are excellent

critical evaluation of circumcision in the western region, Saudi Arabia

In Muslim communities, circumcision is a highly recommended religious procedure and is the commonest surgical operation. However, it is still considered a minor procedure, therefore, there is no comprehensive study to evaluate the current practice performed by medical and nonmedical practitioners, and there are neither established criteria of a satisfactory circumcision, nor guidelines to minimize the preventable complications. We conducted a prospective study over 4 years to evaluate the current practice of circumcision in our community [Jeddah] by screening a random sample of 1000 circumcised children which indicated high incidence of complications [18.3%] and non-cosmetic results [35.8%]. From this screening study we were able to identify criteria for the satisfactory circumcision and to recommend certain guidelines for the performance of satisfactory circumcision with minimal complications and discomfort to babies. We applied these recommendations in 500 circumcisions performed in our hospital with very encouraging results. This paper presents the findings from the screening study, the recommended guidelines, and their effects on the performance of the 500 circumcisions

Maximal anal dilatation for treatment of haemorrhoids

A prospective study to assess the short and long term results following maximal anal dilatation for treatment of haemorrhoids was carried out in King Abdulaziz university hospital, Jeddah. A regular regimen of using anal dilators after maximal dilatation was not used in this study. The series comprised 522 patients treated over a period of 5 years between January 1980 and January 1985. Follow-up at 6 months was available in 470 patients; 57% were cured, 32% improved, 6% unchanged, 2% were worse and 3% had further treatment. Follow-up at 4 or more years was available in 107 patients: 51% were cured, 26% improved, 9% unchanged, 5% were worse and 9% had further treatment. The outcome at 6 months and 4 years was good in most of the patients and comparable with that obtained by other surgical procedures for treatment of haemorrhoids. This indicates that anal dilatation is a satisfactory procedure for treatment of haemorrhoids in our patients. The results are also comparable with those from other anal dilatation studies and indicate that our abandoning the use of anal dilators after maximal dilatation does not seem to have influenced the results

Source of infection in postcholecystectomy wound sepsis

A prospective bacteriological study was carried out on 212 patients undergoing elective cholecystectomy to identify and compare bacteria from bile and septic wounds. Bacteria were isolated from the bile in 43 patients [20%]: 28 patients [13%] developed post-operative wound sepsis. Of 28 patients 20 [71%] with wound infection had positive bile culture. Of those 20 patients, 16 [80%] with wound sepsis and positive bile culture were found to have the same organisms in both bile and wound. Escherichia coli was the commonest organism isolated from both bile and septic wounds. Anaerobic organisms were isolated from the bile of two patients and from infected wound in only one patient. Cholecystectomy with duct exploration was associated with an incidence of wound infection as compared with cholecystectomy alone. A non-functioning gall bladder and operative cholangiography were not demonstrable risks in our series. The sensitivity of organisms recovered from bile to various antibiotics was assessed. The use of prophylactic antibiotics preferably as per-operative single doses in elective cholecystectomy is recommended