Fistulotomy versus fistulectomy as a primary treatment of low fistula in Ano

Fistula in ano is common surgical condition that is treated by different surgical modalities. Is to compare the outcome and complications of fistulotomy and fistulectomy as primary treatment of low fistula in ano. A prospective randomized study was done on 76 patients of low fistulae in ano who were admitted to the surgical department at Alkindy teaching hospital from January 2009-January 2010. Fistulotomy was done in 32 patients, and fistulectomy was done in 44 patients. Patients were followed up post operatively for one year and the healing time was estimated in both groups and complication rate was recorded including bleeding, infection, incontinence and recurrence. Out of 76 patients included in this study,65 patients [85.53%] were found intraoperatively to have intersphincteric fistulae and 11 patients[14.47%] were low tansphincteric fistulae. The operating time for fistulotomy [15-25 minutes] was shorter than that for fistulectomy [20-35 minutes]. The healing time was found to be shorter in fistulotomy group [26.38 days] than that of fistulectomy[38.64 days]. The complications which were recorded include bleeding occurred in only one out of 44 patients [2.27%] following fistulectomy, while no bleeding developed following fistulotomy. Infection developed in one case out of 32 [3.12%] following fistulotomy and one case out of 44 [2.27%] following fistulectomy. Two cases out of 32 [6.25%] developed minor incontinence following fistulotomy and 5 cases out of 44 [11.36%] following fistulectomy. Recurrence developed in 2 cases out of 32 [6.25%] of fistulotomy and 3 cases out of 44 [6.82%] following fistulectomy. The recurrence in both groups developed within 4-6 weeks following surgery. Fistulotomy can be used as a primary treatment of low fistula in ano as the operating time is shorter and it takes shorter period of time for the wound to heal and the incidence of complications is comparable to that of fistulectomy

Comparison between the diagnostic values of serum inflammatory markers, interleukin-6 and C-reactive protein in detection the severity of acute appendicitis

The aim of this study was to compare the diagnostic values of serum inflammatory markers, C-reactive protein [CRP] and interleukin-6 [IL-6] in detection the severity of acute appendicitis. This is a prospective study from December 2008 to March 2009 included all patients who had appendectomy in Department of Surgery. Al-Kindy Teaching Hospital - Baghdad/ Iraq. Serum for estimating levels of C-reactive protein [CRP] and interleukin-6 [IL-6] was taken pre-operatively. Depending on the macroscopic evidence during the operation and the histopathological examination of the specimens, the patients were separated into 3 groups, group one with negative appendectomy [normal appendix], group two with non-complicated acute appendicitis [catarrhal, suppurative], and group three with complicated acute appendicitis [perforated, angrenous]. The histopathological results were correlated with CRP and IL-6 values statistically. A total number of 50 patients were included in this study, 28 males [56%] and 22 females [44%]. The mean age was 23 years [ranged from 7 to 50]. On the macroscopic evidence during the operation and the histopathological examination of the specimen, there were 7 patients [14%] in group one, 29 patients [58%] in group two, and 14 patients [285] in group three. Serum IL-16 and CRP values gave true negative results in 6% and 10% respectively, true positive results in 82% and 32% respectively, false negative results in 82% and 32% respectively, and false positive results in 8% and 4% respectively. Therefore, in the present study the sensitivity, specificity, and accuracy of serum IL-6 were calculated as 95.34%, 42.85%, and 88% respectively, and the sensitivity, specificity, and accuracy of CRP values were calculated as 37.20%, 77.42%, and 62% respectively. Laboratory results should be considered to be integrated within the clinical assessment. If used critically, CRP and IL-6 can provide surgeons with complementary information in discerning the necessity for urgent operation

Migration of copper T [IUD] from the uterus to the urinary bladder with calculus formation [unusual case report]

We report a 35 year old lady presenting with a bladder stone formed over a migrated intrauterine device. The lady presented with recurrent urinary tract infection for the last 2 years, irritative lower urinary tract symptoms and hematuria. History was suggestive of intrauterine contraceptive [IUCD] device placement 3 years back. She was treated with antibiotics on random basis but the urinary tract infection recurres few weeks after termination of treatment. Investigations included hematocrit, plain X-ray of abdomen, ultrasound of abdomen, urinalysis, and urine culture and sensitivity. Plain X-ray and ultrasound of the abdomen confirmed a bladder stone. Open cystolithotomy was performed under general anesthesia. The stone formed over a copper-T IUCD. Post operative course was uneventful and the patient is currently asymptomatic. The importance of post-insertion follow up and the need for awareness of migration of IUCD including intravesical migration cannot be overemphasized

Rubber band ligation as an alternative to conventional hemorrhoidectomy as a primary treatment for internal hemorrhoids

Hemorrhoids are common surgical problems and there are many methods of treatment such as conventional hemorrhoidectomy, cryosurgery, excision by laser, and rubber band ligation. To compare the results and complications of rubber band ligation as a primary treatment of internal hemorrhoids with conventional hemorrhoidectomy. This prospective study which was performed in Al-Kindy Teaching Hospital from Jan.2000- Dec.2002.compared the results of two different methods of treatment [rubberband ligation,conventional hemorrhoidectomy]in 268 cases of 2nd, 3[rd] degree hemorrhoids, regarding their efficacy and the complications of these procedures These cases were randomized in equal numbers into two groups: Group 1: Treated by rubber band ligation [134 cases]. Group 2: Treated by conventional hemorrhoidectomy [134 cases]. The average period of follow up after completion of treatment was three months for both groups. Symptomatic improvement occured in 128 patients treated by rubber hand ligation 95.52% and in 125 patients 93.28% treated by conventional hemorrhoidectomy. No improvement occured in 6 cases 4.48% treated by rubber band ligation,and9cases 6.72% who were treated by conventional hemorrhoidectomy had residual symptoms. The complications were generally minor, including pain, slight rectal bleeding , thrombosed external piles and were managed satisfactorily. Rubber band ligation had less early and late complications than conventional hemorrhoidectomy in the treatment of the second and third degree hemorrhoids

Evaluation of the risk factors in abdominal wounds dehiscence

Postoperative abdominal wound dehiscence is still a great surgical problem. Though it is not very common, but may cause a serious complication leading to death. To evaluate risk factors associated with postoperative abdominal wound dehiscence. Thirty-seven patients, 25 males and 12 females, with postoperative abdominal wound deniscence [burst abdomen] were identified during the period from Jan.2000-Dec.2002. On evaluation of these cases we stressed on the associated risk factors that might participate in the development of such complication, these are [1] Hypoalbuminemia [2] Anemia [3] Malnutrition [4] Chronic lung disease [5] Emergency surgery [6] Surgeon's experience [7] Repeated vomiting [8] Prolonged intestinal paralysis [ileus]. [9] Repeated urinary retention [10] Increased coughing [11] Local wound infection. We grouped the patients accordingly to the number of risk factors. Group [1] with no risk factor, group [2] with one risk factor, group [3] with two risk factors, group [4] with three risk factors, and group [5] with four or more risk factors. The majority of patients had one or more of risk factors. Two patients 5.4% with one risk factor, five patients 13.5% with two risk factors, nine patients 24.35% with three risk factors, twenty patients 54.05% had four or more risk factors and one patient 2.7% had no risk factors. No statistical differences in the increased tendency to postoperative abdominal wound dehiscence with the increased number of risk factors among the first three groups, but group four with the 3 risk factors was significally different [P value< 0.01], the same applied for group five too. No differences in the approach of the operation, whether median or Para median incisions, were related to the development of burst abdomen. The majority of burst abdomens were noticed to follow emergency operations 86.5% as opposed to cold operations 13.5%. Special attention should be paid for patients who had, at least, three risk factors for the development of burst abdomen; such patients should be considered for non-absorbable tension suture

Prospective study of primary repair of penetrating colonic injuries

Penetrating injuries are the most common injuries to the colon. They are the most severe and destructive injuries. These injuries were treated by different methods since the Second World War including colostomy, primary repair with exteriorization of the injured segment followed by replacement of the exteriorized segment back into the peritoneal cavity and primary repair. These methods of treatment result in different morbidity and mortality rates. Compare the results and complications of primary repair with those of faecal diversion as primary treatment of penetrating colonic injuries, including destructive injuries to the colon. [82] Cases of penetrating colonic injuries were included in the study. The patients were admitted to Al -Kindy teaching hospital during the last eight years, from 1994 to 2003. After per-operative evaluation and identification of colonic injuries were done, the patients were randomized irrespectively to the previously diagnosed risk factors into two groups, primary repair group and faecal diversion group. Five cases were excluded from the study, as they died within 24 hours from the time of injury, due to other causes not related to colonic injuries. Out of the studied 77 cases, 29 were randomized as primary repair group, 48 as faecal diversion group. The average age of primary repair group was 29.7 years while that of faecal diversion was 22.3 years. 48 cases were randomised as diversion group, 43 patients 89.58% were males and 5 patients 10% 42 were females. Male to female ratio was 8.6:1; 29 cases were randomised as primary repair group, 26 patients 89.65% were males and 3 patients 10.35% were females. Male to female ratio was 8.6:1. Septic related complications were 3 of 29 patients 10.34% in primary repair group, 13 of 48 patients 27.08% in faecal diversion group. Over all complication rates were 6 of 29 patients 20.65% for the primary repair group and 16 of 48 patients 33.32% for faecal diversion group. From that, we concluded that primary repair could be used safely as primary treatment to penetrating colonic injuries in spite of the presence of risk factors

Subphrenic abscess complicating burn injury

A patient in whom a right subphrenic abscess developed as sequale to burn sepsis is described, drainage of the abscess through right sub-costal incision was done and revealed 500 cc of pus of the same bacteriology as the wound and blood, eventually resulted in cure