ABSTRACT
To hypothesize that mobile cecum is a rare etiological factor and cecopexy is the choice of treatment in patients with recurrent right lower abdominal pain. Prospective study was conducted in the department of general surgery, SSG Hospital, Baroda, from January 2008 to December 2009. Patients with recurrent right lower abdominal pain were planned for appendectomy. In those patients with intraoperative findings suggestive of macroscopically normal appendix while cecum found to be mobile and no other gross abnormality, appendectomy was performed with cecopexy, fixing cecum to lateral abdominal wall with polypropylene 3-0 suture in interrupted manner. Histopathological examination was confirmed in all the cases. A total of 110 patients complaining of recurrent right lower abdominal pain, with clinical and radiological findings suggestive of appendicitis, were planned for appendectomy. Of 110 patients, 20 were found to have macroscopically normal appearing appendix and of those 20 patients, 8 had cecum unattached to the lateral peritoneal wall. The rest of 90 patients had grossly inflamed appendix in which 10 patients had cecum unattached to the lateral peritoneal wall. Appendectomy and cecopexy were performed in all the patients. On histological examination of the excised appendices, of those 20 with macroscopically normal appearance, 11 had features suggestive of chronic appendicitis and remaining 9 patients were found to have normal histology. While the other 90 with grossly inflamed appendix showed pathological changes of acute inflammation. A total of 64 patients of 110 were followed up till date with no recurrence of abdominal pain. A mobile cecum should be considered a cause of recurrent right lower abdominal pain, and cecopexy is easy to perform and good treatment of choice for a mobile cecum.
ABSTRACT
The objective of the study was to compare single-layered intestinal anastomosis and double-layered intestinal anastomosis in terms of safety and cost-effectiveness. A comparative prospective study was conducted in the Department of General Surgery, SSG Hospital, Baroda, from May 2007 to November 2009. All the patients above the age of 12 years, requiring intestinal anastomosis in emergency or electively, were randomly assigned either of the group. Those requiring anastomosis to the stomach, or to the duodenum, or to the rectum were excluded. Single-layered anastomoses were constructed with a continuous 3-0 polypropylene suture. Double-layered anastomoses were constructed using interrupted 3-0 silk Lembert sutures for the outer layer and a continuous 3-0 polyglactin suture for the inner layer. Comparison was made in terms of time required for anastomosis, anastomotic leak and other complications, and the cost incurred. Seventy-three single-layered and 72 double-layered anastomoses were performed. Age and sex difference was not significant. The mean time required to construct single-layered anastomosis was 9.5 min and that for double-layered anastomosis was 19.3 min. Anastomotic leak and other complications were similar in both the groups. The length of hospital stay was also comparable. The expenditure for the procedure was significantly different (` 298 for single-layered anastomosis, whereas ` 390 for double-layered anastomosis). Single-layered intestinal anastomosis does not carry any increased risk of anastomotic leak when compared with the conventional double-layered technique, can be constructed in shorter time and at a lower cost.
ABSTRACT
Pollicisation of the index finger is perhaps one of the most complex and most rewarding operations in hand and plastic surgery. It however has a steep learning curve and demands very high skill levels and experience. There are multiple pitfalls and each can result in an unfavourable result. In essence we need to: Shorten the Index, recreate the carpo metacarpal joint from the metacarpo phalangeal (MP) joint, rotate the digit by about 120° for pulp to pulp pinch, palmarly abduct by 40-50° to get a new first web gap, Shorten and readjust the tension of the extensors, re attach the intrinsics to form a thenar eminence capable of positioning the new thumb in various functional positions and finally close the flaps forming a new skin envelope. The author has performed over 75 pollicisations personally and has personal experience of some of the issues raised there. The steps mentioned therefore are an algorithm for helping the uninitiated into these choppy waters.
