A Comparative Study Between Use of Topical Honey and Edinburgh University's Solution of Lime (EUSOL) Dressing in Necrotizing Fascitis Wounds.

Introduction Necrotizing soft tissue infection is potentially life-threatening and involves subcutaneous fascial planes, later involving overlying skin and, eventually, underlying muscles. Early diagnosis and prompt treatment are necessary for this disease's management to avoid significant morbidity and fatality. After resuscitation and optimization, early surgical debridement is followed by serials of dressing. Various materials like Edinburgh University's solution of lime (EUSOL), normal saline, povidone-iodine, and honey have been used as dressing solutions for necrotizing fasciitis. This study is based on comparing the effects of honey and EUSOL as dressing solutions in necrotizing fasciitis wounds. Methods A randomized clinical trial was conducted at the Civil Hospital Karachi, from March 2020 to July 2021. This study has been approved by the ethical review committee of the institution and registered at clinicaltrial.gov. Based on the dressing solution for necrotizing fasciitis, patients were divided into two groups, The honey group (intervention group) contains 90 patients, and the EUSOL group (control group) has 85 patients. Results A total of 175 patients' data were analyzed, 90 in the honey group and 85 in the EUSOL group. Patients presented to the hospital with symptoms of 6.20 ± 2.72 days in the honey group and 6.67 ± 4.08 days in the EUSOL group. The days required for clearance of slough in the honey group were 2.83 ± 0.79, while 2.48 ± 0.82 days in the EUSOL group with a p-value of 0.005. The duration of hospital stay was 4.96 ± 1.31 days in the intervention group and 9.33 ± 1.45 days in the control group, with a p-value of 0.007. Wound healing days were 20.23 ± 4.45 in the intervention group while 28.38 ± 7.06 days in the control group, with a significant p-value of 0.000. Conclusion While managing necrotizing soft tissue infection wounds with honey. Honey promotes faster wound healing and shorter hospital stays compared to EUSOL.

A rare case of idiopathic ileocolic intussusception in an adult.

Intussusception is an invagination of one segment of the bowel into its adjoining segment. In children, the cause is usually benign, while in adults it is secondary to a mass lesion. Here we present a case in which the preoperative diagnosis of intussusception secondary to colonic mass was made, but no definitive cause was identified by histopathology. A 30-year-old male presented with abdominal pain, altered bowel habits, weight loss, loose motions, bleeding per rectum, and vomiting. The abdomen was distended, firm, mildly tender, and guarded. A vague mass of 15 × 10 cm was palpated on the left upper quadrant. X-ray and ultrasound showed dilated small bowel. A computed tomography scan suggested ileoileal intussusception. Colonoscopy showed a growth at 15 cm of the anal verge. Exploratory laparotomy was performed, showing the presence of ileocolic intussusception with two large perforations. Subtotal colectomy with ileostomy was done. The histopathological examination showed signs of perforation.

A safe quick technique for placement of the first access port for creation of pneumoperitoneum.

INTRODUCTION: Closed and open techniques for creation of pneumoperitoneum are being used simultaneously with varying frequencies. Some studies analyzing slight modifications to both approaches have been published and others are under way. We conducted this study to eliminate some of the disadvantages of the open technique, an already proven safer technique. PATIENTS & METHODS: In a total of 1250 consecutive patients, who underwent various laparoscopic procedures, a modified open technique was used. This technique involves identification and incision of a point at a junction of the umbilical stalk and linea alba infraumbilically. With this technique, penetration of a blunt trocar was possible under direct vision with minimal and controlled axial force. Time needed to induce pneumoperitoneum, intraoperative (vascular and other organ injury) and postoperative complications were recorded, and data were analyzed. RESULTS: Intraabdominal access was successfully achieved in all cases without any vascular or solid organ injury except in 3 (0.24%) cases. In these 3 cases, the procedure failed due to severe adhesions, because of previous abdominal surgeries. Mean time taken to induce pneumoperitoneum was 4.0 minutes (range, 2 to 9.5), while time required to close the first access port was 4.5 minutes (range, 3 to 8). Enterotomy occurred in 2 (0.16%) cases, while a postoperative port-site hernia occurred in 2 (0.16%) cases. Port-site infection occurred in 6 (0.48%) cases, and port-site hematoma in 4 (0.32%) cases. Gas spillage was recorded in only 6 (0.48%) cases. CONCLUSION: We recommend a modified open technique as the technique of choice in all cases requiring laparoscopic surgery in general and developing countries in particular where intraabdominal adhesions are not uncommon.

Laparoscopic-assisted management of impalpable testis in patients older than 10 years.

OBJECTIVE: Cryptorchidism affects 1% of male births. The majority of patients with undescended testis are identified and treated in childhood, but a significant proportion of them especially in third-world countries are neglected and present late. Herein, we present our initial experience of managing impalpable testis in older children and adults with laparoscopic assistance. PATIENTS AND METHODS: This study was conducted from 2003 through 2008 at LUMHS Jamshoro. Thirty-two patients with 40 impalpable testes were included in this study. Diagnostic laparoscopy was performed in 32 anesthetized patients. Laparoscopic-assisted orchiopexy or orchiectomy was performed in patients with intraabdominal testis. Testicular vessels and vas deferens were mobilized and after obtaining sufficient length were brought through the posterior wall of the inguinal canal by creating a neo-inguinal ring medial to the epigastric vessels after a small inguinal incision. RESULTS: Of 40 impalpable testis, ultrasound localized 16 (40%) of them, and on laparoscopy, 36 (90%) were localized, 30 (75%) as intraabdominal and in 6 (15%) cases vas and vessels were entering into the internal inguinal ring (intracanalicular). The remaining 4 patients were diagnosed as having vanishing testis (anorchia). Laparoscopic orchiectomy was performed in 14 (35%) of these testes, while single-stage laparoscopic-assisted orchiopexy using Prentiss' maneuver was performed in 16 (40%) testis. No major complications occurred. Seven testes were associated with ipsilateral hernias and were simultaneously repaired laparoscopically. CONCLUSION: Laparoscopic-assisted single-stage orchiopexy is a safe and successful procedure for intraabdominal testis in adolescents and older patients. The additional benefit of shortening the usual course of spermatic cord was beneficial to fix the testis in the scrotum without tension.