IntroductionMeckel’s Diverticulum is the most common congenital disease and seen in 2% of population. It is difficult to diagnose preoperative, mostly seen during operation with its various presentation.Material and Methods This is a retrospective study in which all the cases diagnosed as Meckel’s diverticulum with its complication diagnosed while doing operation were included. Demographic data, clinical presentation, preoperative diagnosis, intraoperative findings, surgical procedure performed, histopathological report and postoperative follow up of patients were recorded and statistically analyzed. The aim of this study was to assess various presentation of Meckel’s diverticulum in 8 years of duration in college of medical sciences, Bharatpur Nepal. ResultsOut of 32 cases, there were 20 male and 12 female with M:F ratio1.66:1. The mean age was 8.34 ± 3.98 years. All together sixteen (50%) patients had features intestinal obstruction. Perforation was seen in 28.1% patients, intussusception in 21.8%, diverticulitis in 15.6%, small bowel volvulus around fibrous band in 18.8%, internal herniation in 9.4% and massive bleeding in 6.3% patients. The average distance from ileocecal junction was 40-60 cm. All cases underwent emergency laparotomy, presence of Meckel’s diverticulum was incidental intraoperative finding. Three cases had superficial wound infection. Small intestine mucosa followed by gastric, pancreatic and colonic mucosa were most common histological finding. The average duration of hospital stay was 5 to 8 days.ConclusionMeckel's Diverticulum is a true diverticular anomaly that may remain clinically silent for lifetime, or it may have life-threatening complications. Due to nonspecific features in case of acute abdomen, Meckel’s diverticulum and its complications should be kept as an important differential diagnosis.Keywords: intestinal obstruction; meckel’s diverticulum; volvulus.
Background & Objectives: Though abdominal surgery has been practiced for many centuries, the optimal technique for anastomosis of small bowel and large bowel remains controversial. This study was conducted with objective to compare the outcome of stapled and handsewn technique of anastomosis of the lower gastrointestinal tract.Materials & Methods: This prospective study was done in the Department of General Surgery and Surgical Gastroenterology, College of Medical Sciences, Bharatpur in the period between 1st October 2014 to 30th September 2015. A total of 50 patients who underwent resection and anastomosis for various conditions of small bowel and large bowel were alternatively placed in handsewn and stapled group. Both the groups were compared in terms of mean time required to perform the intestinal anastomosis, mean operating time, postoperative complications like anastomotic leak rate and wound infection rate, and the time of postoperative hospital stay.Results: The mean duration to perform the intestinal anastomosis was 32.04±4.51 minutes in the handsewn group and 11.00±1.91 minutes in the stapled group(p<0.001).The mean operative time was 147.12±20.91 minutes in the handsewn group versus 132.52 ± 15.71 minutes in the stapled group(p<0.05). The mean duration of postoperative hospital stay was 9.04±2.77 days in the handsewn group versus 8.44 ± 2.32 days in the stapled group (p>0.05). There was no significant difference in the anastomotic leak rate and surgical site infection rate among the two groups.Conclusion: Stapling technique can significantly reduce the time for the anastomotic procedure and also the duration of the operation. However, there was no difference in the rate of anastomotic leak and wound infection between the handsewn and stapled anastomosis. Therefore, stapled anastomosis can be considered a better option over handsewn bowel anastomosis.
Background: Penile cancer is now a rare condition. The low incidence of the disease makes a valid estimation of its prognosis difficult. In this study, we made an attempt and propose a nomogram to develop a prognostic rule that could predict the Cancer-Specific Mortality (CSM) free rates in patients with primary penile squalors cell carcinoma of the penis (PPSCC).Methods: This study included 1304 patients diagnosed with PPSCC between the years 2004 & 2011 and treated with penile tumor excision. Subjects were staged as per Surveillance, Epidemiology & End Results stage (SEER), American Joint Committee on Cancer (AJCC), TNM classification and tumor grade (TG). CSM free rates were determined. Univariate and multivariate Cox regression model was used to test the prediction of the CSM free rate. The predictive rule accuracy was created using the receiver operating characteristic curve. Results: The clinico-pathological profile depicts a mean age of 64.66 ± 14.38 yrs. The most common primary site involved was glans penis (n= 483, 37%) and the disease was most commonly diagnosed at AJCC stage I (n= 670, 51.4%) disease. The cumulative 5-year CSM free rates according to Fine & Gray, & Kaplan-Meier methods were 81.8% and 79.8%, respectively. The predictive accuracy as per SEER stage, AJCC stage, TNM stage alone were 68.8%, 70.3%, 72.3%, respectively. When TG was combined, the predictive accuracy increased to 72.8%, 73.1%, and 75.0%, respectively. TNM stage with TG was most accurate in predicting CSM free rate compared to other models. Conclusions: TNM stage with TG and AJCC stage with TG appear to have comparable accuracy to predict the CSM free rate in patients with PPSCC, the TNM stage with TG is the most accurate (75%) method to predict the CSM free rates. The addition of the TG variable improved the accuracy of these prognostic models.
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