Objectives: To compare efficacy of topical 0.2% glyceryl trinitrate ointment with lateral internal sphincterotomy in treatment of patients with chronic anal fissure. Study Design: Randomized Control Trial. Setting: Department of General Surgery, DHQ Teaching Hospital, Sahiwal. Period: From 20 September 2016 to 31 December 2017. Material & Methods: A total number of 60 patients included in this study and divided into two groups GTN and LIS group through computer generated randomization method. Three main outcome variables were assessed in this study; pain relief, healing of fissure and recurrence. SPSS version was used to analyze data. P value ≤ 0.05 was considered as significant. Results: A total number of 60 patients included in this study. Relief of pain GTN and LIS was (95%) and (86.7%) respectively. Fissure healing GTN and LIS was noted as (88.3%) and (83.3%) respectively. Recurrence was not found in any patient of the present study. Relief of pain was statistically significant. Conclusion: Topical application of GTN ointment for relief of pain is safe and effective method for relief of chronic anal fissure but pain relief is slow. On other hand lateral internal sphincterotomy is first line treatment and treatment of choice for chronic anal fissure when performed by an experienced surgeon.
ABSTRACT… Introduction: Laparoscopic cholecystectomy is a standard and widely used procedure in the treatment of chronic cholecystitis for quite a long time now but there is a recent development in technique because of advent of harmonic scalpel (HS). Thus this study was conducted with an objective to compare frequency of post-operative complications in patients undergoing laparoscopic cholecystectomy by conventional versus harmonic technique. Data Source: Primary data based on patients presenting with chronic cholecystitis to the surgical department at tertiary care hospital. Study Design: Randomized Control Trial. Study Setting:The study was conducted in surgical unit-I, Jinnah Hospital Lahore. Duration of Study: Study was conducted in duration of one year i.e. January 2015 to December 2015. Subjects & Methods: After approval from the hospital ethical review board, 400 patients of either sex with age from 16 to 60 years and a diagnosis of chronic cholecystitis were included using purposive non-probability sampling technique. They were then randomly assigned to either conventional or harmonic group for laparoscopic cholecystectomy using lottery method at a ratio 1:1. . Information regarding their demographic characteristics and frequency of gall bladder perforation during surgery along with readmission in patients was noted in a structured proforma and data was analyzed using SPSS version 21.0. Results: The mean age of patients was 48.19 ± 6.484 years with about 156 (39%) male patients while 244 patients (61%) were female. About 15 (7.5%) patients in harmonic group and 16 (8%) patients in conventional group of laparoscopic cholecystectomy had gall bladder perforation during the procedure while 20 (10%) patients of harmonic group and 27 (13.5%) patients in conventional group were readmitted. On application of chi square test it was seen that the differences were statistically insignificant in both groups for the complications related to the procedure. Conclusion: It can be concluded from this study that both treatments are equally effective in terms of gall bladder perforation and rate of readmission. Thus, any of the techniques can be selected without much fear of complications depending upon the health care facility and financial constraints of health system in a resource depleted developing country. Key words:Laparoscopic Cholecystectomy, Harmonic Scalpel, Gall Bladder Perforation, Electrocautry.
Introduction: Laparoscopic cholecystectomy is a standard and widely usedprocedure in the treatment of chronic cholecystitis for quite a long time now but there is a recentdevelopment in technique because of advent of harmonic scalpel (HS). Thus this study wasconducted with an objective to compare frequency of post-operative complications in patientsundergoing laparoscopic cholecystectomy by conventional versus harmonic technique. DataSource: Primary data based on patients presenting with chronic cholecystitis to the surgicaldepartment at tertiary care hospital. Study Design: Randomized Control Trial. Study Setting:The study was conducted in surgical unit-I, Jinnah Hospital Lahore. Duration of Study:Study was conducted in duration of one year i.e. January 2015 to December 2015. Subjects& Methods: After approval from the hospital ethical review board, 400 patients of either sexwith age from 16 to 60 years and a diagnosis of chronic cholecystitis were included usingpurposive non-probability sampling technique. They were then randomly assigned to eitherconventional or harmonic group for laparoscopic cholecystectomy using lottery method ata ratio 1:1. . Information regarding their demographic characteristics and frequency of gallbladder perforation during surgery along with readmission in patients was noted in a structuredproforma and data was analyzed using SPSS version 21.0. Results: The mean age of patientswas 48.19 ± 6.484 years with about 156 (39%) male patients while 244 patients (61%) werefemale. About 15 (7.5%) patients in harmonic group and 16 (8%) patients in conventionalgroup of laparoscopic cholecystectomy had gall bladder perforation during the procedurewhile 20 (10%) patients of harmonic group and 27 (13.5%) patients in conventional group werereadmitted. On application of chi square test it was seen that the differences were statisticallyinsignificant in both groups for the complications related to the procedure. Conclusion: It canbe concluded from this study that both treatments are equally effective in terms of gall bladderperforation and rate of readmission. Thus, any of the techniques can be selected without muchfear of complications depending upon the health care facility and financial constraints of healthsystem in a resource depleted developing country.
<p><strong>Background and Objective:</strong> Inguinal hernia is one of the most common type of hernia affecting both genders. New surgical interventions to repair hernia are being developed for the better outcome of patients by reducing the operative time and postoperative complications. The objective of this study was to compare the prolene sutures and skin staples for mesh fixation in inguinal hernioplasty with mean operative time and post-operative pain as outcome determinants.</p> <p><strong>Methods:</strong> This randomized controlled trial was conducted in the Department of General Surgery, DHQ Teaching Hospital, Sahiwal Medical College, Pakistan from January 1st, 2019 to December 31st, 2019. A total of 180 patients admitted for hernioplasty were recruited after institutional ethical approval. The study participants were randomized into group A and B. Mesh fixation was done by using prolene suture in group A, while skin staples were used in group B. The duration of procedure and post-operative pain after 1 week was noted using visual analogue scoring system. The comparison between groups was done through independent sample t-test. p-value < 0.05 was considered to be statistically significant.</p> <p><strong>Results: </strong>Mean age of the patients in group A and B was 39.21 ± 11 years and 40.16 ± 5.72 years respectively. The mean operative time was 52.15 ± 9.78 minutes in group A and 36.92 ± 3.95 minutes in group B (p = 0.000). Post-operative pain after 1 week was reported in 26.7% cases in group A while it was seen in only 10% cases in group B (p = 0.004).</p> <p><strong>Conclusion:</strong> The outcome determinants of mean operative time and postoperative pain after inguinal hernioplasty were better achieved in cases treated by skin staples as compared to prolene sutures.</p>
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