BACKGROUND Fistula-in-ano or anal fistulas are documented since ancient times and their management has always been a challenge. Various modalities of treatment are available and newer ones are being added each day. The aim of this retrospective study is to analyse the outcome of the video assisted anal fistula treatment (VAAFT), one of the modalities of treatment for complex anal fistulas done at our centre. METHODS Records of patients who had been treated through VAAFT by single senior consultant surgeon of Minimal Access Surgery unit between April 2013 and March 2019, were collected and analysed. RESULTS Altogether, records of 48 (forty-eight) patients who had undergone VAAFT during the period were analysed. Data revealed that 38 male (79.17 %) and 10 female (20.83 %) patients with mean age of 49.96 ± 12.22 years were operated. Most commonly, trans sphincteric followed by inter sphincteric type of fistulae were encountered. In 3 cases, internal opening couldn’t be visualised. Six patients were documented to have a recurrence within 6 months of the procedure and in the rest were cured except in a small subset of patients who did not follow up. CONCLUSIONS Amongst the wide range of armamentarium available today for the treatment of complex anal fistulas, video assisted anal fistula treatment (VAAFT) is a novel sphincter saving technique. The recurrence rate at our centre was at par with other studies and with zero incontinence rate, however further RCTs are required. KEYWORDS Complex Anal Fistula, Fistula-in-Ano, MEINERO Fistuloscope, VAAFT
Introduction: The Morgagni hernia is one of the rarest hernias. With the overall incidence rate of 3% of all the diaphragmatic hernias. Laparoscopic repair has proved to be successful in the repair of this hernia. The minimal access surgery entails the benefits of the early ambulation and less necessity of analgesia with early postoperative recovery. The defect closure can be done with primary closure or using the prosthetic mesh which may be composite or polypropylene. The recurrence rate is not yet exactly known in cases of primary repair. Some studies favor the use of prosthetic mesh in all the cases of diaphragmatic mesh repair. Case Presentation: A 75 year old lady presented with complaints of abdominal pain for 4 to 5 months and vomiting for 1 month. With a history of intermittent fever. Physical examination revealed tenderness in the epigastrium, so she was considered the indication for the laparoscopic diaphragmatic hernia repair with prosthetic composite mesh placement. Conclusions:The Morgagni hernia repair with minimal access surgery may be a boon in the surgical field. This is a rare case of hernia in both the Morgagni's and Larrey's space. Which demonstrates all the benefits of minimal access surgery. Further randomized control trials may be needed to prove the exact advantages of minimal access surgery vs open surgery.
Sleeve gastrectomy is one of the most commonly performed procedure for treatment of morbid obesity. The surgery evolved from two step procedure of biliopancreatic bypass/duodenal switch. The procedure is safe and associated with symptoms of gastroesophageal reflux, food intolerance and vomiting. These symptoms are attributed to the improper sleeve position and deformity, due to the loss of natural attachments of the stomach. We here by present a case with morbid obesity in which we did sleeve gastrectomy with sleeve fixation. Post operatively patient had benefit from complications which are previously attributed due to sleeve rotation .Our patient was 51 year old male with the history of morbid obesity since 10 years with the BMI of 44.20 . Patient has the history of Smoking, hypertension, Obstructive sleep apnea, Diabetes Mellitus with renal failure. After preoperative workup and anaesthetic check up patient was taken up for surgery and sleeve gastrectomy procedure with sleeve fixation was done. Gastrograffin study done on post op day 1 was normal and Patient was started orally liquids on day 1 and discharged on day 2. On follow up patient was doing fine, lost 36 kg weight in 8 months. There was no problem of gastroesophageal reflux, heart burn, food intolerance and vomiting. Aim -To devise the gastric sleeve fixation for the laparoscopic sleeve gastrectomy. Technique -The gastric tube is fixed along the new greater curvature with the gastrocolic omentum using the PDS 3-0 in continuous fashion. The interrupted suture is used to fix at the lower part of the tube with the transverse mesocolon near the lower edge of pancreas. Conclusion -the gastric fixation stratergy is safe and easy. It can reduce the problems arising from the improper gastric tube position, reducing the incidence of food intolerance and gastroesophageal disease.
Background: Laparoscopic repair of duodenal perforation using the omental patch is one of the traditional techniques, which gives better postoperative recovery in patients with little chances of abdominal wound infection. This article is about the technique used for the laparoscopic repair of the duodenal perforation by Grahams patch with a twist in the conventional technique. Methods: In Hanging method of duodenal repair first, an intra-corporeal suture is taken at the upper margin of perforation and both end of the thread is taken out of anterior abdominal wall and duodenum is pulled up. Now under vision the next two parallel sutures are passed, thus avoiding the posterior duodenal wall incorporation. Finally omentum flap is used for the closure of perforation. Conclusions:The laparoscopic closure of the duodenal perforation by "Hanging Method" is an appropriate Laparoscopic technique, as "hanging" the anterior wall of duodenum gives us better vision of the posterior wall of duodenum, while taking the suture through anterior duodenal wall. Further since the gall bladder is retracted there is an easy available working space for intracorporeal suturing.
Background: Seizure is a pediatric emergency. Accurate determination of the etiology of seizures is very important to start an effective treatment. The study aims to determine the spectrum of Imaging abnormalities by Magnetic Imaging Resonance (MRI) in children who presented with seizures. Methods: It is a hospital-based prospective observational study which was carried out in Government Medical College and Rajindra Hospital, Patiala. This study included 50 pediatric patients in the age group between 0 months to 18 years who were referred to the Department of Radiodiagnosis for brain MRI between October 2017 to September 2019. Results: Neuroimaging abnormality was found in 19 (38%) cases. 31 (62%) patients had no abnormal finding. The most common imaging findings were inflammatory granuloma in 5 (10%) patients. Other findings were-Hypoxic-ischemic injury (HII) in 4 (8%), Mesial temporal sclerosis in 2(4%), cerebral atrophy in 1(2%), Hemorrhage in 1(2%), Tuberous sclerosis in 1(2%), Focal cortical dysplasia in 1(2%), Lissencephaly in 1 (2%), Joubert syndrome in 1(2%), and Arachnoid cyst in 1 (2%) patients. Conclusion: The MRI was able to identify brain lesions in 38% of pediatric patients who presented with seizures. The study revealed inflammatory granuloma as the commonest cause of seizures in children, followed by Hypoxic-Ischemic Injury. Early recognition of potentially treatable diseases helps in timely treatment and arrest of disease progression. It is recommended to use MRI as a primary investigation during the evaluation and management of pediatric seizures.
Introduction: The radiation proctitis is a known complication following the pelvic radiation therapy. Radiation proctitis is categorized as acute and chronic. Most of the cases are managed conservatively except in grade four chronic radiation proctitis, which active surgical management is needed. Previously these surgeries were done by conventional open technique. With the evolution of minimal access surgery it has now possible to do these surgeries by laparoscopic methods. Case Presentation: We here by present a case of 75 year old male patient presented with passage of dark colored blood mixed stools with tenesmus, pain and diarrhea. Patient had surgical history of transurethral resection of the prostrate (TURP) done for Benign Prostatic Hypertrophy. The tissue diagnosis of specimen was adenocarcinoma of prostate. Patient had received radiotherapy 9 months back for that prostatic carcinoma. The colonoscopy was suggestive of severe distal rectal proctitis, which was managed by laparoscopic proctectomy with partial sigmoidectomy and permanent end sigmoid colostomy. Conclusions: Laparoscopy has definitive role in management of chronic radiation proctitis, blessing the patient with benefits of minimal access surgery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.