Background: The last century has witnessed immense evolvement of management of patients with abdominal trauma. Moreover the recent trend has shifted to selective operative management rather than exploratory laparotomy in trauma patients with suspected intraabdominal injuries and is considered more rational as well. Diagnostic laparoscopy is highly sensitive in detecting intra-abdominal injury with subsequent reduction in the rate of negative laparotomy and procedure related morbidity. Objective: The study was carried out to find the role of diagnostic laparoscopy in abdominal trauma. Methods: An observational study was carried out in the casualty block of Dhaka Medical College Hospital from 1st June 2015 to 30th March 2016. A total of 50 successive patients were assigned in this study. All of them were admitted with abdominal trauma and underwent diagnostic laparoscopy during the period of 10 months. The study was designed to find out whether laparoscopy can help in identifying intra-abdominal injuries with consequent avoidance of unnecessary operative explorations. Results: Intra-abdominal injuries other than GIT perforation were diagnosed by laparoscopy with 100% accuracy but in case of bowel injury the diagnostic accuracy was 80%. Conclusion: Diagnostic laparoscopy is the procedure of choice in doubtful intra-abdominal injuries with impressive accuracy except for bowel injury. Subsequently it reduced the need for negative laparotomies with their procedure related adverse effects. Journal of Surgical Sciences (2018) Vol. 22 (1): 47-51
Background: Despite the improvement in availability and utilization of Long Acting Reversible Contraceptive (LARC) methods which comprises intrauterine contraceptive devices(IUCD) and implants, premature discontinuation is becoming a public health concern and its consequence may lead to failure of a program. Therefore identifying the causal factors are important for designing a strategy to overcome the problem. Objectives: To measure discontinuation of intrauterine contraceptive device (IUCD) and implants and identify baseline characteristics associated with premature discontinuation. Materials and Methods: This retrospective study was conducted among the clients attended in Model Family Planning Clinic of Dhaka Medical College Hospital from January,2018 to December, 2018. Records of all clients who discontinued LARC prematurely (before device expiration) and clients who wished for discontinuation but did not do so during this period were explored. Results:Total 233 implants were removed during the study period among them 87 were removed before their expiry date. Total 252 clients came for early removal (within 1 year of insertion) of cuT but only 39 were removed. On the other hand 82 clients came for premature discontinuation(after 1 year of their insertion) during this period, among which 18 were removed before the date of expiry. Side effects associated with the method itself and the procedure, expulsion, failure and other similar inconveniences contributed for discontinuation. Conclusions: Higher level of discontinuation of LARC may substantially contribute to high fertility rate, unwanted pregnancies and induced abortions. Also, premature termination makes the method less cost effective. Therefore appropriate counseling, follow up care and management of side effects along with information on contraceptive effectiveness, insertion and removal procedure are very important. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 112-118
Background: Chronic anal fissure is a benign disorder that is associated with considerable discomfort. Surgical treatment in the form of lateral internal sphincterotomy has long been regarded as the gold standard of treatment. Two methods of sphincterotomy are currently practiced: open or closed technique. Objective: The objective of this study was to compare the early outcome of closed versus open lateral internal anal sphincterotomy for the treatment of chronic anal fissure, based on the assessment of post-operative pain and complications. Methods: A comparative study was conducted at the department of surgery in Dhaka Medical College & Hospital, over a period of 6 months from April 2015 to September 2015. A total of 80 patients were purposefully included in this study and were equally divided into two groups; Group A included 40 patients undergone closed lateral internal anal sphincterotomy and Group B included 40 patients undergone open lateral internal anal sphincterotomy. Patients were followed up postoperatively for 6 weeks to assess any complications. The outcomes were compared between the groups using the Chi-square (x2) test and Student's "t" test. Results: Delayed postoperative healing was found in 7.5% patients of the open lateral internal anal sphincterotomy group. The mean pain score and duration of hospital stay were lower in closed lateral internal anal sphincterotomy group. Conclusion: Closed lateral internal sphincterotomy is preferred to open technique in the treatment of chronic anal fissure, as it is effective, safe, less expensive, and is associated with low complication rate. Journal of Surgical Sciences (2018) Vol. 22 (1): 52-57
The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), has evolved rapidly as a global pandemic stretching the healthcare systems worldwide to their limits. This pandemic has resulted in significant changes to surgical practice across the world. Surgeons need to react immediately to this unexpected clinical challenge in a customized and dynamic approach to the selection, screening, planning, and conduct of surgery for their patients. This current literature will review various international society guidelines to provide a set of recommendations to safely accommodate the exponentially rising cases of SARSCoV- 2 infected patients without compromising the care of emergency surgery and oncological patients or jeopardizing the well-being of hospital staff. The recommendations include guidance for selection and screening of patients during different phases of COVID-19 spread throughout the country. Personal protective equipment requirements for safety measures are also reviewed for each phase as minimum requirements. We also provide recommendations on the patient prioritization for surgery, selection of surgical techniques to reduce transmission and exposure risk, operating room set up and conduct of general surgery. During the COVID-19 pandemic, every surgical unit needs to follow clear guidelines to ensure both patient and staff safety. These current guidelines may assist to provide guidance to units in developing their own protocols. J Bangladesh Coll Phys Surg 2020; 38(0): 116-121
Background: Peptic ulcer perforation management is still an enigma. Though the overall incidence has been reduced worldwide due to wide use of anti-ulcerants, still it is not uncommon. But there is a debate regarding its conservative management over surgical management. Objective: To determine whether surgery could be avoided in selected patients with perforated peptic ulcer disease Methods: This study was conducted in the department of Surgery of Sir Salimullah Medical College and Mitford Hospital during the period from 1st March 2016 to 31st August 2016. After approval from the institutional ethics committee, 30 patients of suspected perforated peptic ulcer disease were successively assigned in this study on clinical and radiological basis. All were given non-operative regimen up to 24 hours. Then they were closely monitored to see improvement of clinical condition or development of any complication. Non-operative treatment was abandoned if the patient failed to improve or deteriorated within 24 hours of non-operative treatment. The data were collected by active participation of patients’ interview in preformed data collection sheet. Results: The data analysis of 30 patients yielded that most of them (86.67%) recovered well after receiving non-operative management, whereas only 4 patients (13.33%) showed no progression and were treated by laparotomy. 73.08% patients with uneventful outcome left the hospital within 10 days of admission and the others were a little late to leave. Conclusion: Patients with perforated peptic ulcer disease can be effectively treated by conservative approach in properly selected cases by proper monitoring under strict supervision of an experienced consultant. Journal of Surgical Sciences (2018) Vol. 22 (2) : 95-98
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