Peptic ulcer perforation is a common lifethreatening emergency needing immediate intervention. Laparoscopic closure of perforation is now widely practiced over conventional open closure. This study aimed to compare laparoscopic peptic ulcer perforation closure with conventional open closure in terms of operative time, postoperative analgesia, complications, hospital stay, and return to routine activities. This unicentric, nonblinded, prospective, randomized study was carried out in 50 patients with peptic ulcer perforation who were randomly allocated to undergo either laparoscopic closure or open closure surgery with 25 patients in each group. The mean operative time (60 vs 90 min) was less in the laparoscopic group (p<0.05). Postoperative analgesia requirements (1 vs 6 days) were also less in laparoscopic patients (p<0.05). Complications (nil vs 6; p<0.05) and hospital stay (3 vs 8 days) were less in laparoscopic patients (p< 0.05). Patients return to normal activities (5 vs 10 days; p< 0.05) earlier in laparoscopic perforation closure than in open closure. Our study has shown better outcomes and lesser morbidities with laparoscopic approach in terms of shorter operative time, shorter hospital stay, less analgesic requirements, and less wound infections. Patients also return to routine activities earlier with the laparoscopic approach. It is a safe alternative to open surgery and should be a preferred choice when there are no contraindications to laparoscopy.
Loop ileostomy is a commonly performed procedure for various surgical operations and is now gaining on conventional loop colostomy. There are different methods of loop ileostomy closure. This study was carried out to compare hand-sewn loop ileostomy closure and stapler anastomosis side-to-side closure. AIMS: To compare both types of closure in terms of operative time, patients' hospital stay, postoperative complications like anastomosis leak, postoperative intestinal obstruction etc., and finally cost effectiveness. MATERIALS AND METHODS: This study was carried out in 50 patients of loop ileostomy closures. Twenty Five (25) patients were taken in each type of closure selected randomly and outcome was compared for parameters like operative time, postoperative complications like anastomosis leak and postoperative obstruction, hospital stay and cost effectiveness. RESULTS: The average operative time for the hand-sewn group was 51 minutes and for the stapler group it was 42 minutes. Anastomotic leak or fistula formation occurred in 4% and small bowel obstruction occurred in 8 % of patients of the hand sewn group and in none of the stapler group. The average duration of hospital stay for the stapler group was 8 days and for the hand-sewn group it was 9 days. However, cost was significantly higher in the stapler anatomosis group. SUMMARY AND CONCLUSION: It was evident that stapler closure was more effective than hand-sewn loop ileostomy closure in prevention of postoperative complications; however, cost was a major factor against it.
Introduction: Blunt abdominal trauma occurs when injury to organs inside abdominal cavity is present due to external forces exerted over abdomen as result of trauma. Wide spectrum of clinical presentation is seen ranging from milder forms of injury to fatal solid organ injuries with irreversible shock and ongoing bleeding. Management ranges from watchful observation to emergency laparotomy. Aim of this study was to evaluate different clinical presentation, organ specific injury and management of blunt abdominal trauma. Material and Methods: A retrospective study with 25 patients sustaining Blunt abdominal trauma who came to Trauma centre in Guru Gobindsingh Government Hospital, Jamnagar attached to medical college from 2016 to 2018 were included. The patients were selected randomly. Results: Blunt abdominal injury was seen in all age from 1 to 60 years. Highest incidence noted in age group 11 to 20 years. Male predominance was noted with Male: Female ratio21:4 of 5.25:1.Most common mode of injury was road traffic accident (44%). Most common injured organ was Liver (32%). Liver and spleen injuries were associated with rib fractures. Abdominal pain and tenderness was most common clinical presentation (90%). Patients with hemodynamic instability had more mortality. Conclusion: Blunt abdominal injury is one of the commonest injuries encountered in polytrauma patients. Morbidity and mortality can be prevented by timely initial resuscitation and correct diagnosis as well as management (operative or non operative) which depend on patient's hemodynamic stability and findings of imaging studies.
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