Introduction:Fournier's gangrene is an aggressive disease with high morbidity and mortality. The aim of this study was to assess risk factors associated with mortality among patients of Fournier's gangrene.Materials and Methods:Between May 2011 and September 2012, all patients of Fournier's gangrene treated at our center were included in the study. All patients underwent emergency surgical debridement and received broad spectrum intravenous antibiotics. Their baseline characteristics, treatment, and follow-up data were recorded and analyzed.Results:A total of 30 patients were included in the study. Of these, six patients (20%) died during the treatment. Age <55 years, total leukocyte count <15000 cumm, extent of the area involved, septic shock at admission, visual analog scale (VAS) <7 at admission, and Fournier gangrene severity index (FGSI) score <8 at admission were significantly associated with increased mortality.Conclusion:In patients of Fournier's gangrene, increased age, total leukocyte count, extent of the area involved, septic shock at admission, VAS score, and FGSI score at admission have a significant association with mortality.
Biliary obstructions are rarely caused by a foreign body and have received sparse attention. We present an unusual case with pruritis and abdominal pain caused by impacted full length surgical gauze within the common bile duct. The patient had previously undergone an open cholecystectomy. Radiological investigations were inconclusive and suggestive of either a calculus or a cholangiocarcinoma. Surgical exploration revealed full length surgical gauze within the common bile duct. Because imaging modalities are often non-determinant, the possibility of biliary tract obstruction from a foreign body should be borne in mind for patients with unusual presentations, especially those who have previously undergone surgery.
INTRODUCTION:Laparoscopic Cholecystectomy has evolved as the standard of care for the treatment of Gall Stone disease over the past decade. Several patient and procedure related factors have been implicated in setting of failure to complete the procedure by minimal invasive method and various scores have been developed to precisely predict a Difficult Laparoscopic Cholecystectomy. AIMS: The present study was conducted to ascertain various patient related preoperative risk factors for conversion of laparoscopic Cholecystectomy to open method and to validate the Risk Score for conversion. SETTINGS & DESIGN: A total of 100 patients with diagnosis of Gall Stone Disease admitted to our surgical Unit between October 2011 and April 2013 were assessed for various pre-determined risk factors and were accordingly categorized into three levels of anticipated difficulty according to RSCLO and our new scoring system. The patients were then subjected to Laparoscopic Cholecystectomy by the same surgical team and the procedure was then graded as difficult or not according to the pre-defined criteria. The findings were analysed by appropriate statistical analysis. RESULTS: Presence of factors like Male sex, history of attacks of acute cholecystitis, increased GB wall thickness, presence of supra-umbilical abdominal scar, obesity and a contracted GB were associated with a significantly higher rate of conversion to open method. RSCLO was found to correlate better with the outcome in this setting than our New Scoring System. CONCLUSION: Several patient related factors may be helpful in predicting a Difficult Laparoscopic Cholecystectomy pre-operatively. RSCLO Scoring system may be useful as a pre-operative tool to predict intra-operative difficulty during LC. KEY WORDS: Difficult laparoscopic Cholecystectomy, RSCLO, pre-operative factors. INTRODUCTION:Laparoscopic Cholecystectomy has evolved as the Gold Standard procedure for treatment of Gall Stone Disease. In approximately 2-15% of the patients failure to achieve the desirous aim mandates the conversion of the procedure to Open Method 1. Various patient and procedural related factors have been implicated for this conversion. Extensive studies and various protocols have also been suggested to identify 'Difficult Laparoscopic Cholecystectomy' preoperatively. Previous attacks of acute cholecystitis, GB wall thickness, inability to delineate the anatomy and previous abdominal surgery are some of the factors that have been identified as potential risk factors for the conversion. The present study was conducted to ascertain patient related pre-operative risk factors for conversion of laparoscopic Cholecystectomy to open method and to validate the Risk Score for conversion.
BACKGROUND Prospective studies and Meta-analysis have indicated that non-mesh repair is inferior to mesh repair based on recurrence rates in inguinal hernia. The incidence of complications immediately and later in postoperative period in either of the repairs are also less in the mesh repairs as compared to the non-mesh repairs.
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