Diabetic foot wounds present a great challenge to surgeons. They are difficult to heal and are a significant risk factor for non-traumatic foot amputation besides being a huge financial burden. NPWT systems commercially available (VAC™ system, KCI Inc., USA) are costly precluding widespread use. To determine whether negative-pressure wound therapy (NPWT) would afford quicker wound recovery as compared to saline-moistened gauze in the treatment of diabetic foot wounds. Sixty patients were randomized into either the experimental NPWT group or conventional dressing group (control). All patients were given medical therapy for diabetes and antibiotics given according to culture and sensitivity patterns. All foot ulcers were surgically debrided prior to initiation of NPWT or conventional treatment. In the NPWT group, dressings were changed every 48-72 h. In the control group, conventional dressings were applied at the time of surgical debridement and changed twice a day thereafter. End point of study was when wound was ready for either skin grafting or secondary suturing. End point was achieved in the NPWT group in 17.2(SD±3.55) days, compared to 34.9 (SD±5.96) days in the control group (p<0.001). Number of dressing applied were 7.46(SD±2.25) in NPWT group versus 69.8(SD±11.93) in conventional dressing group (p<0.001). Ninety percent cases were successfully treated in NPWT Group as compared to 76.6 % in conventional group. Rate of healing of ulcer is faster in NPWT group as compared to conventional group. Economically modified NPWT is more cost-effective to the patients in our setup.

INTRODUCTION: Intestinal anastomosis is a surgical procedure to establish communication between two separated portions of the intestine. This procedure restores intestinal continuity after removal of a pathological condition affecting the bowel. Intestinal anastomosis can be performed by a hand-sewn technique using absorbable or non-absorbable sutures, mechanical stapling devices. Sutured anastomosis (hand-sewn technique) is the commonly used method. The newer stapling devices for intestinal anastomosis has provided an alternative option to perform rapid anastomosis.1 Various studies have contradictory results in terms of duration of procedure, post operative recovery and anastomotic leak. There are insufcient evidence to demonstrate superiority of either technique and more studies are needed to demonstrate the superiority of either technique. AIM MATERIAL AND METHODS:: To study and compare the effectiveness of staplers vs hand sewn anastomosis in Intestinal surgeries. A comparative observational study Consists of patients presenting with need of bowel resection and anastomosis inclusion criteria at Apollo Hospital Gandhinagar, Gujarat. The patients who are admitted for elective as well as emergency resection & anastomosis of small and large intestines for various illnesses are selected after thorough clinical examination and investigations to conrm the diagnosis co- morbid conditions. Details were recorded in the proforma prepared. : 62.5% complications in comorbid subjects and 37.5% complications in non comorbid subjects.RESULTS The mean of anastomotic time for hand sewn group was 27.8 minutes whereas for the stapler group it was 9.0 minutes mins .With respect to return of bowel sounds, mean time was 46.32 hours in the hand sewn group and 35 hours in the stapler group Mean day of hospitalization was 8.16 days in hand sewn and 7.8 days in stapler technique. mean time taken for resumption of oral feeds the was 66.96 hours in hand sewn group and was 59.52 hours in stapler group .hand sewn group had total ve complications(20%), whereas stapler group had three complications(12%) Both the groups did not have any mortality. The mean cost of hand sewn anastomosis is 717.4 Rs which is signicantly less than mean cost of stapled anastomosis which is 33,754 Rs. : Stapler anastomosis signicantly reduces operative time and time taken for return of normal bowel sounds.CONCLUSION Because of the shortened total operating time in the stapled anastomosis .There is increased risk of overall complications in patients having co- morbidities in both hand sewn and stapled anastomosis. Mechanical staplers are far more costly than suture materials. Stapling technique can be used safely and effectively