Objective: To determine the frequency of fecal incontinence in the two-staged Seton fistulotomy in complex fistula in ano. Study Design: Prospective Cohort study. Setting: Surgical Out-patient Department at Shaikh Zayed Hospital Lahore. Period: September 2015 till March 2016. Material & Methods: After ethical review board approval, data was collected from 100 patients who fulfilled the inclusion criteria. All the procedures were conducted in the lithotomy position, under spinal or general anesthesia. A rigid sigmoidoscopy and proctoscopy was done prior to intervention. Fistula tract was marked using hydrogen peroxide (H202) for the identification of the internal opening. The external opening was gently probed using a standard 3 mm blunt-tipped probe till the internal opening was reached. The portion of the track outside the sphincter mechanism and any lateral tracts were laid open. A feeding tube of size 5 French was loosely tied around the remaining muscular portion of the sphincter complex. The seton was left in place for six weeks followed by secondary fistulotomy. Patients were evaluated for incontinence one month after the second procedure. Results: In our study, mean age was calculated as 47.38+10.96 years, 73%(n=73) were male and 27%(n=27) were females, frequency of fecal incontinence in the two-staged Seton fistulotomy in complex fistula in ano was recorded in 17%(n=17). Conclusion: The frequency of fecal incontinence in the two-staged seton fistulotomy for complex fistula in ano was acceptable in our study population and in tandem with literature. The procedure may be a suitable alternative to loose-seton placement alone.
Aim: The outcome comparison of total extraperitoneal versus mesh repair for inguinal hernia. Study design: Quasi experimental study. Place and duration of study: Department of Surgery, M. Islam Teaching Hospital, Gujranwala from March 2018 to March 2019. Methodology: After the approval of hospital ethical committee, a total of 50 patients were included and randomly divided into two groups equally. Group A (Total extraperitoneal), Group B (Mesh repair). An informed consent was taken from every patient about operative procedure and the outcome. A detailed history of the patient i.e. clinical examination, routine investigations (CBC, Urine R/E, urea, creatinine) and some specific investigations (chest X-ray, ECG and ultrasound abdomen and prostate) was done for surgery. All data of patients was collected on proforma and was analyzed with the help of a computer SPSS programme 20. Results: The mean age of patients was 34.22±11.54 years in group A and 35.63±11.25 years in group B. All male and female patients included in this study in both groups. Twelve (48%) of patients were direct inguinal hernia in group A 13(22%) were in group B and 14(56%) patients were in group A and 11(44%) patients were in group B. The mean±SD postoperative hospital stay was 24.48±4.62 in group A and 34.65±12.26 hours in group B (p 0.001). The mean±SD postoperative recovery time in weeks was 2.18±0.43 in group A and 2.90±0.46 weeks in group B (p 0.001). Only 2 (4%) patient had postoperative infection on first week and 4 (8%) patients had infection respectively. No recurrence was seen in group A and only 3% recurrence was in group B. Conclusion: It is concluded that group A had shorter hospital stay, recovery time, postoperative time and less infection rate as compared to group B. In group A 13% patients had severe pain and in group B 25% patients. Keywords: Inguinal Hernia, Total extraperitoneal, Mesh repair.
Background: Pilonidal sinus is disease of young age andits prevalence is higher in men compared to women (almost twice).It is a disease that arises from hair follicles particularly present in the natal cleft. It occurs commonly in Jeep Drivers and hence gets the name from there “Jeep Drivers Disease” and also commonly occurs in Barbers. It leads to formation of abscesses and chronic wounds with discharge and pain. Disease can have huge impact on social life and quality of life. In most cases the treatment is incision and drainage. Study design: It is a case series study. Place and duration of study: Department of General Surgery at Shaikh Zayed Hospital Lahore from January 2019 to January 2021. Aim: To compare the relative effects of open and closed surgical techniques on the recurrence rate, rate of infection and time of healing for pilonidal sinus. Methodology: Patients with pilonidal sinus disease from January 2019 to January 2021 received surgical treatment either excision followed by primary closure as in closed technique (group A) or excision followed by leaving the wound open for healing by secondary intention as in open technique (group B). Surgical management is widely based upon two techniques open and closed. In open technique wound is left open and heals by secondary intention while in closed technique it is closed primarily and heals by primary intention. The better choice between these two techniques is still a topic of debate. Results: The most common age group for pilonidal sinus was between 16-25 years of age. The mean age came out to be 26.7 years. The mean healing time was 15 days in group A and 42 days in group B. The duration of hospital stay ranged between 2-8 days for group A and 5-16 days for group B. Early postoperative complications seen was infection in 1 patient (7.69%) in group A and 5 patients (35.71%) in group B and these cases were managed conservatively.1 (7.69%) case of aseptic gaping of wound after stitch removal was seen in group A and was managed with closed technique. Recurrences reported in group A was 1 case (7.69%) at 6 months and was surgically managed by open technique. There were a total of 4 (28.57%) recurrences which were left open to heal by granulation. Conclusion: It is concluded that better management option for pilonidal sinus disease is primary closure of defect. So it is suggested that management of pilonidal sinus disease should be individualized but preference must be given to closure of wound after excision. Keywords: Pilonidal sinus, Primary Closure, Open Technique.
Aim: To study about the management of duodenal injury in two clinical aspects, blunt and penetrating injury, along with its complications. Study design: Observational case series. Place and duration of study: Accident & Emergency and General Surgery Departments at M. Islam Teaching Hospital, Gujranwala from March 2019 to March 2020. Methodology: One hundred patients presenting in Accident & Emergency and General Surgical Department of with penetrating chest trauma as diagnosed clinically were included. Routine investigations like complete blood tests, X-rays and special investigations i.e. ultrasound, CT scan were done only in cases where patients were stable. Each hemithorax was divided into medial and lateral hemithorax by an imaginary line drawn longitudinally from clavicle down to the costal margin passing through the nipple. All patients were observed for the type of treatment they were getting i.e. thoracotomy or tube thoracostomy. Patients who were initially treated with tube thoracostomy were cautiously observed for any developing indications for thoracotomy. If such indications arose thoracotomy would be arranged at the earliest possible. Results: A total of 100 patients, 85 (85%) were males and 15 (15%) were females. Male to female ratio was 5.66:1. The mean age of patient was 35.65±9.75 years. There were 38 (38%) had road traffic accidents, 10 (10%) were fall, 7 (7%) injured with fight, 41 (41%) victims of firearm injury and only 4 (4%) victims of stab. The mean blood pressure was 82.15±7.97mmHg. Eighty five (85%) patients were stay in the hospital for 2 weeks and while 15 (15%) were hospital stay >2 weeks. The mean values of hospital stay was 12.45±4.16 days. Conclusion: It is concluded that penetrating thoracic trauma is a major cause of morbidity and mortality. The overall complications rate for blunt trauma injuries after adequate treatment is 18% and mortality rate is 8%. Keywords: Blunt trauma, Thorocotomy, Tube thoracostomy, Pneumothorax
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