Objective: This study is done to compare the fistulotomy and fistulectomy for the treatment of fistulas in ano. This study is designed for the comparison of these surgical procedures to find out their results. Materials and methodology: this study was done at the surgery department of Sir Ganga Ram hospital Lahore during Jan 2021 to Dec 2021. 60 patients were included in this study and they were divided in two groups each of 30 participants. The group 1 patients were treated with fistulotomy while those of group 2 were selected for fistulectomy surgeries. The patients aged 20 years to 65 years were part of this study who were admitted to the department of surgery for planned fistulas operations. Before surgery Consent was taken from the patients themselves or by their close relatives.
Objective: Current study aims to compare the Limberg flap technique with primary midline wound closure to treat the chronic pilonidal sinus disease. Study design: A comparative study was done in Surgery Department Sir Ganga Ram Hospital Lahore from January 2020 to September 2021 Method: The sample size for the study is 60 patients who were regularly visiting the hospital due to PS disease. All the patients were divided into two groups A and B. Group A had 30 patients treated with the Limberg flap method and group B had 30 patients treated with primary midline wound closure. Before starting the treatment a brief description of the treatment was given to all patients and consent was signed from all participants. The final decision for treatment was decided by the team of senior surgeons as well as with help of the patient's own choice. Limberg flap and primary midline wound closure (PMC) were applied to patients who regularly followed the instruction for chronic pilonidal sinus treatment. Primary midline closure was applied on patients who had a cosmetic concern and did not have a recurrence problem. Results: Total 60 patients were divided into two groups, Group A (Limberg flap) had 30 patients in which 25 (83%) were males and 5 (16.6%) females. The mean age for this group was 25 ± 5.00 years. The patients without a previous history of pilonidal sinus disease (primary case) was 17 (56.6%) and the recurrence case was 13 (14.3%). Group B (primary midline wound closure) had 30 patients in which 18 (60%) were males and 12 (40%) females. The mean age for this group was 28 ± 3.00 years. The patient without a previous history of pilonidal sinus disease (primary case) was 28 (93.3%) and the recurrence case was 2 (6.6%). The comparison of 3rd-week outcomes shows that in group A 25 (83,3%) patients had painless walking, 23 (76.6%) patients start their routine work and 26 (86.6%) patients had treatment satisfaction. In group B 21 (70%) patients reported painless walking, 18 (60%) patients started their routine activity and 22 (73.3%) patients shows satisfaction with treatment. Conclusion: Hence we concluded that a better improvement percentage was measured high in group A (Limberg flap) than group B (PMC). Therefore limberg flap is better technique to treat the chronic pilonidal sinus disease. Keywords: chronic Pilonidal Sinus, primary midline wound closure (PMC), Limberg flap
Background: Mostly bacterial infections are treatable with oral and injectable antibiotics, but surgical site infections (SSI's) are an important root cause of post-surgical mortality and morbidity. We have undertaken this study in our department to find out the bacterial micro flora isolated from surgical site infections of clean and clean contaminated wounds and their antimicrobial susceptibility at Surgical Unit I, JHL. Methods: It was a descriptive case series study carried out at Surgical Unit I, Department of Surgery Jinnah Hospital Lahore/Allama Iqbal Medical College. Total 60 cases were selected who developed surgical site wound infections within 30 days postoperatively. Patients with clean and clean contaminated wounds were included and those with dirty and contaminated wounds were excluded. Patient having diabetes, chronic liver disease, on immunosuppressant drugs were also not included. Wound swabs were taken from surgical site infected patients for microbiological analysis and drug sensitivity. Swabs were transported to the microbiology laboratory of JHL. Their culture and sensitivity report was recorded in a predesigned proforma. Results: A total 60 patients were included who developed SSI post-operatively within 30 days. The age range of patients was 18–70 years, with mean age of the patients 38.5 year. There were 38(63.33%) female and 22(36.66%) male patients. There were 28(46.66%) elective operations and 32 (53.33%) emergency operations. Our study patients who developed SSI postoperaticely were discharged from the hospital and were managed on OPD basis, while no patient died due to SSI. Amongst the positive growth cultures, the most common pathogenic micro flora isolated was Eschericia Coli with an overall incidence of 18(30%) followed by Staphylococcus aureus in 14(23.33%) cases. Meropenem was 100% effective against all E. coli isolates and all MRSA positive 8(13.33%) cases showed sensitivity to vancomycin. Conclusion: In our study patients who had SSI, Escherichia coli was the most common bacterial pathogen isolated from wounds and high resistance to antibiotics was observed amongst various microbial flora thereby regular antimicrobial susceptibility tests and antibiograms should be carried out in SSIs. Keywords: Surgical Site Infections (SSIs), clean-contaminated, anti-microbial susceptibility, cultures.
Aim: To compare the outcomes of both 0.2% glyceryl trinitrate and lateral sphincterotomy to treat the anal fissure. Study design: Comparative study. Methods: This study was performed at the surgery department sir Ganga Ram Hospital hospital Lahore, Pakistan from 1st June 2020 to 30 Dec 2021. Total 80 patients were the participant of this study. After the diagnosis of anal fissure and before the starting treatment, a detailed scenario of its treatment, process, side effects, and chances of recurrence were explained to patients then consent was signed by the individual patients. Patients were divided into two groups to compare the outcomes of both sphincterotomy and glyceryl trinitrate. Group A had 40 patients and Group B had 40 patients as well. The age of all the patients was above the 18 years. Results: Group A had 14 (35%) patients of age range 18-30 years and 26 (65%) of 31-60 years old. 13 (32.5%) females, 27 (67.5%) males, mild pain in 10 (25%), severe pain in 30(75%), Constipation was reported in 16(40%) patients and 29(72%) patients had bleeding issues. Group B found with 17 (42.5%) patients of age range 18-30 years and 23 (57.5%) of 31-60 years old. 10 (25%) females, 30 (75%) males, mild pain in 12 (30%), severe pain in28(70%), Constipation was reported in 20(50%) patients and 31(77%) patients had a bleeding issue. The final comparison after six weeks of treatment shows the 65% of patients healed with the lateral sphincterotomy and 47% of patients healed with ointment of 0.2% glyceryl trinitrate. The healed proportion was measured high for the lateral sphincterotomy treatment as compared to the ointment of 0.2% glyceryl trinitrate. Conclusion: We concluded that lateral sphincterotomy has an effective response to treat the anal fissure as compare to 0.2% ointment of glyceryl trinitrate. Keywords: Lateral sphincterotomy, ointment of 0.2% glyceryl trinitrate, anal fissure.
Objective: The main purpose of the study is to compare the outcomes of Limberg flap and open procedure to treat the chronic pilonidal sinus. Pilonidal sinus is a disorder of the sacrococcygeal region mostly found in younger folk. Its treatment consists of several methods but in this study, we will go through Limberg flap and open procedure to compare the outcomes of both methods. Study design: Comparative study. Material & Methods: This study was conducted from January 2020 to December 2022. 84 patients included 59 males and 25 females having age between 18 to 40 years were part of the study. All the selected patients were diagnosed with chronic pilonidal sinus and recommended for surgery at sugery Unit1 sir ganga ram hospital Lahore, Pakistan. A total of 84 patients were divided into two groups, group1 consists of 42 patients treated for the Limberg flap technique. Group 2 also contains 42 patients treated for an open procedure. The patients who were suffering from the chronic pilonidal sinus were part of the study while patients who had acute inflammation of the sinus, history of previous treatment of pilonidal sinus were omitted from the study. Results: Out of 84 patients 42 were part of group 1 and the remaining 42 were in group 2. In group1, the mean ±SD age of patients was 26 ± 2.00, 30 (71.4%) males and 12 (28.5%) females. While in group2 the mean ±SD age was 25 ± 3.00, 29 (69%) were males and 13 (30.9%) females were part of this group. The measured p-value for both groups was <0.05. General characteristics of patients show that high percentage of males was affected from pilonidal sinus disease. In group1 patients who had a 2 days stay at the hospital, recurrence was reported in 10 (23.8%) patients with P-value >0.05, irregular scar formation was observed in 16 (38%) patients, the pain was reported in 18 (42.8%) patients, and wound healing after 2 weeks was noted in 20 (47%) patients. In group 2, patients had 6 days stay at the hospital, recurrence was reported in 13 (30.9%) patients with value >0.05, irregular scar formation was observed in 26 (61%) patients, the pain was reported in 34 (80%) patients and wound healing after 2 weeks was noted in 12 (28.57%) patients. p-value was measured <0.05 for all the parameters. Conclusion: Eventually, we concluded significant results of the Limberg flap than the open procedure. A high percentage of complications were measured in patients treated with the open procedure in comparison to the Limberg flap. Keywords: Chronic pilonidal sinus, Limberg flap, open procedure.
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