Background: Inguinal hernia is common surgical problem for which mesh based technique, particularly Lichtenstein repair is considered gold standard. However it has its own limitation such as foreign body sensation, wound infection, cord fibrosis, chronic pain, etc. Desarda technique for hernia repair is emerging technique for inguinal hernia repair known for its low cost procedure, less recurrence rate and feasibility of the procedure. The objective of the study was to compare treatment of primary inguinal hernia repair with these methods in terms of various operative and post-operative parameters.Methods: 64 patients included in the study and operated after randomization. Intra-operative time, local complication, return to everyday activity, post-operative pain, foreign body sensation and early recurrence were analysed.Results: 51 patients were analysed with a minimum follow up period of 3 months and rest were lost on follow up. Operative time was less in Desarda’s repair (28.24 vs. 30.88 min). Desarda repair was cost effective, return to everyday activity was early in Desarda group, there was significantly (p<0.001) less post-operative pain measured on VAS on 2nd POD, 7th POD and 1 month. No recurrence observed.Conclusions: Desarda repair is easy to perform and takes less time to perform, it is also cost effective. Desarda repair when compared with Lichtenstein was superior in terms of postoperative pain, return to everyday activity and no foreign body sensation. Desarda repair is superior to mesh based technique in terms of outcome.
Background: Appendix is a vestigial organ in human body. Inflammation of appendix is termed as appendicitis. The diagnosis of appendicitis still holds dilemma amongst surgeons leading to negative appendectomies on one hand and appendicular perforation on the other hand of therapeutic spectrum. Judicial patient selection for appendectomy and follow up histopathological examination for incidental findings is the cornerstone in management of appendicitis. The current study aims to assess the demographic and histopathological findings of all the appendectomies occurring within study period at our center.Methods: It was a retrospective study over two years done in a teaching hospital of Dehradun. Hospital records were retrieved from medical records department and looked for histopathological findings, demographic details and intervention. The data was analyzed in SPSS version 23. Qualitative and quantitative data were expressed in proportions and mean respectively. T-test was applied for comparison.Results: About 2/3rd of participants were males. The peak age was 20-30 years. 100 underwent open appendectomy and 45 had lap appendectomy. Commonest histopathological exam finding was acute appendicitis (46.2%) followed by peri appendicitis (40%) and resolving appendicitis (28.9%). One specimen had tubercular appendix. There were no negative appendectomies.Conclusions: Elective appendectomy in patients satisfying clinical, lab and radiological criteria can reduce negative appendectomies. Histopathological examination of appendix still holds a valid role for any incidental findings requiring further management.
Background: Post-operative adequate analgesia plays an important role in early mobilization, short hospital stay and patient satisfaction in laparoscopic cholecystectomy. The use of opioids for providing postoperative analgesia has been marked by side effects like vomiting, nausea, sedation, respiratory distress, etc. hence, alternate drugs like paracetamol (PCM) and diclofenac are commonly used. In this study, we have compared the analgesic efficacy and any associated side effects of the two commonly used non-opioid NSAIDS namely paracetamol and diclofenac.Methods: We compared 50 patients undergoing laparoscopic cholecystectomy in ASA I and II. They were randomly divided into two groups, Group A and Group B. Group A was administered intravenous PCM and Group B was administered injection diclofenac sodium. Postoperatively, these patients were assessed for pain, blood pressure, respiratory rate, and presence of any side effects like nausea, vomiting or any respiratory discomfort.Results: The mean DBP, MAP and VAS score was significantly (p-value <0.05) in Group A as compared to Group B patients at 4, 8, 12 and 24 hours postoperatively. There was no statistically significant difference in mean SBP and O2 saturation in both groups. The mean pulse rate was lower in Group A as compared to Group B at 8, 12 and 24 hours.Conclusions: This study concluded that postoperative PCM infusion provided better analgesia for a prolonged period of time with minimal side effects.
Background: Cholelithiasis is one of most common condition requiring surgical intervention specially in females in Indo-Gangetic belt. Techniques of cholecystectomy have evolved from open to laparoscopic procedures. Efforts have been made to perform it with lesser ports for better operative outcomes like less complications and better cosmetic appearance. This study aims to compare the postoperative outcomes of 4 port versus 3 port laparoscopic cholecystectomy.Methods: This is a prospective comparative study. 104 patients for 4 port laparoscopic cholecystectomy and 110 patients for 3 port cholecystectomy were allocated randomly. Preoperative assessment was done in both the groups and Informed consent was taken. Intra operative parameters like duration of surgery, blood loss, surgical complications were assessed. Postoperative follow up was done at 1 week, and scar assessment at 2 weeks. Findings were entered in Microsoft Excel and analyzed using SPSS by applying t-test and chi-square test.Results: Female: male ratio was 14:1 and age varied between 32-51 years. The mean operative time was in 3 port was 64.6 min and 56.42 min in 4 port (p<0.05). Complications like conversion to open procedure, bleeding from liver bed, cystic artery bleeding and port site infections were comparable in both groups. Analgesic requirement was significantly less after 24 hours in 3 port (p=0.02).Conclusions: 3 ports cholecystectomy is better in terms of lesser postoperative pain, cosmetic outcome, hospital stay, lesser assistance. The authors recommend 3 ports LC as a routine procedure in gallstone diseases.
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