Background: The word anastomosis originates from the Greek word (ἀναστόμωσις) meaning communicating opening. Gut anastomosis is one of the frequently performed surgeries in both emergency and elective setup. Anastomosis following gut resections in emergency set up is mostly done due to traumatic rupture, benign or malignant perforation or obstruction and in certain other inflammatory conditions. Anastomosis is also done in some elective conditions like mostly due to malignancy of GI system. As conventional practice following gut anastomosis, patients are kept “NIL BY MOUTH” till bowel sounds return.Methods: It’s a prospective study, carried out over period of 18 months in Department of General Surgery, Sri Guru Ramdas Institute of Medical Sciences and Research, Vallah, Amritar. The objective of this study was to whether early enteral feeding within 48 hours of small gut anastomosis is tolerable to the patient. Whether early enteral feeding within 48 hours of small gut anastomosis is beneficial to the patient.Results: This prospectively conducted comparative study was carried out on 60 patients, meeting inclusion criteria, undergoing gastrointestinal anastomosis either elective or emergency, in the Department of General Surgery, SGRD Medical College, between Jan 2012 to June 2013. Random selection of patients into group A (30) and group B (30) was done after having fulfilled inclusion and exclusion criteria. The group A was fed via enteral route within 48 hrs of enteric anastomosis. The group B was fed via enteral route after 48-72 hours or appearance of full peristaltic sounds following enteric anastomosis. These patients were followed in post-operative period for their drain output, any nausea, vomiting, or significant abdominal distension, prolonged ileus, clinical leakage, infective complications, hospital stay.Conclusions: The following inferences can therefore be drawn from this study: Appearance of intestinal peristaltic sounds is earlier in early enterally fed group, Mean duration of post-operative hospital stay is lower in early enterally fed group, mean post-operative day 4 albumin level is higher in early enterally fed group. The rate of infective complications (UTI, RTI, wound complications) is equal in both the groups. The rate of clinical leakage, nausea/vomiting are equal in both the groups. The rate of re-exploration for anastomotic leakage is equal in both the groups.
Background: Pancreatology and pancreatic surgery was developed on the basis of increase in knowledge of anatomy and physiology of the pancreas in the beginning of the 20th century. Although our knowledge of pancreatic head anatomy has increased, anatomical data characterizing the pancreatic ductal system remain limited. Furthermore, the relation of pancreatic ductal system anomalies and different pancreatic disorders remain to be evaluated.Methods: The present study was conducted in Department of Paediatric, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar from August 2014 to November 2016. Total 50 subjects were included. Study was done with aim to study cases clinically and segregate cases with pancreatic disorder which need evaluation by special imaging modalities and surgical management, to compare the nature of information obtained from various modalities to study various corollaries of modern imaging study, to study whether the information from various imaging modalities are complimentary, competitive and to study pancreatic ductal structure in different pancreatic diseases.Results: In the present study, we have a total of 50 patients. Among them 25 (50%) suffer from chronic pancreatitis, 13 (26%) from acute pancreatitis, 6 (12%) from periampullary carcinoma, 3 (6%) from carcinoma head of the pancreas, 1 (2%) from pancreatic ascites following acute pancreatitis, 1 (2%) from annular pancreas and 1 (2%) from cystic neoplasm of pancreas. These patients were investigated by transabdominal USG, MDCT scan, ERCP and conventional and stimulated MRCP to study the pancreatic duct diversities in different pancreatic diseases and the advantage of lemon juice stimulated MRCP over conventional MRCP.Conclusions: Pancreatic disorders were most frequently seen in male patients. Age group between 31 to 50 years were mostly suffering from inflammatory disorders like acute and chronic pancreatitis. The frequency of malignant condition was increased after 50 years of age. Most common pancreatic disorder in our study was chronic pancreatitis. Trans-abdominal USG was found to be very useful initial investigation for the evaluation of pancreatic duct morphology. Best investigation for malignant pancreatic condition was MDCT following pancreatic protocol.
Background: Necrotizing fasciitis including Fournier’s gangrene is an uncommon, critically serious infection of the subcutaneous tissue and fascia with relative sparing of the skin and muscle. Despite modern supportive measures, the reported mortality rate still is high and this is due to part to the aggressive nature of the infection. The present study was performed upon 50 patients to study clinicopathology of necrotizing fasciitis with special reference to Fournier’s gangrene. Methods: This cross-sectional study was conducted in Surgery ward of SGRD Hospital, for a period of 1 year (1st January 2015 to 31st December 2015). The performa filled for patients with necrotizing fasciitis was designed on the basis of NICE guidelines and details like history, examination, general survey, local examination, systemic examination and investigations, statistical analysis of data done. Results: Necrotizing fasciitis, though it is found at any age but is a disease of middle and old aged adults in this part of the world, being commonest in the 4th, 5th, 6th decades of life and is more common in males. The disease is more common in people with low socio-economic groups with poor personal hygiene, diabetes mellitus and history of drug addiction. Trauma is the most common predisposing factor for the necrotizing fasciitis as a whole whereas idiopathic cause is the most common cause in cases of Fournier’s gangrene. Polymicrobial infection is the most common variety, where in E. coli, Streptococcus, Bacteroids are most commonly isolated. Regarding monobacterial infection streptococcus being the most common. Conclusion: Current study showed increased frequency of necrotizing fasciitis in people aged above 40 years. Diabetes mellitus and other premorbid conditions increase the risk of mortality. Polymicrobial infection in combination of Escherichia coli, Streptococcus, Pseudomonas, Bacteroids and Staphylococcus were the most commonly found. Early debridement, parenteral combined antibiotic and supportive measure formed the basis of treatment. Septicemia was a common complication which was often cause death.
Background: Inguinal hernia may be generally defined as a protrusion of viscus or part of a viscus though inguinal canal. The only way recommended to treat inguinal hernias now a day is to perform tension free Lichenstein repair. In this study, we have done a prospective study on clinical outcomes of lichtenstein tension free inguinal hernioplasty under local anaesthesia in Department of General Surgery, Sri Guru Ram Dass Hospital and Research, Sri Amritsar from 15 August 2014 to 15 February 2017, a period of 2 and half years.Methods: A prospective study was conducted in patients admitted in wards with inguinal hernia from General Surgery Outpatient Department. The series consisted of 60 patients between 15 to 74 years.Results: It is found that no recurrence has yet occurred in 2½ years follow up and it is well accepted specially in older age group (55 -74 years).Conclusion: The methods of Lichtenstein’s tension free inguinal hernioplasty under local anaesthesia is safe, simple, effective, economical, and without any side effects such as hypotension, nausea, vomiting, urinary retention, and spinal headache.
Background: Hernia may be generally defined as a protrusion of viscus or part of a viscus though an abnormal opening in the walls of its containing cavity. The Greek word ‘hernia’ means an offshoot, a budding or bulge. But the Latin word ‘hernia’ means a rupture or tear. The most important principle in reconstruction surgery is to avoid tension when restoring the muscular or elastic structures. The modern biologically based concept for repair of groin hernia, acquired during adult life, is application of a patch, avoidance of tension and use of local, spinal or epidermal anaesthesia.Methods: Present study is a Prospective study conducted in the Department of General Surgery in Sri Guru Ramdas Medical College and Hospital. Patients admitted in wards with inguinal hernia from General Surgery out-patient Department were selected for study. The study consisted of 60 patients between 15 to 74 years; The study period is from April 2015 to September 2016. The main aim and objective of any hernia repair is to avoid any recurrence and also acceptability to the patient in terms of pain, discomfort, other complications during follow up and obviously in terms of cost- effectiveness of repair.Results: The present study comprises 60 cases of inguinal hernia who were admitted in the wards of Department of General Surgery in the Sri Guru Ramdas Institute of Medical sciences and research. The study was carried out during span of 1½ years. All of these cases were studied prospectively and results were analysed from various angles. Among total 60 cases in this study, maximum cases belonged to age group 35-44 years ;15 (25%) and minimum to age group 65-74 years 5 (8.3%). Case distribution as per type of hernia, it was observed that among total 60 cases 34 (56.67%)had inguinal hernia and rest 26 (43.3%) had inguino scrotal hernia. Most 0f the cases had right sided hernia 35 (58.33%), left sided hernia was seen only in 23 cases (38.33%) whereas bilateral hernia was present in 2 (3.33%).Conclusions: From our results of observations in the study we can conclude that-The methods of Lichtenstein’s tension free inguinal hernioplasty under local anaesthesia is safe, simple, effective, economical, and without any side effects such as hypotension, nausea, vomiting, urinary retention, and spinal headache.
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