Objective: To evaluate the safety and cost effectiveness of single layer interrupted intestinal anastomosis in comparison with the double layer conventional method of intestinal anastomosis. Study Design : Prospective comparative study. Period & Setting: Surgical unit 4 DHQ hospital Faisalabad operated by single team during 12 months starting from Feb. 2007 to Jan. 2008. Materials and Methods: The cases were assigned to the two techniques, each being applied on alternate patient, single layer extra mucosal interrupted anastomosis anddouble layer anastomosis. In group 1 we used black silk 3/0 and in double layer we used vicryl 3/0 for inner continuous layer and black silk 3/0 for outer continuous layer. Comparison between two techniques was done on the bases of procedure time, cost effectiveness, morbidity in terms of rate of leakage/. Results: Average time for the construction of the single layer anastomosis was 20 minutes and in double layer was 35 minutes, the difference in average time is statistically significant (p<.001) while average duration of stay was 168 hrs and 216 hrs in group 1 and 2 respectively (p<.001). Leakage rate was double (12%) in group 2 while 6% in group 1. Moreover structure material consumption was more in two layered technique and longer stay added to that lead to more hospital expenses on two layered technique. Conclusion: Anastomosis usinga single layer interrupted extra mucosal technique was faster to perform, cost effective, less likely to leak and as strong as a 2-layer anastomosis.
Diabetes mellitus (D.M) is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades. Patients with D.M are prone to multiple complications such as diabetic foot ulcer (DFU). Despite of the advantages of debridement, adequate debridement must always precede the application of topical wound healing agents, dressings or wound closure techniques. Objective: The objective of the study was to compare the efficacy of adjuvant topical oxygen therapy with conventional methods and conventional methods alone in management of infected diabetic wounds. Study Design: Randomized Control Trial. Setting: Surgical Unit III, Allied Hospital, Faisalabad. Period: 4 months from March to June 2017. Methodology: A total of 120 cases included in this study were admitted either through OPD or emergency ward. Group A (Topical oxygen therapy was given along with conventional methods). Group B (Only conventional methods of wound care were applied). All patients were given single dose IV antibiotic half an hour before induction of anesthesia. All diabetic patients were administered regular insulin to control blood glucose levels. Good debridement was done, removing all dead tissue. Simple available cellophane bag applied, sterilized with antiseptic solution, tailored according to size of affected part used tapped on open side of body of patient like tourniquet. 100% oxygen was given in bag with routinely available oxygen cylinder exposing whole affected part of body or limb. Oxygen in chamber was given for maximum one and a half hour twice daily in one sitting for 7-10 days. Gram positive, gram negative and anaerobic cover was given with antibiotics. Wound was washed daily with normal saline. After clinical improvement patient was discharged and called for follow up at outdoor on weekly basis initially and then fortnightly for 6 months. Results: Mean age was calculated as 49.56+7.02 and 49.11+6.59years in group A and B respectively. 53.33% (n=32) in group A and 58.33% (n=35) in group B were males, while 46.67% (n=28) in group A and 41.67% (n=25) in group B were females. Comparison shows that 46.67% (n=28) in group A and 26.67% (n=16) in group B had efficacy; p value was calculated as 0.02 showing a significant difference. Conclusion: Efficacy of adjuvant topical oxygen therapy with conventional methods is significantly higher when compared with conventional methods alone in management of infected diabetic wounds.
Background: Open Lichtenstein inguinal hernioplasty is universally accepted as a safe, well-understood method with a high success rate, the laparoscopicrepair of an inguinal hernia is a comparatively recent technique. Although the laparoscopic approach to a hernia repair procedure is related to less pain and faster recovery than openrepair, many surgeons are not familiar with this technique due to the technical demands and a long learning curve. In literature, there is controversy about the efficacy of both techniques. So, this study is conducted to evaluate a technique with better efficacy that will be offered to the patients in the future. Objectives: To compare the outcome of open mesh hernioplasty (Lichtenstein technique) with laparoscopic total extraperioneal (TEP) mesh repairs for the treatment of inguinal hernias. Study Design: Randomized control trial. Setting: Department of Surgery, Allied Hospital, Faisalabad. Period: From 7th February 2014 to 6th August 2014. Materials and Methods: 154 male patients with age between 20-45 years were included. Patients having INR > 1.5, history of chronic cough and previous abdominal surgery were excluded. Laparoscopic hernioplasty was performed in group A (n=77) and open hernioplasty was performed in group B (n=77). Results: The mean age of the patients was 32.91±7.78. In group A, 3 (3.9%) patients had ascrotal hematoma, while it was 12(15.6%) in group B. There is statistically significant difference between two groups (p-value=0.014). Conclusion: Laparoscopic TEP can be performed safely with acceptable postoperative complication and is better treatment modality than open mesh hernioplasty.
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