Introduction: Most non-retractile foreskins have been diagnosed with phimosis and referred for circumcision. However, many patients can be managed with corticosteroid cream. This study evaluates the effectiveness of the topical application of corticosteroid cream and manual prepucial stretching in the treatment of phimosis. Methods: This was a longitudinal observational study carried out among children aged six months to 10 years with the diagnosis of phimosis between 1st September 2019 to 31st August 2020. The patients were advised to apply 1% Hydrocortisone cream together with manual prepucial stretching twice daily for four weeks. Patients were assessed at four weeks and six months at the outpatient clinic using Kirkos grading for retractability. Results: A total of 110 patients were diagnosed with phimosis during the study period. Fourteen patients had pathological phimosis out of which four had balanitis xerotica obliterans and were excluded from the analysis. Ninetysix patients with physiological phimosis were treated conservatively with 1% hydrocortisone and manual prepucial stretching. Among them, 87 cases were successfully treated whereas five patients had a partial response with treatment failure in four cases. Those five cases with partial response underwent adhesiolysis while circumcision was performed in the remaining four patients with treatment failure. Prepucial retraction was possible in four weeks in most of the patients with physiological phimosis with successful results in 90.6% of cases. Conclusions: All non-retractile prepuce are not pathological phimosis and doesn’t need circumcision. Local application of a potent corticoid cream and foreskin stretching is a safe, simple, and effective long-term treatment for physiological unretractable foreskin in children.
Introduction: Laparoscopic cholecystectomy (LC) has a low risk for postoperative infective complications. The incidence of iatrogenic gall bladder perforation leading to spillage of bile and stones seems to be higher ranging between 5 and 40%. Studies have also shown an increased incidence of complications like surgical site infection (SSIs) after bile spillage. This study aims to assess the prevalence and outcome in bile spillage during LC. Methods: A cross-sectional study was conducted at KIST Medical College and Teaching Hospital. All the patients who underwent elective LC from February 2018 to March 2020 were studied. A total of 187 patients were enrolled. The required data was entered in the proforma by reviewing the patient’s medical records. The data was entered and analyzed using the SPSS version 26. Descriptive statistics and chi-square test were carried out. Results: The prevalence of bile spillage was 29.4%. The prevalence of SSIs among the bile spillage and non-bile spillage groups was 10.9% and 8.3% respectively. There was no significant association between SSIs and bile spillages (p value 0.584). There is no significant association post operative use of antibiotics and SSIs among patients with bile spillage (p value = 0.163). Conclusion: The prevalence of bile spillage during LC was higher when compared to other national and international studies. However, the rate of SSIs among bile spillage was lower. Bile spillage during LC doesn’t cause SSIs post-operatively and use of postoperative antibiotics among bile spillage patients doesn’t prevent SSI during elective LC thus use of antibiotics in such cases should be limited.
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