Introduction: Gallstone disease occurs in 3%-20% of the world population and about 15% of people with gallstone disease develop stones in the common bile duct (CBD). Smaller stones are amenable to be removed by endoscopic retrograde cholangio-pancreatography (ERCP) while larger stones require surgery-either open or by laparoscopic. Materials and Methods: This was a prospective study between January 2010 and December 2012 in two hospitals in Chittagong, Bangladesh, on ultrasonography upper abdomen. And where ultrasonography was not able to diagnose the location and cause of obstruction than magnetic resonance cholangio-pancreatography (MRCP) was done. To rule out malignancy, contrast enhanced computerized tomography was done in selected cases. The patients were divided into two groups on the basis of management-Group A: CBD exploration with insertion of T-tube and Group B: CBD exploration with primary closure. All operated patients underwent a longitudinal choledochotomy. Then the stones were removed and CBD was flushed with normal saline ensuring no distal obstruction. Initially we used T-tube cholangiogram to see distal clearance which was replaced by choledochoscope later on. Primary closure was done in 37 (53%) cases where T tube drainage was given in 34 (47%) cases and T-tubes were kept in situ for 9-10 days. Bile duct was closed with interrupted absorbable catgut 3-0 suture and a sub hepatic drain was kept for 48 hours. All patients were given pre-operative and post-operative antibiotics and follow up was taken for next 6 months. Results: Out of 71 patients, 46 (61%) were females and 29 (39%) males. In all patients cholecystectomy was done along with CBD exploration. Three patients who were planned for primary closure without T-tube, T-tubes were inserted due to CBD trauma, oozing, and gross swelling. Complication like biliary leakage was seen in only one patient with primary closure which was managed by keeping subhepatic drain for 5 days. Two patients in the T tube group developed wound infection while only one developed this complication in the primary closure group. No patient in the study developed cholangitis. No patient was expired in the study. Conclusions: Primary closure without external drainage after choledochotomy is feasible, safe, and cost-effective.
A subdural hematoma is a collection of blood below the inner layer of the dura but external to the bran and arachnoid membrane.Chronic subdural hematoma is commonly associated with cerebral atrophy, occur in the elderly after apparently insignificant head trauma. The incidence of Chronic subdural hematoma increases with age and after 70 years of age. Surgical evacuation of hematoma is indicated in patients who are clinically deteriorate or do not improve. Surgery can bring a rapid clinical improvement with a favorable outcome in over 80% of patient. Methods: This study was a prospective intervention study. Results: It was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B in GOS scoring on the 7th POD. The alive patients were again divided into 4 sub groups, as shown in the table. Among total 60 patients, in Group A 1(3.4%) died and 3 (10.0%) died in Group B. After 3 months follow up, it was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B. The alive patients were again divided into 4 sub groups, as shown in the table. Persistent vegetative and severe disability was not improved in Group B. Conclusion: In my study it was observed that the surgical outcome in single burr hole craniotomy is better than double burr hole craniotomy for treating of chronic subdural hematoma. Bang. J Neurosurgery 2020; 9(2): 99-104
Background: Pilonidal sinus is a common disease of young adult usually caused by insertion of fallen hair into skin (Gluteal cleft). Wide excision surgery is a common practice but due to high recurrence and long duration of healing there are more simple alternatives. Our experience with transposition of Rhomboid flap in the treatment of pilonidal sinus are described. The conventional way of treatment of pilonidal sinus is block excision and lay open of the sinus result in 5-14 days hospital stay healing time of 6-10 weeks. In our study all patients hospital stay was 2-3 days, healing time was less than two weeks with minimum complication. The aim of the study is to do rhomboid flap for the treatment of pilonidal sinus, so to avoid complications and recurrence, to shorten hospital stay and to give better outcome. Methods: Total 6 patients of 18-40 years of age after doing all investigations and clinical examinations, excision of pilonidal sinus was done and repaired by rhomboid transposition flap in the same setting. All the patients were followed up post operatively for 3 months to see any discharging sinus. Results: All 6 patients were discharged on 3 rd post operative day and stitches were removed on 8 th post operative day and approximate time to resume their work is 14 days. Conclusion: Pilonidal sinus surgery is a challenging operation for the surgeon because of recurrence and complication. Rhomboid flap technique has become familial because of its advantage of early healing, less hospital stay and very low recurrence rate.
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