Background: Even with a low post-operative infection complication rate in elective laparoscopic cholecystectomy (LC), most surgeons use prophylactic antibiotics out of habit. This prospective study was done to analyze the need for such prophylaxis in cases of elective LC.Methods: 135 successive patients undergoing elective LC were included in the study. Patients were randomized into 3 groups. Group A (n=45) cases received 3 doses of injection ceftriaxone in the post op period, group B (n=48) cases received a single dose of injection ceftriaxone at the time of induction of anesthesia, and group C (n=42) cases did not receive any antibiotic pre or post operatively. Post-operative infectious complications between three groups were compared.Results: There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, duration of surgery and hospital stay. Intraoperative spillage of bile [6.7% (A): 4.6% (B): 5.2% (C)] did not increase infectious complications.Conclusions: Routine use of prophylactic antibiotic in a clean, uncomplicated cases of laparoscopic cholecystectomy is not required. One dose of ceftriaxone at the time of induction or 3 doses of injection ceftriaxone post operatively following elective LC even in the urban Indian setting should be abandoned as it neither reduces the rate of surgical site infection but also contributes to adverse reactions, drug resistance, and unnecessary financial burden.
Spindle cell sarcomas are a group of aggressive malignant soft tissue tumors with a diverse clinical presentation. A 32 years old woman presented with a recurrent nerve sheath tumour, involving flexor carpi ulnaris and a portion of ulnar nerve. Wide local excision of the tumour was done creating a 4 cm gap defect in the ulnar nerve. Distal nerve transfer and Guyon’s canal release was done and anterior transposition of ulnar nerve to distal motor branch of ulnar nerve end to side (ETS) supercharge was done preserving motor function to the little and ring finger. Achieving negative surgical margins in primary soft tissue sarcoma is a critical for local disease control. The anatomical and functional compromise that can occur while giving adequate clearance margin for the tumor can be overcome by microsurgical techniques and neuroanastomosis with positive outcomes like preservation of function and better prognosis.
In our study we have attempted to assess and evaluate the rationality of drugs given during post-operative period using standard WHO indicators. A total of 602 patients were included with maximum number of patients in 20-40 and 40- 60 years’ age group. The most common diagnoses for admission were Sebaceous cyst (65), Hernia (52), Diabetic ulcer/ abscess (47) and Cholelithiasis (43). The most common procedures performed in our hospital were Excision biopsy (109), Incision & drainage (55), Wound debridement (48) and Laparoscopic cholecystectomy (39). 208 patients received general anaesthesia, 233 received local anaesthesia and 161 of them were given spinal anaesthesia. Maximum number of patients stayed for a period of 2-4 days. The common group of drugs prescribed were antibiotics (976), I.V. fluids (652), analgesics (652), gastrointestinal drugs (590) and antiseptics (328). The most common analgesics given were Paracetamol (385) and Tramadol (173). The most common antibiotics given were Cefotaxim (420), Metronidazole (451). An average of 6.12 drugs was prescribed per patient. Percentage of drugs prescribed by generic name was (21.3%). Percentage of antibiotics prescribed per prescription was 100%. Percentage of encounters with injection was 88.9%. Percentage of drugs from NLEM was 90.09%. To conclude, the duration of stay in the hospital, the post-operative treatment given and the average number of drugs given per encounter in our study is acceptable.The clinicians should be encouraged to prescribe generic drugs from the list of essential medicines. Antibiotic stewardship should be followed for facilitating the rationale use of antibiotics.
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