Background: Fistula in ano is a common problem. Surgical techniques such as fistulectomy, fistulotomy were associated with complications like excessive bleeding, infection, recurrence etc. The employment of cyano acrylate glue is one of the newer promising techniques. The aim of this study was to evaluate the efficacy of cyanoacrylate glue in the treatment of anal fistulas.Methods: Study was conducted on patients with fistula-in-ano admitted to various surgical units in hospitals attached to Bangalore Medical College and Research Institute from November 2016 to May 2018. A total of 30 patients fulfilling the criteria were included in the study. Under spinal anesthesia, patients were posted for the procedure. Post operatively the patients were examined every 2 weeks for the first 2 months, and then once every 3 months. If the fistula failed to heal with primary treatment at a 4-week interval, a second glue treatment was performed. Post-treatment the success of the procedure was assessed by the incidence of infection and recurrence.Results: Twenty two patients got healed with primary application with stoppage of any discharge from the fistulous track. Two patients required one more application, and one patient required fistulotomy. One patient developed complex fistulas and had to be treated with colostomy and fistulectomy. 4 patients developed purulent discharge after application of glue and were treated with IV antibiotics and healed completely.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to fistulectomy in patients with anal fistulas.
Background: Laparoscopic cholecystectomy is often associated with intra operative difficulties leading to increased intra and post-operative morbidity. Accurate prediction of a difficult laparoscopic cholecystectomy can reduce the complication rate, rate of conversion and overall medical cost. This study was an attempt to validate a scoring system developed to predict difficult laparoscopic cholecystectomy.Methods: 100 patients undergoing laparoscopic cholecystectomy were included. Details such as age, sex, BMI, previous surgical history, history of hospitalisation for biliary disease, sonographical wall thickness, pericholecystic collection and presence of impacted stone were noted. With these, pre-operative score was calculated using the scoring system. Intra operative details and complications were noted and were classified as easy, difficult and very difficult. Student t test and chi square test was used to test the difference of significance (p<0.05).Results: Male sex, higher BMI, a history of previous surgery, a history of prior hospitalisation for biliary disease, a palpable gall bladder, a thickened gall bladder wall, impacted stone and pericholecystic collection all had a statistically significant accurate prediction of the difficulty in laparoscopic cholecystectomy. The mean duration of surgery was 62.7±33.15 minutes. The scoring system developed by Randhawa et al predicted difficult laparoscopic cholecystectomy with a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2%.Conclusions: The proposed scoring system predicted difficult laparoscopic cholecystectomy with a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2%.
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