Background: Stoma closure is one of the most frequently performed surgery. The common complications are surgical site infection (SSI) and poor scar cosmesis. Compared to the conventional linear closure, the pursestring closure technique is expected to have less wound infection, smaller size scar and good patient satisfaction. The aim of this study is to evaluate the feasibility of PSC of stoma site at a tertiary hospital and comparing it with LC of stoma. Materials and methods: This study was performed in the Department of General Surgery, Chittagong Medical College Hospital for a period of one year with a sample size of 72. About 36 subjects were enrolled in each group, Group-A (Linear closure) and Group-B (Purse string closure). Each patient of both group were observed for wound infection, post-operative pain, scar formation, patient satisfaction, and length of post-operative hospital stay. Results: The level of pain according to VAS score was 4 in 36 (100.0%) in Group A and 6(16.7%) in Group B. One third (33.3%) patients had wound infection in Group A and 4(11.1%) in Group B. The mean duration of hospital stay was 9.72±3.46 days in Group A and 7.97±2.46 days in Group B which is statistically significant (p<0.05). The mean patient satisfaction score was 17.75±1.59 in Group A and 22.12±0.73 in Group B which is statistically significant (p<0.05). The mean patient scar assessment scale was 42.47±0.99 in Group A and 35.88±2.81 in Group B which is statistically significant (p<0.05). The mean observer scar assessment scale was 41.97±1.28 in Group A and 36.22±2.73 in Group B which is statistically significant (p<0.05). Conclusion: Purse-string skin closure for stoma reversal had significantly less incidence of surgical wound infection, improved the scar outcome, good patient satisfaction, reduce complications and better cosmesis. JCMCTA 2022 ; 33 (1) : 25-28
Key Words: laparoscopic repair; early return to work; peptic ulcer performationDOI: 10.3329/jcmcta.v21i2.7731 Journal of Chittagong Medical College Teachers' Association 2010: 21(2):16-20
Background : This is a hospital based prospective, cross sectional and interventional case control study conducted in department of urology, Chittagong Medical College, Bangladesh. Materials and methods : Total 120 patient of upper ureteric stone were included in this study divided by Group-A (60) and Group-B (60). Group-A 60 patient under went in situ ESWL and group-B 60 patient under went push back, DJ stenting and ESWL. Number of Shock wave session, energy used (KV) stone clearance, complications of ESWL like loin pain, haematuria, fever and Lower Urinary Tract Symptom (LUTS) and cost were compared between the two groups were recorded and analyzed. Results : In Group A total stone clearance were 96.7% (58/60) and group-B were 98.3% (59/60). But it was not statistically significant (p=0.559). Mean hospital stay of in situ group (Group A) was 1.03 ± 0.181 days compared to 2.57 ± 0.722 day in push back ESWL group (Group B). It was statistically highly significant (p=0.000). In group-A there was loin pain in 20 (33.33%). Haematuria 12(20%), fever in 06 (10%) and LUTS in 16 (26.7%) patients. In group B loin pain was in 35 (58.3%) (p-0.006). Haematuria 26(4.33%) (p=0.06), fever 14 (23.7%) (p=0.05) LUTS was 30 (50%) (p=0.009). More energy of ESWL (Kilo Volt-KV) required in group A than in group B. But is was not statistically significant (p=0.190). Conclusion : Complications between the groups were statistically highly significant. In situ ESWL is very good option for the management of upper ureteric stone. It is non-invasive, effective, safe, cost savings, less hospital stay and usually does not need anaesthesia. JCMCTA 2017 ; 28 (1) : 57 - 62
Due to errors in this paper, a corrected version is reprinted in Vol.20(2) 2009 p.53-55.Key words: colo-duodenal fistula; malignant; clinical suspicion DOI: 10.3329/jcmcta.v20i1.4940 Journal of Chittagong Medical College Teachers' Association 2009: 20(1):64-67
Premedication with midazolam is widely used in paediatric anaesthesia to reduce fear, anxiety, emotion, psychological trauma and ensure smooth separation from parents. However, various routes and dosing regimens are recommended for paediatric premedication and variable efficacy is found when use in different routes. The aim of our study to compare the efficacy and acceptable route between intranasal versus sublingual midazolam premedication for smooth separation from parents before entering the operation theater. It will be a comparative, cross-sectional prospective clinical study. 120 unmedicated children, ASA I or II, Age 1–6 years, who will be scheduled for routine elective surgery and who will be planned to receive midazolam as a premedicant drug, will be randomly assigned to one of the two groups. Group–I receives intranasal midazolam 0.2 mg kg-1 and Group–II receives sublingual midazolam 0.2 mg kg-1 after having obtained the parent’s informed consent. Heart rate, Systolic blood pressure, SpO2, Sedation and Anxiolysis Scores will be assessed in 4-point scale by the anaesthesiologist every 3 min prior to surgery. Sixty patients will be enrolled in each group, I and II. Data will be compiled and analyzed in computer, using statistical software package SPSS. JCMCTA 2016 ; 27 (2) : 24 - 30
Background: Laparoscopic cholecystectomy has become the treatment of choice for symptomatic gall stone disease. But post operative pain may prolong hospital stay and increase morbidity. The aim of the study was to find out the effect of port site infiltration of Bupivacaine in reducing post operative pain following routine laparoscopic cholecystectomy. Materials and methods: This is a double blind randomized controlled trial conducted in the Department of Surgery, Chittagong Medical College Hospital, Bangladesh. A total 200 patients underwent routine laparoscopic cholecystectomy were enrolled in the study. All patients are assigned in two groupscontrol group (Infiltration of 20 ml normal saline at port site) and Bupivacaine group (20 ml Bupivacaine at port site). Both groups are followed at 4 hrs, 12 hrs and 24 hrs after operation to assess the intensity of pain by using Visual Analogue Pain Scale (VAS). Time regarding the first analgesic request by the patients, total dose of analgesic, days of return to normal day to day activities and normal works were also recorded. Results: The mean age of control group and Bupivacaine group were 41.64 and 37.54 years respectively. At 4hrs post operative mean pain score were 6.76 and 5.62 respectively (p value 0.015). At 12 hrs mean pain score were 4.4 and 3.88 respectively (p value 0.001). At 24hrs pain score were 2.66 and 2.08 respectively (p value 0.002). Mean time of first analgesic required were 4.8hrs and 7hrs respectively (p value 0.000). Mean duration of hospital stay were 2.26 days and 2.22 days respectively (p value 0.371). Total dose of analgesic required were 12 and 9 between the groups respectively (p value 0.000). Mean time of return to normal day to days activities were 3.98 days and 2.98 days respectively (p value 0.000). Return to normal work after 6.98 days and 6.46 days respectively between the groups (p value 0.008) that is statistically significant. Conclusion : Infiltration of Bupivacaine at port site at post operative period of laparoscopic cholecystectomy patients significantly reduces pain than control group. It helps patients for early mobilization, early return to normal activities and works. Thus it reduces overall cost and morbidity of symptomatic cholelithiasis patients. JCMCTA 2017 ; 28 (2) : 64-68
Keywords: colo-duodenal fistula; malignant; clinical suspicionDOI: 10.3329/jcmcta.v20i2.5629Journal of Chittagong Medical College Teachers' Association 2009: 20(2):53-55
Background: Laparoscopic Cholecystectomy (LC) has become the treatment of choice for symptomatic gallstone disease. But it becomes difficult to perform safely and some cases require conversion to Open Cholecystectomy (OC). There is no clear consensus among the laparoscopic surgeons to determine preoperative parameters that can predict difficult laparoscopic cholecystectomy. The aim of this study is to predict the difficult laparoscopic cholecystectomies by correlating with preoperative clinical and radiological findings. Materials and methods: This prospective observational study was performed in the Department of Surgery at Chittagong Medical College Hospital for a period of one year from April 2018 to March 2019. The sample size was 151. Pre-operative clinical and ultrasonographic criterias were correlated with intraoperative difficulties encountered. Peroperative difficulties were considered in terms of pericholecystic adhesion, difficult callots triangle dissection, difficult GB bed dissection and unusual bleeding during surgery. Results: Out of 151 patients underwent LC in this study; 93 (61.6%) cases the procedure was uneventful and the other 58 (38.4%) procedures were difficult. Among those difficult 58 cases, 13 (8.6%) patients required conversion to open cholecystectomy. Difficult LC were found in BMI >30kg/m2, hospitalization for 3 or more times due to acute painful attack and GB wall thickness >3 mm. Conclusion: Pre-operative prediction of difficult LC can be determined by correlating with clinical and radiological findings that help the surgeons to better prepare for intra-operative difficulties and risk of conversion to open cholecystectomy. IAHS Medical Journal Vol 4(2), December 2021; 70-73
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