Background:In emergency settings, several surgical procedures are described while dealing with pathology of terminal ileal lying within 15 cm of the ileocecal valve, but there is still confusion and controversy over the optimal surgical treatment.Methods:A nonrandomized study of 210 patients with near terminal ileal pathology (within 15 cm) was carried out over a period of 10 years. The study included 112 cases in which an ileocecal anastomosis with inclusion of appendicular stump was used in terminal ileal pathologies, and in rest 98 cases, other surgical procedures were used. The outcomes were measured in relation to postoperative complications and mortality.Results:Postoperative complications encountered in emergency ileocecal anastomosis with the inclusion of appendicular stump were wound infection in 31 patients (34.72%), respiratory complications in 10 patients (11.2%), septicemia in 6 patients (6.72.%), and anastomotic leak in one patient (1.12%).Conclusion:The technique of ileocecal single-layer anastomosis with the inclusion of appendicular stump was found to be very effective in dealing this common problem and had less morbidity and mortality.
OBJECTIVE:This retrospective comparative study was undertaken from data of various peripheral centers of Kanpur and around, to assess the impact of Laparoscopic Appendectomy on the patients care where prior to it, conventional open appendectomy (OA) was in vogue. PATIENTS AND METHODS: This retrospective study was done on the patients who were operated by different surgeons in different peripheral hospitals for appendectomy during period of 36 months (from Dec 2010 to Nov 2013).Total data of 360 patients collected out of which the number in each group of patients who underwent laparoscopic appendectomy and patients who had open procedure kept same i.e. 180. Each patient's data was selected in a non-randomized fashion. Both groups were studied for length of hospital stay, operating time, complications and conversion rate and cost involved (consumables only). RESULTS: Analysis of both groups within same interim period showed same age/sex distribution and diagnosis was made mainly on clinical grounds supported by hematological and ultra-sonology tests. Within the laparoscopic group, average length of stay was 3.14 (2-4) days, compared with 4.19 (2-7) days of open appendectomy. Operating time for laparoscopic group was 1.02 (1-1.5) hours with only six conversion into Lanz incisions. In the open group the operating time was 51.5 min (30-90min) and there were 40 laparotomies due to uncertain diagnosis, in three cases due to extensive adhesions appendectomy could not be performed. 28 of these cases also required adjunctive imaging for diagnostic purposes. CONCLUSIONS: This study identified the value of the laparoscopic technique for appendectomy in a non-specialist center. This benefits the patients with low morbidity, shorter hospital stay, minimal operating time and quicker recovery. Cost factors and expertize available however refrain these peripheral hospitals to adopt laparoscopic appendectomy as routine procedures. But these results show that practice of LA also inspired the practitioners of low experience to take on this procedure with confidence and maintain their laparoscopic skills which potentially could be utilized for other related laparoscopic operations.
To compare affectivity of adrenergic alpha1 receptor antagonists (Alpha 1 blockers) in different combinations, with simple observations in terms of distal ureteric stone expulsion. STUDY DESIGN: Randomized trial. MATERIALS AND METHODS: This study was conducted in Kanpur during period of 2 years from May Dec. 2010 to Nov 2012.Total 120 patients were divided into four groups containing 30 patients in each group. Group A patients were offered alpha 1 blocker (Tamsulosin) alone while group B patients treated with alpha1 blocker (tamsulosin) with synthetic steroid (Deflazacort), group C patients were treated with alpha 1 blocker (tamsulosin) with calcium channel blocker (Nifedipine) and group D were given NSAIDS analgesics only as control group. Data regarding stone size, stone expulsion rate and passage time, and Pain control were collected and analyzed. Frequency and percentages were calculated for categorical variables while mean ± SD was used to express continuous variables. Chi square test and Student t test were used to compare categorical and numerical variables respectively. RESULTS: After randomization, data for 30 patients in each group were analyzed. The mean age of patients in groups A, B, C and D was 37.37 ± 7.51 years, 37.90 ± 10.34 years, 38.78 ± 8.82 years and 37.34 ± 7.6 years respectively (p 0.756). The mean stone size was 6.39 ± 1.78 mm in group A compared to 6.47 ± 1.71 mm in group B, 7.42 ± 1.2 in group C and 6.12 ± 2.4 in group D (p 0.81). In group A, for stone size of <5mm, 12 (90%) patients expelled the stone, while for the same stone size, in group B expulsion noted in 13 (96%), patients in group C expulsion noted in all 12 patients(100%) while in control group expulsion noted in just 9 (60%). The expulsion rate in group A , B, C and D for stone size of more than 5 mm, was in 16(87%), 16(90%) , 17(92%)and 8(38%), respectively (p < 0.001). The mean time taken for stone expulsion was 8.32 ± 2.73 days in group A, 6.88 ± 2.46 days in group B, 7.22 ±2.3 days in group C and 12.23 ± 2.12 days in group D (p < 0.001). Patients taking tamsulosin alone or in combination experienced significantly less pain attacks compared to patients on control therapy (p 0.017). CONCLUSION: Alpha1 blocker (tamsulosin) is a safe and effective treatment modality for distal ureteral stones of appropriate size. Alone & different combination of tamsulosin with deflazacort and with nifedipine has definite edge over tamsulosin alone, but needs larger schoolwork for Safety and efficacy.
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