Objective: The aim of this study was to assess the initial outcome of non-operative, conservative management in selective penetrating abdominal injury in a tertiary care hospital. Material and Methods: This was a cross sectional study done on purposively selected 36 patients with penetrating abdominal injuries of all ages admitted within 6 hours of the incident. All patients confirmed peritoneal breach and standard algorithm of management was followed. Closed monitoring was ensured with repeated investigations at regular intervals. Outcome parameters included surgical site infection (SSI), fever, hypothermia, wound dehiscence, fecal fistula, length of stay, pulmonary complication and death. Results: A total of 36 patients with a mean age of 30 years (SD= 6.7), consisting all males, mostly (58%) from rural areas and 73% from low socioeconomic condition. Site of injury was noted in the epigastrium (42%) and right iliac region (22%). Among them, 33 (92%) patients were successfully managed with non-operative management and 3 (8%) patients needed laparotomy. Routine imaging and clinical observation could detect hollow viscus injury within 36 hours in 3 patients. Hospital stay was significantly lower (< 7 days) in conservative management. Conclusion: Clinical examination alone and/or together with different diagnostic methods could reduce the number of negative laparotomies and associated morbidities. Single surgeon must closely monitor a patient of penetrating abdominal injury and take vital decisions from the time of admission until discharge.
Background: The prevalence of urolithiasis has increased during the last decades and now affects approximately 9% of the adult population specially in developed countries. European Urology Guidelines recommend PCNL in stones larger than 2 cm in size and ESWL in stones smaller than 2 cm in size as the first treatment option. With advances in technology, new generation flexible ureteroscopes with safe and effective lithotripters such as holmium laser have been developed and RIRS became an important alternative in the treatment of large urinary stones. Objective: To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones and to compare its results with those of percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively analyzed a total of 50 patients ─ 27 patients (20 males and 7 females) who underwent PCNL and 23 patients (17 males and 6 females) who underwent RIRS between January 2015 and December 2017. Results: The mean duration of operation was 60.65 ± 23.56 minutes in the RIRS group and 50.55 ± 12.77 minutes in the PCNL group (p<0.047). The hospital stay was significantly shorter in the RIRS group (2.21 ± 0.9 vs 5.29 ± 1.53 days in the RIRS and PCNL groups, respectively; p<0.016). Stone-free rates after one session were 88.6% and 84.8% in the RIRS and PCNL groups respectively. Blood transfusions were required in five patients in the PCNL group. Complication rates were higher in the PCNL group. Conclusion: This study reveals that RIRS can be an alternative to PCNL in the treatment of kidney stone. J Enam Med Col 2019; 9(2): 84-89
Background: Inguinal hernia repair is one of the most common surgical procedures in Bangladesh. The option of surgical treatment remains controversial. Laparoscopic hernia repair has all the benefits of a tension free repair. We aimed to compare postoperative outcome and cost between laparoscopic and open inguinal hernia repair. Objective: This study was conducted with an objective to compare the effectiveness of each procedure and complications if any. Materials and Methods: Fifty cases of inguinal hernia admitted in the tertiary care center were selected by nonprobability (purposive) sampling method. All patients with uncomplicated hernia treated by open or laparoscopic method were included. The age/sex, incidence, mode of presentation, surgical treatment and postoperative complications were evaluated and compared with standard published literature. Results: Postoperative wound infection developed in three cases of open hernioplasty and one case in laparoscopic surgery. Hematoma and seroma at the operated site were found in one case of laparoscopic hernioplasty and in two cases of open hernioplasty. Orchitis was more prevalent in the laparoscopic hernioplasty patient with incidence among two cases as compared to one in open group. The mean duration of hospitalization was 59.62±6.11 hours in case of laparoscopic hernioplasty while 53.33±8.26 hours in open hernioplasty. The mean duration of procedure was 72.33 minutes in laparoscopic group while 64.62 minutes in open surgery. The mean cost for the laparoscopic repair group was around taka 63000/= whereas in the open group it was around 42000/= only with significant difference. Prolonged groin pain was seen in four cases in open group as compared to one in laparoscopically operated cases. Conclusion: There were less post-operative complications in the laparoscopic group. J Enam Med Col 2020; 10(1): 17-22
Background: During last 2−3 decades image-guided drainage procedures have been developed complementing modern surgical drainage techniques. The development of interventional radiological procedure has made percutaneous puncture and drainage of abdominal fluid collection possible. Image-guided percutaneous drainage of appendicular abscess has become well-established because of its proven safety and efficacy. Objectives: To evaluate the safety and feasibility of USG-guided percutaneous aspiration for draining appendicular abscess with special attention to the need for conversion and to see the nature of complications after draining of abscess. Materials and Methods: Between May 2013 to May 2014, 25 cases of appendicular abscess were selected from the admitted patients (surgery department) in Enam Medical College & Hospital who underwent USG-guided percutaneous aspiration. Procedure was performed mostly under local anaesthesia. Patients were followed up for 6 months. Interval appendicectomy was not performed routinely. Results: USG-guided aspiration was successful in 23 (92%) patients and in 2 (8%) patients procedure failed. Single attempt was successful in 21 (84%) cases and 4 (16%) patients needed double attempt for draining appendicular abscess. In 23 (92%) patients, PCA was done under local anaesthesia and two (8%) patients needed general anaesthesia. Complications developed in 4 (16%) patients. Four (16%) patients needed follow-up USG. Average hospital stay was 5 days (2−8 days) and average duration of using I/V antibiotic was 3.5 days (2−5 days). Conclusion: USG-guided percutaneous aspiration is an easy and safe method for draining appendicular abscess with minimum procedural complications.
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