INTRODUCTIONChronic fissure in ano is very common in all age group of people due to present days hi-fi method of food habits, modified life style and inborn errors of health conscience. The present generation is more moribund on the development of technology and work styles of these techis are tedious. Requirement of the remedies are long standing, permanent and symptom or complication free. Early mobilization after any procedure is the only way out for earned population. In the development of the internet medicine access leads to the attitude of clearance of the physician doubts. Based on the above wide range of criteria among these lies the choice of the treatment to be very selective and preferably high in placement of the best treatment for them.Lateral internal sphincterotomy is the only choice in the treatment of the fissure in ano. Complete Sphincterotomy and partial sphincterotomy was followed in variable individuals. 1,2 But post-operative complication like incontinence is to be made into account for the follow up ABSTRACT Background: Lateral internal sphincterotomy is the only choice in the treatment of the fissure in ano. Complete and partial sphincterotomy was followed in variable individuals. But post-operative complication like incontinence, early mobilization and early recovery is to be made into account for best results among these patients. Methods: This study is made in 2015-2016 period among 52 patients with chronic fissure in ano, partial sphincterotomy i.e., division of internal sphincter below the dentate line was performed. Post-operative follows up and symptoms were recorded, in such cases treated adequately. The period of revisit was decided according to patient compliance 1 month, 3months, 6 months. The data was collected prospectively and recorded in view of change in the treatment. Results: 47 of the patients were pain free within first 5 days of surgery. Remaining 5 patients required further division for pain relief due to persistent pain after 3 weeks. The associated post-operative complication among these patients was itching due to burning sensation in and around the anus which resolved later. None among these patients developed fecal incontinence. Conclusions: Among all age group of the patients included in this study were subjected to same type of the procedure and results were recorded to give better prognosis with lowest degree of recurrence for which repeat of the same procedure gave the complete relief. Lateral internal partial sphincterotomy is an effective technique for complete relief of pain in chronic fissure in ano.
Background: In the modern surgical practice, Hernioplasty remains the commonest surgical procedure in general surgery. Though most of the patient recovers completely without complications, certain number of patients experience a stormy and complicated post-operative period in terms of seroma, infection, pain and last but not the least mesh reaction which is a rare but serious complication. Current day practice involves hernioplasty with polypropylene mesh rather than herniorraphy in most surgical centres, hence every effort should be made to reduce mesh related complications. Mesh reactions are more common in patients with preexisting allergic diseases like atopic dermatitis, asthma, allergic rhinitis, seasonal urticarial and also in patients with elevated serum IgE levels. This retrospective observational study was conducted in patients who underwent open inguinal and ventral hernioplastyfrom March 2010 to Feb 2017 in the Department of General Surgery, Coimbatore medical college hospital, Coimbatore. This study focuses mainly on patients who developed mesh reaction in the post-operative period particularly in patients who have existing atopic manifestations. After analyzing the results of our study, we conclude that IgE antibodies estimation pre-operatively in patients with existing allergic diseases can be used as a predictor for assessing mesh related reactions in the post-operative period. In this continuation we are planning immuno-electrophoresis to pinpoint the gamma globulin associated with mesh reaction.
BACKGROUNDIn the modern medical era, laparoscopic approach to surgical conditions has reached to a height that it is performed even for malignant conditions. The minimal access surgery which has grown up from minimally invasive surgery has given us the faith that nearly all surgeries can be done by laparoscopy. The first laparoscopic cholecystectomy was done by Prof. Dr. Med Erich Muhe of Germany in the year 1985. About ten lakh cholecystectomies are performed ever year, of which 96% are done by laparoscopic method. Laparoscopic cholecystectomy is the most common laparoscopic procedure. By number of studies and research works, it is stated that laparoscopic cholecystectomy is superior to conventional open method because of its advantages like smaller incisions, early recovery, less post-operative pain and hospital stay with better cosmesis. However, laparoscopic cholecystectomy also has got its own disadvantages and complications. In 1992, an NIH consensus conference held in Bethesda approved laparoscopic cholecystectomy as the treatment of choice for symptomatic cholelithiasis. Conversion to open technique is a major morbidity of laparoscopy, as it loses its supremacy over open technique once the conversion takes place. With growing experience of laparoscopic cholecystectomy and completion of the learning curve, the indications for laparoscopic cholecystectomy have been extended approaching that of open cholecystectomy. Complications of laparoscopic cholecystectomy have been minimised to as low as 2 -6%. However, a substantial proportion of patients had to be converted to open surgery because of technical difficulties or intraoperative complications. Conversion rates of 2.6% to 14% had been described in different studies. The factor to be considered with conversion is that it should never be considered a complication, but rather a correct judgement by the surgeon. The aims of the present study are: 1. To study the incidence of conversion of laparoscopic cholecystectomy. 2. To analyse the reasons for the conversion of laparoscopic cholecystectomy owing to per operative complications likea) Arterial injury, b) Hepatobiliary tract injury, c) Dense adhesions, d) Aberrant anatomy, e) Technical issues.
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