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A Comparative Analysis of Aqueous Human Placental Extract Soaked Dressings Over Conventional Saline Dressings in Traumatic and Diabetic Ulcers in GRH Madurai
No full textA Comparative study Between Covering Ileal Loop-Without Ostomy or Delayed Ostomy and Diversion Ileostomy for Patients Undergoing Large Bowel Anastomosis
No full textComparison of Open Haemorrhoidectomy With and Without Lateral Anal Sphincterotomy in Reduction of Postoperative Pain
No full textA Retrospective Comparison on Surgical Management of Varicose Veins With and Without Venous Stripping
No full textEvaluation of the Use of Subcutaneous Drains to Prevent Wound Complications in Emergency Laparotomy Surgeries
No full textINTRODUCTION:
Surgical site infection is defined as wound infection following an invasive procedure. Inspite of advances in dressing and management of post operative patient this remains a substantial risk and main reason for prolonged hospitalization of postoperative patients.
SSI previously termed postoperative wound infection is defined as that infection presenting up to 30 days after a surgical procedure if no prosthetic is placed and up to one year if a prosthetic is implanted in the patients.
The overall infection rate increases in cases of colorectal surgery and also in emergency surgeries. Factors contributing to this are diverse. Laparotomies carry a higher risk of wound infection and a combined rate of 15% has been reported in upper and lower gastrointestinal surgery, over three times the average risk.
OBJECTIVES:
1. To compare the effectiveness of subcutaneous negative suction drainage tube and conventional abdominal wall closure with regard to surgical site infection and wound dehiscence.
2. To compare need for secondary suturing.
3. To compare the duration of hospital stay in 2 groups.
METHODS:
All patients undergoing emergency laparotomy surgeries in view of peritonitis in the Institute of general surgery, Age more than 18 years, Subcutaneous fat more than 1.5 cm were included in the study.
- Patients fulfilling inclusion criteria.
- Patients are divided into two Groups:
● Group A- 35 patients underwent Conventional abdominal wall closure.
● Group B – 35 patients had suction drains inserted in the subcutaneous tissue.
- Incidence of Surgical site infections and wound dehiscence, need of secondary suturing, length of hospital stay in both groups were assessed.
RESULTS:
In this study there is no statistical significance between both the groups in view of surgical site infection and wound dehiscence (P values are >0.05 : 0.205, 0.568).
CONCLUSION:
Previous studies shows that Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of wound infection, dehiscence, wound secondary suturing and duration of hospital stay in SSI. But In our study placement of subcutaneous drains doesn’t reduced the rate of SSI significantly and infection rate was similar to patients without drains. However results may vary if more patients are included in study hence large scale studies are required
A Prospective study on Efficacy of Ultrasound Guided Aspiration Over Incision & Drainage in the Management of Lactational Breast Abscess
No full textINTRODUCTION:
Lactational Breast Abscess refers to accumulation of pus in an area or segment of breast in lactating mothers & it usually occurs as result of inadequately treated infectious mastitis.
Bacterial Mastitis is the most common variant of mastitis & it is associated with lactation in vast majority of the cases.
Though its overall incidence is gradually on the decline, Breast abscess is still a commonly encountered problem in the developing countries owing to poor maternal hygiene, decreased nutrition, poor breastfeeding techniques, poor
standard of living, delay in prompt diagnosis & antibiotics administration.
Lactational Mastitis is mainly caused by Staph aureus or Streptococcus species & in case of hospital-acquired infections,they’re likely to be Penicillin-resistant.
The intermediary is usually the infant, as about 50% of infants harbour Staphylococci in their nasopharynx by the third day of life.
Eventhough mastitis is initiated by ascending infection from a sore/cracked nipple, in majority of the cases, the lactiferous ducts get blocked by epithelial debris resulting in stasis.
AIMS AND OBJECTIVES:
1. To determine the efficacy of Ultrasound guided Aspiration over
the Conventional Incision & Drainage procedure in the
Management of Lactational Breast Abscess in terms of
Healing rate, Cost Effectiveness & Cosmesis.
2. To consider Ultrasound guided Aspiration as first line of
treatment in cases of Lactational Breast Abscess.
3. To determine the advantages of USG guided aspiration in
reducing hospital stay & postop pain.
4. To find out its effectiveness in reducing post-operative
complications & recurrence.
MATERIALS & METHODS:
STUDY DESIGN:
Prospective Observational Study.
STUDY CENTRE:
Institute of General Surgery - Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai – 03
SAMPLE SIZE:
This study involved 60 patients who met the Inclusion criteria and were randomly allocated into two treatment groups of 30 each.
INCLUSION CRITERIA:
All Lactating females diagnosed with Breast abscess by clinical examination as well as sonographic confirmation.
EXCLUSION CRITERIA:
• Non-lactating females with breast abscess
• Recurrent/Chronic Breast abscess at presentation
• Fistula/Sinus/Skin necrosis overlying Breast abscess
• Immuno-compromised patients like Diabetes, Renal Failure,
Tuberculosis, Patients on Steroid therapy and Patients of suspected malignancy of breast.
CONCLUSION:
Lactational Breast Abscess still remains a common concern in the developing countries. Any lactating female in her early postpartum period with history of pain over the breast, associated with fever & redness should arouse a strong suspicion of Lactational abscess.
Once the clinical examination as well as the patient’s history favor the diagnosis of Breast abscess, the patient must be immediately subjected to Ultrasound examination to reaffirm the condition as well as to guide the drainage of abscess.
Once proven, it is essential to treat the abscess at the earliest and the treatment modality has to be decided based on various factors such as patient’s acceptance, ease of technique, feasibility, the need for repeated aspiration/drainage, time for resolution as well as cosmetic & functional outcome.
Ultrasound guided Needle aspiration under antibiotic cover has superseded the conventional incison & drainage procedure in the management of lactational breast abscesses owing to it’s colossal superiority over the other as cited in our study.
Based on the various factors mentioned above & the numerous advantages of USG guided aspiration over the incision & drainage procedure, we can conclude that Ultrasound guided needle aspiration is a very safe & efficient modality of
treatment of lactational breast abscess and it must be considered as first-line of management in cases of lactational breast abscess
Clinical study and Management of Incisional Hernia
No full textINTRODUCTION:
Incisional hernia is a protrusion of abdominal viscera through the sites of previous operation or traumatic wound of the abdominal wall.The lower abdominal incisions are associated with highest incidence of incisional hernia The pressure in the lower abdomen is more than upper abdomen and the posterior rectus sheath is deficient below the umbilicus and the stress and strain on lower abdomen predispose to herniations.
AIMS AND OBJECTIVES:
• To analyse various etiological factors for incisional hernia.
• To study the description of cases in relation to age an dsex.
• To study the details of the previous surgeries undergone.
• To study various surgical modalities in the treatment of incisional hernia.
MATERIALS AND METHODS:
INCLUSION CRITERIA:
• All patients admitted in general surgery ward diagnosed as incisional Hernia.
• All patients who have undergone single/multiple abdominal surgeries(lap/open).
• All patients with recurrent incisional hernias.
• Age group between 20-70.
EXCLUSION CRITERIA:
• Extremes of age 70.
• Any ventral hernia other than incisional hernia.
• Patients who expire without undergoing surgery.
• Patients who did not undergo/not willing for surgery.
METHODOLOGY:
After getting Ethical committee apapproval patient satisfying inclusion criteria were selected and Informed consent obtained.Patient details regarding clinical history were collected and tone and previous nature of surgery were determined.Preoperative assessment of the patient is done and type of surgery for each patient is individualised and planned.post procedure patient if followed up and post operative complications if any noted.Data is then analysed and conclusion is arrived.
RESULTS:
In the current study done among 50 patients , 25 patients were in the age group of 40 – 50 years which was calculated as 50 %. 21 patients were in the age group of 51 – 60 years which was calculated as 42%. The remaining four patients were in the age group of 61 – 70 years which was calculated as 8%. In our study, out of 50 patients, 36 patients were females which was calculated as 76 . The remaining 14 patients were males which was calculated as 28%. In our study, out of 50 patients, 22 patients of incisional hernia had previous surgery of trans-abdominal tubectomy which was calculated as 44%. Patients had previous surgery of lower segment 99aparotom section which was calculated as 36%. Six patients had hysterectomy done which was calculated as 12%. Two patients had history of surgery done for duodenal perforation which was calculated as 4 % and the remaining two patients had operated for ileal perforation which was calculated as 4%. In our study group, out of 50 patients, forty patients had undergone surgery through Transverse infra umbilical which accounts for about 80% 12% which accounts for Infra umbilical midline incision.
CONCLUSION:
Incisional hernia is one of the preventable Surgical conditions when combined with effective operative technique and post operative care. But it also depends upon the patients factors and their compliance to post operative
instructions.Once Incisional hernia has been diagnosed it needs to corrected surgically. The type of surgery is individualised to each patient.Laparoscopic mesh repair has evolved which can prevent furthur new scars.Transversus abdominis muscle release has now revolutionised the hernia society with its huge impact on large ventral hernias with loss of domain.Though mortality is minimum,the morbidity is sufficient enough to incapacitate the patient. And hence proper preoperative management with meticulous surgical technique and post operative care is essential to prevent the occurrence of incisional hernia
Efficiency of Blunt Abdominal Trauma Severity Score (BATSS) in Predicting the Necessity of Laparotomy in Blunt Abdominal Trauma
No full textINTRODUCTION:
Abdominal trauma is one of the most common causes among injuries caused due to road traffic accidents. Motor vehicle accidents account for 75 to 80% of blunt abdominal trauma. Blunt injury of abdomen is also a result of fall from height, assault with blunt objects. Sport injuries and fall
from riding bicycle.
Blunt abdominal trauma is usually not obvious. The knowledge in the management of blunt abdominal trauma has progressively increased due to the inpatient data gathered from different parts of the world. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality remain at large. The reason for this could be due to the interval between trauma and hospitalization, delay in diagnosis, inadequate and lack of appropriate surgical treatment, post operative complications and associated trauma especially to head, thorax and
extremities.
In view of increasing number of vehicles and consequently road traffic accidents, this dissertation has been chosen to study the case of blunt abdominal trauma with reference to the patients presenting at RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL, MADRAS MEDICAL COLLEGE, CHENNAI.
AIMS AND OBJECTIVES:
Abdominal trauma is the third leading cause of death in trauma patients after head and chest with majority of cases being non penetrating or so called BLUNT ABDOMINAL TRAUMA (BAT).
The main causes of BAT are motor vehicle crashes, direct traumas and fall from height.
More than 50% of mortalities due to crashes led BAT are preventable and under this circumstance IN TIME LAPAROTOMY plays a major role.
However difficulty in diagnosing patients with intraabdominal injuries explains the real need for an
accurate and in hand method to evaluate the patients who require further surgical intervention like laparotomy.
Frequently FAST is used. Since the ability of FAST in determining the necessity of laparotomy is blurred, a better applicable scoring system for selection of patients suspected with BAT is sought to make easy triage to save time, reduce unnecessary CT scans, radiation exposures and cost for diagnosis and treatment.
To obtain blunt abdominal trauma patients signs as well as clinical data and to clarify the accuracy, sensitivity, specificity, negative and positive predictive value of BLUNT ABDOMINAL TRAUMA SEVERITY SCORING (BATSS) and its effectiveness in predicting the need for laparotomy.
MATERIAL AND METHODS:
The study was carried out in Institute of General Surgery, MADRAS MEDICAL COLLEGE AND RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL. All injured patients were brought to an emergency resuscitation area where primary-survey, resuscitation, and a secondary survey in a standard method were conducted and clinical findings noted. Pulse rate, saturation and blood
pressure recorded and all basic blood investigations carried out. The Focused Assessment with Sonography for Trauma (FAST) investigation was performed during primary-survey, after securing airway and establishing adequate oxygenation/ ventilation. The FAST investigation was classified
as positive (clearly showing fluid on at least one window), or negative. No quantitative score system will be used for the quantity of fluid seen.
CONCLUSION:
This scoring will help in better triage of the trauma patient on arrival and reduce the need for further
imaging and reduce the time interval between arrival and surgical intervention.
With reduction in need for further imaging, it also provides additional benefit by reducing exposure to unnecessary radiation, administration of contrast and reduction in costs, overcrowding of casualty departments and possibility of immediate referral to a tertiary care trauma centre due to inadequate infrastructure to manage a case of blunt abdominal trauma.
We conclude by stating that the Blunt Abdominal Scoring System (BATSS) is an excellent predictor of intra-abdominal injury and can be used as a tool by physicians/paramedics in
referral/monitoring of high-risk patients in a resource limited setting
A Comparative Clinical study on Open Versus Laparoscopic (TEP/TAPP) Inguinal Hernia Repair Techniques
No full textINTRODUCTION:
Hernia is defined as a protrusion of a viscus or a part of a viscus through an abnormal opening in the walls of its containing cavity. It is derived from the latin word 'hernios' meaning rupture. Most commonly seen in the inguinal region followed by paraumbilical/incisional hernia.
Inguinal hernia occurs in about 15% of adult population and inguinal hernia repair is one of the mostc ommonly performed surgical procedure.
In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique. Evolution in the treatment of inguinal hernias has equalled to the technological developments in this field. The most significant advances to impact inguinal hernia repair have
been the addition of prosthetic materials to conventional tissue repairs. The laparoscopic inguinal hernia repair includes Totally Extraperitoneal approach (TEP)/Trans Abdominal Preperitonealapproach (TAPP).
Over 60 randomized trials have compared laparoscopic surgery
with Lichenstein repair. Following introduction of mesh for hernia repair, newer measures focus on post hernioplasty pain syndrome, quality of life and return to normal activities. They show although laparoscopic operation takes longer to perform, proven advantages are reduced pain both following surgery, more rapid return to full activity and reduced chance of wound complications.
A repair that results in an asymptomatic recurrence will not as clinically significant as a repair that imparts a significant amount of chronic pain, but does not lead to recurrence.
AIM OF THE STUDY:
The aim of this study is to prospectively compare the results of open mesh technique and laparoscopic repair for inguinal hernia and to compare operative time, post operative pain, length of hospital stay, return to normal activities and its complications.
MATERIALS AND METHODS:
STUDY DESIGN:
Prospective study.
STUDY POPULATION:
Patients – male and female presenting with inguinal hernia.
SAMPLE SIZE:
In this prospective study a total of 50 patients with inguinal hernia were enrolled into two comparative groups ,namely Lichtenstein’s and laparoscopichernia repair.
INCLUSION CRITERIA:
• All male and female patients with inguinal hernia consented for inguinal hernia repair.
• Incomplete hernia.
• Recurrent hernia.
EXCLUSION CRITERIA:
• Age >80 years.
• Age<12 years.
• Pregnancy.
• Scrotal abdomen.
• Obstructed hernia.
• Medically unfit patients (chronic asthma, COPD, Cardiac diseases).
CONCLUSION:
Laparoscopic hernia repair is safe and provide less postoperative morbidity in experienced hands and definitely had many advantages over open repair such as early resumption of daily activities and work, better subjective and objective cosmetic results with some limitations like more operative time.For bilateral and recurrent inguinal hernias laparoscopic approach is recommended. From the results of this study we find the outcomes of laparoscopic inguinal hernia are comparable with open repair. Laparoscopic repair has an advantage of less post operative pain, decreased hospital stay, faster recovery and improved cosmesis. It may soon become the procedure of choice not only for bilateral and recurrent hernias but also for primary, unilateral hernias.
The open repair has a definite advantage over laparoscopic repairfinancially; however the decreased hospital stay and faster recovery mayreduce the economic burden of laparoscopic surgery to some extent. The openrepair remains a good option especially for older, high risk patients and easy toperform, inexpensive and can be done under local anesthesia. However, the trend in surgery today is of minimally invasive surgery and rightfullyso as our study proves
A Study on the Degree of Gall Bladder Wall Thickness by Ultrasonography and It’s Impact on Outcomes of Laparoscopic Cholecystectomy in a Tertiary Care Hospital
No full textAIM:
To study the efficacy of pre operative Gall bladder wall thickness by ultrasonography and it’s impact on outcomes of Laparoscopic Cholecystectomy.
Objectives:
PRIMARY OBJECTIVE :
To study the impact of gall bladder wall thickness by ultrasonography and it’s outcomes following laparoscopic cholecystectomy. Patients are grouped under 4 categories
Normal wall thickness - 2-4 mm Moderately thickened - >4-6mm Severely thickened - >6mm.
SECONDARY OBJECTIVE:
1. To study the prevalence of complications.
2. To study the most common complication.
3. Complications included are
Adhesions, hemorrhage, injury to biliary structures, bile leak post operatively and surgical site infections.
4. To study the duration of hospital stay.
Materials and Methods:
Site of study:
Study was conducted at Rajiv Gandhi Government General Hospital, Chennai, a multispeciality tertiary care hospital.
Type and Duration of Study:
Study was a retrospective-prospective analysis of preoperative ultrasonography of gall bladder wall thickness and it’s impact on surgical outcome of laparoscopic cholecystectomy.
The total duration of study was around 9 months from 01 March 2022 to November 15 2022.
Sample size and study population: Sample size is 60 and the study population includes the patients admitted in Rajiv Gandhi Government General Hospital for elective laparoscopic
cholecystectomy in the department of General Surgery.
RESULTS:
The Prevalence of intraoperative complications was found to be maximum among patients with severely thickened gall bladder wall followed by those with moderately thickened gall bladder wall. The most common complication was found to be hemorrhage followed by adhesions , bile duct injury, adhesions with bile duct injury. Patients with severely thickened gall bladder and moderately thickened gall bladder developed wound infection while it was nil among patients with normal and mildly thickened gall bladder. Those with severely thickened gall bladder wall had a prolonged post operative stay at the hospital averaging 7.3 (~7 ) days.
CONCLUSION:
In conclusion, laparoscopic cholecystectomy is treatment of choice for cholelithiasis.
Preoperative prediction with ultrasonographic parameters has a positive prediction for difficult laparoscopy. It can help us in predicting difficult surgery, prevent complications, obtain adequate and proper consent from patient, as well as proper planning of surgery. An increase in the thickness of the gall bladder wall leads to an increased risk of complications as well as an increased length of stay in hospital post operatively