Impact of “Lateralizing” the Sigmoid Colostomy on Port Ergonomics in Laparoscopic Anorectoplasty for High Anorectal Malformations

2020 ◽  
Author(s):  
Vikesh Agrawal ◽  
Deepak Sulya ◽  
Himanshu Acharya ◽  
Abhishek Tiwari ◽  
Dhananjaya Sharma
Keyword(s):  
Operative Time ◽  
Statistical Tests ◽  
Iliac Fossa ◽  
Central India ◽  
Anorectal Malformations ◽  
Left Iliac Fossa ◽  
High Type ◽  
Medical College ◽  
Second Stage ◽  
Sigmoid Colostomy

Abstract Introduction The high-type anorectal malformations (ARM) are conventionally managed by an initial left iliac fossa sigmoid colostomy, followed by laparoscopic anorectoplasty (LARP). Such a stoma occupies left half of the infraumbilical region and hinders the LARP ergonomics, leading to the surgeon's discomfort. We studied the outcome and impact of “lateralizing” (shifting laterally in the abdominal wall) the colostomy on port ergonomics. Materials and Methods This prospective study was conducted in the pediatric surgery unit of a medical college in central India between March 2014 and June 2017 in two parts. In the first part of the study, neonates with high ARM were block randomized in two groups: conventional colostomy (CC) in left iliac fossa and lateral colostomy (LC, laterally placed abdominal colostomy). Outcomes of colostomy were compared among these two groups. In the second part of the study, 40 consecutive infants from both types of colostomy groups underwent ergonomic comparison and assessment of the surgeon's discomfort during LARP (CC-LARP and LC-LARP). Standard statistical tests were used for comparison. Results In the first part of the study, 203 ARM cases were included in this study; 100 underwent CC and 103 underwent LC. Colostomy prolapse, excoriation, reversed stoma, and short distal limb were significantly higher in the CC group. In the second part of the study, the LC-LARP group showed many significant advantages over the CC-LARP group, including less peri-stomal adhesions, better vision, shorter operative time, and better ergonomics (better manipulation, elevation, and azimuth angles). The LC-LARP also significantly reduced the surgeon's discomfort. Conclusion Lateralization of high-sigmoid colostomy should be preferred over left iliac fossa sigmoid colostomy for ARM, as it improves the port ergonomics and reduces the surgeon's discomfort for second stage LARP.

scholarly journals Divided and Separated Sigmoid Colostomy in Anorectal Malformation : Six Years Experience at Dhaka Shishu Hospital

2018 ◽  
Vol 9 (2) ◽  
pp. 311-314
Author(s):  
Md Delwar Hossain ◽  
Md Shahjahan ◽  
Md Saifullah ◽  
Kazi Md Noor Ul Ferdous ◽  
M Kabirul Islam
Keyword(s):  
Wound Infection ◽  
Anorectal Malformation ◽  
Parastomal Hernia ◽  
Anorectal Malformations ◽  
Common Complication ◽  
Medical College ◽  
Satisfactory Outcome ◽  
Surgical Options ◽  
Sigmoid Colostomy

Background : There are various surgical options for management of anorectal malformations (ARM). Colostomy is a common part of the management of high anorectal malformation in the pediatric population.Objective : The aim of this study was to find out the most common complications after formation of divided sigmoid colostomy.Methods : This prospective observational study was done in the Division of Pediatric Surgery, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka from January 2012 to December 2017. Divided and separated sigmoid colostomy was doneon 116 patients admitted with ARM during this period. Follow up on 2nd, 4th and 8th week after operation was done and in each follow up patients were assessed clinicallyfor wound infection, skin excoriation, prolapse of colostomy, retraction of colostomy and parastomal hernia. If colostomy complications were found then managed as per standard method.Results : The mean age of patients was 2.43±1.29 days and majority of the patients 66 (56.9%) were male.About half of the patients 50(43.1%) had fistula and 21(18.1%) patients had associated anomaly. Among 116 patients 51 (43.97%) developed complications after colostomy. The most common complication was skin excoriation found in 35 (30.2%) patients followed by wound infection in 8(6.9%). Prolapse and retraction of colostomy was found only in 6 (5.17%)and 2 (1.7%) cases respectively. No patient developed parastomal hernia and there was no mortality.Conclusion : Divided and separated sigmoid colostomy provided satisfactory outcome in the management of high anorectal malformation. Skin excoriation was the most common complication and few developed wound infection and prolapse of colostomy.Northern International Medical College Journal Vol.9(2) Jan 2018: 311-314

Lichtenstein Versus Desarda’s Technique of Hernia Repair

2020 ◽  
Vol 22 (2) ◽  
pp. 99-103
Author(s):  
Md Fardhus ◽  
AMSM Sharfuzzaman ◽  
Md Nayeem Dewan ◽  
Md Abul Hossain ◽  
Ahmed Sami Al Hasan ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Operative Time ◽  
Seroma Formation ◽  
Age Group ◽  
Serous Fluid ◽  
Medical College ◽  
Randomized Control ◽  
And Gender

Aim: To compare Desarda’s versus Lichtenstein’s mesh repair in patients with unilateral, primary, reducible inguinal hernia in terms of mean operative time and seroma formation Methods: This randomized control trial conducted at Department of Surgery, Patuakhali Medical College & Hospital, Patuakhali. Eighty patients with unilateral, primary, reducible inguinal hernia were randomly distributed into two groups to undergo hernia repair i.e. Lichtenstein (L) and Desarda’s (D). Outcome was measured in terms of mean operative time and seroma formation. Seroma formation was defined as presence of enclosed cavity containing serous fluid determined by ultrasonography at 30th post-operative day. Results: Thirty three patients (41.25%) were above 50 years of age, whereas remaining 47 patients (58.75%) were below 50 years of age. Five patients (6.25%) were female and 75 patients(93.75%) were male. Seroma formation was 5% in Desarda’s group while 7.5% in Lichtenstein group (P> 0.05). Similarly difference in mean operative time was statistically non-significant. Seroma formation was common in older age group. There was no effect of smoking, obesity, operative time and gender on seroma formation. Conclusion: It is concluded that there is no difference in frequency of seroma formation and mean operative time in Desarda’s or Lichtenstein’s technique of hernia repair. Journal of Surgical Sciences (2018) Vol. 22 (2) : 99-103

Abdominal apoplexy during pregnancy

2020 ◽  
Vol 13 (10) ◽  
pp. e235946
Author(s):  
Jasmeet Kumari ◽  
Rosemary Harkin
Keyword(s):  
Iliac Fossa ◽  
Unknown Origin ◽  
Breech Presentation ◽  
Sudden Onset ◽  
Left Iliac Fossa ◽  
Safe Delivery ◽  
Uterine Contractions ◽  
Early Labour ◽  
Increased Risk ◽  
High Index Of Suspicion

We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. ‘Abdominal apoplexy’ (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.

Imperforate hymen mimicking acute appendicitis in an adolescent woman: a rare presentation

2021 ◽  
Vol 14 (3) ◽  
pp. e238547
Author(s):  
Victoria Rose Russell ◽  
Mohamed Ibrahim ◽  
Georgina Phillips ◽  
Tom Setchell ◽  
Sanjay Purkayastha
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Female Genital Tract ◽  
Delayed Diagnosis ◽  
Rare Presentation ◽  
Left Iliac Fossa ◽  
Imperforate Hymen ◽  
Retrograde Menstruation ◽  
Low Incidence

Imperforate hymen is a rare congenital malformation of the female genital tract. The condition poses several diagnostic challenges owing to its low incidence and often atypical presentation. Classical symptoms include amenorrhoea and cyclical abdominal pain. Delayed diagnosis leads to potentially irreversible and lifechanging sequelae including infertility, endometriosis and renal failure. A premenarchal 13-year-old girl with a background of chronic constipation presented with symptoms mimicking acute appendicitis. The underlying cause was imperforate hymen and retrograde menstruation. The diagnosis was made during diagnostic laparoscopy. As with this patient, pre-existing symptoms are often troublesome long before the true diagnosis is made. This case report highlights the importance of recognising imperforate hymen as a potential cause of acute abdominal pain in premenarchal adolescent girls. The clinical picture may present as right or left iliac fossa pain. Early identification reduces the risk of adverse complications and avoids unnecessary and potentially harmful interventions.

scholarly journals STUDY OF RIGHT ILIAC FOSSA MASS IN PATIENTS ATTENDING ANDHRA MEDICAL COLLEGE, VISAKHAPATNAM

2016 ◽  
Vol 3 (51) ◽  
pp. 2635-2638
Author(s):  
Sudhakar Waddi ◽  
Suganakar Kodi ◽  
Chandana Vemuri ◽  
Deepika P
Keyword(s):  
Iliac Fossa ◽  
Medical College

scholarly journals Treatment of Complex Whole Liver Intrahepatic Ductal Stones Using a Patented Stone-Clearance Sheath Combined with Nephroscopic Holmium Laser Lithotripsy

2021 ◽  
pp. 1-4
Author(s):  
Yuancai Xie ◽  
Dingwen Zhong ◽  
Yanda LU ◽  
Donghua Xie ◽  
Xianjin Cheng ◽  
...  
Keyword(s):  
Operative Time ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Control Group ◽  
Observation Group ◽  
Clearance Rates ◽  
Stone Clearance ◽  
Second Stage ◽  
Holmium Laser Lithotripsy ◽  
One Year

Purpose: To investigate the clinical efficacy of nephroscopic laser lithotripsy with the aid of a patented suctioning sheath in treating complicated whole-liver dispersed intrahepatic ductal stones. Methods: From September 2013 to September 2017, 150 patients who were diagnosed with whole-liver dispersed intrahepatic ductal stones were included in this study and were divided into two groups randomly. The control group consists of 75 patients who were treated by traditional surgery combined with choledochoscopic laser lithotripsy. The observation group consists of the other 75 patients who were treated by traditional surgery combined with nephroscopic laser lithotripsy with the aid of the patented sheath. Related treatment outcome parameters were compared. Results: There were no significant differences in first surgery operative time, first surgery bleeding amount, complication and stone clearance rates (P>0.05). However, the second surgery operative time was (63.58±9.84) min while the complication rate was 7.5% in the observation group, significantly less than that of control group (P<0.05). There were significantly higher first-stage and second stage sinus ductal stone clearance rates and final stone clearance rate in the observation group compared to that of control group (P<0.05), while operative times, hospitalization duration and cost, and one year stone recurrent rate were significantly lower (P<0.05). Conclusion: The efficacy of using the patented stone-clearance sheath combined with nephroscopic holmium laser lithotripsy was significant, warrants more extensive clinical adoption.

scholarly journals Hubungan Faktor Maternal terhadap Posisi pada Waktu Persalinan Kala II dengan Kejadian Ruptur Perineum

2020 ◽  
Vol 2 (1) ◽  
pp. 31-36
Author(s):  
Wa Ode Hajrah ◽  
Niken Purbowati ◽  
Novia Nuraini
Keyword(s):  
Maternal Age ◽  
Statistical Tests ◽  
Reproductive Organs ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Second Stage ◽  
Second Stage Labor ◽  
Relationship Of ◽  
The Relationship

erineal rupture needs attention because it can cause dysfunction of the female reproductive organs, as a source of bleeding, a source, or a way in and out of infection, then it can cause death due to bleeding or sepsis. About 85% of Women who delivery vaginally experience perineal rupture, in the age group 25-30 years 24%, while in maternal age 32-39 years by 62%. In Asia, perineal rupture is also a problem in society, 50 % of the world's occurrence is in Asia. The study aims to determine the relationship of maternal factors to the position of the second stage labor and perineal rupture occurrence. This research applied a descriptive-analytic method using a cross-sectional research design. The research sample was 102 respondents, accidental random sampling, which was all labor with perineal rupture in July to November 2018. Statistical tests used chi-square. The results of perineal rupture with maternal age was p-value 0.042 (p <0.05), perineal rupture with maternal parity was p-value 0.01 (p <0.05). Suggestions for various maternal positions in maternity and ANC classes to prevent perineal rupture.

scholarly journals Breeding behaviour of the Coromandel Damselfly Ceriagrion coromandelianum (Fabricius) (Zygoptera: Coenagrionidae) in central India: copulation

2018 ◽  
Vol 10 (9) ◽  
pp. 12203
Author(s):  
Nilesh R. Thaokar ◽  
Payal R. Verma ◽  
Raymond J. Andrew
Keyword(s):  
Abdominal Segment ◽  
Central India ◽  
Botanical Garden ◽  
Reproductive Behaviour ◽  
Copulation Duration ◽  
Mate Location ◽  
Courtship Display ◽  
Second Stage ◽  
Bright Yellow ◽  
Two Stages

The Coromandel Damselfly Ceriagrion coromandelianum can be easily identified because of its bright yellow abdomen, greenish thorax and eyes.  In females, the abdomen is darker with light brown colouration extending to dark brown towards the terminal end.  The documentation of the reproductive behaviour of Ceriagrion coromandelianum was carried out at the botanical garden of Hislop College, Nagpur, India.  The males of C. coromandelianum arrive early in the morning by 07:00hr at the ovipositing site.  They belong to “sit and wait” type of mate-location.  While perched and waiting for the female to arrive they at times exhibit abdominal bobbing, and oviposition posture.  The territorial area of male C. coromandelianum is very small, within a range of about 45cm around his perch.  There is no precopulatory courtship display and the male move toward the arriving receptive female and directly tries to form a tandem link.  The other males of the group follow the pair.  The tandem pair flies towards the safety of the surrounding vegetation to copulate. Before copulation, the male fills his penis vesicle with sperm material by the process of “intra male sperm translocation” which lasts for 30±8 seconds.  The female curves her abdomen ventrally forward so that her gonopore which is located between the eighth and ninth sternite comes to lie before the secondary copulatory apparatus of the male and forms a strong genital link, to form the copulatory wheel.  The copulation duration can be long (34–55 min) or short (12–15 min).  Two stages of copulation depending upon the pumping movement of the couple can be differentiated.  During the first stage, the male rhythmically and forcefully depresses and stretches the first two abdominal segments, vigorously pumping the penis inside the female vagina which accounts for 72% of the copulation duration.  The second stage starts with rapid short thrusting movement which are not forceful but exhibit shallow movements of the first two abdominal segment of the male.  The tandem pairs after copulation may directly move for oviposition or settle around the surrounding foliage and exhibit “post-copulatory resting” (PCR) behaviour.  It is noted that 23.3% females immediately commence oviposition, 53.4% exhibit brief, while 23.3% display prolonged PCR behaviour.  

A COMPARATIVE STUDY OF LEVELS OF HIGH SENSITIVITY CREACTIVE PROTEIN (hs-CRP) IN DIABETIC AND NON- DIABETIC POPULATION OF CENTRAL INDIA

2021 ◽  
pp. 31-32
Author(s):  
Parag Gupta ◽  
Lal Pranay Singh
Keyword(s):  
Diabetes Mellitus ◽  
Central India ◽  
High Sensitivity ◽  
Control Group ◽  
Low Grade ◽  
Medical College ◽  
Diabetic Population ◽  
Hs Crp ◽  
And Control

Background: Diabetes mellitus is the most common metabolic disorder characterized by metabolic abnormalities and long term complications. It is characterized by hyperglycemia resulting from defect in insulin secretion and in its action. It has become a leading cause of morbidity and mortality world over. hs- CRP is a marker of low-grade inammation and it is raised in patients with type 2 DM. The present study was undertaken with the objective of studying the relation of High Sensitivity CRP (hs-CRP) in patients of type 2 Diabetes Mellitus and in non-diseased population. Methods: This was a comparative observational study, conducted at Diabetic clinic, Index Medical College, Indore during August 2014 to July 2015. Cases and control were selected as per the inclusion criteria. Statistical analysis was done using SPSS v20. Mean age of the group was 48years. The mean hs CRP in the diabe Results: tic group was 0.45 compared with 0.35, in the control group. hs CRP levels are directly related to insulin resistance and is Conclusion: highly associated with diabetic population.

scholarly journals Rising rates of second stage caesarean section and its impact on maternal outcome

2018 ◽  
Vol 7 (7) ◽  
pp. 2681
Author(s):  
Shanmugapriya Kumaresan ◽  
Malarvizhi Loganathan
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Adverse Outcomes ◽  
Cesarean Sections ◽  
Maternal Complications ◽  
College Hospital ◽  
Second Stage Of Labor ◽  
Medical College ◽  
Second Stage ◽  
Second Stage Of Labour

Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. With this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlights includes the rate of caesarean deliveries in the second stage of labour, the indications for delivery and the associated maternal morbidity in this cohort of women.  Methods: This was a prospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between July, 2016 and December 31, 2017 at government medical college hospital Dharmapuri. The main outcome measures were second stage caesarean section, indications and its maternal morbidity.Results: 250 women underwent caesarean delivery in the advanced labor. Among the 250 patient’s majority of them were in the age group of 21-30 yrs. about 76% of the patients were primigravidae and only the remaining 24% were multigravida. The commonest indications for doing caesarean section in the second stage of labor was cephalo pelvic disproportion and non-reassuring fetal heart rate patterns. The difficult task was delivery of the deeply engaged head, the increased likelihood of intraoperative and post-operative complications.Conclusions: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and morbidity.

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