scholarly journals A Comparative Study between the Outcome of Primary Repair versus Loop Ileostomy in Ileal Perforation

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Sushil Mittal ◽  
Harnam Singh ◽  
Anand Munghate ◽  
Gurpreet Singh ◽  
Anjna Garg ◽  
...  
Keyword(s):  
Indian Subcontinent ◽  
Primary Repair ◽  
Loop Ileostomy ◽  
Ileal Perforation ◽  
Defunctioning Ileostomy ◽  
Surgical Emergency ◽  
Abdominal Emergencies ◽  
Group A ◽  
Perforation Peritonitis ◽  
Group B

Introduction. Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions.Methods. Sixty proven cases of ileal perforation patients admitted to Surgical Emergency were taken up for emergency surgery. Randomisation was done by senior surgeons by picking up card from both the groups. The surgical management was done as primary repair (group A) and loop ileostomy (group B).Results. An increased rate of postoperative complications was seen in group A when compared with group B with 6 (20%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation as compared to 2 (6.67%) in ileostomy closure. A ratio of 1 : 1.51 days was observed between hospital stay of group A to group B.Conclusion. In cases of ileal perforation temporary defunctioning loop ileostomy plays an important role. We recommend that defunctioning ileostomy should be preferred over other surgical options in cases of ileal perforations. It should be recommended that ileostomy in these cases is only temporary and the extra cost and cost of management are not more than the price of life.

scholarly journals The benefits of protective defunctioning ileostomy in ileal perforation surgery

2019 ◽  
Vol 6 (7) ◽  
pp. 2565
Author(s):  
Abhilekh Tripathi ◽  
Anjali Sethi ◽  
Deepak Sethi
Keyword(s):  
Hospital Stay ◽  
Psychological Impact ◽  
High Morbidity ◽  
Ileal Perforation ◽  
Defunctioning Ileostomy ◽  
Primary Surgery ◽  
Protective Ileostomy ◽  
Group A ◽  
Group B ◽  
The Impact

Background: Perforation of bowel, particularly ileal perforation, is a significant emergency surgical problem in developing and underdeveloped nations and usually associated with high morbidity and mortality. The study is focussed on evaluating the impact of protective ileostomy in ileal perforation and to compare its outcome in term of post operative complication, hospital stay, psychological impact and mortality with primary surgery without ileostomy and observe its effect on prognosis of patient as a whole. Aim of the study we compared two modalities of treatment, primary surgery without ileostomy v/s primary surgery with protective defunctioning ileostomy with respect to post operative complications, duration of hospital stay, morbidity, mortality and psychological impact.  Methods: We studied 50 patients of ileal perforation (diagnosed per-operatively) admitted to tertiary level hospital and operated upon for laparotomy. Patients were divided in 2 groups: Group A = Protective defunctioning ileostomy along with primary surgery, and Group B = Primary surgery alone. Primary surgery includes primary closure of perforation or resection and end to end anastomosis.Results: The commonest cause of non-traumatic ileal perforation was typhoid (52%) followed by non specific, tuberculosis and diverticulitis. Different types of operative procedures were performed. In Group A, total no. of dreaded complications like faecal fistula was 1 while in Group B, 10 patients developed faecal fistula. Other complications like wound infection and wound dehiscence were 28% in Group A while 96% in Group B. Overall mortality rate was 24% with 12% mortality in group A and 36% in group B. Mean hospital stay in Group A patient was 12.640±5.75 days (1-23 days) and those of group B was 23.760±16.04 days (5 - 59 days).  Conclusions: Construction of protective defunctioning ileostomy in case of distal ileal perforation repair or anastomosis greatly reduces the dreaded complication and mortality in comparison to perforation repair or anastomosis without protective ileostomy. Although it is associated with ileostomy related complications, but they are only temporary and obviously no more than the price of life saved. 

A Foxtail-Shaped Vermilion Flap to Reconstruct the Medial Tubercle in Asymmetric Bilateral Cleft Lip With Contralateral Lesser Form Defect

2019 ◽  
Vol 56 (8) ◽  
pp. 1052-1057
Author(s):  
Yuta Nakajima ◽  
Shunsuke Yuzuriha ◽  
Fumio Nagai ◽  
Kenya Fujita ◽  
Masahiko Noguchi
Keyword(s):  
Cleft Lip ◽  
Primary Repair ◽  
Tertiary Care ◽  
Senior Author ◽  
The Body ◽  
University Hospital ◽  
Bilateral Cleft Lip ◽  
Group A ◽  
Cleft Lip Repair ◽  
Group B

Objective: There have been few reports addressing asymmetric bilateral cleft lip repair with contralateral lesser form defects. Two studies have described the thin medial tubercle as the most common remaining labial deformity. In this study, we aimed to evaluate the use of a foxtail-shaped vermilion flap to reconstruct the median tubercle in primary repair. Design: A blinded retrospective study of photography and chart review. Setting: Shinshu University Hospital, tertiary care. Private practice. Patients: Forty-nine patients with asymmetric bilateral cleft lip with lesser form defects treated using a primary “unilateral” repair by the senior author (S.Y.) between 2007 and 2017. Interventions: The foxtail-shaped vermilion flap was applied at the time of the primary nasolabial repair. This flap is similar to Noordhoff laterally based triangular vermilion flap but with modifications to the shape and length. The body of the flap is wider than the pedicle to add tissue to the center of the vermilion, and the length is sufficiently elongated to reach the lesser side. Main Outcome Measure: Lip shape was graded on a 4-point scale when patients were 1 year old. Results: Twenty-two patients were treated with the foxtail-shaped vermilion flap (group A) and 27 patients with Noordhoff triangular vermilion flap (group B). Group A had a better lip shape than group B ( P = .006). Conclusions: The foxtail-shaped vermilion flap is useful to reconstruct the median tubercle in asymmetric bilateral cleft lip repair with contralateral lesser form defects.

scholarly journals Anatomical derangements after failed PSARP: correlating MRI and operative findings

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amr Abdelhamid AbouZeid ◽  
Shaimaa Abdelsattar Mohammad
Keyword(s):  
Primary Repair ◽  
Levator Ani ◽  
Colostomy Closure ◽  
Redo Surgery ◽  
Anorectal Angle ◽  
Pelvic Mri ◽  
Group A ◽  
Faecal Continence ◽  
Group B ◽  
Operative Findings

Abstract Background Redo surgery for anorectal anomalies (ARA) may be considered a special category of reconstructive surgery with less predictable outcomes. In this report, we studied anatomical derangements in a group of boys following a previously complicated PSARP procedure, in addition to the effect of reoperation on rectifying this distorted anatomy. Results The study included 27 boys who were re-operated after a previous complicated PSARP. Included cases were divided into two groups: group A (14 cases) was referred before colostomy closure with an obviously complicated primary operation, and group B (13 cases) was referred with delayed complications after colostomy closure. Pelvic MRI examinations were performed before reoperation in 19 cases. In nine of these cases, a repeat MRI examination was performed at follow-up after reoperation to study the effect of redo surgery on rectifying the distorted anatomy. Abnormal wide anorectal angle and wide pelvic hiatus were common anatomical derangements after a previously complicated PSARP. An important goal of reoperation was reconstruction of the levator ani behind the anorectum trying to create a more acute anorectal angle and a narrower pelvic hiatus. The success of this corrective step was evaluated by MRI comparing pre- and postoperative measurements that showed a favourable decrease in the values of anorectal angle and hiatal/PC ratio. Improvement of faecal continence was documented after reoperation in 8 out of 10 cases in group B. Conclusion A wide pelvic hiatus was a frequently encountered postsurgical complication after failed PSARP that has most probably resulted from poor reconstruction of the pelvic floor at time of the primary repair. Re-approximation of the split halves of levator ani in the midline behind the anorectum at reoperation can help to correct the distorted internal anatomy and improve bowel control in these cases.

scholarly journals Comparison of primary repair with healing by secondary intention for the treatment of pilonidal sinus, at a Tertiary Care Hospital in Karachi, Pakistan.

2019 ◽  
Vol 26 (08) ◽  
pp. 1306-1310
Author(s):  
Muhammad Ghayasuddin ◽  
Fareya Usmani ◽  
Amtullah Sheikh ◽  
Hamid Raza
Keyword(s):  
Pilonidal Sinus ◽  
Primary Repair ◽  
Tertiary Care ◽  
Healing Time ◽  
Random Allocation ◽  
Care Hospital ◽  
Secondary Intention ◽  
Group A ◽  
The Mean ◽  
Group B

The aim of our study is to assess the surgical outcome of healing by primary intention and compare it with primary repair for the treatment of pilonidal sinus. Study Design: Randomized controlled trial. Setting: Tertiary Care Center in Karachi Pakistan. Period: Two years from April 2015 to April 2017. Materials and Methods: 60 patients were divided into two groups by utilizing a Random Allocation Software. All the patients involved in the study signed a duly informed consent. The inclusion criteria were patients who presented to us with a pilonidal sinus and agreed to participate in the study. All the procedures were performed by the same team of surgeons. Patient follow up was bi-weekly at the outpatient. Data were collected in a predesigned proforma with various variables such as patient demographics, clinical findings, treatment option used, postoperative results, complications (if any), healing time, length of hospital stay and time for a return to function among others. The data were analyzed using IBM SPSS version 21.0. A p value of less than 0.05 was considered to be statistically significant. Results: N= 60 patients were included in the study. There were n= 51 men (85%) and n= 9 women (15%). The mean age of patients in group A was 26.45 +/- 5.81 years and the mean age of participants in group B was 27.10 +/- 5.75 years. Symptoms lasted for 6.52 +/- 2.03 days, the most common presenting complaint was pain in 51.66% of patients followed by discharge in 40% and swelling in 33.33% respectively. The mean length of stay at the hospital for both the groups was 4.40 +/- 2.11 days (4.09 +/- 1.96 days in group A and 4.85 +/- 2.33 days in group B), mean time to return to normal functioning was 17.88 +/- 8.46 days (14.50 +/- 7.30 days in group A and 23.80 +/- 6.50 days in group B). The mean healing time postoperatively for both the groups was 39.98 +/- 24.46 days (21.90 +/- 10.15 days in group A and 67.30 +/- 9.09 days in group B. Early postoperative infection was found in n=7 (11.66%) patients, wound necrosis was found in n= 2 (3.33%) patients, and recurrence of the pilonidal sinus was found in n= 3 (5%) of the patients respectively. Conclusion: According to the results of our study primary closure technique provides better outcomes in terms of early return to functioning, shorter duration of wound healing and lower rates of wound infection as compared to excision and healing by secondary intention.

scholarly journals Early Post-operative Outcome of Primary Repair of Bladder Exstrophy With or Without Osteotomy

2014 ◽  
Vol 2 (2) ◽  
pp. 63-67 ◽  
Author(s):  
S. M. Borhan Uddin ◽  
Md. Abu Bakar Akan ◽  
Rajib Khastgir ◽  
Md. Ruhul Amin
Keyword(s):  
Abdominal Wall Defect ◽  
Primary Repair ◽  
Bladder Exstrophy ◽  
Pubic Symphysis ◽  
Surgical Reconstruction ◽  
Paediatric Surgery ◽  
Cross Sectional ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Bladder exstrophy (BE) is a variety of infraumbilical midline anterior abdominal wall defect. This rare spectrum of anomalies involves the urinary tract, genital tract, musculoskeletal, system and sometimes the intestinal tract. Surgical reconstruction with or without osteotomy is the treatment of choice for BE. Objective: To evaluate the intersymphyseal gap (ISG) before, during and after operation (pubic diastasis) and to evaluate the status of post-operative wound healing.Materials & Methods: This cross sectional study was conducted on 18 patients of paediatric age group over a period from February 2007 to October 2008 who were admitted with classical bladder extrophy (BE) in the department of paediatric surgery, BSMMU.. They were divided into two groups. In group-A: 8 patients of BE were undergone primary repair with osteotomy and in group-B primary repair done in 10 patients without osteotomy. Results: Two (2) months post-operative follow-up revealed that all osteotomy patients (group- A) developed re-diastasis of pubic symphysis. Statistically no significant difference of ISG was observed in two groups of patients. Wound healing was better in without osteotomy (group-B) patients (80% vs 50%) and wound failure was more in osteotomy patients (50% vs 20%). Moreover, osteotomy group need hospitalization for longer period of time.Conclusions: Although osteotomy is an essential step in the management of BE, this study revealed that it does not improve the early post-operative outcome.DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19546

scholarly journals A comparative study between single layer versus double layer closure in ileostomy reversal

2014 ◽  
Vol 6 (2) ◽  
pp. 43-46 ◽  
Author(s):  
Sushil Mittal ◽  
Harnam Singh ◽  
Gurpreet Singh ◽  
Anand Munghate ◽  
Anjna Garg ◽  
...  
Keyword(s):  
Double Layer ◽  
Indian Subcontinent ◽  
Intestinal Anastomosis ◽  
Single Layer ◽  
Ileostomy Closure ◽  
Layer Versus ◽  
Choice Of Procedure ◽  
Postoperative Leak ◽  
Group A ◽  
Group B

Background:  Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. Formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel. The technique for stoma reversal has remained controversial is the use of either one or two layers of sutures for anastomosis.Methods:  Sixty patients with ileostomy were taken for study .These patients divided in two groups A and B, 30 each. These patients were taken up for ileostomy closure in single layer (group A) (n-30) &double layer (group B) (n-30). Results: 60 Patients of ileostomy were studied, divided equally in 2 groups, A decreased intra operative time was seen in Group A when compared with Group B with no any significant comparative complication in these groups. Conclusion: Two-layer anastomosis for ileostomy closure offers no definite advantage over single layer anastomosis in terms of postoperative leak and other complications. Single layer ileostomy closure technique is safe, easy to perform and simply to taught. Considering duration of the anastomosis procedure and medical expenses single-layer intestinal anastomosis may prove the choice of procedure for most of the surgeons. DOI: http://dx.doi.org/10.3126/ajms.v6i2.10080Asian Journal of Medical Sciences Vol.6(2) 2015 44-47

scholarly journals Posterior and postero-lateral incidental durotomy during lumbar spine surgery: primary repair versus augmented primary repair

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Mansour A. Makia ◽  
Ahmed Alawamry ◽  
Ahmad M. Elsharkawy
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Revision Surgery ◽  
Primary Repair ◽  
Csf Leak ◽  
Lumbar Spine Surgery ◽  
Blood Patch ◽  
Group A ◽  
Group B ◽  
Incidental Durotomy

Abstract Background Incidental durotomy (ID) during lumbar spine surgery is a frequent complication of lumbar spine surgical procedures. Many surgical techniques were described in literature for repair of durotomy, however it is a matter of debate if one technique is a gold standard method of repair. Our study described two groups with posterior and postero-lateral ID that occurred during lumbar spine surgery: group A with 34 cases with a mean age of 49.85 years repaired by primary water tight closure using prolene or silk sutures, and group B with 34 cases with a mean age of 47.18 years treated with augmented primary repair (sutures augmented with a graft from lumbar fascia and tissue sealant "Fibrin glue"). Patients were evaluated for risk factors for durotomy, post-operative clinical outcome, and need for revision surgery. Results Eleven cases of group A and nine cases of group B had previous spine surgery. The dural tear was < 2 cm in 41.7% of group A and 83.3% of group B. Better outcome was achieved in 32 patients of group A and 30 patients of group B. Among our study cases 2 patients from group A and 4 patients from group B needed revision surgery due to CSF leak which failed to stop with conservative management and percutaneous blood patch. Conclusions Dural closure technique after ID does not seem to influence revision surgery rates due to cerebrospinal fluid (CSF) leakage and its complications. Durotomies that were immediately recognized and treated did not lead to any significant consequences.

An ultrastructural study of sertoli cells in two geographically isolated populations of Aphanius dispar

1992 ◽  
Vol 50 (1) ◽  
pp. 548-549
Author(s):  
Taber A. Ba-Omar ◽  
Philip F. Prentis
Keyword(s):  
Ultrastructural Level ◽  
Uranyl Acetate ◽  
Freshwater Teleost ◽  
Isolated Populations ◽  
En Bloc ◽  
The North ◽  
Group A ◽  
Ultrathin Sections ◽  
Group B ◽  
Geographically Isolated

We have recently carried out a study of spermiogenic differentiation in two geographically isolated populations of Aphanius dispar (freshwater teleost), with a view to ascertaining variation at the ultrastructural level. The sampling areas were the Jebel Al Akhdar in the north (Group A) and the Dhofar region (Group B) in the south. Specimens from each group were collected, the testes removed, fixed in Karnovsky solution, post fixed in OsO, en bloc stained with uranyl acetate and then routinely processed to Agar 100 resin, semi and ultrathin sections were prepared for study.

Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0220-0228 ◽  
Author(s):  
Marion Vircoulon ◽  
Carine Boulon ◽  
Ileana Desormais ◽  
Philippe Lacroix ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Medical Group ◽  
Consensus Definition ◽  
Transcutaneous Oxygen ◽  
European Consensus ◽  
Group A ◽  
One Year ◽  
Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

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