scholarly journals COMPARISON OF MINI CHOLECYSTECTOMY VERSUS OPEN CHOLECYSTECTOMY IN PATIENTS WITH CHOLELITHIASIS

2020 ◽  
Vol 11 (2) ◽  
pp. 34-42
Author(s):  
Dr. Uzair Karim Qasrani

ABSTRACT Objectives: The objective of this study is to compare the outcome of mini cholecystectomy with open conventional cholecystectomy in the management of cholelithiasis. Study Design: This was a randomized controlled trial. Study Period: Study was conducted in  Department Of Surgery, Teaching Hospital Dera Ghazi Khan, from June 2017 to Dec 2017 for a period of six month.   Patients and Methods: A total of 100 cases; 50 cases in each group was included in the study. 100 patients were admitted from OPD of Teaching Hospital Dera Ghazi Khan fulfilling inclusion criteria. Demographic information was recorded. All admitted patients were diagnosed on the basis of history, clinical examination and relevant investigations. Written consent was obtained. Data entry and analysis was done by using SPSS 11. Data was analyzed according to the proposed analysis plan.   Results: Mean age of all patients was 39.96±3.84 years. Age range of patients was 30-48 years. In Group-A mean hospital stay was 5.38±1.15 and in Group-B mean hospital stay was 3.02±0.58 days respectively. At 1st visit 14(28%) patients in Group-B and only 1(2%) patient in Group-A had wound infection. According to p-value wound infection was significantly associated with treatment group. Patients in Group-A had less infection rate as compared to Group-B patients. i.e. (p-value=0.000) Whereas at 2nd visit 8(16%) patients in Group-B and 3 patients in Group-A suffered from wound infection. At 2nd visit wound infection was statistically same in both treatment groups. i.e. (p-value=0.110). It was observed that in Group-B only 44(88%) of the patients had severe pain whereas only 12(24%) of the patients in Group-A had severe pain. Keeping in mind this results rate of severe pain at 12th hour was high in Group-B patients as compared to Group-A patients. i.e. (p-value=0.000).   Conclusion:  Mini cholecystectomy is effective and associated with less patients discomfort in terms of post operative pain and infection as well as with less hospital stay.

2019 ◽  
Vol 26 (05) ◽  
Author(s):  
Ashar Ahmad Khan ◽  
Abdul Rashid Surahio ◽  
Umair Maqsood

Objectives: To see the outcome of colostomy reversal with and without mechanical bowel preparation. The purpose of the study is to determine wheth­er the mechanical preparation before the elective col­orectal surgery is more beneficial for the patients. Study Design: Randomized controlled trial. Settings: Department of General Surgery, Nishtar Medical University/Hospital, Multan. Period: 1st July 2016 to 31st December 2017. Materials & Methods: A total of 302 patients with sigmoid colostomy of more than 1 month duration and undergoing colostomy closure, patients above 12 years of age of both genders were included. Patients with h/o pelvic irradiation, peritonitis, CRF and CLD were excluded. Selected patients were placed randomly into two groups. Group A included cases in which mechanical bowel preparation was done 6 hours prior to operation while group B included patients in which no mechanical bowel preparation was done. Mean Hospital stay was noted in every patient of both groups from day of operation to day of discharge. Wound infection was noted on seventh post-operative day. Results: Mean age was 36.62 ± 7.23 years. Mean duration of disease was 3.05 ± 1.04 months. Mean hospital stay in group A (mechanical bowel preparation) was 5.29 ± 1.05 days and in group B (without mechanical bowel preparation) was 3.87 ± 1.17 days with p-value of 0.0001. Wound infection in group A (mechanical bowel preparation) was found in 19 (12.58%) and in group B (without mechanical bowel preparation) was found in 08 (5.30%) patients with p-value of 0.027. Conclusion: There were no significant effect of mechanical bowel preparation before colorectal surgery and no more benefit and it should be reserved for selective cases only.


2017 ◽  
Vol 24 (09) ◽  
pp. 1316-1321
Author(s):  
Shibber Ahmed ◽  
Ishtiaq Ahmad ◽  
Humayun Amjid ◽  
Aamir Furqan

Objectives: Is to compare outcomes in terms of mean post-operative pain andhospital stay between stapled versus conventional hemorrhoidectomy. Hypothesis: There isa difference in mean post-operative pain and hospital stay between stapled and conventionalhemorrhoidectomy, stapled technique is better than conventional technique. Study Design:Randomized control trial. Setting: Department of General Surgery Bakhtawar Amin MemorialHospital Multan. Period: February 2016 February 2017. Methodology: A total number of 60patients enrolled in the study, both genders. Statistical software SPSS ver.23 was used toanalyze the data. Mean and SD were calculated and presented for numerical variables likeduration of hemorrhoids, age and pain score while frequencies and percentage were calculatedand presented for categorical variables like ender and grade of hemorrhoids. Independent t-testand chi square test were applied to see effect modification. P value ≤0.05 was considered assignificant. Results: Total number of 60 (100%) patients in the study, 32 (53.3%) were maleand 28 (46.7 %) were female. Mean hospital stay in group A was 1.63 ± 0.71 and in groupB means duration of hospital stay was 1.73 ± 0.74. A P value was 0.001. On stratification ofdata it is concluded that in group A 9 patients have no pain 6 have mild and 6 have moderatepain and 5 patients have severe pain, similarly in group B, 3 patients have no pain 2 have mildpain 1 have moderate pain and no patient have severe pain. P value for male patients was2.65. Conclusion: This study confirms that stapled hemorrhoidectomy is associated with lesspostoperative pain with no effect of age and gender on outcome.


Author(s):  
Sahrish Bachani ◽  
Shahid N. Memon ◽  
Muhammad R. Pathan ◽  
Rehmat Sehrish Shah ◽  
Aneeta Kumari ◽  
...  

Background: Thyroid lobectomy is a common operative technique of management of benign solitary thyroid nodules in which drains are used routinely. Objective of this study to compare the outcome of thyroid lobectomies undergone with and without drains in patients of benign solitary thyroid nodules.Methods: A comparative cross-sectional research was completed on 98 patients of benign solitary thyroid nodules at surgery department of Liaquat University Hospital Jamshoro. Patients having age of 18-60 years underwent thyroid lobectomies were included and distributed in two groups A and B. Group A includes thyroid lobectomies with drain and Group B without drain. Postoperative outcomes including pain score assessed via visual analog score (VAS), hospital stay and complications including wound infection, seroma and hematoma.Results: Out of 98 cases, 49 underwent thyroid lobectomy with drain and 49 without a drain. Females patients were in majority in group A 42 (85.7%) and also in group B 47 (95.9%). No significant difference (p-value=0.674) was in mean age of group A 30.8±10.2 years and group B 31.8±12.2 years. Higher mean with significant difference (p-value=0.001) was in pain score of group A 5.61±1.25 as compared to group B 3.55±0.70. No significant difference was in complications; seroma 1 (2.04%) vs 5 (10.20%), hematoma 1 (2.04%) vs 1 (2.04%) and infection 3 (6.12%) vs 0 (0.0%) in group A and B respectively. Higher mean with significant difference (p-value=0.001) was in hospital stay of group A 2.40±1.57 days as compared to group B 1.42±0.54 days. No significant difference (p-value=0.748) was in overall rate of complications in group A 5 (10.20%) and B 6 (12.24%).Conclusions: Thyroid lobectomy with drain is not effective in lowering the postoperative complications whereas enhanced the risk of postoperative pain, wound infection and duration of hospital stay as compared to thyroid lobectomy without a drain.


2012 ◽  
Vol 19 (06) ◽  
pp. 894-904
Author(s):  
CHOUDRY AMJAD ALI ◽  
RAHEEL AZHAR KHAN ◽  
AMJAD IQBAL ◽  
Tasadaq Khurshid

Objective: To compare the, post op analgesia, vomiting, shivering, length of hospital stay, peri-operative haemodynamicchanges and recovery time in patient under going open cholecystectomy under general anaesthesia versus those receiving epiduralanaesthesia. Study design: Quasi experimental study. Place and duration of study: Combined Military Hospital Rawalpindi from 15 October2007 to 15 April 2008. Methodology: American Society of Anaesthesiology (ASA) physical status (PS) I and II patient of either genderundergoing un-complicated open cholecystectomy were randomly divided into two groups, group A (n=30) received general anaesthesia (GA)and group B (n=29) received thoracic epidural anaesthesia (EA). Patients of both the groups were assessed for peri-operative haemodynamicchanges, recovery time, post op analgesia, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups andobtain P-value. P-value of less than 0.05 was considered significant. Results: 9 out of 30 patients (30%) of group “A” (general anaesthesia) and4 out of 29 patients (13.79%) in group “B” (epidural anaesthesia) had vomiting. Shivering was seen in 3 out of 30 (10%) in group “A” (generalanaesthesia) and 1 out of 29 (3.44%) patient in group “B” (epidural anaesthesia). Urinary retention was seen in 1 out of 30 (3.33%) in group “A”(general anaesthesia) and 8 out of 29 (27.5%) in group “B” (epidural anaesthesia). Urinary retention was relieved by psychotherapy. None ofthe patient required catheterization. Post operative recovery from surgery was determined by gastrointestinal motility (passage of flatus andstart of oral sips). In group “A” (general anaesthesia) 6 patients (20%) started oral sips in first post operative day, 16 patients (53.33%) onsecond post operative day, 8 patients (26.66%) in third post operative day. In the group “B” (epidural anaesthesia) 13 patients (44.8%) startedoral sips on first post operative day, 15 (51.72%) on second post operative day and one patient (3.44%) on third post operative day. Regardingthe length of hospital stay 17 patient (56.66%) of group “A” (general anaesthesia) were discharge by third post operative day and 22 patient(75.77) were discharge by third post operative day in group “B” (epidural anaesthesia). Conclusions: The use of intra-operative epiduralanaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the post operative pain and vomitingin patients under going open cholecystectomy.


2012 ◽  
Vol 11 (4) ◽  
pp. 273-283 ◽  
Author(s):  
Souvik Chatterjee ◽  
Sujoy Kumar Bala ◽  
Partha Chakraborty ◽  
Rajesh Dey ◽  
Santanu Sinha ◽  
...  

Background: Traditionally, enteric feeds are withheld for a period of 48-72 hrs, sometimes even more following enteric anastomosis depending upon return of full peristaltic sounds. This results in a period of nonstimulation   of gut –‘Gut Rest’, which was supposed to result in better anastomotic healing. But this same also deprives the intestinal mucosa of surface nutrients as well as prolongs parenteral fluid therapy, thereby   depriving the patients of adequate nutrition. Along with it, prolonged parenteral therapy also keeps the  patients bound to bed with its resultant complications like, prolonged hospital stay and increased cost of   therapy. Objectives: To compare the benefits of early enteral feeding over conventional enteric feeding following  enteric anastomosis with special regards to patients recovery and complications. Methods and  materials: The selection of patients into group A (60) and group B (60) was done after having fulfilled inclusion and exclusion criteria. Informed consent was obtained. The patients of group A were fed via   enteral route within 24 hrs of enteric anastomosis. The patients of group B were fed via enteral route after 48-72 hrs or appearance of full peristaltic sounds following enteric anastomosis. These patients were followed   in post operative period for their drain output, any nausea, vomiting or significant abdominal distension, prolonged ileus, post operative duration of shospital stay, post operative infective complications (e.g. wound infection, UTI, RTI), and different haematological and biochemical examinations. Results: This   study shows that post operative nausea-vomiting, anastomotic leakage rate, re-exploration, wound infection and RTI rates are higher in group A than those of group B. In this study, the incidence of UTI in post operative period is higher in group B. But the differences in above mentioned variables are not statistically significant. Whereas appearance of intestinal peristaltic sound is earlier in group A (42.8 ± 10.68 hours)   compare to that of group B (52.6 ± 13.46 hours). Here, the difference is statistically significant (p value = 0.000022) The duration of post operative hospital stay is shorter in group A (8.45 ± 5.143 days) than that of group B (10.533 ± 4.952 days). The difference of duration post operative hospital stay is statistically significant (p value = 0.0257). Removal of nasogastric tube, resumption of oral feeding, and passage of first flatus and/or defecation were earlier in the group A than that of the group B; the differences were statistically significant. The post operative day-5 albumin level is better in group A (3.147 ± 0.4409 gm/dl) than that of group B (2.935 ± 0.3124 gm/dl). This difference is also statistically significant (p value = 0.0029). There are three mortalities in group Awhereas one mortality in group B. This difference in mortality in two   groups is not statistically significant. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12597 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Ayoub ◽  
Y Tryliskyy ◽  
M K Baig

Abstract Introduction Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines till now and so surgeons have different practice based on their preferences. Method This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection. Results 90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1). Conclusions Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.


2020 ◽  
pp. 63-68
Author(s):  
Phat Ho Tan ◽  
Tam Vu Thi Minh ◽  
Trong Huynh Nguyen Dang ◽  
Phuong Tran Nhat Thi Anh ◽  
Ngan Tran Thi Kim ◽  
...  

Background: Hepatic encephalopathy is an important evidence that confirms impairment of liver function, may occur in about 40% of cirrhotics. Data about efficacy of rifaximin plus lactulose in the treatment of Vietnamese patients was still limited. This study aimed to determine the precipitating factors and to access the efficacy of lactulose plus rifaximin in overt hepatic encephalopathy. Patients and Methods: The prospective single-blind randomized controlled trial, 43 cirrhotics with overt hepatic encephalopathy without portal systemic shunting addmitted to gastroenterology department of Cho Ray Hospital from March 2019 to August 2019, were randomized into two groups (group A lactulose plus rifaximin 1.100 mg/day, n = 21; and group B only lactulose; n = 22). All patients were recorded for onset factors, clinical characteristics and assessing the recovery of hepatic encephalopathy. Results: The mean age of patients in this study was 54.8 ± 12.1 years (the ratio of male to female patients is 4.38 : 1). The leading cause of cirrhosis was alcohol (39.5%). The most common clinical symptoms were jaundice (83.7%), spider naevi (41.9%) and ascites (37.2%). The most common triggers were infection (51.2%), gastrointestinal bleeding (37.2%) and constipation (25.6%). The percentage of patients with complete improvement after treatment with lactulose plus rifaximin was 81% compared to 63.6% in the lactulose-treated patients only (95% CI: 0.539 - 1.147, p value = 0.206). Conclusion: Our data revealed that common triggers of hepatic encephalopathy were infections, gastrointestinal bleeding and constipation. The combination of lactulose plus rifaximin was more effective than rifaximin alone in the treatment of overt hepatic encephalopathy. Key words: hepatic encephalopathy, precipitating factor, lactulose, rifaximin


2020 ◽  
Vol 27 (12) ◽  
pp. 2541-2547
Author(s):  
Muhammad Arif ◽  
Sabih Nofal ◽  
Ahsan Khan ◽  
Mariam Tariq Awana ◽  
Anum Arif

Objectives: To compare the efficacy of 0.2% glyceryl trinitrate ointment versus internal sphincterotomy after hemorrhoidectomy. Study Design: Randomized Controlled Trial. Setting: Department of Surgery Unit III, at Lahore General Hospital, Lahore. Period: 6 months (August 2017 to February 2018). Material & Methods: The OPD of the Department of Surgery included 124 patients who satisfied the inclusion criteria. There were two groups of patients, Group A and Group B. Group-A was told to use gloved finger three times daily for 0.2 percent GTN ointment topically. For Group B, lateral internal sphincterotomy was performed as day care procedure. On visit, patients were assessed for pain relief by using VAS. All data was collected using a pre-designed (attached) proforma. In SPSS v23.0 the data were input and analyzed. It was stratified for age, sex, disease duration and hemorrhoid stage. The effectiveness of both groups was compared by using a p-value of 0.05 as significant for a chi-square test. Results: Male predominance; in group-A, 41(66.1%) patients were male and 21(33.9%) were female, while in group-B, 52(83.9%) patients were male and 10(16.1%) were females. Efficacy was found in 11(17.7%) patients in group-A (0.2% GTN) while in 25(40.3%) patients in group-B (Internal sphincterotomy) with p-value of 0.006 which is statistically significant. Conclusion: Open hemorrhoidectomy internal sphincterotomy is an effective method to reduce pain after hemorrhoidectomy in contrast to Glyceryl Trinitrate (GTN) topical cream of 0.2 percent.


2021 ◽  
Vol 8 (5) ◽  
pp. 1507
Author(s):  
Amit Yadav ◽  
Lakshman Agarwal ◽  
Sumit A. Jain ◽  
Sanjay Kumawat ◽  
Sandeep Sharma

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.


2011 ◽  
Vol 18 (01) ◽  
pp. 106-111
Author(s):  
ARSALAN SIRAJ ◽  
ATHAR ABBAS SHAH GILANI ◽  
MUHAMMAD FAROOQ DAR ◽  
Sohail Raziq

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.


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