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Abstract Treatment of fistula in ano by seton has become less in vogue due to the complications and disadvantages associated with its use. In its place, more technically demanding and expensive procedures, with less morbidity but more recurrence, such as endorectal advancement flaps and laser, are being employed more commonly. To overcome some of the limitations of conventional seton, we have designed a composite seton. In the present study, we evaluated our experience with a composite seton made from two silastic vessel loops sutured together with 5-0 polypropylene. The composite seton was found to not present many of the disadvantages of the conventional seton. The use of the composite seton resulted in low incontinence and recurrence rates, less pain, and high quality of life. This technically simple and cheaper material may have a wider applicability.
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BACKGROUND: Although colorectal cancer (CRC) may not be uncommon in India, accurate data regarding its demographics and surgical outcomes is sparse. METHODS: With an aim to assess demographics and perioperative outcomes of CRC in Kerala, all members of Association of Surgical Gastroenterologists of Kerala (ASGK) were invited to participate in a registry. Data of operated cases of CRC were entered on a web-based questionnaire by participating members from January 2016. Analysis of accrued data until March 2018 was performed. RESULTS: From 25 gastrointestinal surgical centers in Kerala, 15 ASGK member hospitals contributed 1018 CRC cases to the database (M:F 621:397; median age-63.5 years [15-95 years]). Rectum (39.88%) and rectosigmoid (20.33%) cancers comprised the majority of the patients. Among them, preoperative bowel preparation was given to 37.68%, minimally invasive surgery (MIS) was performed in 73%, covering stoma in 47% and had an overall leak rate of 3.58%. In colonic malignancies, MIS was performed in 56.74%, covering stoma created in 13% and had a leak rate of 2.71%. Of 406 patients with rectal cancers, neo-adjuvant radiotherapy/chemoradiotherapy was given to 51.23%. The mean hospital stay for MIS in both rectal and colonic cancer patients was significantly shorter than open approach (10.46 ± 5.08 vs. 12.26 ± 6.03 days; p = 0.001and 10.29 ± 4.58 vs. 12.46 ± 6.014 days; p = <0.001). Mortality occurred in 2.2% patients. CONCLUSION: A voluntary non-funded registry for CRC surgery was successfully created. Initial data suggest that MIS was performed in majority, which was associated with shorter hospital stay than open approach. Overall mortality and leak rate appeared to be low.
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Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/cirurgia , Gastroenterologistas/organização & administração , Sistema de Registros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Anastomótica/epidemiologia , Catárticos , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Neoplasias Colorretais/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Cuidados Pré-Operatórios/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Laparoscopic repair of duodenal ulcer perforation has certain advantages over open repair. However, the conversion rate to open surgery is still high. The most common reason for conversion is inadequate localization of the ulcer perforation site during laparoscopy. Here, a technique is described which will aid in localizing the perforation, make suturing and repair easier, and helps in checking the integrity of the repair at the end of the procedure. This is done by compressing the gall bladder with an instrument like a laparoscopic fan retractor and simultaneously depressing the first part of the duodenum with another instrument. This results in bile flowing out through the perforation and simultaneously depressing the duodenum downward, making it more easily visible and making identification easier. Suturing is easier due to the liver also getting retracted simultaneously and more space being available consequently. Integrity of the anastomoses is also easily ascertained by this maneuver.
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AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed. RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d. CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.
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Pâncreas/patologia , Pancreatopatias/patologia , Pancreatopatias/cirurgia , Pancreatite Necrosante Aguda/patologia , Pancreatite Necrosante Aguda/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pancreatopatias/fisiopatologia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemAssuntos
Hematoma/etiologia , Pancreatite/complicações , Esplenopatias/etiologia , Doença Aguda , Adulto , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Pancreatectomia , Pancreatite/diagnóstico por imagem , Pancreatite/cirurgia , Ruptura Espontânea , Esplenectomia , Esplenopatias/diagnóstico por imagem , Esplenopatias/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We report a 6-year-old girl who received a left-lobe live-related liver transplant for decompensated liver disease after a failed Kasai's surgery for biliary atresia. Preoperatively, her nails were white, dystrophic, brittle with severe onycholysis, clubbing and watch-glass deformities. Nail scrapings were negative for fungus. Five months after transplantation, her nails had become near normal. There is only one such documented case in literature on reversal of nail changes in an adult.
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Atresia Biliar/complicações , Atresia Biliar/cirurgia , Criança , Feminino , Humanos , Transplante de Fígado , Doenças da Unha , Resultado do TratamentoRESUMO
BACKGROUND: Hepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an obstruction to the outflow of blood from the liver. Early decompression is needed to prevent liver dysfunction and death. Radiological intervention includes angioplasty of stenosis and webs and the placement of transjugular intrahepatic portosystemic shunts (TIPPS). Side-to-side portacaval shunt (SSPCS) remains the gold standard for achieving good long-term results. CASE PRESENTATION: A 37-year old lady underwent side-to-side portacaval shunt for Budd Chiari syndrome. She had early shunt blockage and this was successfully treated with the placement of a metallic stent across the shunt. CONCLUSION: At five years, she remains asymptomatic, with normal liver functions, no ascites, and normal flow through the stent on Colour Doppler examination.