Search

Background: The management of low anal fistulae presents a significant challenge, necessitating a choice between fistulectomy and fistulotomy. This study evaluates the outcomes of these surgical options with a focus on their implications for sphincteric function. Methods: A total of 50 patients were equally divided into two groups to undergo either fistulectomy or fistulotomy at the Medical College Kolkata. The study aimed to compare operation duration, postoperative pain, wound health, recurrence rates, and incidences of incontinence. Results: Fistulotomy was associated with significantly shorter operation times (88% of cases were <30 min, p<0.001) and lower postoperative pain scores (76% scored <4, p<0.001) compared to fistulectomy. No significant difference was observed in wound complications and recurrence rates between the two procedures (fistulectomy 4% vs. fistulotomy 8%, p>0.05). Both methods showed a high rate of sphincteric function preservation, with minimal incidences of incontinence. Histopathological examination predominantly identified non-specific inflammation, with one case of tuberculosis noted in the fistulotomy group. Conclusion: Fistulectomy and fistulotomy are both effective for treating low anal fistulae, with the choice of procedure depending on patient-specific factors and clinical judgment. The study underscores the importance of surgical technique selection to optimize patient outcomes while maintaining anal continence. [ABSTRACT FROM AUTHOR]

Background: Hypospadias is a common congenital anomaly affecting male infants, with varied presentations and management strategies. This study aims to evaluate the types, surgical interventions, and outcomes of hypospadias repair in a pediatric population. Methods: A prospective analysis was conducted on 50 pediatric patients undergoing hypospadias repair over 18 months. Data on demographics, clinical findings, operative procedures, and postoperative outcomes were collected and analyzed. Results: The cohort predominantly consisted of toddlers (52%), with a majority presenting with distal penile (48%) and proximal penile (46%) forms of hypospadias. The TIP repair was the most common surgical technique employed (40%). The overall complication rate was 32%, with urethrocutaneous fistula (20%) being the most frequent. Parental satisfaction was high (60%), though a proportion reported dissatisfaction or uncertainty regarding the outcomes (40%). Conclusion: Early detection and intervention are crucial in managing hypospadias, with TIP repair being a reliable surgical option. However, the considerable complication rate calls for enhanced surgical precision and postoperative care. Further, effective communication with parents is essential to manage expectations and improve satisfaction. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is the gold standard for treating symptomatic gallstone disease, yet the procedure faces challenges, including the risk of conversion to open surgery. A standardized method for grading operative findings could enhance surgical planning and outcomes. Methods: A new scoring system was developed and validated in a descriptive cross-sectional study at a rural hospital, involving 106 patients undergoing laparoscopic cholecystectomy. Factors such as gallbladder inflammation, adhesions, wall thickness, and visibility of anatomical landmarks were graded to assess operative difficulty. Results: The study identified significant associations between operative difficulty and the need for conversion to open cholecystectomy (Chi-square value: 106.0000, p-value: <0.0001). Moderate difficulty was most common (50%), with severe and extreme difficulties leading to all conversions. Factors like gallbladder appearance, BMI, and identification time of the cystic artery and duct significantly influenced operative challenges. The system showed potential in predicting surgical outcomes and enhancing decision-making. Conclusion: The proposed scoring system effectively quantifies operative difficulties in laparoscopic cholecystectomy, offering a predictive tool for assessing the risk of conversion. Its adoption could lead to better surgical planning, reduced conversion rates, and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Perforative peritonitis is a critical medical condition with a high morbidity and mortality rate. The APACHEII scoring system, a widely used tool in intensive care units, has been studied for its efficacy in predicting outcomes in such cases. Methods: This prospective study evaluated the effectiveness of the APACHEII score in predicting mortality among 60 patients with perforative peritonitis. The sensitivity and specificity of the scoring system were analyzed, with a focus on the correlation between APACHEII scores and patient outcomes. Results: The study found that duodenal perforation was the most common type (43.3%), with a higher incidence in males. Non-survivors had a significantly higher mean age (57.18 years) compared to survivors (40.65 years, p=0.0003). A critical finding was the 100% mortality rate in patients with an APACHEII score of =15, indicating high predictive accuracy at this threshold. The sensitivity and specificity of the APACHEII score were both 100% for this cut-off value. Conclusion: The APACHEII scoring system demonstrates high effectiveness in predicting mortality in patients with perforative peritonitis. Its use in clinical settings for prognostic assessments is strongly supported by these findings. [ABSTRACT FROM AUTHOR]