Surgical Outpatient Department Research Articles

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN HEMOROID PADA PASIEN DI POLI BEDAH RSUD RAJA AHMAD TABIB TAHUN 2019-2022

Background: Hemorrhoids, also known as piles, are a common medical condition worldwide. Hemorrhoids occur when blood vessels in the anal or rectal area swell and become inflamed. Factors contributing to the occurrence of hemorrhoids include age, occupation, obesity, gender, constipation, and prolonged sitting during bowel movements. This research aims to provide valuable information for the Indonesian community, doctors, and researchers regarding the risk factors associated with hemorrhoid occurrence. Methods: The research design used in this study is an Observational Case Control with a Retrospective approach. The population in this study consisted of patients who visited the surgical department of RSUD Raja Ahmad Tabib from 2019 to 2022, totaling 6,549 patients. Sample selection was done using Simple Random Sampling, with a total sample size of 82 individuals. The research results were analyzed using the Chi-Square test. Results: In this study, the Chi-Square test analysis revealed factors related to the occurrence of hemorrhoids: Based on Age (p=0.672), Based on Gender (p=0.004), Based on Obesity (p=0.049), and Based on Occupation (p=0.000). Conclusion: Based on the research findings, it can be concluded that there is a significant association between Gender, Obesity, and Occupation with the occurrence of hemorrhoids among patients in the surgical outpatient department of Raja Ahmad Tabib Regional General Hospital from 2019 to 2022.

Evaluation of hepatic and renal functional changes in patients undergoing laparoscopic cholecystectomy

Background: In this era of laparoscopic surgery, with the use of carbon dioxide insufflation in creating pneumoperitoneum for ease of trocar insertion and visualization of anatomy, it comes certain systemic changes in the patient due to the compression effect of the gas as well as resorption of it through peritoneum. Aims and Objectives: The aim of the study was to assess baseline standards of hepatic and renal functional status in pre-operative patients in comparison with post-operative patients undergoing laparoscopic cholecystectomy (LC). Materials and Methods: Cases were chosen among the persons who presented with chronic calculus cholecystitis to the surgical out-patient department of Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata. Pre-operative liver function tests (LFT) and renal function tests (RFT) values were recorded. Again, LFT and RFT values were evaluated on post-operative day 1 (POD1) and POD12. Results: Serum conjugated and unconjugated bilirubin, aspartate amino transaminase, alanine amino transaminase, urea, estimated glomerular filtration rate values increases immediate postoperatively on POD1 but returns to normal pre-operative levels on POD 12. Serum alkaline phosphatase, albumin, and creatinine values decrease on POD1 and return to normal pre-operative values in POD 12. Conclusion: Hepatic and renal function changes in the immediate post-operative period of 24 h following LC. This change is transient and returns to normal levels within POD 12.

Clinicopathological Study of Patients with Non-inflammatory Benign Breast Disease at Combined Military Hospital (CMH) Chattogram

Introduction: Breast lump is a very common problem among females attending surgical outpatient department. Its development and growth are under the control of various hormones and various physiological statuses like menstruation, pregnancy, lactation and menopause. Objectives: To evaluate the clinicopathological status of patients with non-inflammatory benign breast disease (NIBBD). Methods: This clinical study was conducted at the department of surgery, CMH Chattogram, this study was done during January 2018 to May 2019. Patient presented with breast lump, nipple discharge, sinus and mastalgia in whom histopathology revealed any type of non-malignant BBD were included in the study. Patient treated on outdoor patient basis were excluded and patient with malignant breast lesions or acute breast abscess requiring incision and drainage were excluded from the study. Results: Majority of the patients, 41(74.5%) had breast lump followed by 10(18.2%) had breast pain, 6(10.9%) had nipple discharge and 3(5.5%) had enlargement of breast. Most of the site was found unilaterally 54(98.2%). Majority of the patients, 27(49.1%) had fibroadenoma, 14(25.5%) had fibrocystic diseases, 10(18.2%) had fibroadenosis, 2(3.6%) had duct ectasia, 1(1.8%) had cystosarcoma Phyllodes and 1(1.8%) had Lipoma. Conclusion: Maximum age group was 3rd to 4th decade. Most of the patients clinically presented with lumps in the breast followed by pain, enlargement of breast, fever and nipple discharge. Mostly encountered breast lesion was fibroadenoma other common lesion were found fibrocystic diseases, fibroadenosis, duct ectasia, cystosarcomaphyllodes and Lipoma. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 27-30

Site of Service Disparities Exist for Total Joint Arthroplasty.

The rate of outpatient total joint arthroplasty procedures, including those performed at ambulatory surgical centers (ASCs) and hospital outpatient departments, is increasing. The purpose of this study was to analyze if type of insurance is associated with site of service (in-patient vs outpatient) for total joint arthroplasty and adverse outcomes. We identified patients undergoing unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) using Current Procedural Terminology codes in a national administrative claims database. Eligible patients were stratified by type of insurance (Medicaid, Medicare, private). The primary outcome was site of service. Secondary outcomes included general complications, procedural complications, and revision procedures. We evaluated the associations using adjusted multivariable logistic regression models. We identified 951,568 patients for analysis; 46,703 (4.9%) patients underwent UKA, 607,221 (63.8%) underwent TKA, and 297,644 (31.3%) underwent THA. Overall, 9.6% of procedures were outpatient. Patients with Medicaid were less likely than privately insured patients to receive outpatient UKA or THA (UKA: odds ratio [OR], 0.729 [95% CI, 0.640-0.829]; THA: OR, 0.625 [95% CI, 0.557-0.702]) but more likely than patients with Medicare to receive outpatient TKA or THA (TKA: OR, 1.391 [95% CI, 1.315-1.472]; THA: OR, 1.327 [95% CI, 1.166-1.506]). Patients with Medicaid were more likely to experience complications and revision procedures. Differences in site of service and complication rates following hip and knee arthroplasty exist based on type of insurance, suggesting a disparity in care. Further exploration of drivers of this disparity is warranted and can inform interventions (eg, progressive value-based payments) to support equity in orthopedic services. [Orthopedics. 2024;47(3):179-184.].

An immobile thyroglossal duct cyst with tongue protrusion: A case report

The thyroglossal duct cyst is one of the most common lesions in the midline of the neck and is found in around 7% of the population. They often present as painless neck swellings that move in response to tongue protrusion and during deglutition. We describe a case of thyroglossal duct cyst that was atypical in that the cyst was distant from the midline, it did not move in response to tongue protrusion, and the swelling was significant that resembled a colloid goiter. A 36-year-old male presented to the surgical outpatient department with a complaint of painless swelling in the neck for the past year. A 6.5×4.5 cm2 swelling was observed in the anterolateral aspect of the right side of the neck extending to the thyroid notch. Neck ultrasound and fine needle aspiration cytology showed features suggestive of a thyroglossal duct cyst. The patient was prepared for the Sistrunk procedure for thyroglossal duct cyst excision. The patient was on regular follow-up postoperatively for 6 months, and no evidence of any recurrence was seen.

Incidence, types, and associated factors of external abdominal hernias among adult patients visiting the surgical outpatient department, eastern Ethiopia: a multicentre cross-sectional study

Background: Abdominal hernia is the most common surgical alignment that affects all age groups and sexes. It is characterized by the protrusion of abdominal contents through the abdominal wall's muscles and fascia. In this study, the incidence, types, and associated factors of external abdominal hernias at Hiwotfana Comprehensive Specialized Hospital and Jugal Regional Hospital, eastern Ethiopia, were ascertained. Objective: To identify the incidence, types, and associated factors of external abdominal hernia among adult patients who visited the surgical outpatient department of Hiwotfana comprehensive specialized hospital and Jugal regional hospital from 20 October to 5 December 2022. Methods: A cross-sectional study was conducted from 20 October to 5 December 2022, on adult patients who visited the surgical outpatient department at the Hiwotfana Comprehensive Specialized Hospital and Jugal Regional Hospital in eastern Ethiopia. All adult patients who visited the surgical outpatient department of each hospital were enroled in the study using a stratified random sampling technique. Both descriptive and inferential statistics were conducted, and the results were presented in text, graphs, and tables. Odd ratios for the strength and directions of association were used with a 95% CI, and a P value of less than 0.05 was considered to declare statistical significance. Result: A total of 403 participants were included in this study from two different governmental hospitals in Harar town, with a 100% response rate. The incidence of the external abdominal wall hernia was 41 (10.2%). The epigastric hernia had the highest prevalence (41.5%, n=17). Constipation [adjusted odds ratio (AOR)=2.91, CI=1.119–7.579), prolonged cough (AOR=3.993, CI=1.358–11.741), history of abdominal surgery (AOR=5.764, CI=1.837–18.083) and heavy lifting (AOR=5.476, CI=2.505–11.969) had statistically significant association (P≤0.05). Conclusion: The incidence of external abdominal wall hernia in our area is similar to the other existing literature reported from different areas. Epigastric hernia is the most prevalent type of external abdominal hernia and is commonly encountered in female patients. Constipation, a prolonged cough, previous abdominal surgery, and heavy lifting are significantly associated with an external abdominal wall hernia.

Macrodactyly Lipomatosa in the Left Index Finger and Thumb: A Radiological and Clinical Perspective

Macrodystrophia Lipomatosis (MDL) is a rare congenital, non-hereditary, and benign form of gigantism characterised by the overgrowth of adipose tissue in a specific area of the body, usually affecting the hand or foot in the distribution of the median and plantar nerves, respectively. Here, the authors present a case of a 21-year-old male patient, who presented to the Surgical Outpatient Department (OPD) with the gradual, progressive enlargement of the left index finger and thumb over the last six months, experiencing difficulty in holding objects and maintaining grip. This case highlights the importance of radiological imaging in diagnosis and treatment planning. Macrodystrophia lipomatosis should be considered as a differential diagnosis for hypertrophic digits, even in adult patients.

Patient Satisfaction with Quality of Nursing Services at Surgical Outpatient Department (SOPD) of Abubakar Tafawa Balewa University Teaching Hospital Bauchi

Introduction: Patient satisfaction is an essential tool in measuring the quality of health care services; as it gives an idea of the staff's progress towards patients' desires and is found to be useful in measuring patients' expectations. The study aimed to assess patient's level of satisfaction with the quality of nursing services they had received at the surgical outpatient department of ATBUTH Bauchi, Bauchi state, Nigeria.
 Methods: A cross-sectional study design was conducted at the surgical outpatient department (SOPD) of ATBUTH, Bauchi, using a SERVQUAL questionnaire.
 Results: The result from the study shows that 110 (56.4%) of the respondents were males, while 85 (43.6%) respondents were females. and their ages ranged from 33 to 37 years. The majority 50 (25.6%) of the respondents were business people. The variation in socio-demographic characteristics of patients was found to affect satisfaction by 27.5% among patients receiving care in SOPD ATBUTH, with p<0.05. The patients' levels of satisfaction differed between the different nursing services but were overall satisfied with the services they received.
 Conclusion: The level of satisfaction of patients revealed by the grand mean score (4.11) shows that the respondents generally agree that they were satisfied with the care they received. The study concludes that overall, the patients were satisfied with the quality of nursing services they had received in the S.O.P.D of ATBUTH but recommended an investment in modern technologies and training by the hospital management to help improve the quality of these services.

Surgical Audit of Operated Patients in a Tertiary Care Hospital in Karachi, Pakistan

Objectives To audit operated patients in emergency and electively from 1st January 2018 to 31st December 2019 in all three surgical departments to know the outcome of the patients at a tertiary care hospital in Karachi, Pakistan. Material and Methods A retrospective study conducted in all three Abbasi Shaheed Hospital surgical units from 1st January 2018 to 31st December 2019. In this study total of 5079 patients were included who were admitted through the emergency and surgical outpatient department. They were operated in emergency and elective theaters in all three surgical departments of Abbasi Shaheed Hospital. Data was collected on pre-designed performa from emergency and elective theater, wards, High-dependency unit and Intensive care unit maintained registers by staff. Results A total of 5079 cases were operated during January 2018 to December 2019. Among all the age ranges 1282 belongs to the age range of 21-30 years. Amongst which 59.6% were males. The most common diagnosis made in elective patients was chronic calculous cholecystitis (25.8%) and an abscess in emergency (39.4%). The most common procedure performed in elective surgeries was combined laparoscopic and open cholecystectomy (26.8%) and incision and drainage in the emergency (39.4%). Elective surgeries were mainly performed by Associate Professors (28.7). While, emergency surgeries were mainly performed by post-graduate trainees (70.2%). Surgical unit II has performed most surgeries (39.5%). Elective procedure constitutes about (51.60%). Total 19 patients expired out of 350 patients who were shifted or admitted in surgical ICU and 12 patients expired in all three wards. Conclusion We have a higher number of elective surgeries as compared to the emergency surgeries. Consultants have performed most of the elective surgeries. Emergency surgeries mostly by residents and senior registrars. We have zero mortalities in our elective surgeries in comparison with emergency surgeries. We call attention to conduct continuous audits at our hospitals and all levels of health care and demand from higher authorized personnels to incorporate audit awareness in our teaching. Along with it, a proper database should be installed with updated records maintenance to improve the lack of health care.

Chromophobe: A rare histological variant of renal cell carcinoma

Background: Renal cell carcinoma (RCC) is an adenocarcima of the kidney. It is a highly heterogeneous disease with sixteen known subtypes out of which five predominate. The most common subtype is clear cell RCC which accounts for 75-85%. The chromophobe subtype of RCC is rarely seen. It is reported to constitute 4-5% of RCC subtype. This study was aimed at reporting the first case of chromophobe renal cell carcinoma in our community a rare histological subtype of RCC which was discovered incidentally. Our objective was to describe the clinical, histological and immunohistochemical evaluation of a case of chromophobe RCC.
 Case report: We present a 60-year-old man who was seen at the surgical outpatient department of our center with a request for general health check-up. He had basic laboratory and imaging investigations. These were essentially normal except for an incidental finding of a left renal mass on abdominopelvic sonogram. Computed tomography urography showed a suspected clinically localized malignant left renal mass. Histological and immunohistochemistry are consistent with a chromophobe RCC. His clinic follow-up remains unremarkable.
 Conclusion: We reported the clinical, histological and immunohistochemical evaluation of a rare case of chromophobe RCC. This was discovered incidentally following general health check. He had open radical nephrectomy and clinic follow-up 1 year after discharge has been uneventful.

Total Bilateral Extraperitoneal Varicocelectomy with Hernioplasty

Background: A varicocele is characterized by the abnormal dilation of veins draining the testis. In many cases, a varicocele coexists with an inguinal hernia, either presenting with symptoms or remaining asymptomatic. This study aimed to evaluate the efficacy of laparoscopic total extraperitoneal varicocelectomy with concomitant hernioplasty. Method: A 27-year-old male presented to the surgical outpatient department with a painless inguinoscrotal swelling. Physical examination revealed a reducible 3 × 3 cm swelling with a positive cough impulse. Bilateral examination revealed a grade 3 varicocele and a reduced right inguinal hernia. The patient underwent laparoscopic surgery, with caution taken to avoid the use of energy sources. Results: Pre op sperm count was 16 million/ml and after 1 month improved to 34 million/ml. Sperm motility improved grossly, pre op majority of sperms were dead and it improved to 58.3%. Conclusion: Laparoscopic varicocelectomy by extra peritoneal route is a safe procedure and avoids intraperitoneal adhesions and bowel injury as compared to transabdominal pre peritoneal route.

Retroperitoneal Liposarcoma Presenting as Right Inguinal Hernia - A Rare Entity

Background: The purpose of this case report is to highlight a rare entity of retroperitoneal liposarcoma presenting as inguinal hernia. Difficulty in preoperative diagnosis, surgical management & outcome are discussed. Pitfalls in diagnosis and management are also highlighted. Introduction: Inguinal hernia is a common condition with the majority of patients presenting in the surgical outpatient department. Retroperitoneal sarcoma projecting through the groin is very rare. In literature only 10 cases have been published over the last 30 years. Case Presentation: Middle age person presented in OPD with complaint of right Inguinal swelling for 1 & ½ years. He was diagnosed with right inguinal hernia. On exploration there was a huge mass communicating to retroperitoneum. Laparotomy was done & mass excised. On histopathology it was revealed to be liposarcoma. Conclusion: Sometime history, clinical examination and even investigations can be misleading but if inguinal hernia is large, growing slowly, non-reducible then retroperitoneal tumor must be ruled out carefully in differential diagnosis of hernia by extended preoperative workup.

Efficacy of Ligation of Inter-sphincteric Fistula Tract technique for fistula-in-ano: A prospective observational study

Background: Fistula-in-ano is one of the commonest diseases presented to the surgical outpatient department that affects the patient physically and psychologically. As the disease is known for recurrence, the ideal technique for fistula repair is still undetermined. Materials and Methods:We hereby report 85 patients diagnosed clinically and radiologically having fistula-inano who underwent the Ligation of Inter-sphincteric Fistula Tract (LIFT) procedure at a tertiary care center. Results: The median time for the LIFT procedure was 32.5 minutes (range 25-40 minutes), and the median time taken for healing of the wound was around eight weeks. The majority of patients (95.4%) had no recurrence, and only 4 (4.6%) had a recurrence on follow-up within one year. None of the patients presented with stool or flatus incontinence. Conclusion: The LIFT technique can be the preferred treatment option for fistula-in-ano that are having simple straight tract, single opening lying posteriorly, and having either trans-sphincteric or inter-sphincteric variety with lower complication rates and preserving continent anal sphincter allowing patients to return early to their routine activities normal daily activities

Management of chronic fissure in ano-lateral internal sphincterotomy versus 2% diltiazem gel local application: a prospective comparative study

Background: Fissure-in-ano is one of the most common benign anorectal disorders often encountered in surgical outpatient department. Various pharmacological agents and surgical interventions have been tried in the management of fissure in ano. In this study we have compared medical management by topical diltiazem gel with established surgical procedure of lateral internal sphincterotomy (LIS) in the management of chronic anal fissure. Methods: A total of 50 patients with chronic fissure in ano involved in this prospective comparative study, between December 2020 to May 2022, at Rajarajeswari Medical College and Hospital, Bengaluru. Selected patients were put under two groups of 25 participants each, A (2% diltiazem group) and B (lateral internal sphincterotomy - LIS group) using simple randomization technique and were to receive treatment accordingly. Fissure healing and pain relief were recorded on presentation and during follow up visits. Results: The results were compared weekly for 4 weeks and monthly for 2 consecutive months. Fissure healing and pain relief were recorded. Conclusions: Both 2% diltiazem group and LIS group are equally effective and did not show any difference in pain relief or fissure healing with p value not significant (>0.05).

Primary tuberculosis of the breast from mankweng hospital

Object of study: To share our experience with a rare case of Primary Tuberculosis of Breast.
 The problem to be solved: Tuberculosis of the breast is a rare type of extrapulmonary tuberculosis and usually affects young lactating multiparous women. It accounts for less than 0.1 % of all breast pathologies. Tuberculosis of the breast is often misdiagnosed. Therefore, a high index of suspicion is needed when evaluating cases of breast abscesses, fistulae, or mass.
 Main scientific results: A case of a 27-year-old female with no known co-morbidities, HIV negative who presented to our Surgical Outpatient Department with a 1-year history of a painless left breast lump. No previous history of pulmonary tuberculosis was reported. Breasts ultrasonography indicated BIRADS (Breast Imaging-Reporting and Data System) V: lesion highly suspicious of malignancy. Histopathological analysis of the core biopsy showed features of a necrotizing granulomatous mastitis with adjacent fat necrosis. Ziehl-Neelsen stain was negative though histological results were worrisome of a mycobacterial infection. Patient responded well to antitubercular therapy as evidenced by lump regression, ulceration healed, peau d’orage currently resolved, and the overall size of the breast is going back to its normal state.
 The area of practical use of research results: Family medicine physicians, Primary health care center, District level or regional level hospital.
 An innovative technological product: a high index of suspicion tuberculosis is needed when evaluating cases of breast abscesses, fistulae, or mass. Awareness of this condition is important as it can clinically, and radiologically mimic breast carcinoma.
 Scope of application of an innovative technological product: Family medicine physicians, Primary health care center.

CLINICO-PATHOLOGICAL PROFILE OF BENIGN ANO-RECTAL DISEASES: HAEMORRHOIDS, FISSURE IN ANO, FISTULAE AT HIND INSTITUTE OF MEDICAL SCIENCES, SAFEDABAD, BARABANKI, UTTAR PRADESH, INDIA

Background: Benign anorectal diseases are frequently encountered conditions presenting to a surgical facility. However, there are limited studies on its epidemiology and clinical profile, especially from countries like India. In the present study, we made an attempt to study the clinical spectrum of different benign anorectal diseases among patients presenting to our facility. Aim and Objective: To study aetiopathogenesis and clinical presentation of Benign Ano-Rectal Diseases – i.e., Hemorrhoids, Fissures and Fistulae. Methods: It is an analytical study conducted between January 2021 to June 2022 at Hind Institute of Medical Sciences, Safedabad, Barabamki, Uttar Pradesh, India, where clinical records of all the patients presenting to surgical outpatient department or indoor patients wards with any ano-rectal condition were retrieved and a list of those presenting with benign ano-rectal conditions was made. Spectrum of benign ano-rectal conditions, their age and sex profile were noted. Results: Majority of patients with benign anorectal conditions were males. The age group of 30–40 years was most commonly affected by anorectal diseases.Pain and constipation were most common presenting complaint followed by bleeding and pus discharge. Among different benign ano-rectal conditions, fissure in anowas the most common.

A CLINICAL STUDY OF INCIDENCE OF MALIGNANCY IN SOLITARY THYROID NODULE IN A TERTIARY CARE HOSPITAL

Introduction:Thyroid nodules are common entities presenting to the surgical outpatient department. They are defined as A discrete swelling in an otherwise impalpable gland. Incidence of malignancy has been observed to be quite high in solitary thyroid nodules. Thus, they have to be evaluated properly for optimum management. Aim of the study is to identify the incidence of malignancy in solitary nodule thyroid. Materials and Methods:This study was a prospective non-randomized hospital based interventional study carried out on 50 patients who presented clinically with solitary thyroid swellings who thereby underwent surgery for the disease from August 2020 to July 2022 at the Department of General surgery of our institute. Results:There were 50 cases of clinically detected solitary thyroid nodule with female preponderance more than males. The mean age of the incidence of solitary thyroid nodule was 40.6 years. The incidence of malignancy in solitary thyroid nodule was found to be 18%. Conclusions:It is concluded from the present study that 18% of solitary thyroid nodules are malignant, with female preponderance and a mean age of solitary thyroid nodule is 40.62 years.

Study of Demographics, Clinical Profile and Risk Factors of Inguinal Hernia: A Public Health Problem in Elderly Males.

Inguinal hernia repair is the most commonly performed elective surgery in Indiadraining significant healthcare resources. This observational study was conducted at a tertiary-level institute in northern India to look into the demographics, clinical profile and risk factors of inguinal hernia. This study was conducted as an observational study at the tertiary care centre of northern India, including 110 patients who had come to the surgical outpatient department for inguinal hernia repair. After obtaining informed consent from all the participants, demographic details, history and clinical examination were recorded. This was a prospective, single-centre, non-randomized, observational study. In our study, 43 patients (39%) were >50 years of age. One hundred and sevenpatients (97.27%) were males, and three (2.72%) were females. Male: Female ratio was 32:1.The preponderance of males was due to their involvement in more strenuous exercises and lifting weights and the anatomical differences between them. The main risk factor in the present study was lifting heavy weights 55%, followed by altered bowel habits 36.36% and respiratory disease (chronic obstructive airway disease). Smoking and diabetes were also associated as risk factors for the hernia. In this study, the most common side of hernia was on the right side, 63%, on the left, 33% and bilateral in 4% of patients. The indirect hernia was the most common type. Inguinal hernia is a surgical problem found commonly in the male elderly. Right-sided inguinal hernia is common, with the indirect type being more frequent. Heavy weight lifting and strenuous exercises were commonly found risk factors.

The efficacy of Ksharsutra, Fistulectomy and Ligation of Intersphincteric Fistula Tract (LIFT) procedure in management of Fistula in ano a prospective observational study

BackgroundFistula in ano is always a troublesome condition for the clinician and the patients owing to its complexity, recurrences, and high morbidity since ancient times. There is no gold standard treatment modality to date documented in the literature for complex fistula in ano.Material and methodsWe enrolled 60 consecutive adult patients attending the surgical outpatient department of a tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 20 each in the Ligation of intersphincteric fistula tract (LIFT), Fistulectomy andKsharsutra(Special medicated seton) group were respectively recruited randomly. A prospective observational study was conducted. The primary outcomes were postoperative recurrence and morbidity. Post-operative morbidity is measured in terms of postoperative pain, postoperative bleeding, pus discharge and post-operative incontinence. The result of the study were analysed after 6 months of follow-up by clinical examination at outpatient department and at 18 months follow up done telephonically.ResultsAt 6 months of follow-up, 2 patients (10%) had a recurrence in the Ligation of intersphincteric fistula tract procedure group, 3 patients (15%) in the fistulectomy group and 6 patients (30%) in Ksharsutra group, however 3(15%), 4(20%) and 9(45%) patients developed recurrence in Ligation of Intersphincteric fistula tract, Fistulectomy and Ksharsutra group respectively at 18 month of follow-up. The differences in the recurrence were not statistically significant.The mean Visual analogue score for postoperative pain after 24 h as well as after 48 h were statistically significant in Ligation of intersphincteric fistula tract versus Ksharsutra group (p < 0.05). The Visual analogue score for post–operative pain was also significant in the Ligation of the intersphincteric fistula tract versus the Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation of intersphincteric fistula tract procedure. Postoperative morbidity was statistically significant between the Ligation of intersphincteric fistula tract versus the Ksharsutra and the Ligation of intersphincteric fistula tract versus Fistulectomy.ConclusionLigation of intersphincteric fistula tract had less postoperative morbidity compared to Fistulectomy and Ksharsutra procedure; although recurrence was less compared to other methods it was statistically not significant.

Role of Autologous Platelet Rich Plasma in the Management of Chronic Non Healing Ulcers

Background: Chronic non-healing leg ulcers are a major health problem worldwide and have great impact on personal, professional and social levels, with high cost in terms of human and material resources. The present study was conducted with an aim to demonstrate the efficacy of autologous platelet rich plasma (PRP) in chronic non-healing leg ulcers in comparison to conventional dressings. Methods: About 50 patients presenting with chronic non healing ulcers to the surgical outpatient department in a tertiary care centre over a period of one year were included in the study, of which 25 patients received autologous PRP dressings other 25 patients received conventional dressings. Ulcer measurements were taken on day 1, 15, 28 and 42 days. Results: The mean duration of healing of the ulcers was 3.9 weeks in PRP group and 6.2 weeks conventional dressing. PRP dressing group showed a reduction in ulcer size of about 45.50 percent as compared to 14.80 percent in conventional dressing group. Conclusion: Chronic non healing ulcers are often difficult to heal because they lack the necessary growth factors to maintain the healing process. Conventional therapies do not provide satisfactory healing, since these treatments are not able to provide the necessary growth factors (PDGF, EGF, VGEF etc.) which are essential for the healing process. PRP is a safe, affordable, biocompatible and simple office based procedure for the treatment of non-healing ulcers.