BACKGROUNDSurgical site infections is a dangerous condition posing a heavy burden on the patient and social health system. The use of preoperative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. Hence, the present study was undertaken to compare and evaluate the efficacy of 2% chlorhexidine-alcohol versus 5% povidone-iodine in abdominal surgeries for prevention of SSI. MATERIALS AND METHODSThe present one year randomised controlled trial was conducted in the Department of General Surgery, Government Rajaji Hospital, Madurai, over a period from 2014 to 2015 on 120 patients undergoing elective abdominal surgeries. The patients were divided into two groups by computer randomisation that is Group A (chlorhexidine-alcohol group) and Group B (povidone-iodine group). The surgical wounds were examined for any infections present.
BACKGROUND Anastomotic leak is an important cause of postoperative morbidity and mortality in patients who have undergone bowel anastomosis. The aim of the study is to know about the significance of various factors influencing anastomotic leak. MATERIALS AND METHODS A total of 68 patients who underwent small bowel anastomosis in our study period were followed up and grouped according to the occurrence of anastomotic leak into leak and non-leak groups. The common factors between the two groups were compared to know the significance of each factor in anastomotic leakage. RESULTS It has been found out that ASA Score ≥3, low serum total protein, low serum albumin, low haemoglobin, severe peritoneal contamination, perioperative fall in blood pressure and high mean duration of surgery were significantly associated with the occurrence of anastomotic leakage. CONCLUSION Adequate attention should be paid to the various preoperative, intraoperative and postoperative factors which influence anastomotic leakage in small bowel anastomosis in order to keep the morbidity and mortality to a bare minimum.
BACKGROUND Seroma formation and its sequelae including infection, flap necrosis, delayed wound healing and patient discomfort form one of most commonly encountered complication following mastectomy and axillary dissection. Mechanical closure of dead space by flap fixation is a simple surgical procedure that eliminates dead space after mastectomy by decreasing the movement of flap over chest wall and thereby reducing the exudate. The aim of this study is to evaluate the effect of mechanical closure of dead space after mastectomy in prevention of seroma formation. MATERIALS AND METHODS A total of 80 patients of carcinoma breast who underwent modified radical mastectomy in Department of General Surgery, Government Rajaji Hospital, Madurai, during the period from March 2016 to August 2016, were included, randomised into two groups based on inpatient number. 42 patients with odd IP number in conventional simple wound closure (Group A) and 38 patients with even IP number in flap fixation (Group B). Patients were evaluated for day 1 drain volume, total drain volume, drain removal day, seroma and wound complications. RESULTS Of the 80 women, 42 women with mean age 48 ± 8 years belongs to group A and 38 women with mean age 46 ± 7 years belongs to group B. Average size of the tumour at presentation was 3.4 cm. 36 (45%) women presented with stage IIA disease and 44 (55%) with stage IIB disease. Drain volume in first postoperative day varied from 100 to 200 mL with average of 170 mL in group A and 163 mL in group B. There was no statistically significant difference in the drain volume in first postoperative day (p>0.05). The average total drain volume in the postoperative period in group A was 1426 mL and 932 mL in group B. P value was found to be significant (<0.001). The average day of drain removal in group A was 13 days and 8 days in group B. P value was found to be significant (<0.001). 8 patients developed seroma in group A vs. none in group B. P value was found to be significant (>0.05). One patient developed wound complication (cellulitis) vs. none in group B. There was no statistically significant difference in the incidence of wound complications in both groups. CONCLUSION The present prospective study demonstrated that the mechanical obliteration of dead space by flap fixation significantly decreases the incidence of seroma formation. So, when performing modified radical mastectomy, the flap fixation technique is a valuable technique for reducing seroma formation allowing early drain removal and increased patient satisfaction.
BACKGROUND Liver abscess continues to be a major diagnostic and therapeutic challenge to the medical fraternity. It is a life-threatening and a potentially serious condition if left untreated. Therefore, it is very important for prompt diagnosis and appropriate management at the earliest. This study was conducted to assess the incidence, aetiology, clinical presentation, management and prognosis of liver abscess in patients attending a tertiary care referral hospital. MATERIALS AND METHODS This study was conducted in Madurai Medical College Hospital, Madurai, from March 2015 to August 2016. The study population consists of patients admitted in General Surgery Wards of Madurai Medical College and Hospital, Madurai, with features suggestive of liver abscess. RESULTS Liver abscess was more commonly seen in the age group of 41-50 years. Male predominance 97.9% was seen in liver abscess. Nearly, two thirds of cases of liver abscess had a history of alcohol intake. Majority of liver abscess were amoebic and nearly 10% were pyogenic. Escherichia coli was the commonest organism causing pyogenic liver abscess. Abdominal pain was the commonest symptom of liver abscess followed by abdominal distension and fever. Right hypochondrial tenderness and intercostal tenderness were the common clinical signs in liver abscess. There was a predominant involvement of the right lobe of the liver. Percutaneous aspiration of abscess with antiamoebic and antibiotics forms the mainstay of treatment. Percutaneous catheter drainage is method of choice in failed aspiration and laparoscopic drainage or laparotomy and drainage is indicated in ruptured liver abscess. CONCLUSION Liver abscess was more commonly seen in the age group of 41-50 years. Male predominance 97.9% was seen in liver abscess. Nearly, two-thirds of cases of liver abscess had a history of alcohol intake. Majority of liver abscess were amoebic and nearly 10% were pyogenic. Escherichia coli was the commonest organism causing pyogenic liver abscess. Abdominal pain was the commonest symptom of liver abscess followed by abdominal distension and fever. Right hypochondrial tenderness and intercostal tenderness were the common clinical signs in liver abscess.
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