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BACKGROUND AND OBJECTIVES Anal fissures are commonly encountered in routine colorectal practice. Chronic fissures have traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. In this study, we compare topical 2% Diltiazem gel and lateral internal sphincterotomy with respect to symptomatic relief, healing and side effects in the treatment of chronic fissure in ano. METHODS 60 patients with chronic fissure in ano were randomly divided into Diltiazem gel and internal sphincterotomy groups. Patients were followed up at weekly intervals for minimum of eight weeks. Data was recorded accordingly. RESULTS Fissure completely healed in 28(93.33%) out of 30 patients treated with 2% Diltiazem gel between 4-8 weeks. Healing was 100% with internal sphincterotomy. The mean duration required for healing of fissure was 4.86 weeks in Diltiazem gel group and 3.66 weeks in internal sphincterotomy group. 61.5% patients were free from pain after treatment with Diltiazem gel whereas in internal sphicterotomy group 66.66% patients had pain relief at the end of 4 weeks. INTERPRETATION AND CONCLUSION Comparison between Diltiazem gel application and internal sphincterotomy did not show any significant difference in fissure healing and pain relief. No side effects were seen in Diltiazem gel therapy. Topical Diltiazem should be the initial treatment in chronic fissure in ano. It is better to reserve internal sphincterotomy for patients with relapse or therapeutic failure to prior pharmacological treatment.

Background: Bassini's repair and the Lichtenstein's tension free mesh hernioplasty are commonly used hernia repair techniques and yet there is no unison as to which is the best technique. Our hospital being in a rural setup and catering to majority of poor patients who are daily wagers, open hernia repairs are commonly done. This study was undertaken to compare the technique and post-operative course so as to determine the best suitable of the two procedures for them. Materials and Methods:A comparative randomized study was conducted on a total of 70 patients with inguinal hernia and were operated upon by either of technique and followed up.Outcome of both the techniques were analyzed and compared with other similar studies.Results: Study involved 35 each of Modified Bassini's Repair (MBR) and Lichtenstein's Mesh Repair (LMR), over a period of 18 months. MBR took more operating time than LMR. Commonest complication in both the groups was seroma formation. There were two recurrences in the MBR group and none in LMR group.Conclusion: LMR was comparatively better than MBR due to its simplicity, less dissection and early ambulation in the postoperative period and with no recurrence, in our study. NaveeN N.1 , SriNath r.2

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Background: Surgical Site Infections (SSIs) are infections of tissues, organs or spaces exposed by surgeons during performance of an invasive procedure and continue to be a major source of morbidity following operative procedures. Wound irrigation is the steady flow of a solution across an open wound surface meant to remove cellular debris and surface pathogens contained in wound exudates or residue from topically applied wound care products.Methods: This prospective comparative study was conducted to compare the effectiveness of Pressurized Pulse Irrigation (PPI) and Standard Irrigation Technique (SIT) in laparotomy wounds. Duration of the study was for a period of 12 months and included 100 consecutive patients undergoing laparotomy.Results: 13% of patients who underwent laparotomy had SSI out of which 9 patients had superficial infection only. 8% of 50 patients who had PPI developed SSI, whereas 18% of those who underwent SIT had SSI. Though PPI had less incidence of SSI, statistically it was insignificant.Conclusions: The study showed a decrease in the incidence of postoperative SSI in both elective and emergency laparotomy wounds irrigated with PPI compared to SIT, though the study was statistically insignificant since the p value was less than 0.005 with a odds ratio of 2.52. The study results suggested that there was decrease in the incidence of SSI in PPI patients and also that it decreases the postoperative stay, morbidity and cost.