BACKGROUND Wet to dry normal saline mechanical debridement is the most common, cost effective debridement method, which is used widely,1 including in our hospital setup in wound care management. Papaya is an enzymatic debriding agent which has been in use for many years.2 We wanted to compare the effectiveness of papaya and normal saline in healing of ulcers and evaluate the role of papaya dressing in wound debridement, granulation tissue formation, reduction in ulcer size, and ulcer healing. METHODS This is a comparative interventional study of 100 patients done at Sri Venkateshwara Medical College, Tirupathi, from December 2017 to December 2018. Patients were selected and randomized into two groups - Group I (treated with papaya) and Group II (treated with normal saline). Patients were clinically assessed at the time of inclusion and daily dressing was done. Patients were assessed weekly for 4 weeks and response noted regarding slough reduction, granulation tissue formation, reduction in ulcer size, and overall response to treatment. Additional treatment and follow, up to 3 months were recorded. RESULTS The disappearance of slough / necrotic tissue was significant in the papaya group in the third and fourth week when compared to the normal saline group. 23 patients in the normal saline group, and 27 patients in the papaya group did not require any additional treatment. 22 patients underwent SSG in the normal saline group and 19 patients in the papaya group. Five patients underwent secondary suturing in the normal saline group and four patients in the papaya group. 23 patients in the normal saline group and 27 patients in the papaya group did not require any additional treatment. CONCLUSIONS Papaya is a better and effective debriding agent in comparison to wet to dry normal saline dressing and it also promotes faster granulation tissue formation. Overall response to treatment with papaya is good. KEYWORDS Papaya Dressing, Normal Saline Dressing, Ulcer Healing

BACKGROUNDThe goal of enteric anastomosis is to prevent leakage, to promote healing, to preserve bowel length, and to prevent stricture formation. An effective anastomosis requires adequate mobilization, perfusion, apposition, and inversion of the mucosal edges into the bowel lumen. METHODSAfter taking the institutional ethical committee approval for the study, the study was conducted at SVRRGG Hospital (a tertiary care centre of about 950 bed size), Tirupati. All patients were above 18 years and were admitted for undergoing gastrointestinal anastomoses electively. Patients who underwent gastrointestinal anastomoses as an emergency procedure in SVRRGG Hospital, Dept. of General Surgery, Tirupati from October 2017 to September 2018 were included in this study. RESULTSOut of the 60 cases in this study, 49 cases were done electively, and 11 cases were done on an emergency basis. The overall leak rate was 11.7%. The p-value is more than the significance level 0.05; the difference in leak rate between elective and emergency cases is not significant. CONCLUSIONSThis study is an attempt to evaluate various factors involved in bowel anastomotic leaks, various presentations of anastomotic leaks, and morbidity and mortality associated with them. With the observations and analysis, we concluded that various preoperative factors like haemoglobin %, nutritional status, serum albumin levels, intraoperative factors like degree of contamination, type of anastomosis and pathology involved have significant impact on outcome of bowel anastomosis.