Mostafizur Rahman, Mohammad Samir Azam Sunny, A. Chowdhury, S. Saha, R. Hoque, A. B. Adhikary
Background: Bronchodilator {P2selective adrenergic drug-salbutamol) causes bronchodilation and increases the vital capacity, tidal volume and total lung capacity and reduces gas trapping. Use of bronchodilator in patients undergoing Off-pump coronary artery bypass graft (OPCABG) may lead to better preservation of pulmonary function. Objective: To evaluate the role of bronchodilator on preservation of post-operative pulmonary function in patients who underwent OPCABG. Methods: This study was conducted on 50 patients randomized into two groups to assess the pulmonary function after off-pump CABG. Among them, 25 patients (group-I) were treated by preoperatively bronchodilator and compared them with other 25 patients (group-II) who were not treated by preoperative bronchodilator. We compared arterial blood gas analysis, duration of total mechanical ventilation, days spent in the surgical ICU and spirometric indices. Results: Mean±SE value of mechanical ventilation time after operation in group-I was 14.25±0.85 hours and in group-II was 16.88±0.85 hours. Mean±SE value of ICU stay after surgery was 98.64±2.07 hours in group I and 110.56±2.36 hours in group-II. Both results were statistically significant (P=0.042 and P=0.001 respectively). The FVC and FEV1 after admission were not statistically significant (P>0.05). On the day before surgery the values of FVC and FEV1 were increased (more in group-1 who were treated with bronchodilator) and 7th postoperative day the value were decreased (more in group -11 who were not treated with bronchodilator). The results were found statistically significant in between two groups (P<0.05). Significant difference were found in PaO2 and PaCO2 on arterial blood gas analysis at half an hour after extubation and on 1st POD (P<0.05). Mean±SE value of postoperative hospital day in group-1 was 8.88±0.24 days and in group II was 10.14±0.43 days which was found statistically significant (p=0.014). Among post-operative pulmonary complications, in group 1, one (4%) patient was found with pleural effusion and one (4%) patient with atelectasis. but in group-II, one (4%) patient was found with pleural effusion and five (20%) patients were found with atelectasis. Conclusion: Use of bronchodilator preoperatively in patients who underwent OPCABG with impaired pulmonary function leads to reduced mechanical ventilation time, less ICU stay after surgery, better preservation of pulmonary function, reduced post-operative pulmonary complications and reduced hospital stay. Journal of Surgical Sciences (2014) Vol. 18 (2) : 51-56
{"title":"Pre-operative Bronchodilator Treated Patients Preserve Better Pulmonary Function in CABG Cases","authors":"Mostafizur Rahman, Mohammad Samir Azam Sunny, A. Chowdhury, S. Saha, R. Hoque, A. B. Adhikary","doi":"10.3329/jss.v18i2.43756","DOIUrl":"https://doi.org/10.3329/jss.v18i2.43756","url":null,"abstract":"Background: Bronchodilator {P2selective adrenergic drug-salbutamol) causes bronchodilation and increases the vital capacity, tidal volume and total lung capacity and reduces gas trapping. Use of bronchodilator in patients undergoing Off-pump coronary artery bypass graft (OPCABG) may lead to better preservation of pulmonary function. \u0000Objective: To evaluate the role of bronchodilator on preservation of post-operative pulmonary function in patients who underwent OPCABG. \u0000Methods: This study was conducted on 50 patients randomized into two groups to assess the pulmonary function after off-pump CABG. Among them, 25 patients (group-I) were treated by preoperatively bronchodilator and compared them with other 25 patients (group-II) who were not treated by preoperative bronchodilator. We compared arterial blood gas analysis, duration of total mechanical ventilation, days spent in the surgical ICU and spirometric indices. \u0000Results: Mean±SE value of mechanical ventilation time after operation in group-I was 14.25±0.85 hours and in group-II was 16.88±0.85 hours. Mean±SE value of ICU stay after surgery was 98.64±2.07 hours in group I and 110.56±2.36 hours in group-II. Both results were statistically significant (P=0.042 and P=0.001 respectively). The FVC and FEV1 after admission were not statistically significant (P>0.05). On the day before surgery the values of FVC and FEV1 were increased (more in group-1 who were treated with bronchodilator) and 7th postoperative day the value were decreased (more in group -11 who were not treated with bronchodilator). The results were found statistically significant in between two groups (P<0.05). Significant difference were found in PaO2 and PaCO2 on arterial blood gas analysis at half an hour after extubation and on 1st POD (P<0.05). Mean±SE value of postoperative hospital day in group-1 was 8.88±0.24 days and in group II was 10.14±0.43 days which was found statistically significant (p=0.014). Among post-operative pulmonary complications, in group 1, one (4%) patient was found with pleural effusion and one (4%) patient with atelectasis. but in group-II, one (4%) patient was found with pleural effusion and five (20%) patients were found with atelectasis. \u0000Conclusion: Use of bronchodilator preoperatively in patients who underwent OPCABG with impaired pulmonary function leads to reduced mechanical ventilation time, less ICU stay after surgery, better preservation of pulmonary function, reduced post-operative pulmonary complications and reduced hospital stay. \u0000Journal of Surgical Sciences (2014) Vol. 18 (2) : 51-56","PeriodicalId":33248,"journal":{"name":"Journal of Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76404641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rashidul Lslam, S. H. Sheikh, A. Taher, S. Khatun, A. Habib, G. Salauddin, T. Khan, KM Saiful Lslam
Background: The study was undertaken to validate the efficacy of Delorme's procedure as the treatment modality of choice for full-thickness rectal prolapse. Materials and Methods: In this study, results of Delorme's procedure for full-thickness rectal prolapse were assessed retrospectively. 14 patients with full-thickness rectal prolapse who were operated on with Delorme's procedure between January 2010 and October 2013 in the department of Colorectal surgery, Bangabandhu Sheikh Mujib Medical University were included in the study. Results: There were 8 males with mean age of 32.62 years (range 15-70) and 6 females with mean age of 26 years (range 12-70 ).The mean operative time was 65±4.5 minutes (range 60-90); there was no mortality and blood loss was minimal. Mean hospital stay was 3.5 days (2-6 days). Outcomes of the procedure were satisfactory and no patient reported recurrence of the disease in the follow up period.Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases. Conclusion: Delorme's operation is a safe and effective treatment for complete rectal prolapse in patients of all age groups. Journal of Surgical Sciences (2015) Vol. 19 (1) : 21-24
{"title":"Delorme's Procedure for Full-Thickness Rectal Prolapse - Our experience in Bangabandhu Sheikh Mujib Medical University","authors":"Rashidul Lslam, S. H. Sheikh, A. Taher, S. Khatun, A. Habib, G. Salauddin, T. Khan, KM Saiful Lslam","doi":"10.3329/jss.v19i1.43773","DOIUrl":"https://doi.org/10.3329/jss.v19i1.43773","url":null,"abstract":"Background: The study was undertaken to validate the efficacy of Delorme's procedure as the treatment modality of choice for full-thickness rectal prolapse. \u0000Materials and Methods: In this study, results of Delorme's procedure for full-thickness rectal prolapse were assessed retrospectively. 14 patients with full-thickness rectal prolapse who were operated on with Delorme's procedure between January 2010 and October 2013 in the department of Colorectal surgery, Bangabandhu Sheikh Mujib Medical University were included in the study. \u0000Results: There were 8 males with mean age of 32.62 years (range 15-70) and 6 females with mean age of 26 years (range 12-70 ).The mean operative time was 65±4.5 minutes (range 60-90); there was no mortality and blood loss was minimal. Mean hospital stay was 3.5 days (2-6 days). Outcomes of the procedure were satisfactory and no patient reported recurrence of the disease in the follow up period.Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases. \u0000Conclusion: Delorme's operation is a safe and effective treatment for complete rectal prolapse in patients of all age groups. \u0000Journal of Surgical Sciences (2015) Vol. 19 (1) : 21-24","PeriodicalId":33248,"journal":{"name":"Journal of Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73483771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Khan, A. H. Sikder, A. Khan, Alfi Rahman, A. Hasan, J. Hossain, Mohammed Rafiqul Lslam
Objectives: To find out the efficacy of single dose antibiotic vs multiple dosesin preventing wound infection following appendicectomy for uncomplicated appendicitis. Methods: A prospective comparative study was conducted in the Department of Surgery, Chittagong Medical college Hospital from January'2009 to June'2009. 100 patients with uncomplicated appendicitis who underwent appendicectomy during that period were included in this study. Among them 50 cases were included in study group ·(SG) who were given only single dose of combination drugs ( lnj. Cefuroxime + lnj. Metronidazole).ln rest of the 50 cases (CG), antibiotics were continued for 7 days postoperatively. Result: Maximum incidence of acute appendicitis was in the 2nd and 3rd decade of life with male preponderance .Rate of wound infection in the study group and control group was 4% and 2% respectively which was not statistically significant .The duration of antibiotic therapy had no significant effect on the length of hospital stay between the two groups ; 2.48 days vs 2.9 days [mean + s.d. 69.6 # 16.8 hours ] in the study and control group respectively, though treatment cost was higher in control group in comparison to the study group . Conclusion: Single dose of preoperative antibiotics is adequate for prevention of postoperative wound infection following appendicectomy for uncomplicated appendicitis. Journal of Surgical Sciences (2015) Vol. 19 (1) : 17-20
{"title":"Antimicrobial Therapy in Preventing Wound Infection Following Appendicectomy in Uncomplicated Appendicitis: A Comparative Study Between Single Dose And Multiple Doses In Adults","authors":"M. Khan, A. H. Sikder, A. Khan, Alfi Rahman, A. Hasan, J. Hossain, Mohammed Rafiqul Lslam","doi":"10.3329/jss.v19i1.43772","DOIUrl":"https://doi.org/10.3329/jss.v19i1.43772","url":null,"abstract":"Objectives: To find out the efficacy of single dose antibiotic vs multiple dosesin preventing wound infection following appendicectomy for uncomplicated appendicitis. \u0000Methods: A prospective comparative study was conducted in the Department of Surgery, Chittagong Medical college Hospital from January'2009 to June'2009. 100 patients with uncomplicated appendicitis who underwent appendicectomy during that period were included in this study. Among them 50 cases were included in study group ·(SG) who were given only single dose of combination drugs ( lnj. Cefuroxime + lnj. Metronidazole).ln rest of the 50 cases (CG), antibiotics were continued for 7 days postoperatively. \u0000Result: Maximum incidence of acute appendicitis was in the 2nd and 3rd decade of life with male preponderance .Rate of wound infection in the study group and control group was 4% and 2% respectively which was not statistically significant .The duration of antibiotic therapy had no significant effect on the length of hospital stay between the two groups ; 2.48 days vs 2.9 days [mean + s.d. 69.6 # 16.8 hours ] in the study and control group respectively, though treatment cost was higher in control group in comparison to the study group . \u0000Conclusion: Single dose of preoperative antibiotics is adequate for prevention of postoperative wound infection following appendicectomy for uncomplicated appendicitis. \u0000Journal of Surgical Sciences (2015) Vol. 19 (1) : 17-20","PeriodicalId":33248,"journal":{"name":"Journal of Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90550968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: In spite of long journey of intestinal anastomotic techniques surgeons still are not free from doubt about the leakage after colorectal anastomosis. In distal rectal anastomosis after cancer surgery it poses more risk due to poor colonic vascularity and reduced remaining tissue to nourish the anastomotic site. Exploration of surgical staplers has provided some procedural advantages and sense of security to surgeons as well as to patients in respect to sphincter saving and thereby improving quality of life. However, outcome measures of these devices should be made to see its efficacy over conventional hand-sewn technique because their cost play role in treatment plan. The result of such comparative study may help surgeons to counsel the patients. Objectives: To find out whether stapled anastomosis is safer than hand-sewn anastomosis in colon and rectal cancer surgery. Materials and methods: The quasi-experimental study was undertaken in the department of general and colorectal surgery, Bangabandu Sheikh Mujib Medical University hospital during Feb 2005 to June 2008. Total 100 patients were selected. 48 patients underwent 'Stapled' and 52 underwent 'Hand-sewn' anastomosis. The patients were treated and postoperatively managed by same colorectal surgeon. The outcome variables were 'time required for anastomosis', 'postoperative hospital stay' and early and late 'complications' in postoperative and follow-up period. Result and observation: The age, sex, socio-economic status or co-morbidities did not show any statistical difference between two groups as in the hospital stay (p=.821 ). The time required for anastomosis showed strongly significant difference (18.17 min and 26.85 min; p=.000) in favor of stapling group. The hemorrhage from anastomotic line (p=1.00), anastomotic leakage (p=.413), ileus/ obstruction (p=.640) and wound dehiscence (p=.640) were much less in stapled group though they lack statistical power. All others except anasotomotic stenosis (p=.514) showed almost similar results. Conclusion: The stapled anastomosis was found to be less time consuming which was statistically significant. Both early and late complications except anastomotic stenosis showed results in favor of stapled group though they lack statistical strength. So, considering user perspective, time requirement and postoperative complications stapling technique appear to be safer and superior to hand-sewn technique though it demands statistical strengthening on large scale study. Journal of Surgical Sciences (2015) Vol. 19 (1) : 8-16
{"title":"Stapled Versus Hand-Sewn Anastomosis in Colorectal Cancer Surgery: A Comparative Study","authors":"J. L. Singha, Zahidul Haq, Ma Majid, Abu Taher","doi":"10.3329/jss.v19i1.43771","DOIUrl":"https://doi.org/10.3329/jss.v19i1.43771","url":null,"abstract":"Introduction: In spite of long journey of intestinal anastomotic techniques surgeons still are not free from doubt about the leakage after colorectal anastomosis. In distal rectal anastomosis after cancer surgery it poses more risk due to poor colonic vascularity and reduced remaining tissue to nourish the anastomotic site. Exploration of surgical staplers has provided some procedural advantages and sense of security to surgeons as well as to patients in respect to sphincter saving and thereby improving quality of life. However, outcome measures of these devices should be made to see its efficacy over conventional hand-sewn technique because their cost play role in treatment plan. The result of such comparative study may help surgeons to counsel the patients. \u0000Objectives: To find out whether stapled anastomosis is safer than hand-sewn anastomosis in colon and rectal cancer surgery. \u0000Materials and methods: The quasi-experimental study was undertaken in the department of general and colorectal surgery, Bangabandu Sheikh Mujib Medical University hospital during Feb 2005 to June 2008. Total 100 patients were selected. 48 patients underwent 'Stapled' and 52 underwent 'Hand-sewn' anastomosis. The patients were treated and postoperatively managed by same colorectal surgeon. The outcome variables were 'time required for anastomosis', 'postoperative hospital stay' and early and late 'complications' in postoperative and follow-up period. \u0000Result and observation: The age, sex, socio-economic status or co-morbidities did not show any statistical difference between two groups as in the hospital stay (p=.821 ). The time required for anastomosis showed strongly significant difference (18.17 min and 26.85 min; p=.000) in favor of stapling group. The hemorrhage from anastomotic line (p=1.00), anastomotic leakage (p=.413), ileus/ obstruction (p=.640) and wound dehiscence (p=.640) were much less in stapled group though they lack statistical power. All others except anasotomotic stenosis (p=.514) showed almost similar results. \u0000Conclusion: The stapled anastomosis was found to be less time consuming which was statistically significant. Both early and late complications except anastomotic stenosis showed results in favor of stapled group though they lack statistical strength. So, considering user perspective, time requirement and postoperative complications stapling technique appear to be safer and superior to hand-sewn technique though it demands statistical strengthening on large scale study. \u0000Journal of Surgical Sciences (2015) Vol. 19 (1) : 8-16","PeriodicalId":33248,"journal":{"name":"Journal of Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74246797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract not available Journal of Surgical Sciences (2014) Vol. 18 (2) : 43-44
外科科学杂志(2014)Vol. 18 (2): 43-44
{"title":"The Practices of Disclosure and Management of Medical Errors by Surgical Trainees-Better Preparing A Future Surgeon","authors":"Z. R. Khan, Ibrahim Siddique","doi":"10.3329/JSS.V18I2.43754","DOIUrl":"https://doi.org/10.3329/JSS.V18I2.43754","url":null,"abstract":"Abstract not available \u0000Journal of Surgical Sciences (2014) Vol. 18 (2) : 43-44","PeriodicalId":33248,"journal":{"name":"Journal of Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79669443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract not available Journal of Surgical Sciences (2015) Vol. 19 (1) : 1-2
中华外科杂志(2015)Vol. 19 (1): 1-2
{"title":"Making Surgery Safer","authors":"Mahmud Hasan","doi":"10.3329/jss.v19i1.43768","DOIUrl":"https://doi.org/10.3329/jss.v19i1.43768","url":null,"abstract":"Abstract not available \u0000Journal of Surgical Sciences (2015) Vol. 19 (1) : 1-2","PeriodicalId":33248,"journal":{"name":"Journal of Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73431551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. H. Sheikh, Omar Faruk, F. Begum, M. Parvin, Rayhanur Rahma, T. Khan, L. Lima
Background: Rectovaginal fistula is abnormal epithelial-lined connections between the rectum and vagina. Rectovaginal fistula represents an often devastating condition in patients and a challenge for surgeons. Successful management of this condition must take into account a variety of variables including the etiology, size, and location of the fistula. Repair options include advancement flaps, plugs, fistula ligation, and tissue interposition. Method: We treated five cases of low rectovagianl fistula by endorectal local advancement flap in Colorectal Surgery Unit of Bangabandhu Sheikh Mujib Medical University between January 2011 to January 2014. Aim of this study was to evaluate the outcome of Endorectal local advancement flap in terms of cure, recurrence or failure in the management of rectovaginal fistula. Result: Out of five, four patients had rectovaginal fistula due to obstetric cause, one was post-surgical. One patient developed partial flap necrosis. The patient was managed by conservative means. Post-operative hospital stay was 5 days (range 4 -7 days). All patients achieved complete healing after the procedure. Conclusion: Rectovaginal fistula repair by endorectal local advancement flap should be part of the armamentarium of colorectal surgeons for treating persistent rectovaginal fistula. Journal of Surgical Sciences (2014) Vol. 18 (2) : 62-66
{"title":"Endorectal Local Advancement Flap in Treating Rectovaginal Fistula-Our Experience in Bangabandhu Sheikh Mujib Medical University","authors":"S. H. Sheikh, Omar Faruk, F. Begum, M. Parvin, Rayhanur Rahma, T. Khan, L. Lima","doi":"10.3329/jss.v18i2.43758","DOIUrl":"https://doi.org/10.3329/jss.v18i2.43758","url":null,"abstract":"Background: Rectovaginal fistula is abnormal epithelial-lined connections between the rectum and vagina. Rectovaginal fistula represents an often devastating condition in patients and a challenge for surgeons. Successful management of this condition must take into account a variety of variables including the etiology, size, and location of the fistula. Repair options include advancement flaps, plugs, fistula ligation, and tissue interposition. \u0000Method: We treated five cases of low rectovagianl fistula by endorectal local advancement flap in Colorectal Surgery Unit of Bangabandhu Sheikh Mujib Medical University between January 2011 to January 2014. Aim of this study was to evaluate the outcome of Endorectal local advancement flap in terms of cure, recurrence or failure in the management of rectovaginal fistula. \u0000Result: Out of five, four patients had rectovaginal fistula due to obstetric cause, one was post-surgical. One patient developed partial flap necrosis. The patient was managed by conservative means. Post-operative hospital stay was 5 days (range 4 -7 days). All patients achieved complete healing after the procedure. \u0000Conclusion: Rectovaginal fistula repair by endorectal local advancement flap should be part of the armamentarium of colorectal surgeons for treating persistent rectovaginal fistula. \u0000Journal of Surgical Sciences (2014) Vol. 18 (2) : 62-66","PeriodicalId":33248,"journal":{"name":"Journal of Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85454282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Rahman, S. Hossain, A. Taher, Rashidul Lslam, L. Lima, A. Alam, G. Salahuddin, T. A. Khan, K. N. Naznin
Background: Colorectal cancer is the second most common malignancy in the western countries and the rectum is the most frequent site involved. Carcinoma of the lower part of the rectum involving the anal canal and carcinoma of the anal canal are now successfully managed by laparoscopic abdomino-perineal resection (APR) and postoperative morbidities are less and recovery is uneventful. In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as equivalent to conventional open surgery in terms of oncological clearance. The purpose of the study is to compare the early outcomes of laparoscopic abdomino-perineal resection (LAPR) surgery in low rectal and anal cancer patients in terms of surgical site infections, postoperative pain, recovery, hospital stay and margin clearance of tumor with that of open abdomino-perineal resection (OAPR) surgery. Methods: This randomized controlled trial was carried out in the Colorectal Surgery Unit of Bangabandhu Sheikh Mujib Medical University, Dhaka from May, 2012 to April, 2013. 50 patients in low rectal and anal canal cancers were randomized into two groups with 25 patients in conventional open abdomino-perineal resection (OAPR) and rest 25 patients in laparoscopic abdomino-perineal resection (LAPR). Early outcome variables after surgery were evaluated. Results: Demographic data and baseline characteristics are equivalent in both groups of population. Tumors were more common in rectum (80% and 76%), most of the tumors were adenocarcinomas (80% and 72%) and most of the tumors were present in stage-II (40% and 48%) with grade-2 (64% and 52%) in LAPR and OAPR groups respectively. During early post-operative follow up, abdominal surgical site infection was found more in conventional open abdomino-perineal resection (OAPR) patients than that of laparoscopic abdomino-perineal resection (LAPR) patients (p =0.001). Other morbidity and colostomy related complications were not significant in early post-operative period in both groups of population. Degree of pain was also less after laparoscopic abdomino-perineal resection (p=0.001 ). Stoma function occurred earlier after Laparoscopic abdomino-perineal resection (p =0.017) and ambulation, feeding liquid and feeding solid all had no difference for both groups. Shorter mean length of postoperative hospital stay and early hospital discharge was possible after Laparoscopic abdomino-perineal resection (p =0.001 ). Oncologic parameters were equivalent to those with open procedures. Conclusion: The patients undergoing laparoscopic APR for low rectal and anal canal carcinoma have overall superior outcomes in terms of surgical site infection, postoperative pain, postoperative hospital stay and has equivalent oncological clearance as with those with open procedures. Journal of Surgical Sciences (2014) Vol. 18 (2) : 57-61
{"title":"Early Outcome of Laparoscopic Abdomino-perineal Resection (APR) in Low Rectal and Anal Cancer- Our Initial Experience in Bangabandhu Sheikh Mujib Medical University","authors":"R. Rahman, S. Hossain, A. Taher, Rashidul Lslam, L. Lima, A. Alam, G. Salahuddin, T. A. Khan, K. N. Naznin","doi":"10.3329/jss.v18i2.43757","DOIUrl":"https://doi.org/10.3329/jss.v18i2.43757","url":null,"abstract":"Background: Colorectal cancer is the second most common malignancy in the western countries and the rectum is the most frequent site involved. Carcinoma of the lower part of the rectum involving the anal canal and carcinoma of the anal canal are now successfully managed by laparoscopic abdomino-perineal resection (APR) and postoperative morbidities are less and recovery is uneventful. In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as equivalent to conventional open surgery in terms of oncological clearance. The purpose of the study is to compare the early outcomes of laparoscopic abdomino-perineal resection (LAPR) surgery in low rectal and anal cancer patients in terms of surgical site infections, postoperative pain, recovery, hospital stay and margin clearance of tumor with that of open abdomino-perineal resection (OAPR) surgery. \u0000Methods: This randomized controlled trial was carried out in the Colorectal Surgery Unit of Bangabandhu Sheikh Mujib Medical University, Dhaka from May, 2012 to April, 2013. 50 patients in low rectal and anal canal cancers were randomized into two groups with 25 patients in conventional open abdomino-perineal resection (OAPR) and rest 25 patients in laparoscopic abdomino-perineal resection (LAPR). Early outcome variables after surgery were evaluated. \u0000Results: Demographic data and baseline characteristics are equivalent in both groups of population. Tumors were more common in rectum (80% and 76%), most of the tumors were adenocarcinomas (80% and 72%) and most of the tumors were present in stage-II (40% and 48%) with grade-2 (64% and 52%) in LAPR and OAPR groups respectively. During early post-operative follow up, abdominal surgical site infection was found more in conventional open abdomino-perineal resection (OAPR) patients than that of laparoscopic abdomino-perineal resection (LAPR) patients (p =0.001). Other morbidity and colostomy related complications were not significant in early post-operative period in both groups of population. Degree of pain was also less after laparoscopic abdomino-perineal resection (p=0.001 ). Stoma function occurred earlier after Laparoscopic abdomino-perineal resection (p =0.017) and ambulation, feeding liquid and feeding solid all had no difference for both groups. Shorter mean length of postoperative hospital stay and early hospital discharge was possible after Laparoscopic abdomino-perineal resection (p =0.001 ). Oncologic parameters were equivalent to those with open procedures. \u0000Conclusion: The patients undergoing laparoscopic APR for low rectal and anal canal carcinoma have overall superior outcomes in terms of surgical site infection, postoperative pain, postoperative hospital stay and has equivalent oncological clearance as with those with open procedures. \u0000Journal of Surgical Sciences (2014) Vol. 18 (2) : 57-61","PeriodicalId":33248,"journal":{"name":"Journal of Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88708302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Mohammad, Ashrafur Rahman, N. Jahan, F. Ahmed, Mahmud Hasan
Despite significant improvement in the management strategy, pancreatic cancer continues to be a great challenge for surgeons and oncologists. Length of survival largely depends upon stage at diagnosis and a completeness of resection. Distal pancreatectomy with RO resection has been reported as a favorable method in selected pancreatic body and tail tumors. Additional organ resections are rarely required. A young woman was diagnosed with a tumor in the body and tail of the pancreas that required splenectomy in addition to dista1 pancreatectomy. Postoperative course was uneventful. Histopathology revealed the tumor as moderately differentiated adenocarcinoma with extensive areas of necrosis, haemorrhage and cholesterol cleft formation. Resected end of pancreas was free of tumor. She has completed a course of chemotherapy and is doing well after 8 months of surgery. Journal of Surgical Sciences (2014) Vol. 18 (2) : 78-82
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