A Comparative Study of Primary Common Bile Duct Closure vs T-Tube Drainage After Open Common Bile Duct Exploration At TMMC&RC Moradabad

2023-06-01T10:53:38+00:00

Background: There are two ways for extracting the common bile duct stones which includes Endoscopic retrograde cholangiopancreatography and a surgical method through the laparoscopic or open method. The placing of T - tube is associated with having a prolonged length of hospital stay that is always more than 10 days. Also there has been a less incidence of the recurrent stones that got reported in terms with the primary closure of the CBD while it gets compared with the drainage of the T - tube. This study was a comparative study carried out in the patients of Uttar Pradesh in regards to the primary common bile duct closure versus the T - tube drainage after there is the exploration of the common bile duct. Subjects and Methods: Inclusion Criteria are Age more than 18 years, Patients with large CBD stones presenting with symptoms of obstructive jaundice who have either had failed ERCP, or have refused ERCP, Large and impacted stones. Exclusion Criteria are pancreatic pathology, Recurrent CBD stones, Renal failure, Malignancy, alll the cases declared unfit by the anesthesiologist for the surgery. Results: The majority of the cases were female which accounts for 84.1% and only 15.9% of them were male. Majority of the cases suffered from a severe pain in their abdomen which accounted for 63.6%, 31.8% of clinical jaundice and only 4.5% experienced fever with the pain abdomen. 81.8% got diagnosed with choledocholithiasis and only 18.2% of them were found to have cholelithiasis along with choledocholithiasis. After the 14th day the representation of the distribution of frequency in accordance with the T tube cholangiogram showed that the result was positive in 50% and negative in 50%. None of the patients had any retained stones in them and 90.9% of the cases did not face any T- tube site infection post the treatment and only 4 of the patients had faced the infection in T- tube site. The Bile leak post the removal of T tube which was done after 3 days shows that the majority of the cases did not report any incidence of bile leak that accounted for 88.6% and only 5 subjects had experienced bile leak. Conclusion: Primary common bile duct closure can be considered to be a safer and much more effective way for managing the open common bile duct exploration in regards to the common bile duct stones.

Risk Factors for Surgical Site Infections After Appendectomy for Acute Appendicitis

2024-06-07T05:53:41+00:00

Background: Surgical site infections are the most common hospital-acquired infections that increase overall cost and length of hospital stay, and are largely preventable. In the meantime, appendectomy remains a common surgical procedure related to a considerable risk of surgical site infections (SSIs). We aim to identify risk factors for SSI in patients who had undergone appendectomy in our setting. Subjects and Methods: A total of 292 patients who underwent open appendectomy between July 2017 to June 2021 in People’s Dental College and Hospital, Kathmandu, Nepal were included. We divided patients into two groups based on the occurrence of SSI postoperatively; the SSI group and the non-SSI group. Patient demographic characteristics and perioperative data were compared between two groups. Results: Out of total 292 patients who underwent open appendectomy, 39 (13.4%) patients developed SSI. Mean ages were 31.8 ±8.08 years. In logistic regression analysis, on multivariate analysis, out of independent variables sex (male), presence of comorbidity, WCC (≥ 16000 /mm3)), CRP (≥ 65), type of appendicitis (complex), and duration of surgery (>60 mins), only WCC (≥ 16000/mm3)), and type of appendicitis (complex) were associated with an increased risk of SSI (P <0.005). Conclusion: White cell counts (≥ 16000/mm3)), and type of appendicitis (complex) were associated with an increased risk of SSI. Early diagnosis and prompt treatment are essential to decrease morbidity and financial burden due to surgical site infection.

Academia Journal of Surgery

A Comparative Study of Primary Common Bile Duct Closure vs T-Tube Drainage After Open Common Bile Duct Exploration At TMMC&RC Moradabad

Risk Factors for Surgical Site Infections After Appendectomy for Acute Appendicitis