Minimally invasive procedure for hemorrhoids: Surgical results

Objectives: The purpose of the present study was to determine the surgical results of stapled hemorrhoidectomy and overall satisfaction of the patient and to evaluate its suitability as a routine day care surgery procedure in this part of the world. Materials & Methods: A total of 30 patients were operated from June 2006 to Dec 2008. The median age of the patients was 49.1 years. The main symptom was digital recognition of perianal mass (96%). The procedure was performed under regional (epidural or spinal) or general anesthesia. The average operative time was 31.08 minutes. The procedure was performed with PPH03, a 33 mm diameter hemorrhoidal circular stapler. The patients were prospectively evaluated for postoperative pain and bleeding, satisfaction scores, anorectal function, return to work and cost effectiveness of the procedure. Results: The duration of the PPH procedure ranged from 30-45 minutes (average 31.08 minutes). The suture line was on average 3.5cm (3 - 4.5) above the dentate line. Excision of external skin tags while undergoing PPH was performed in 16.6% cases (n=5). No stapler failure was detected. Seven patients (23.3%) had bleeding after the stapler off and 3 patients (10%) had bleeding in the first post operative day. Patients average pain score was 1.57 (VAS 1-5) at 24 hrs in the 1st postoperative period. Of note, three patients had no pain at all immediately after surgery. No patients had recurrence of hemorrhoidal prolapse, bleeding or anastomotic stricture upon rectal exam or fecal incontinence Ninety percent of patients (n=27) were discharged in a day while as 10% were discharged after 2 days because of their co morbid conditions Return to work was early between 5-7 days postoperatively with high patient satisfaction score. Conclusions: Stapled hemorrhoidectomy (SH) is a safe, effective and well tolerated procedure in the treatment of grade 3 and grade 4 hemorrhoids with less postoperative pain and high patient satisfaction, which seems to have all the requirements for Day Care Surgery

Etiological and clinical profile of acute renal failure in children attending SKIMS Srinagar

Background: Acute renal failure is an important problem in childhood in hospital practice. It is a catastrophic and life threatening event. Objectives: The present study focuses on the “etiological and clinical profile of ARF in children attending SKIMS”. Study designed: Prospective study. Material & Methods: This study was conducted over a period of 2 ½ years from 2006 – 08. 100 cases of children upto the age 18 years with ARF who were admitted in SKIMS were studied. Results: Out of 100 cases of ARF, 51 (51%) were girls and 49 (49%) were boys; 36% of patients were 10 years of age. Sepsis was the commonest cause of ARF (18%) followed by acute gastroenteritis (15%) and post streptococcal glomerulonephritis (12%). The commonest clinical presentation was oliguria (60%) followed by edema (45%), vomiting (39%), and breathlessness (26%). Anuria was present in 13% of patients. Convulsions were the most common major systemic complications. The treatment modality was conservative in 80%, renal replacement therapy (RRT) in the form of peritoneal and hemodialysis was performed in 20% of the patients. The overall mortality rate was 20%. Mortality was highest in patients with sepsis and rapidly progressive glomerulonephritis. Outcome data at 3 months showed normal renal function in 72 (90%), and CKD in 5 (6.3%). Three (3.8%) patients lost followup. Conclusions: ARF is fairly common in children with a mortality rate of 20% in our study. Even today, sepsis is the most common cause of ARF followed by acute gastroenteritis. If these conditions are treated early and promptly, the occurrence of ARF can be prevented. If the patient develops ARF, an early referral to a specialized center with dialysis facilities can significantly improve the final outcome