Vivek Kumar Roy

Abstract

Introduction: Laprotomy remains one of the commonest emergency surgical procedure performed worldwide. But over the last few years, various perioperative quality improvement initiatives involving early interventions, intensive postoperative care, and indivisualised care approaches have ensured a decrease in the average mortality rate by 3.8%-8.3. An ideal scoring system should accurately predict outcomes, help determine who deserves more aggressive care, guide in deciding the extensiveness of surgery, and can be used broadly access emergency laprotomies for various disease pathologies. The scoring system should also be capable of analyzing risk adjusted morbidity and mortality amongst various healthcare providers. Aim: To access the accuracy of P-POSSUM score on predicting the mortality and morbidity in emergency laparotomy patients and to establish that the preoperative score is more accurate that admission score. Materials and Methods: 150 Cases of emergency laparotomy in General Surgery Department in IGIMS, Patna from September, 2020 to February, 2022 were taken up in this study. Patients below 18 years, routine surgery and 6 patients who could not be followed up for complete 30 days were excluded. Physiological P-POSSUM was calculated at the time of admission and just before operation, post resuscitation. Operative score was same for both Physiological P-POSSUM scores. Results: Mortality predicted at admission had statistically significant difference and p value was.05. Most common complication was wound infection followed by septicaemia. Conclusion: P-POSSUM is a better predictor of mortality and morbidity in emergency laparotomies when scoring is done preoperatively.   Keywords: Preoperative, Emergency laparotomy, Postoperative, Prediction, Mortality, score.

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Abstract

Background: Stoma closure is associated with several complications, wound infection being the most common. This study is done to establish that purse string suture closure method for stoma closure is superior to the conventional linear mattress closure and is associated with better wound healing cosmesis. Methods: This Prospective randomized controlled study enrolled 80 patients who underwent stoma closure from April 2021 to March 2022 in department of General Surgery in IGIMS, Patna. Patients were divided in two groups inclusive of ileostomy and colostomy based on type of closure technique. Conventional linear closure method was applied to Group A and purse-string technique applied to Group B patients. All Patients were followed regularly upto three months after operation. Rate of infection, pain as assessed by VAS score and satisfaction as assessed by POSAS Score were done. Results: Purse string Closure had better outcome in terms of wound infection rate and Cosmetic results over a 3 months follow up. Ten patients in Group A and 2 from Group B out of 40 patients had wound infection. Patients with purse-string suture had statistically significant greater satisfaction over 3 months. Medium operative time of Group A was 100 minutes and that of Group B was 98 minutes. There were no significant difference in regards duration of hospital stay was more in Linear Group than Purse String (Group B). Conclusion: Purse-string closure was associated with better cosmesis and lower infection rate in comparison to Linear conventional closure. Keywords: Purse­string, Suture, Ileostomy, Colostomy

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