Efficacy of tube Cecostomy in preventing post appendectomy fistula
Objective: This study was conducted to determine role of tube cecostomy in preventing fecal fistula formation after appendectomy in the patients with appendicular mass or abscess.
Study design and Duration: It is a descriptive case series study. Study was started in July 2017 and it was completed in December 2017 comprising on 6 months duration.
Setting: This study was conducted in surgical unit of Bahawal Victoria Hospital Bahawalpur, Pakistan.
Patients and Methods: In this study 34 cases were included having appendicular mass or appendicular abscess. These cases were admitted in the ward via emergency department. Initially detailed history was taken and thorough examination was done. All necessary investigations were carried out to confirm the diagnosis. An inclusion criterion was formed on which basis only those cases were included in this study which presented with appendicular abscess or phlegmon formation. After investigations, which cases had other diagnosis, they were excluded from the study. All data of the patients in study group was documented properly. After taking anesthesia fitness these cases were operated and tube cecostomy was performed after appendectomy. These cases were retained in the ward for 4-6 days. Monitoring was done. Findings per operating were noted down. Complications during operation or after it were observed. Which cases developed any complication they were retained for more time and other cases were discharged on good antibiotics and they were called on follow-up after 10 days. Proper consent was taken from the patients for including their data in the study. Consent was also taken from the in charge of ward for conducting this study. Data was analyzed on Microsoft office and SPSS version 2017 and results were calculated in the form of frequencies and expressed in tables and graphs.
Results: Total 34 cases were studied. Ages of these cases was ranging from 15-50 years with mean age of 27.5 years. Minimum age of the patient was 15 years and maximum age reported was 46 years. Most of the cases were between 20-30 years age. During operation findings were gangrenous appendix in 14 cases, perforated appendix with abscess formation in 12 cases and in 8 cases there was perforated appendix without abscess formation which presented relatively earlier. Complications after tube cecostomy included leakage from pericatheter in 3 cases, early dislodgement of catheter occurred in one case and retained catheter in 2 cases. After removal of catheter fistula formation was not seen in any patient that indicated this method prevents fecal fistula formation and it is much safe method with less morbidity and early recovery. Post operative complications were seen in 6 cases and in rest of 28 cases no complications occurred. There were both male and female patients In this study accounting 22 males and 12 females.
Conclusion: After appendectomy for appendicular abscess or appendicular mass fecal fistula formation is much common, this can be prevented by tube cecostomy. It is a very effective procedure and simple to perform with good outcome
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