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JOURNAL READING
INTRODUCTION
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Polymicrobial necrotizing
fasciitis of the perineal,
perianal, or genital areas.
INTRODUCTION
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It is important to prevent fecal contamination in order to provide


healing without wound infection. Still no consensus on management
of fecal contamination by colostomy or bowel catheterization has
been achieved

Aimed to compare methods of preventing fecal


contamination to their prognosis and cost efficiency in
patients with FG

Comparing : duration of hospital stay, mortality,


additional surgery requirements, and cost
STUDY DESIGN
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single-center (
at the
Department of 48 patients from
Retrospective Cross Sectional General March 2002 to
Surgery, February 2009
Cukurova
University
Turkey
PATIENTS – INCLUSION CRITERIA
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Patients with serious perianal necrotizing


infections who were diagnosed as having FG

Preserved sphincters and without rectum injury


after debridement
PATIENTS – EXCLUSION CRITERIA
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Patients who were


subjected to
Cases which were not
close to the anal channel colostomy because of
sphincter damage and
rectum injury
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Daily maintenances  feces
softener, and peristaltism-
Intervention increasing medicines were
administered
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Pateints who were subjected to bowel


management catheter (BMC) instead of
colostomy (the BMC group)

patients who were subjected to


colostomy for fecal diversion
(the colostomy group)
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• All patients were taken into operation


under emergency conditions.
• Wounds were closed by the use of
medical dressings after the wide
debridement of all necrotizing tissues
Intervention
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Tissue defects were closed through skin graft or with


primary wound closure, after wound healing was ensured

Colostomies of patients who were successfully treated


and discharged were closed 128 days later on average.

BMCs were removed when wound healing processes were


finished
Study Procedures
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48 Patients

completed the study


protocol: Colostomy Group BMC Group 16
• 24 patients in the CG (75%)
32 patients patients
• 15 patients in the BMCG
(93.8%)
Exitus 8 patients Exitus 1 patient

Comparing : duration of
hospital stay, mortality,
additional surgery
requirements, and cost
Outcome Assessment
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• Duration LOS
Outcome • Total Cost
• Number of surgery
To compare : • Complication
Statistical Analysis
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P value lower
Chi-Square test than 0.05 were
T-test   analysis of
Continous categorical considered to
Variable variables be statistically
meaningful.
Result
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Result
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Discussion
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 Our results suggest that BMC method is able to


shorten the total duration of hospital stay (P< 0.05).
 Since there was no need to perform additional
surgeries for colostomy closure and colostomy
complications in the BMC group, average number of
surgeries was found to be lower, as expected
(P<0.05)
 The BMC method was determined to decrease total

costs by shortening total duration of hospital stay, as


expected (P<0.05)
CONCLUSION
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In conclusion, it is suggested that BMC


method should be considered instead
of colostomy in suitable cases. It may
relieve patients, patients’ relatives,
healthcare organizations, and the
national economy of a serious burden,
based on our experience.
Modification…
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 Professional  EBM  Critical Analysis

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