early experience of laproscopic cholecystectomy from K.M.C / civil hospital Khairpur Mir's

Objective: To see feasibility, per operative difficulties and overall results of lap: Cholecystectomy in our newly established minimal invasive surgical setup

Study Design: Randomized Descriptive study

Place and Duration of Study: This study was conducted in Surgical Department of newly established Khairpur Medical College/ Civil Hospital Khairpur Mir's from August 2014 to May 2015

Materials and Methods: The data of all the 100 patients with the diagnosis of gall stone disease was entered in specific proforma, who were admitted at K.M.C / Civil Hospital Khairpur Mir's. The consent for laproscopic procedure was taken prior to surgery. All the base line blood and radiological investigations were done. Cardiac and general anesthesia opinion were also taken. The procedure was carried out by conventional "four port" method on scheduled elective operation list

Results: In this study male to female ratio was 1:6.1 and mean age was 38.5 years. In 52 patients gall bladder was non inflamed and callot's triangle was clear but in 48 cases various kinds of abnormalities were present. In 40% cases operative technique was modified by different means. Conversion rate remained 09%. In 56 cases operative time was 40 mints, in remaining 44 patients it was beyond 40 mints. Post operatively 26 patients developed various minor and major complications. There was no mortality in our series

Conclusion: Lap: Cholecystectomy is safe and effective procedure, applicable to any general as well as teaching hospital. Over all our results are acceptable according to the national and international studies

Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy

This comparative prospective study was conducted at the Ghulam Muhammad Mahar Medical College Hospital and Red Crescent General Hospital, Sukkur, Pakistan, for a period of two years from July 2012 to June 2014. The study included 1800 patients who underwent laparoscopic cholecystectomy for symptomatic cholethiasis. These patients were divided in to two groups. Group I included 900 patients, who underwent conventional laparoscopic cholecystectomy with the four port technique. In these patients, the gall-bladder was retrieved through umbilical port by a sterile surgical hand glove [size 6[1/2] or 7 inches] endobag. The fascial defect of 10 mm umbilical port was closed by vicryl "0" with J-shaped needle, while three 5 mm ports closed by applying steri strips. Group-II also included 900 patients. In these patients laparoscopic cholecystectomy was done by using three ports, 10 mm epigastric working port, 5 mm umbilical port for 5 mm telescope and lateral 5 mm port for assistant. The gall-bladder was retrieved through epigastric port without endobag. The results of both these techniques were collected and analyzed on SPSS version 14. The mean age of patients was 45 years. The male to female ratio was 1:3. In group-I, after laparoscopic cholecystectomy, gall-bladder was retrieved safely through 10 mm umbilical port in surgical glove endobag. In acutely inflamed cases, the gall-bladder was opened at the umbilical port site inside the endobag and decompressed before retrieval. In this group, wound infection of umbilical port occurred in 5.11% patients, port-site hernia in 3.66%, port-site bleeding in 1.33% while difficulty in retrieval of gall-bladder in acutely inflamed cases in 1.88% patients. In group-II, wound infection in epigastric port was found in 1.55% patients, port-site hernia in 0.11%, port-site bleeding in 4%, difficulty in retrieval of gall-bladder in 5.33% while leakage /perforation of gall-bladder in 4.11% patients. The serious complications like wound infection and port-site hernia are more frequently found in group-I patients as compared to group-II

Coronary endarterectomy for severe diffuse coronary artery disease

To determine the outcome of Coronary Endarterectomy [CE] in patients undergoing Coronary Artery Bypass Graft [CABG] surgery for diffuse Coronary Artery Disease [CAD], in terms of postoperative mortality and morbidity, relief from angina and survival at one year. A case series. Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from January 2003 to November 2005. Included in the study were all patients with such diffuse CAD that conventional bypass grafting was not possible. Those with the diseased coronary artery supplying an akinetic myocardium and a fixed perfusion defect on perfusion scan, or with poor left ventricular function [ejection fraction < 30%] in association with severe chronic hepatic disease and deranged liver function tests, permanent severe immune deficiency state, or poor results at lung function tests were excluded. Cardiopulmonary Bypass [CPB] was used in all patients. All patients were followed up for a mean time of one year, for assessment of postoperative mortality and morbidity, relief from angina and survival. Fifty five patients [3.2%] underwent CE of at least one major coronary artery for severe diffuse atheromatous disease. The mean age was 53.9 +/- 9.5 years. Twenty six [47.3%] had previous Myocardial Infarction [Ml], 16 [29.1%] had unstable angina, 12 [21.8%] had poor Left Ventricular [LV] function, 5 [9.1%] underwent emergency CABG surgery for impending infarction, 39 [70.9%] had angina Canadian Cardiovascular Society [CCS] class II/III, 11 [20%] had critical left main stem disease and 12 [21.8%] required Intra-Aortic Balloon Pump [IABP] for hemodynamic support. There were 2 [3.6%] early deaths and 2 [3.6%] cases of non-fatal infarctions. Three [5.4%] patients had low Cardiac Output [CO] after operation. At one year follow-up, there were no late deaths and 43 patients [91.5% of those reporting for follow-up] did not have angina. CE acted as an adjunct to CABG surgery with acceptable operative risks and satisfactory results at one year in terms of mortality and angina relief

Incidence of gall stones in Carcinoma gall bladder patients

To determine the incidence of Gall stones in cases of Carcinoma Gall bladder.Retrospective descriptive study conducted from June 1999 to August 2002.Surgical B Ward of Khyber Teaching Hospital, Peshawar.All patients who were diagnosed as having Carcinoma Gall BladderThe presence or absence of stones was noted in cases of Carcinoma Gall Bladder, detected on preoperative ultrasonography or per-operatively on macroscopic examination, and later confirmed on histopathology. Out of the 40 patients with Carcinoma Gall Bladder in this series, 37 [924%] had Gall stones. There were 34 [85%] females and 6 [15%] males with an age range from 27 to 65 years. Six [15%] patients were in Stage /, 15 [37.5%] in Stage II, 14 [35%] in Stage III, while 5 [12.5%] cases were in Stage IV In 36 patients simple cholecys-tectomy was performed, whereas in 4 patients only biopsy was taken from liver metastasis.There is a strong association of Carcinoma Gall bladder- with gall stones

Right ventricular myxoma with heart failure

Cardiac myxomas are histologically benign tumors but they may be lethal because of their strategic position. These are mostly located in the left atrium and uncommonly in the right atrium. We report a case of a large right ventricular myxoma presenting with heart failure

Aortic valve replacement for aortic stenosis - 12 Year experience of a single surgeon

Aortic Valve Replacement [AVR] is a standard procedure carried out for severe pathological changes in aortic valve. In our study 30 patients had AVR for aortic stenosis from Dec. 1989 to Dec. 2002. There were 25 male and 5 female. Most of the patients were from poor socioeconomic group. Rheumatic heart disease was the most common cause [72.2%]. Syncope, angina and heart failure were the major indications of surgery. The mean age was 37 years. Starr Edward Valve was most commonly used valve [72.4%]. LV diastolic diameter was associated with increased pre-op NYHA grading, increased inotropic support. Hospital mortality was 5 [16.6%] and late death was 1[3.3%],4 [13.2%] patients were lost to follow up while 20[66.6%] are attending the follow up clinic with most of the cases in NYHA grade 0/I. Bleeding, infarction and postoperative arrhythmias affected the mortality significantly

Multiple valve replacement, a decade's experience

Multiple Valve Replacement is the procedure involving replacement of more than one valve due to pathological changes. It was a prospective and randomized study of 72 patients for Multiple Valve Replacement at Armed Forces Institute of Cardiology [AFIC], by one surgeon. The major cause of multiple valve replacement in our country is Rheumatic heart disease and occurs in younger age group as compared to Caucasians. In this study most of the cases were of Mitral regurgitation with Aortic regurgitation [39.4 percent]. The procedures done were according to the valves involved. Aortic valve replacement [AVR] with Mitral valve replacement [MVR] was maximum in 73.7 percent. Starr Edward Valve was used in the majority of cases [59 percent]. Postoperative complications were present in 54.5 percent of cases. ICU problems were LCO, excessive bleeding, arrhythmias and pulmonary complications. Overall hospital mortality for the whole group was 28.8 percent, late mortality was 15.1 percent. Patients who were lost to follow up were 28.6 percent and 30.4 percent are still having the follow up. The relation of hospital mortality with disease pattern and NYHA grading was significant [p=0.0001]