Lichtenstein repair; A community based teaching hospital experience

To describe our experience of Lichtenstein repair in a community based teaching hospital. This prospective study included patients presenting to the surgical outpatient department of Fatima Hospital for elective hernia repair over a 2 year period. Sixty four patients underwent hernia repair. All were males. Most common [67%] were indirect inguinal hernias. Fifty-seven percent had no symptoms. Chronic constipation was present in 22% and cough in 11% patients. Eighty six percent of the patients had no co-morbidities and 84% patients belonged to ASA class I. Eighty seven percent procedures were performed under spinal anesthesia. Mean operating time was 57 +/- 18 minutes with no operative complications. Four patients had scrotal hematoma and 3 had seromas, while one patient each had wound infection, spinal headache and urinary retention. None of the patients required surgical intervention or mesh removal. Average cost per patient was 3204 +/- 510 rupees. Our outcomes of Lichtenstein repair were comparable with the international and local literature. Further reductions in costs can be achieved by performing the procedure under local rather regional anesthesia

Instrument failure: a preventable cause of conversion in laparoscopic cholecystectomy

This study was done to assess the association between quality of laparoscopic instruments and the incidence of conversation from laparoscopic to open cholecystectomy. Observaional and descriptive study from October 2004 to September 2006. This study was conducted at Baqai Medical University Hospital and two other private hospitals in Karachi. All patients who underwent laparoscopic cholecystectomy, including those that had to be converted. The records of all attempted laparoscopic cholecystectomies were studied retrospectively. Apart from demographic data, the clinical diagnosis, histopathology, conversion rate and quality of the instrument i.e. old or new was studied. SPSS Version 11 was used for statistical analysis. The frequencies were drawn and association between conversion rate and quality conversion rate and quality of instruments was noted using odds ratio. Laparoscopic cholecystectomy was attempted in 93 patients during the study period. Amongst them 79 were females and 14 males, with an age range 16 to 72 years [mean 46 years]. Seven [7.53%] patients had to be converted from laparoscopic to open cholecystectomy. The causes of this conversion were instrument failure in five cases, CBD stone in one and unclear anatomy at Calot's triangle in one case. The laparoscopic instrument that failed during surgery included insufflators in two cases while monitor, camera, and clip applicator, each in one case. Fifty six surgeries were performed with old instruments and 37 with new instruments. Correlating the two variables i.e. conversion rate and quality of laparoscopic instruments revealed that only one case was converted with new instrument, while six conversions were with old instrument. All the instrument failures were with old instruments and the odds ratio was 4.32. The chances of conversion from laparoscopic to open cholecystectomy are 4.32 times more if old instruments are used compared to the new ones. The difference in conversion rate due to instrument failure is stasitically significant