ABSTRACT
Objective: To compare post operative pain and wound infection between mesh and Darn inguinal hernia repair
Study Design: A prospective comparative randomized, clinical trial
Place and Duration: The Study was conducted on 60 patients, 30 in each group during the study period of 8 months from 16th December 2006 to 16th August 2007 at Ziauddin Medical University Hospitals Karachi
Methodology: A total of 60 patients in the age range of 15-70 years with simple inguinal hernia were randomized in two groups i.e. Group A [Lichtenstein] and Group B [Darn] inguinal hernia repair. All inguinal hernias [Direct and Indirect], male patients were included while recurrent/ Obstructed / Strangulated / Irreducible Inguinal Hernia were excluded from the study. After surgery, postoperative pain was assessed using visual analogue scale [VAS]. Surgical wounds were also assessed by using Southampton wound grading score [SWGS] at 48 hours [before discharge] and 7[th] day [in the outpatient department]. Any seroma or infection at wound site if noticed within 7 days of surgery was also noted and all patient's related information was noted in pre set approved proforma from relative hospital's ethical review committee
Results: All were male patients with simple inguinal hernia, admitted through OPD in the ward. Fifty six [93%] out of 60 patients developed pain. Pain intensity was mild in [group A= 5[16.7%], group B= 2[6.6%]]; moderate in [group A= 20[66.6%], in group B=25[83%]] and severe in [group A= 3[10%] and group B= 1[3.3%]]; while no pain was seen in 2 [6.7%] patients in each group that was found statistically non significant [Chi square=2.84, P=0.42[ns]]. Ten [16.6%] out of 60 patients developed wound infection with 5[8.3%] patients of different wound grades in each group [Chi-square test of dependency [Chi square=2.891, P=0.82]]. Statistical analysis of this variable also found insignificant. Hypothesis was made that there is no significant difference in postoperative pain in both groups and Darn causes less postoperative wound infection than Lichtenstein repair
Conclusion: It is concluded that there is no difference in post operative pain and wound infection between well constructed darn and mesh hernia repair however study limitations are that it is of short duration with some shortage of sample size. A long-term study of around 10-15 years is still desirable to judge the both techniques in terms of recurrences
ABSTRACT
To evaluate management and outcome of Iatrogenic Common Bile Duct injury after cholecystectomy. Descriptive study. Isra University Hospital Hyderabad during the period of April 2013 to April 2014. All patients presented with CBD injury after cholecystectomy included while CBD tumor and CBD stone and trauma were excluded from study. Total of sixteen patients with CBD injury were admitted from outside the hospital in surgical ward in Isra University hospital either through OPD or Emergency Room or Endoscopy Suite depending on the mode of presentation and failure of ERCP if performed according to the need and clinical presentation. All patients were resuscitated and investigated thoroughly and the procedure whether ERCP, or reconstructive surgery or conservative treatment performed based on patient's clinical presentation and mode of injury and is recorded in the preset approved Performa from relative hospital's ethical review committee and the data compiled in SPSS version 10. All 16 patients; 4[25%] male and 12[75%] females admitted from outside the hospital in two year period. Presented in variable time interval12 [75%] patients admitted in 1 month, 3[18.8%] in 6 monthsand 1[6.3%] in 12 months. Jaundice was the main presenting symptom. Patients were resuscitated and optimized for invasive procedure i.e. ERCP and reconstructive surgery. Six patients were treated with ERCP successfully and 9 underwent reconstructive surgery and 1with some biliary drainage responded to simple conservative treatment. Operative success rate was 75% with 25% mortality which was related to the presence of peritonitis, development of multiorgan failure and late repair of bile duct injury. Although CBD injury is one of the most devastating complication but its early diagnosis and prompt treatment can prevent patient's life with subsequent few or no complication even after its reconstructive surgery. Training must be emphasized to find the all possible ways of recognizing biliary tract anatomy during surgery and possess skills to overwhelm the primary and leading cause of bile duct injury i.e. the visual misperception