Morbidity and mortality in breast conservation surgery in early carcinoma breast

To study the mortality and morbidity after breast conservation surgery [BCS] in patients with early breast cancer and comparison with local and international literature. An Interventional descriptive study. Place and Fauji Foundation Hospital, Rawalpindi from Jan 2002 to Dec 2003. Thirty diagnosed cases of early breast cancer in clinical stage I and II were included. Patients with solitary lump with size up to 4 cm in biggest diameter, 5 cm with large sized breasts and patients with lump in one breast were included. Patients with multicentric diseases, lump larger than 4 cm in size in greatest dimension, lump situated beneath areola, lumps fixed to skin or deeper structures were excluded. There were 2 [6.67%]cases of seroma formation and 1 [3.33%] case of wound infection, 8 [26.67%]patients suffered persistent painful shoulder movements and arm pain, 4 [13.33%] patients suffered breast disfigurement. 3 [10%] cases of loco-regional recurrence. 1 [3.33%] patient underwent mastectomy and 2 [6.66%] patients underwent further local excision,. Percentage of ductal carcinoma in post-menopausal women was also high. There was no mortality. Breast conservation surgery is equally effective as mastectomy in the treatment of early breast cancer as there is no statistically significant difference in disease-free survival and overall survival

Inguinal hernia repair: a comparison of lichtenstein and darn techniques

To compare the number of postoperative complications and early recurrence between Lichtenstein tension free hernioplasty and Darn repair, for inguinal hernia. The study was conducted at Department of Surgery, Combined Military Hospital Rawalpindi from 1st Jan 2001 to 30th Nov 2002 and included 100 patients. The study design was quasi experimental. A total of 100 patients were selected. 50 patients were treated with Lichtenstein tension free hernioplasty [Group A] and 50 with Darn repair [Group B]. Cases were followed up for one year. The male to female ratio was 46.5:1. Total no of postoperative complications were 7[14.58%] in Group A and 21 [44.68%] in Group B. Haematoma was the most common complication followed by urinary retention and wound infection in both the study groups. Complications like haematoma [8.33% versus 14.89%], urinary retention [2.08% versus 12.76%], wound infection [2.08% versus 8.51%], scar pain [2.08% versus 6.38%] and testicular atrophy [0% versus 2.13%] were significantly low in Lichtenstein tension free hernioplasty as compared to Darn repair [P<0.05]. The early recurrence rate in this study was significantly low in Group A [0] as compared to Group B [O versus 4] but this is statistically insignificant [P>0.05]. Depending upon the surgeon's skills, Lichtenstein tension free hernioplasty has a definite superiority over Darn repair

Carcinoma oesophagus: comparison of various treatment modalities

To compare various modalities of treatment in management of carcinoma oesophagus with particular stress on relief of dysphagia due to ca. Descriptive, retrospective study. Surgical department CMH Rawalpindi. From 1996 to 2000 [4 years]. The study subjects included 33 patients with histopathological diagnosis of carcinoma oesophagus [including criteria], 28 patients were operated upon [curative 18, palliative 10] with 17.5% operative mortality, 4 merited solely on chemo/radiation therapy [advance stage tumor], while 01 patent opted for chemo/radiation despite being favorable candidate for surgery. Of the 33 cases, 29 were operated out of which 11 were subjected to Ivor-lewis procedure, 15 were operated upon through transhiatal approach while in the remaining cases, palliative bypass procedures were done. Surgery [transthoracic + tans hiatal approach] proved to be the only reliable mode of treatment whether supplemented by adjuvan t therapy or not, Chemo/radiation as a sole mode of treatment had drastic results

Hepatic hydatid cyst and omentoplasty

Hydatid cyst liver is a disease, which has been subjected to great diversity as far as the surgical treatment is concerned. A descriptive study was carried out to determine the results of omentoplasty in the management of hydatid cyst liver. A group of 23 patients were included in the study. 16 were adult males and 7 were adult females. Mean age of the patients was 36 years. Intra- operative assessment of the hydatid cyst liver showed 91.3% solitary cysts. Univesicular cysts were 43.3% and multivesicular cysts 52.1%. 86.9% cysts were located in the right lobe of liver. All were subjected to omentoplasty. Post-operatively 4.3% showed bile leakage and 17.3% wound infection. The bile leakage was managed conservatively and it regressed in 4 days. No haematoma or deep abscess was documented. Follow up of the patients showed significant clinical and radiological improvement

Surgical management and outcome in achalasia cardia

The objective of the evidence based clinical report was to assess the outcome of exramucosal modified Heller's cardiomyotomy in terms of effective palliation of dysphagia with minimum complications. Ten patients were included after exclusion of four patients due to poor follow-up. Due to the non-availability of manometry, barium swallow and endoscopy had to be relied upon for the definitive diagnosis. All patients underwent transabdominal modified Heller's myotomy coupled with anterior partial fundoplication [Dor Patch]. Median age of the patients treated was 42.5 years. Seven patients had grade III dysphagia, 2 had grade IV and one patient, an 8 years old child was having grade II dysphagia. In one patient, [10%], mucosa was perforated iatrogenically followed by wound infection. Another patient developed acute coronary syndrome on first postoperative day. In the rest of patients recovery was uneventful. Mean hospital stay was 7.1 days. Immediate relief of dysphagia was noted in all the patients. Mean follow-up was 7.2 months. There was significant improvement in dysphagia following surgery. Outcome was assessed devising a scoring system. Excellent outcome was observed in 80% of cases, good in 10% and fair in 10% of cases

Experience of thymectomies at combined military hospital, Rawalpindi

From April 1998 to January 2002, 10 patients underwent thymectomy at Surgical Unit 1, Combined Military Hospital, Rawalpindi. The mean age of these patients was 31 years. The most common indication for surgery was Myasthenia Gravis associated with Thymoma. Most of the patients were on high doses of Pyridostigmine and steroids for a long period of time. All patients underwent median sternotomy for thymectomy. Two of these patients needed additional treatment in the form of plasmapheresis and immunotherapy in the perioperative period. The mean hospital stay was 13.29 days. One of the patients went into Myasthenic crisis in the postoperative period, all the rest had uneventful recovery. On post-operative histopathology various pathological entities were seen including thymoma, primary germ cell tumor, carcinoid tumor and non-Hodgkin's lymphoma of the thymus

Hepatic duct strictures: presentation and management

A prospective study was conducted in Combined Military Hospital Rawalpindi from January 1998 to December 2000[about 3 years]. A total of 11 patients with radiologically proven strictures of hepatic ducts were included in the study. All the cases were thoroughly investigated by history, physical examination, liver function tests [LFT's], Ultrasound abdomen, Percutaneous Transhepatic Cholangiography[PTC], Endoscopic Retrograde Cholangio-Pancreatography[ERCP] and Computerised Tomography [CT]scan. Out of 11 cases, 8 [72.72%]were male and 3 [27.27%]female with male to female ratio of 2.7:1. The age ranged from 33 years to 66 years with a mean age of 48 years. There were 8[72.72%] cases of benign stricture and 3[27.27%] with malignant pathology. Of the benign strictures, 4 were Type-I, 3 type -11 and 1 Type-III[Bismuth classification] while among malignant strictures 2 were Type-II and 1 Type-I [Klatskin's classification]. The jaundice was the main presenting symptom except in 1 case. Seven patients had abdominal pain, 5 had fever, 2 presented with weight loss and pruritis and mass was palpable in only one case Surgical bypass[hepatico-jejunostomy] was done in 9 cases, 1 with malignant pathology and 8 with benign strictures including redo surgery in two of the later group. Two patients found unfit to undergo surgery or because of advanced malignancy, were subjected to Percutaneous transhepatic biliary drainage[PTBD]. Patients follow- up post-operativly varied from 3 months to 2 years. Outcome of surgical bypass compared favorably with the other studies on this subject

Duodenal perforation simple closure or definitive surgery in emergency laparotomy

Perforated peptic ulcer, an emergency, continues to afflict large number of population. Males are affected more than females. There is close association with Helicobacter pylori and NSAID's ingestion. Duration of perforation > 12 hours, systolic blood pressure less than 100 mm Hg and co morbid conditions are the risk factors. Controversy exists regarding simple closure or definitive surgery in emergency setting. This prospective study was conducted at CMH, Rawalpindi from July 2000 to Dec 2001. 46 males, alternatively allocated to two groups received either simple closure with omental patch or truncal vagotomy with drainage procedure. Risk factors were stratified into scoring system. Patients were followed up and results graded as modified Visick's classification. There was no mortality with risk score 1 or 2 in both groups. 66.6% mortality in group - I and 100% mortality in group - II with risk score 3 was noted. Excellent / good results were obtained in 52.3% of cases undergoing simple closure versus 85% undergoing definitive surgery

Ideal treatment for chronic pilonidal sinus

A hospital-based study was carried out from January 2001 to August 2002 to compare the results of Open excision operation and Karydakis technique for the treatment of pilonidal sinus. In Group A, 23 patients underwent Open excision operation, while in Group B, 22 patients were treated by Karydakis operation. In Group A, the mean hospital stay was 6.74 days, mean healing time and mean period off work were 7.9 weeks and 6.98 weeks respectively. The most common complications after this procedure were sepsis [17.39%] and scar pain [17.39%]. Recurrence occurred in 04 cases [17.39%]. The overall complication rate in this group was 21.74%. On the other hand, in Group B, the mean hospital stay was 3.23 days while, mean period of recovery and mean period off work were 2.95 weeks and 2.68 weeks respectively. Most common postoperative complications were sepsis [13.63%] and wound dehiscence [13.63%], the overall complication rate being 13.64%. Early recurrence occurred in 01 case only [4.5%]. From our study, it is concluded Karydakis technique is superior to Open excision operation in terms of shorter hospital stay and early recovery. Moreover, it is cost-effective procedure with low postoperative morbidity and recurrence rate