Transabdominal preperitoneal laparoscopic inguinal hernia repair

To determine the outcome of transabdominal preperitoneal [TAPP] inguinal hernia repair. Descriptive study. At Surgical C Unit, Khyber Teaching Hospital Peshawar, from April 2010 to June 2011. A total of 88 patients, aged between 16-60 year were included in the study and subjected to transabdominal preperitoneal inguinal hernia repair. The outcome measures such as operative time, length of hospital stay and postoperative complications were analyzed. The mean age of patients was 38.64 +/- 9.04 year. The mean operative time was 60.13 +/- 14.76 minutes. The mean hospital stay was 1.45 +/- 0.72 days. The postoperative complications were urinary retention [n=1 - 1.1%], wound hematoma [n=1 - 1.1%], surgical site infection [n=2 - 2.2%] and recurrence of hernia [n=1 - 1.1%]. Transabdominal preperitoneal inguinal hernia repair is associated with minimal complications but requires a long learning curve

Laparoscopic treatment of hepatic hydatid cyst

To determine the outcome of laparoscopic management of hepatic hydatid disease in terms of complications. Case series. Surgical C Unit, Khyber Teaching Hospital, Peshawar, from February 2007 to March 2010. All patients with 3 or less hepatic hydatid cysts who underwent laparoscopic treatment for hepatic hydatid cyst disease were included during the study period. Laparoscopic aspiration, unroofing and evacuation of the hepatic hydatid cysts was done. Clinicopathologic features, operative time, conversion to laparotomy, morbidity, mortality and recurrence rates were analysed. Forty three patients had laparoscopic treatment for hepatic hydatid cysts. Females were 27 [62.79%] and males were 16 [37.20%]. Mean age of patients was 38.6 +/- 14.03 years [range 15-64 years]. Pain was the commonest presentation occurring in 34 [79.06%] and mass in 9 [20.93%]. Hepatic hydatid cysts were successfully treated laparoscopically in 40 patients. Open surgery conversion was needed in 3 [6.97%] due to inadequate access. The mean duration of surgery was 46.27 +/- 13.84 minutes. Complications included port-site infection in 3 [6.97%], bile leak in 4 [9.30%] and recurrence in 2 [4.65%] cases; there was no mortality in the series. Laparoscopic hepatic hydatid cyst surgery was a safe and effective method in selected patients

Rate and risk factors for surgical site infection at a tertiary care facility in Peshawar, Pakistan

Surgical site infections [SSI] are among the most common complications in surgical patients and have serious consequences for outcomes and costs. This study aimed to determine the rates and risk factors affecting surgical site infections and their incidence at Surgical 'C' Unit, Khyber Teaching Hospital, Peshawar, Pakistan. The study was conducted to compare with rates obtained by large international multi-centre studies. A review of all general surgical interventions involving an incision, excluding anal procedures, performed between December 2008 and March 2009 [n=269] was undertaken. Various clinical parameters were recorded. Infection rates were calculated. Data were analysed using the Fisher's exact test. The overall SSI rate was 9.294%, 4.88% in clean cases [C], 8.39% in clean contaminated cases [CC], and 20.45% in contaminated or dirty cases [D]. There were significantly higher surgical site infection rates among patients with combined American Society of Anaesthesiologists scores II and III than those with ASA score I in clean contaminated [p=0.0007], and dirty cases [p=0.0212]. There were also significantly higher surgical site infection rates among patients with combined Co-morbidity Scale score 1-6 than those with no comorbid factors in clean contaminated [p=0.0002]. Surgical site infection rate was highest in gastrointestinal system surgeries. The Surgical site infections can be minimised by adopting international protocols for surveillance

Is medical expulsive therapy an option for ureteral calculi?

To compare tamsulosin with simple observation in terms of lower ureteral stone expulsion. Randomized controlled trial. Surgical C unit, Department of surgery, Khyber Teaching Hospital Peshawar, from February 2008 to January 2009. The patients were divided into two groups. Group A patients were offered medical expulsive therapy [tamsulosin] while group B patients treated with observation receiving analgesics only. Data regarding age, gender, stone expulsion rate and time, and analgesic requirement were collected and analyzed. Frequency and percentages were calculated for categorical variables while mean +/- SD was used to express continuous variables. Chi square test and Student t test were used to compare categorical and numerical variables respectively. After randomization, 56 patients in group A and 55 patients in group B were analyzed. The mean age of patients in group A and B was 37.37 +/- 7.51 years and 37.90 +/- 10.34 years, respectively [p 0.756]. The mean stone size was 6.39 +/- 1.78 mm in group A compared to 6.47 +/- 1.71 mm in group B [p 0.81]. In tamsulosin group, for stone size of 5mm, 48 [86%] patients expelled the stone, while for the same stone size, expulsion noted in 30 [56%] patients in the observation group [p 0.001]. The expulsion rate in group A and B, for stone size of more than 5 mm, was 91% and 38%, respectively [p<0.001]. The mean time taken for stone expulsion was 8.32 +/- 2.73 days in group A and 12.23 +/- 2.12 days in group B [p<0.001]. Patients taking tamsulosin experienced significantly less pain attacks compared to patients on observation therapy [p 0.017]. Alpha blocker [tamsulosin] is a safe and effective treatment modality for distal ureteral stones of appropriate size

Laparoscopic versus open appendectomy: a comparison of primary outcome measures

The aim of the study was to compare laparoscopic and open appendectomy [OA] in terms of primary outcome measures. Study design: A randomized controlled trial. Place and duration of the study: Khyber Teaching Hospital, Peshawar, Pakistan, February 2008 to December 2009. A total of 160 patients were divided into two groups, A and B. Group A patients were subjected to laparoscopic appendectomy [LA], whereas Group B patients were subjected to OA. Data regarding age, gender, and primary outcome measures, such as hospital stay, operative duration, and postoperative complication, were recorded and analyzed. Percentages were calculated for categorical data, whereas numerical data were represented as mean +/- SD. Chi-square test and t test were used to compare categorical and numerical variables, respectively. Probability

Total versus sub-total thyroidectomy for multinodular goiter

The aim of the study was to compare total and subtotal thyroidectomy [STT] for benign bilateral multinodular goiter [BBMNG] in terms of the proportion of hypoparathy-roidism and recurrent laryngeal nerve paralysis [RLNP]. Quasi experimental Place and duration of study: Department of Surgery, Khyber Teaching Hospital Peshawar, from 1st October 2007 to 30th September 2008. A total of 60 patients with bilateral multinodular goiter, were divided in to two groups A and B [30 patients in each group]. Group A patients were subjected to IT while group patients to STT. Sample technique used was non-probability purposive. Demographic details, biochemical findings, indications for operation, operating time and complications under study were noted for either group. There was no significant difference in the age, gender, hormonal status or duration of goiter between the two groups [P=0.123, P=0.74, P=0.509 and P=0.6, respectively]. The mean operating time was longer [138 +/- 30 min versus 112 +/- 33 min, P=0.046] for TT vs STT. Either temporary RLNP or HPT occurred in 3 [9.9%] or 6 [20%] of the patients undergoing total compared with 2 [6.6%] or 3 [9.9%] of the patients undergoing SIT [P=0.64 and P=0.278, respectively]. Permanent RLNP was observed in none and HPT in one patient only in TT group compared with none of either complication in STT group [P=0.313 for permanent HPT]. The present study shows that TT can be performed without increasing risk of complications, and it is an acceptable alternative for benign MNG, especially in endemic regions, where patients present with a huge multinodular goiter

Influence of ASA score and charlson comorbidity index on the surgical site infection rates

To compare the frequencies of surgical site infections [SSI] in ASA class-I [American Society of Anaesthesiologists-I] with ASA class II-III and CCI-0 [Charlson Co-morbidity Index-0] with CCI 1-6 in clean [C] and clean contaminated [CC] surgeries. Analytical study. This study was conducted in a General Surgical Unit of Khyber Teaching Hospital, Peshawar, from December 2008 to April 2009. A total of 310 clean and clean contaminated general surgical interventions with pre-operative ASA score of I-III, were included in the study, excluding anal and cystoscopic procedures. On the basis of past medical record, patients were grouped into ASA-I [patients without any co-morbidity] and ASA II-III [patients with co-morbidities] on the basis of their ASA score pre-operatively. In the same way patients were divided into CCI-0 [patients without co-morbidities] and CC 1-6 [patients with co-morbidities] according to CCI score. All the patients were operated in the same environment by the same set of surgeons. Postoperatively the surgical wounds were observed for SSI by using ASEPSIS daily scoring system for one month prospectively. SSI rates in ASA-I was compared with SSI rates in ASA II-III. Similar comparison of SSI rates was performed in CCI-0 and CCI 1-6. Data was tested by using the Fisher's exact test with confidence interval of 95%. The overall SSI rate was 6.1% [n=19] with 4.23% [n=5] in clean cases [C] and 7.29% [n=14] in clean contaminated cases [CC]. There were significantly higher surgical site infection rates among patients in ASA II-III than those with ASA-I in clean contaminated surgeries [p=0.003]. There were also significantly higher surgical site infection rates among patients with CCI score 1-6 than those with CCI-0 in clean [p=0.024] and clean contaminated [p=0.002]. American Society of Anaesthesiologists [ASA] score and Charlson comorbidity index [CCI] has strong influence on SSI rates in clean and clean contaminated cases. Patients' with co-morbidities undergoing clean and clean contaminated general surgical procedures have greater SSI rates than those without any co-morbidity