Scar pain, cosmesis and patient satisfaction in laparoscopic and open cholecystectomy

Objective: To compare patient-satisfaction, scar-pain and cosmesis between laparoscopic and open-cholecystectomy. Study Design: Cross-sectional survey. Place and Duration of Study: Khyber Teaching Hospital, Peshawar, from August 2012 to May 2014

Methodology: A total of 400 patients, who had undergone open or laparoscopic cholecystectomy in all units of the Surgical Department, were included. Data was collected on questionnaires given and read to the patients along with counselling and information regarding scar-pain using visual analog score, and satisfaction and cosmesis on a 0 - 10 scale, by a medical professional in the patients' native language. This was done postoperatively on patients' follow-up visits at 1 and 4 weeks

Results: Mean scar pain score at 1 and 4 weeks postoperatively was higher for open-cholecystectomy; 4.96 +/- 1 and 0.96 +/- 1, compared to 2.24 +/- 0.6 and 0, respectively for laparoscopic-cholecystectomy [p < 0.001 and < 0.001]. Cosmesis was higher for laparoscopic-group; 8.6 +/- 1.2 vs. 6.2 +/- 1.46 for open-cholecystectomy [p < 0.001]. Patient-satisfaction was higher for laparoscopic-cholecystectomy; 9.28 +/- 1.5 vs. 8.32 +/- 2.3 for open-cholecystectomy [p < 0.001]. Mean-cosmesis score was higher for laparoscopic-cholecystectomy for those younger than 40, females and unmarried. Mean patientsatisfaction score was higher for those older than 40 years who had undergone open-cholecystectomy, women who had undergone laparoscopic-cholecystectomy and for unmarried patients who had laparoscopic-cholecystectomy

Conclusion: Overall patient-satisfaction and cosmesis scoring was higher for laparoscopic-cholecystectomy especially among females, unmarried and younger than 40 years. Patients of 40 years and older had greater satisfaction scoring for open-cholecystectomy. Therefore, laparoscopic-cholecystectomy should be favoured in females and unmarried patients and those younger than 40 years

Receiver operator characteristic curve analysis of the Lintula score for reduction of negative appendectomies in adults

To evaluate the Lintula score in reducing negative appendectomies in the adult population. Descriptive analytical study. Surgical Department, Khyber Teaching Hospital, Peshawar, Pakistan, from August 2012 to April 2014. A total of 408 emergency patients with a clinical diagnosis of acute appendicitis were included in the study. True or negative appendectomy status was determined per-operatively. Lintula score was calculated afterwards and evaluated for various cut-off points. Among the study population, 72 [17.6%] had a normal appendix by operative assessment and 336 [82.4%] had an acutely inflammed appendix. The receiver operating characteristic curve showed that the optimal cut-off point was

Demographic pattern of male breast cancer: an institutional based study

Male breast cancer incidence rises with age with peak in the 6[th] and 7[th] decade. It is one of the rare diseases and accounts for less than 1% of all malignancies worldwide. It is usually diagnosed in the late stage with poor prognosis. The purpose of this study was to know the demographic pattern and tumour characteristic of breast cancer in men reported at Institute of Radiotherapy and Nuclear Medicine [IRNUM], Peshawar. Retrospective data was collected from the [IRNUM], Peshawar for a period of three years [2006-2008]. The evaluation was done from the histopathological reports of mastectomy and biopsy specimens. All male patients in the age group 26-86 year with breast cancer were included in the study. The age of the patients and tumour characteristics recorded were size, grade, type, skin involvement and stage. Total number of male patients with breast cancer were 31 [2.1%] out of the total patients with breast malignancy during the study period with the mean age of 58.3 years. Tumour size ranged from 2 to 12 Cm. with average of 3.6 Cm. Invasive ductal carcinoma was found in 87%, papillary carcinoma in 6.5%, each of malignant fibrous histocytoma and sarcoma in 3.2% cases. Maximum number of patients was of grade II [41%].Patients in whom stage of the disease was known were 22 cases with 45.5% had stage III disease and 32% had stage IV disease. Skin involvement was found positive in 8 [25.8%]. Due to poor health care system breast cancer is diagnosed in a late stage of the disease and prognosis is poor

Breast disease: causes for delays in presentation

It has been observed that patients with breast disease may delay consulting a doctor. The results are disastrous for patients ultimately diagnosed with malignant breast disease. This study is an observation of the factors which affect the time interval between symptom recognition in breast disease and medical consultation. All patients with breast disease presenting to the outpatient department of our unit between November 2003 and November 2005 and ultimately admitted were included in the study. They were divided into two groups based on whether they presented before or after 6 months of symptom recognition. They were interviewed about factors which had brought them to the hospital. Factors responsible for delays in presentation were also inquired about. Of the 133 patients with breast lumps, 51 [38.5%], presented within, and 82 [61.7%], beyond 6 months of noticing the swelling. Various factors which might have played a role in the delay to seek advice included poverty [52.4%], belonging to remote areas [44.9%], wrong beliefs and fears [67%], lack of education [58.5%] and shyness [18.3%]. Factors responsible for delays in seeking medical advice among patients with breast disease must be targeted to result in earlier presentation. This is especially important in breast cancer which is a curable disease in the early stages

Factors influencing axillary lymph node status in carcinoma breast

The study aimed at observing the factors which might influence the axillary lymph node metastases. The study was an observational one. Place and Duration of Study: The study was carried out at the Surgical A Unit of Khyber Teaching Hospital, Peshawar over one year Subjects and Fifty cases of carcinoma breast undergoing mastectomy and axillary dissection were studied. A total of one hundred and sixty-six lymph nodes were sampled during axillary dissection. Axillary lymph node metastases were correlated with age, duration of symptoms, tumor site, size, type, grade, necrosis, margins, stromal reaction, lymphatic permeation, skin and nipple involvement. The presence of certain factors was observed in the majority of patients with axillary metastases It was concluded that axillary lymph node metastases might be influenced by the above factors