Role of low molecular weight heparin

To evaluate the effectiveness of LMWH prophylaxis for DVT in high risk patients after general surgery. Randomized controlled study. Surgical Unit-IV, District Head Quarters Hospital, Faisalabad. From March 2009 to August 2009. Sixty patients in the LMWH group were given perioperative enoxaparin [Clexane] as prophylaxis while compression stockings were used in another control group comprised of 60 patients. At 5th postoperative day, Doppler study was performed to detect DVT in both groups. Categorical data were analyzed for significance using Chi square test through SPSS. There were significant difference in age factor, history of DVT, Medical factor, surgical trauma factor and interpretation on the basis of points. However, there is non significant difference between LMWH group and control group for chemoprophylasis. LMWH administration is effective for the prevention of venous thromboembolism in high risk patients and its practice should be the standard of care in the practice of surgery

Wound dehiscence; frequency after exploratory laparotomy

Exploratory laparotomy is a common procedure performed at the surgical floor, mainly in emergency. The need for exploration ranges from cases of abdominal trauma to those of preexisting abdominal ailments. Wound dehiscence, either partial or complete does occur after laparotomy and a number of studies have been performed to find out its frequency after laparotomy and to pin point the factors responsible for this complication. This study is designed to find out the frequency of wound dehiscence after exploratory laparotomy. Also it will compare frequency of wound dehiscence in trauma cases versus cases of abdominal pathology. [1] To work out frequency of wound dehiscence after exploratory laparotomy. [2] To know the differential frequency of wound dehiscence after acute abdominal trauma compared with those having preceding underlying pathology and were explored. It was a prospective observational study. Surgical units Allied Hospital, Faisalabad department of surgery. 200 patients operated in emergency and elective lists for abdominal exploration. Non probability [convenience]. [1] Children less than 10 years [2] Sub costal incision [3] Pfennensteil incision [4] Morrison's' incision [5] Grid iron incision and. [6] Incisions to explore the kidney were excluded. [7] Those patient who expired in emergency just after exploration. All patients above 10 years opened by midline laparotomy incision. Out of 200 patients, 20 got wound dehiscence. It included 7 from Group 1 and 13 from Group 2. Improved surgical technique, early arrival in hospital and control of infection can bring the incidence of wound dehiscence after exploratory laparotomy down to a level comparable to international figures

Haemorrhoidectomy

Haemorrhoids are among the commonest surgical problems of anorectal region. Chronic constipation, straining, at defecation or micturation is the main predisposing factors but exact aetiopathogenesis remain unclear. Most patients in the initial stages are treated with conservative or minimally invasive approaches. However haemorrhoidectomy has proven long-term efficacy in the treatment of third degree haemorrhoids. There is still controversy whether open or closed haemorrhoidectomy is treatment of choice. Haemorrhoidectomy whether open or closed is associated with postoperative complications. This study was carried out to compare postoperative complications of both procedures to improve the management of haemorrhoids. To compare postoperative complications in open and closed haemorrhodectomy. Quasi- experimental. Surgical unit-1, Allied Hospital Faisalabad. One year [20/06/o6 to 20/06/07]. 100 cases [50 cases in each]. Convenience sampling. Patients with 3[rd] degree haemorrhoids. * Complicated third degree haemorrhoids. * Patients with other causes of bleeding per rectum. * Patients having associated medical problems. * Patients not willing for surgery. Out of 100 patients 7 had severe postoperative pain, 5 from open and 2 from close group.50 patients had moderate pain, 30 from open and 20 from closed group.8 patients, 5 from open and 3 from closed group got urinary retention. 2 patients both from open group had anal stricture. Closed haemorrhoidectomy is more advantageous with respect to less postoperative pain

Breast lump; its co-relation with malignant lesions and management

To find out correlations between benign and malignant lesions of the breast. Material and Methodss: A total of one hundred female patients who came to surgical outdoor with lump in breast or nipple discharge between ages of 20 and 75 years. Retrospective Study Setting: DHQ/Allied Hospitals, Faisalabad. Duration: 2 years, April 1996 to April 1998. In our study fibrocystic mammary dysplasia was the most common breast lesion in female patients of 20 to 30 years age. Carcinoma of the breast was the most common breast lesion in 35 to 45 years age patients. In majority of the cases lump was found in upper outer quadrant; while in three cases the whole breast was involved. In 12[36.4%] cases, right breast lump was found; while in 21 [63.6%] left breast was involved. ConclusionS: Our females are mostly illiterate and poor. They are unaware of the importance of the disease. In this regard it is suggested that we should organise Breast Screening Programmes, Breast Self Examination Teaching Centres and also Tumour Registries for data collection throughout the country

Delayed primary closure of contaminated abdominal wounds: a new technique

Wound infection is a common complication after surgery for abdominal sepsis. This is more common in the patients where grossly contaminated abdominal wounds are closed primarily. OBJECTIVE: 1] To assess the efficacy of primary and delayed primary closure in prevention of postoperative wound infection of contaminated wounds. 2] To compare the morbidity with two methods of wound closure. DESIGN: Comparative study PERIOD: July 1994 to June 1997. PATIENTS AND METHODS: Total 81 patients were operated having localized or generalized bacterial peritonitis during a period of 3 years at Islamia Trust Hospital Chiniot. 43 were male and 38 were female. 29[35.81%] patients had primary closure. 52 [64.119%] patients had delayed primary closure with subcutaneous proline. All patients were given appropriate peri-operative antibiotic cover. RESULTS AND COCLUSIONS: 16[55.17%] patients with primary closure had wound infection and only 8 [15.38%] patients with delayed primary closure required secondary closure so; 1. There was significant reduction in wound infection after delayed primary closure of grossly contaminated wounds with subcutaneous proline stitch. 2. It is easy, economical and cosmetically superior to the primary closure and other methods of delayed closure. 3. It reduces the hospitalization and so cuts down the morbidity