Inguinal hernioplasty; elective neurectomy for postoperative neuralgias

Chronic pain following inguinal hernia repair is becoming a significant clinical problem involving increased number of patients and surgeons. Much controversy exists regarding treatment. Elective division of the nerves has been proposed to reduce the risk of chronic post operative pain. To evaluate the effectiveness of elective neurectomy during open hernia mesh repair, in reducing postoperative pain. All patients admitted in SUII department of surgery Allied Hospital Faisalabad were included in study. Study was started after the approval of synopsis on with inguinal hernia 2[nd] Feb 2007 to Aug 2007 100 patients of inguinal hernias were divided into 2 groups, 50 in each group i.e. group A and group B. The last patient was registered in the first week of July. convenience nonprobability sampling was used for location of patients in two groups. On day one the pain was assessed in the two groups i. e Group A and group B [convenience non probability sampling technique used for patient grouping]. It was found to be absent in 24/50 [48%] and 18/50 [36%], mild in 10/50 [20%] and 12/50 [24%], it was moderate in 10/50 [20%] and 10/50 [20%] and was severe in 6/50 [12%] and 10/50 [20%] in the two groups respectively. One week after operation in groups A and B respectively, pain assessed with the use of the 4 point verbal scale was absent in 45 patients [90%] and 37 patients [74%], mild in 3/50 [6%] and 4/50 [8%] moderate in 2/50 [4%] and 6/50 [12%] and severe in none and 3/50 [6%]. Postoperative pain was not correlated with the presence of preoperative pain and no correlation was evidenced in the 2 subgroups. One month after operation follow up visits were performed in group A patients and group B patients. In particular, pain was absent in 46/50 [92%] patients in group A and 41/50 [82%] patients in group B. It was mild in 2 [6%] and 6/50 [12%], moderate in 2/50 [4%] and 2/50[4%] none of the patients with elective neurectomy had pain at follow up of one month and 1 [2%] one patient without elective neurectomy had pain. The numbness was assessed by checking sense of touch around the operated area. The difference found between the 2 groups with respect to the presence of numbness was 15/50 [30%] and 7/50 [14%] in the two groups i.e. group A and group B respectively at day 1 and 12/50 [24%] and 7/50 [14%] at follow up of one week and it was 5/50 [10%] and 2/50[4%] at one month in the two groups. When performing lichtenstein inguinal hernia repair routine ilioinguinal iliohypogastric and genital branch of genitofemoral nerves neurectomy is a reasonable option

Role of fast and DPL in assessment of blunt abdominal trauma

To assess and compare the diagnostic accuracy of Diagnostic Peritoneal Lavage [DPL] and Focused Assessment Sonography for Trauma [FAST]. A comparative study. SU II Department of surgery Allied Hospital Faisalabad. From Jan 2006 to Dec 2006 A total of 50 patients irrespective of age and sex, presenting to casualty department with blunt trauma abdomen were included in the study. Patients with equivocal signs of peritonitis under went abdominal ultra sonography followed by diagnostic peritoneal lavage. The operative findings were also recorded. Out of total 50 patients, Sensitivity of FAST was 88.88%, Specificity 91.30%, Accuracy 90.00%, and Positive predictive value 92.30%, Negative predictive value 91.30%. In 3 patients ruled out on ultra sonography but confirmed on Diagnostic peritoneal lavage and exploratory laparotomy [false negative]. Sensitivity of DPL was 96.66%, Specificity 85.00%. Accuracy 92.00%, Positive predictive value 90.62%, Negative predictive value 94.44%. Out of 50 patients 29 had positive DPL wrongly positive in 3 patients, true negative in 17 patients, false negative in 1 patient. 3 patients falsely negative on abdominal ultrasonography, 2 of them were having gut contents on DPL and 1 was having frank blood on DPL.Focused Assessment Sonography for Trauma [FAST] being non invasive should be the first step in assessment of patients with blunt abdominal trauma, when complimented by DPL may helps in defining the organ injury