Inguinal hernioplasty; laparoscopic tep with and without dissection balloon

To compare laparoscopic TEP Inguinal hernioplasty with and without dissection balloon. Observational study. Minimal Invasive Surgical Centre Jamshoro and General Surgical Department at Dow University Hospital, Ojha Campus Karachi. May 2011 and Dec 2012. Twenty [20] male patients with uncomplicated unilateral or bilateral inguinal hernia were prospectively randomized in two groups; group A Commercially available dissection balloon and group B. Telescopic dissection for creating TEP working space. We had 20 male patients for this study. The average age was 43.6 and ranging between 17 to 64 years. Only 2 patients 10% had bilateral groin hernia, 4 patients 40% had direct inguinal hernia in group A and 5 patients 50% had direct hernia in group B. Peritoneum was breached in 5 [50%] patients with telescopic dissection. One patient [10%] with bilateral groin hernia in group B had large tear in peritoneum converted to TAPP while other group normal. The incidence of scrotal edema/seroma was greater in group B then group A. 40% patient in group B developed seroma while 0nly 1 [10%] patient with bilateral groin hernia in group A developed seroma. Pain was scored on VAS at 1 and 4 hours after surgery was higher in group B. The mean operation time was 55 min [45-100] in the group with the balloon and 73 min [50-120] in the group without the balloon [p = 0.004]. TEP laparoscopic inguinal hernia repair is probably the best option amongst the two techniques used in laparoscopic inguinal hernia repair and dissection with balloon is though costly but more helpful in dissection and safer

Experience of the treatment of the patients with polio consequences by Ilizarov's method in Pakistan

This study was conducted in the Midciti hospital, Karachi; Tahir Medical Center, Karachi; Majee Hospital, Hyderabad from Dec.2004 to Apr 2006 to show actuality of the problem of rehabilitation of Post Polio patients in Pakistan and efficiency and advantages of Ilizarov's Method in this matter. During the study period 100 patients were operated, all of them by Ilizarov's Method. Of these 62 were male and 38 females. Combined contracture of hip and knee joints with different degree of extremity shortening and foot deformity or instability were found in 26 cases; 62 patients had knee contracture with leg shortening and foot deformity or instability without hip contracture. Almost all of them were not able to walk without additional support. Some of them used orthopedic brace or crutches, others used to lock their knee by hand or by internal or external extremity rotation in combination with hand support. Two patients could move using wheel chair only and were crawling. Three-segment simultaneous surgical intervention was most common. In 90% of cases good and fair results where achieved and patients were satisfied. Deformities were corrected and required lengthening performed. After treatment most of the patients started to walk without any additional support; crawling and wheel chair patients are able to walk by using orthopaedic brace with sticks. It is concluded that Ilizarov's method is very affective and advanced for the treatment of Post-Polio patients and with well-skilled proper approach and application it is not so cumbersome as considered

Postoperative complications of inguinal hernia repair

To determine the incidence and outcome of inguinal hernia repair complications. A descriptive study Surgical unit I and V of Civil Hospital Karachi; January 1999 to December 2004. Five hundred and forty patients admitted with inguinal hernia were included in the study. Detailed history, physical examination and investigation were carried out. Patients were operated on elective operation list. Patients were randomly assigned to undergo Bassini's Repair [Group A] or Lichtenstein tension free mesh repair [Group B]. Patients were monitored after surgery for clinical signs of complications and their outcome were recorded. Patients were seen every 3 months for 2 years and then every year. Wound seroma developed in 7.1% patients in group A and 8.4% patients in group B; 3.57% patients in group A and 3.1% patients in group B developed haematoma. Abscess formation was noticed in 2.1% patients in group A and 1.9% patients in group B Urinary retention developed in 3.57% patients in group A and 4.6% patients in group B. Numbness or pain in the groin was complained by 7.1% patients in group A and 10% patients in group B .Recurrence developed in Twenty [7.1%] patients in group A and 2[0.8%] patients in group B. In most patients the average hospital stay was 4 days. Postoperative complication, morbidity and mortality can be reduced by monitored training of residents during early learning period and availability of senior surgeon help in difficulties

Application of modified Alvardo score in the diagnosis of acute appendicitis in our setup

The study was undertaken to assess the accuracy of the Modified Alvarado score in predicting appendicitis for patients with right iliac fossa pain admitted in our hospital. This is a prospective study of patients Admitted with suspected appendicitis. This study was conducted at Surgical Unit V Civil Hospital Karachi over one year period front Jan. 2003 to Jan 2004. For every patient suspected of appendicitis the Modified Alvarado score was computed on admission, as laboratory facility for shift of Neutrophils to left was not available. The Modified Alvarado score was recorded on the admission sheet and did not effect the management of the patients. The patients discharged without surgery were reviewed in the out patients clinic to ascertain that they did not need surgery. Sixty two patients underwent appendicectomy. Out of these, 30 patients [48.38%] has a Alvarado score 1-4, 10 patients [16.12%] had a Alvarado score 5-6, 18 patients [29.03%] had a Alvarado score 7-8 and only 2. Patients [3.22%] had a maximum Alvarado score 9, where appendix was found perforated and gangrenous on operative findings. The Alvarado score was not found to be a useful complementary method in the diagnosis of suspected case of acute appendicitis patients in Department of Surgery CHK

Role of ultrasound in predicting conversion from laparoscopic to open cholecystectomy, a surgeon's and radiologist's dilemma!

This prospective study was jointly conducted by the Department of Radiology and Surgical Ward-II, Dow Medical College and Civil Hospital, Karachi from August 2000 to June 2002: 100 patients were selected for this study and all were admitted with complaints of pain in right hypochondrium / epigastrium, dyspepsia, nausea, vomiting and complained of pain in right shoulder. Provisional diagnosis was made on history and clinical examination as cholecystitis. The ages were between 35 to 60 years. 78 patients were female and 22 patients were male. The aim of this study was to assess the role of pre-operative ultrasound findings with operative findings in patients undergoing laparoscopic cholecystectomy. The purpose was to get the proper diagnosis and provide detailed information to the surgeons before operation about the status of liver, Gall Bladder, C.B.D, Biliary Channels, and specially adhesions between the Gall Bladder and the surrounding structures like Omentun, Duodenum etc. In this way, the surgeon was informed about the findings before operation for successful laparoscopic cholecystectomy to avoid the complications of open surgery. Ultrasound is readily available, inexpensive and the modality of choice in the diagnosis of hepato-biliary disease. Out of 100 patients, 74 patients were selected for laparoscopic cholecystectomy [USG findings showed no adhesions]. While 65 patients successfully underwent laparoscopic cholecystectomy, 9 patiems were converted to open cholecystectomy due to unavoidable conditions like inseparable adhesions with surrounding structures [Omentum and Duodenum]. Out of the 26 patients selected for open cholecystectomy [USG showed adhesions] due to cholelithiasis and chronic cholecystitis associated with choledocholithiasis, 3 were found to be without adhesions

Simultaneous correction of post-polio hip and knee joints contractue and foot deformity with limb lengthening by Ilizarov's method

We are presenting the case report of twelve years old girl, who had Post-Polio flexionabduction-external rotation contracture of hip joint, flexion contracture of knee joint, equines deformity of foot and limb shortening. She was treated by Ilizarov's Method in one stage and got excellent result

Incisional hernias: why do they occur?

Over a period of five years 110 cases of incisional hernia were evaluated at teaching hospitals of Dow Medical College and Peoples Medical College, Nawabshah to ascertain their causes. It was found that these hernias were seen more frequently after emergency surgery [87.27%] performed by resident surgeons [89.09%]. About 70% patients had previous history of gynaecological and obstetric operations. Midline incision is more prone to herniation than paramedic and transverse incisions as evidenced by 73.64% patients in this series. Other important causative factors are wound infection [69.09%], chest infection [30.91%], abdominal distension [14.55%] and constipation

Video TURP: need of the time

One hundred transurethral resections of prostate were performed in two medical institutions of Sindh by using a continuous flow electroscope attached with a video camera. The surgeon stands or sits comfortably using a professional monitor as the source of judgment for manipulating the TURP loop. TURP performed with video monitor is more efficient, comfortable and safe as it prevents contamination of the surgeon leading to dangerous infections like HIV, hepatitis B and C. However, the most important aspect of video TURP is that it makes the teaching and training of the procedure quite easy and effective for both the under and postgraduate trainees. The results of video TURP are quite encouraging when compared with a previous study of 57 cases of conventional TURP using the same electroscope

Comparative study of repair of incisional hernia

Repair of incisional hernias was compared with four different techniques in 55 patients to determine the best method of repair with least chance of recurrence. The maximum incidence of incisional hernia was seen in 30-39 years age group and was most frequently seen after gynaecological surgery [37 cases]. Forty eight [88%] patients were operated in emergency by trainee surgeons. Most hernias occurred within one year after surgery and the herniation of lower mid line incision was more frequent [70.9% cases]. History of wound infection of previous surgery was recorded in 45.5% of cases which appeared to be the important risk factor in causation of incisional hernia. It was also observed that simple repair of incisional hernia was associated with a high recurrence than that where synthetic mesh was used in repair where no recurrence was recorded

Repair of vesico-vaginal fistula by using omental flap

Fourteen patients of vesico-vaginal fistula of more then 2 cm, of high type, were treated by transperitoneal trans-vesical approach with extensive dissection and omental flaps over a period of 4 years. Their age ranged from 20 to 76 years. 78.5 percent patients belonged to younger age group [20-40 years] with history of long duration and neglected labour. Three cases were already operated for repair of vesico-vaginal fistulae once or twice trans-vaginally and failure was reported within three months after repair. The success rate of this series is 93%. Out of fourteen repairs only one failure was recorded in one of the recurrent cases, who was diabetic, had renal stone and persistent urinary tract infection

Comparative study of repair of incisional hernia

In this study fifty five patients were operated for the repair of incisional hernias with four different techniques to compare the results and to find out the best possible method of repair with least incidence of recurrence. As the recurrence of the incisional hernia occurs in high percentage of cases causes disappointment to both patient and Surgeon. The maximum incidence of incisional hernia was seen in 40-63 years age group. Incisional hernias were seen more frequently after gynaecological surgery in 37 [67.2%] cases and 18 [32.7%] cases reported after General Surgery Operation. Forty eight [88%] patients presented with incisional hernias were operated in emergency by trainee surgeons. Most hernias occurred within one year after surgery and the herniation of lower mid line incision was more frequent in 70.9% of cases. History of wound infection of previous surgery recorded is 45.5% of cases which is the important risk factor in causation of incisional hernia. In view of literature it is reported that the results are satisfactory with the use of synthetic prosthesis to strengthen the repair in comparison to simple technique. We have also observed after comparing the results of different techniques that simple repair of incisional hernia has significant rate of recurrence where as when synthetic mesh was used in repair no recurrence was recorded