Port site complications in patient after laproscopic cholecystectomy

To assess the frequency of port site complications in patient after laproscopic cholecystectomy. Observational study. This study was carried out in the Department of Minimal Invasive Surgical Centre [MISC] at Liaquat University of Medical and Health Sciences Jamshoro Pakistan, from Oct 2009 to 31[st] May 2011. This study consisted of Four hundred and fifty patients, admitted for laparoscopic cholecystectomy. Base line and specific investigations were done in all patients, especially ultrasound of abdomen for assessment of gallstone disease. Inclusion criteria were that all patients diagnosed as case of gallstone disease on the basis of history, clinical examination and investigations specially ultrasound of abdomen. Exclusion criteria included complicated gallstone disease, unfit patients for general anesthesia, pregnant ladies due to risk of foetal loss, patients with carcinoma of gall bladder, patient with acute pancreatitis and patients with obstructive jaundice. Postoperatively the patients were followed for up to 6 months and observed port site complications. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 315[70%] were female and 135[30%] male. Ratio male: female ratio of 1:2.3. Age ranging from a minimum of 20 year to 65 year with mean age was 38 + 3.4 years. Complications were port site infection in 4 [0.88%] cases, followed by port site bleeding in one [0.22%] case and epigastric port site diathermy burn in one [0.22%] case. In conclusion, we recommend all 10 mm trocar sites be closed care fully. Over stretching of infra / supra umbilical port should be avoided. Gallbladder should be removed in endo-beg

Frequency of early post operative complications of thyroidectomy

To determine the frequency of early post operative complications after thyroid gland. Descriptive case series study. This study was carried out in all four surgical units, Liaquat University Hospital Jamshoro, from September 2009 to July 2010. This study consisted of 100. Detailed Hisotry was taken from all the patients with special regard to the swelling infront of neck, moving up with deglutition and pressure symptoms like dyspnea, dysphagia, engorged neck veins. Detailed Clinical examination of the patient was done and recorded in proforma. Systemic review was also done to see any co-morbidity. All patients underwent for base line and specific investigations especially TSH, T3 and T4 as diagnostic modality and for assessment of thyroid disease. Inclusion criteria were that all patients after counseling for study and taking voluntary consent were included in this study above 15 year of age and irrespective of their sex admitted in surgical units through outpatient department and diagnosed as case of thyroid disease on the basis of history, clinical examination and investigations. Exclusion criteria included unfit patients for general anesthesia, previous thyroid surgery, pre-operative recurrent laryngeal or superior laryngeal nerve involment and traumatic thyroid injury. Follow up of all these patients was done for period of 6 months. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software version 16.0. 100 cases of thyroid were operated. Out of 100 patients including in this study 84 were women [84%] and 16 were male [16%]; with male to female ratio of 1:52. There was wide variation of age ranging from a minimum of 10 years to 70 years with the mean age was 31.78 years. Symptoms of patients were an enlarged painless lump infront of neck in 99 [99%], Discomfort during swallowing in 42 [45%], Tachycardia in 55[55%], Tremors in 41 [41%], heat Intolerance 43[43%] and cold Intolerance in 20[20%] [Table 1]. Clinical examination of patients revealed that thyroid gland was enlarged in 99 [99%] patients, out of whom 59 [59%] patients had Multinodular goiter, while 30 [30%] patients had Solitary Nodule [Solid/ Cystic], 7 [7%] patients had thyroid cancer and 4 [4%] patients had a thyrotoxicosis. The commonest surgical procedure done was subtotal thyroidectomy in 62 patients [62%], near total thyroidectomy in 28 patients [28%] and lobectomy with isthmusectomy in 10 patients [10%]. The common early postoperative complications seen in this study were haematoma formation 9% patients, hypoparathyroidism 3% patients, wound infection 6% patients, laryngeal nerve injury 5% patients and thyrotoxicosis storm in 2% patients [Chart No.2]. We conclude that patients who undergo thyroidectomy an increased risk of developing postoperative hypoparathyroidism. Despite the fact that total thyroidectomy is a more involved procedure that exposes more parathyroid glands and recurrent laryngeal nerves to surgical risk than unilateral thyroid lobectomy, it is an inherently safe procedure

Compare the outcome of open versus laparoscopic varicocelectomy

To compare the outcome of the laparoscopic surgery with open varicocelectomy. It is also assess the operative time, postoperative pain, postoperative recovery of patients and postoperative complications of both procedures such as, bleeding, haematoma, wound infection, hyderocele, laparoscopic related complications and recurrence. Observational Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Jamshoro, from January 2009 to December 2010. This study consisted of 80 patients of varicocele grade III were admitted and divided in two groups. Group A for open varicocelectomy and group B for laparoscopic varicocelectomy in which each group consist of 40 patients. The ages of patients ranged between 11 years to 50 years. The mean age of LV group was 25.72 +/- 6.026 years and for OV group was 27.58 +/- 6.694 years. In OV group 92.5% of patients were having left varicocele, 5% right varicocele and 2.5 bilateral disease where as in LV group 90% of cases were having left, 7.5% right and 2.5% bilateral varicocele. The mean time in OV group was 29.70 +/- 8.498 minutes and 25.08 +/- 5.558 minutes in LV group [p 0.005]. the mild pain was observed in 7 [17.5%] patients of OV group and 16 [40%] patients of LV group. Whereas, severe pain was described by 10[25%] patients in OV group and 4 [10%] patients in LV group [p0.032]. The wound infection was found in 6 [15%] patients of OV group and 2 [5%] patients of LV group. The hydrocele was seen in 5[12.5%] cases of OV as compared 2 [5%] cases of LV group. Residual varicocele and recurrence of varicocele was observed in two cases [2.5%] of OV group and 3 cases of LV group with value p<0.359. It was longer about 2-3 days in 34[855] of OV patients as compared to LV cases where majority 36[90%] were discharged within 1 to 2 days. The results shows that LV is superior than OV in terms of better cosmesis, less operative time, less complications, short hospital stay and early return to work

Pattern of acute intestinal obstruction: is there a change in the underlying etiology?

To study the changing pattern of acute intestinal obstruction at a teaching institute. Patients and It is a prospective descriptive study conducted at a teaching hospital during the period from June 2004 to June 2009. All patients with clinical or radiological evidence of acute intestinal obstruction were included in this study regardless of the gender of the patient. Patients below the age of 10 years were excluded from the study. The treatment strategy was planned ranging from conservative treatment to emergency laparotomy after resuscitation and rehydration of the patient. Details of individual patients were recorded on a pro forma sheet and data analyzed statistically on SPSS version 14. A total of 229 patients with acute intestinal obstruction were admitted and treated. The mean age of the study population was 43.08 +/- 13.07 years. Postoperative adhesions accounted for 41% [n= 95] of the total cases, followed by abdominal tuberculosis [25%, n= 58], obstructed/ strangulated hernias of different types [18%, n= 42]. There was an obvious change in the pattern of etiology of acute intestinal obstruction as the common causes were postoperative adhesions and abdominal tuberculosis instead of obstructed inguinal hernias. An increase in the adhesive obstruction and a concomitant decrease in the incidence of obstructed hernias indicate a changing trend towards early operation before it gets complicated. Abdominal tuberculosis is emerging as another common cause of acute bowel obstruction

Laparoscopic cholecystectomy in the elderly patients. An experience at Liaquat University Hospital Jamshoro

Advancing age with its associated co-morbidities increases the likelihood of postoperative complications as well as conversion rate during laparoscopic cholecystectomy. Recent studies have also questioned efficacy of this procedure in geriatric patients. The present study assesses the safety and applicability of laparoscopic cholecystectomy in geriatric patients. The objective of the present study was to asses safety and applicability of laparoscopic cholecystectomy in the elderly patients of 65 years and above. This is a prospective analysis of 173 patients, over 65 years of age, who underwent laparoscopic cholecystectomy from December 2002 to November 2006 at Liaquat University Hospital, Jamshoro. Patients presenting with complicated and uncomplicated gallstone disease were included in the study population and all of them were operated laparoscopically. The data included demographic details, co-morbidities, underlying biliary pathology, indications for surgery, operative and postoperative complications, morbidity and mortality, and hospital stay. The statistical analysis of the data performed on SPSS version 10. Laparoscopic cholecystectomy undertaken in 173 elderly patients with a mean age of 69.72 years, out of whom 52 [30.05%] were males and 121 [69.94%] were females. Co-morbid conditions were identified in 53.17% [n=92] patients and included hypertension in 38 patients [21.96%], Diabetes Mellitus in 23 patients [13.29%], COPD in 19 [10.98%] patients, Coronary artery disease in 9 [5.20%] and cardiac arrhythmias in 3 [1.73%] patients. Indications for surgery included simple biliary colic in majority of patients [69.94%] and complicated stone disease in 52 [30.05%] subjects. There were 37 [21.38%] emergency laparoscopic cholecystectomies and 136 [78.61%] patients were operated electively. Mean operative time was 100 minutes with a SD 29.03. Fourteen [8.09%] patients required conversion to OC [Open Cholecystectomy] due to various reasons. Mean hospital stay was 6.28 days. Overall 23 [13.29%] patients developed postoperative complications. One patient died of acute MI on 2nd postoperative day. There is no undue risk in laparoscopic cholecystectomy in the elderly population and the procedure can be regarded as safe as in patients below 65 years of age