Presentation and outcome of surgical management of strangulated inguinal hernia at Liaquat university hospital Hyderabad

The objectives of the study are to determine the incidence of strangulated inguinal hernia in patients presenting with irreducibility and obstruction, evaluate the age and sex incidence, see the duration of hospital stay in our setup and see the post operative morbidity and mortality. Experimental Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Jamshoro, from 2007 to 2009. 100 cases of obstructed hernia were selected out of which 85 with strangulation were included in this study. These patients were admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro/Hyderabad. All these patients were admitted in emergency. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 140 patients presenting with obstructed hernia were selected of which 85 were found to have strangulated hernia. There was wide variation of age ranging from a minimum 15 to 70 years with the mean age 42 years. 55 patients had Right sided hernia 64.7% and 30 patients had Left sided hernia 35,2% and no patient with bilateral strangulated inguinal hernia reported 0%. During surgery of 60 patients [70.5%] had gangrenous omentum while 23 cases [27%] ileum was non viable so we had to resort to resection and anastmosis, two cases [2.3%] Ileum was so much contaminated so we had to resort to Ileostomy and two case [2.3%] sigmoid colon was involved so we had to resort to colostomy. Postoperatively majority of them developed wound infection 14 [16,4%] followed by chest infections 10 [11.7%] Haematoma formation was reported in 5 [5.8%] and retention of urine in 3 patient [3.5%]. Good pre-operation assessment and early management will decrease the morbidity and mortality in strangulated inguinal hernia

Outcome of early appendicectomy in appendicular mass versus conservative approach

The objectives of the study are to compare the outcome of early appendicectomy in appendicular mass versus conservative approach. Experimental Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Hyderabad, from January 2008 to December 2009. This study consisted of hundred patients were divided in two groups. Group A for early appendicectomy and group B traditional conservative treatment, each group consist of 50 patients admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro/Hyderabad. Data was analyzed through SPSS software. In conservative management [CM] group 36[72%] were male and 14[28%] female. Ratio male:female ratio of 2.25:1. In immediate surgery [IS] group 34[68%] were male and 16[32%] female with male:female ratio of 2.1:1. There was wide variation of age ranging from a minimum of 10 year to 50 year in both group. The mean age was 22.3 +/- 3.30 years for CM group and 23.4 +/- 3.50 years for IS group. Pain in right iliac fossa were found in all patients in both groups, vomiting was seen 42[84%] patients in CM group and 43[86%] patients in IS group, nausea was seen 17[34%] patients in CM group and 18[36%] patients in IS group, fever was 42[84%] patients in CM group and 44[88%] patients in IS group, diarrhea was 4[8%] patients in both groups, anorexia was seen 35[70%] patients in CM group and 37[74%] patients in IS group, constipation were 9[18%] patients in both groups and urinary complains was 8[16%] patients in CM group and 9[18%] patients in IS group. Ultrasound findings revealed was inflamed appendix with omentum adherent in 10[20%] patients of CM group and 9 [18%] patients of IS group where as inflamed appendix with omentum and abscess formation in 17[34%] patients of CM group and 19 [38%] patients of IS group, and edematous appendix with fecolith and omentum adherent in 23[46%] patients of CM group and 22[44%] patients of IS group. Operative time in both groups was recorded. Operative time range 30 minutes to 90 minutes in both groups. The mean time in CM group was 60.10 +/- 11.90 minutes and IS group was 45.30 +/- 7.96 minutes. The early appendectomy in appendicular mass is a safe alternate to conventional way of managing this problem. Hence, it obviates the need of a second admission and provides curative treatment during the index admission whereby minimizing total expenses

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