Surgical site infection in open versus laparoscopic appendectomy

To compare the rate of surgical site infection [SSI] in patients undergoing open and laparoscopic appendectomy. Randomised controlled trial. Surgical "A" unit, Department of Surgery Khyber Teaching Hospital Peshawar, from March 2008 to February 2011. Patients with signs and symptoms suggestive of acute appendicitis were randomly allocated into two groups, A and B. Group A patients were subjected to open appendectomy [OA] and Group B to laparoscopic appendectomy [LA]. Patients demographics including age, gender and wound infection in terms of SSI were recorded on a proforma. Statistical analysis was performed using SPSS version 11 with proportions and mean +/- SD calculated for categorical and continuous variables, respectively. Probability = 0.05 was taken as significant. Two hundred and ninety two patients were analyzed [146 in group A and 146 in group B]. The mean age of patients in group A was 26.5 +/- 7.1 year and 25.2 +/- 6.5 year in group B. The male to female ratio in group A was 1.21:1 compared to 1.28:1 in group B. Surgical site infection was observed in 10 patients in group A and in 6 patients in group B. There was no significant difference between the two procedures regarding overall SSI rate [p= 0.304]. Laparoscopic appendectomy did not offer significant advantage over open appendicectomy in terms of SSI

Laparoscopic treatment of hepatic hydatid cyst

To determine the outcome of laparoscopic management of hepatic hydatid disease in terms of complications. Case series. Surgical C Unit, Khyber Teaching Hospital, Peshawar, from February 2007 to March 2010. All patients with 3 or less hepatic hydatid cysts who underwent laparoscopic treatment for hepatic hydatid cyst disease were included during the study period. Laparoscopic aspiration, unroofing and evacuation of the hepatic hydatid cysts was done. Clinicopathologic features, operative time, conversion to laparotomy, morbidity, mortality and recurrence rates were analysed. Forty three patients had laparoscopic treatment for hepatic hydatid cysts. Females were 27 [62.79%] and males were 16 [37.20%]. Mean age of patients was 38.6 +/- 14.03 years [range 15-64 years]. Pain was the commonest presentation occurring in 34 [79.06%] and mass in 9 [20.93%]. Hepatic hydatid cysts were successfully treated laparoscopically in 40 patients. Open surgery conversion was needed in 3 [6.97%] due to inadequate access. The mean duration of surgery was 46.27 +/- 13.84 minutes. Complications included port-site infection in 3 [6.97%], bile leak in 4 [9.30%] and recurrence in 2 [4.65%] cases; there was no mortality in the series. Laparoscopic hepatic hydatid cyst surgery was a safe and effective method in selected patients

Aggressive angiomyxoma of scrotum presenting as an Inguinal Hernia

Aggressive Angiomyxoma [AAM] is a rare mesenchymal tumor with a locally aggressive course. The most common location is in the pelviperineal region and occurs mostly in females of childbearing age. In males, it is extremely rare and thus is apt to be mistakenly diagnosed as an inguinal hernia or hydrocele. We report a case of 45 year old man who had right sided scrotal swelling for about four years. It was diagnosed as an inguinal hernia clinically. On further investigations, it was found to be a soft tissue tumor of the scrotum. The patient underwent scrotal exploration. At surgery, a huge lobulated gelatinous mass surrounding the right testicle was found. The mass was excised including the testicle and sent for histopathological analysis. Histologic examination of the excised mass revealed a nonencapsulated lesion composed of sparse spindle-shaped cells and a myxoid stroma with a prominent vascular component. The cells showed focal and weak positivity for desmin. The findings were thus consistent with aggressive angiomyxoma of the scrotum. The margins of the specimen were clear. The patient we report has so far done well with no evidence of recurrence