Can rubber band ligation replace hemorrhoidectomy as a treatment of choice for 3rd degree hemorrhoids: a review

Hemorrhoids are a common cause of rectal bleeding with a prevalence of 4 to 40% worldwide, varying in different geographical locations. The current treatment modality for 3rd degree hemorrhoids includes hemorrhoidectomy, but newer methods like rubber band ligation are rapidly gaining popularity. The purpose of our review was to establish if rubber band ligation can replace the traditional hemorrhoidectomy for the treatment of 3rd degree hemorrhoids.All databases were searched for relevant studies. A total of sixteen studies were included in the review. Current national and international literature points out that the results of rubber band ligation are comparable to hemorrhoidectomy and there are lesser complications associated with rubber band ligation.Reviewing the current recommendations, results, evidence and literature, our study recommends rubber band ligation as the treatment of choice for 3rd degree hemorrhoids

Is routine histopathology of gall bladder after laparoscopic cholecystectomy needed?: a local perspective

Background: Laparoscopic Cholecystectomy is one of the most commonly performed routine operation in modern general surgery. All surgical specimens are routinely sent for histopathology. A wide spectrum of variations is seen under the microscope. Rarely, carcinoma is discovered on histopathological examination. The purpose of the article was to identify and elaborate the major histopathological findings of gallbladder after laparoscopic cholecystectomy in a tertiary health care hospital in Pakistan

Methods: This was a retrospective study and included histopathological specimens of gall bladder after cholecystectomy from February 2004 to April 2013. Data was analysed using MS Excel and SPSS 19.0

Results: Total number of cases: 8376, Chronic Cholecystitis: 7705, Acute or chronic cholecystitis with empyema, mucocele or gangrene: 554, Adenocarcinoma: 91, Adenomatous polyp: 3, Squamous cell carcinoma: 5, Papillary carcinoma: 3, Clear cell carcinoma: 4, Adenosquamous carcinoma: 2, Xanthogranulomatous changes: 54, Dysplasia: 13 and Cholesterosis: 1050

Conclusion: Considering the evidence from our study and the evidence from the literature reviewed, it can be concluded that prevalence of all kinds of gall bladder disease, benign or malignant including carcinoma is no different from the rest of the world. Routine histopathology of gall bladder can be omitted without compromising patient safety as proven and practiced by many centers across the globe

Presentation and management of parathyroid tumors

Objective: To evaluate cases presenting with parathyroid tumors and the efficacy of treatments offered

Methods: Six cases presented with bony manifestations in mandible, femur, tibia and maxilla while one presented with an overt neck swelling. Renal calculi showed in one case. All cases were subjected to assessment of serum parathyroid hormone level and radionuleotide scan.Sonography was done in addition in two of the cases . In all cases parathyroid tumors were identified and subjected to exploratory parathyroid surgery, In addition bony pathologies were subjected to excisions of the lesions

Results: In all the cases serum parathyroid hormone levels were raised.MIBI scans picked parathyroid tumors in almost all the cases. Six of the excised tumors were parathyroid adenomas while one was adenocarcinoma. Additional surgeries done in these cases include excisions of mandibular growths, maxillectomy and osteotomies on tibia and femur. All were giant cell tumours.One case with adenocarcinoma expired. The other cases showed normalization of parathyroid hormone levels

Conclusion: Parathyroid adenoma is the common benign tumor of parathyroid gland usually presenting with exaggerated parathyroid hormone levels. Ultrasound scan screening with tc99 Sestamibi scanning are most helpful in establishing the diagnosis. Parathyroid surgery is safe in experienced hands and is the standard treatment modality to reverse the morbidity associated with pathologies. In all bony lesions with a doubtful clinical diagnosis screening for Parathyroid lesions is mandatory. Gross disfigurements, functional disabilities call for excision of bony lesions

First port placement for pneumoperitoneum

To find out utility of a modified method of creating pneumoperitoneum for laparoscopic surgery. Quasi-experimental study. Ziauddin Medical University Hospital and Kutiyana Memon Hospital, Karachi from September 2007 to March 2008. The modified method for the creation of pneumoperitoneum for laparoscopic surgeries was applied to all patients. Approximately 1.2 cm vertical incision was made below the umbilicus and subcutaneous fat separated by blunt dissection till the rectus sheath visualized. A small incision approximately 5 mm was made in the full thickness of linea alba without opening the peritoneum. An artery forcep was then introduced in the peritoneum to open it. Rate of success of the procedure, time from sub umbilical incision to insertion of telescope and complication / difficulty encountered during the procedure were recorded in the operative notes and pre designed proforma. Results of the present technique was analyzed and compared with published literature in terms of visceral injury and air leak. A total of 55 patients were included in this study. Scar of previous abdominal surgery was present in 16 patients. Mean time from skin incision to insertion of telescope was 55 seconds [ranging from 35 to 95 seconds]. Trocar insertion into extra-peritoneal space occurred in 6 patients. Withdrawl and re-insertion into peritoneal space was successful in all cases except in 2[3.63%] patients in whom procedure was converted to open technique. No bowel or visceral injury occurred during the procedure. Gas leakage was not encountered during entire surgical procedure in all the patients. This modified technique for the creation of pneumoperitoneum for laparoscopic surgery is safe, quick and without the use of any specialized or disposable instruments

Giant cell tumours of the maxilla and tibia presenting concurrently as an initial manifestation of primary parathyroid adenoma

A 14 years female of Afghan origin reported with maxillofacial and tibia growths causing progressive deformities since nine months, both were giant cell tumours on histopathology. Serum calcium was normal, but the parathyroid hormone was exaggerated [678pg/ml]. Ultrasound indicated and Tc-99m Setamibi scan confirmed a left lower parathyroid lesion. A 4cm length mass was identified, removed and proved to be a parathyroid adenoma. Two weeks later a subtotal maxillectomy and six weeks later anterior wedge osteotomy of the tibia were carried out. Serum parathyroid hormone level normalized