Lichtenstien repair of inguinal hernia under local anaesthesia - day case surgery

This prospective study was carried on 250 patients to study the complication and recurrence rate associated with Lichtenstien repair of inguinal hernia in our clinical and socioeconomic settings. The cost effectiveness and return to work after surgery were the other outcome measures. Two hundred and fifty patients underwent mesh repair of inguinal hernia at two different centers over a period of two years. All the patients were operated under local anesthesia. A bolus dose of preoperative antibiotic was given intravenously. The patients were followed up for two years and their post operative course was assessed according to a prescribed proforma. The rate of minor complications was in the range of 11.8%. The recurrence rate was 1.2%.There was minimal pain and the procedure was cost effective in terms of operative cost and less economic loss due to early return to work. It is concluded that Lichtenstien repair as a day case is safe and effective procedure to be performed by a trained general surgeon under local anesthesia. The infection rate and the recurrence rate are low. The compliance and acceptability of the patient and ease of carrying out the procedure under local anesthesia by surgeon is acceptable. In our view this type of hernial repair is an appropriate method in district hospital and tehsial headquarter hospitals where provision of anaesthesia facilities are yet to be fully developed and hospitals cater a major hernial load due to elderly patients with background of farming professions being admitted. The patient can be sent home on same day after surgery

Subcuticular versus interrupted skin closure in appendectomy

A comparative study of skin closure technique in patients undergoing appendicectomy is presented. Fifty patients operated for uncomplicated [non gangrenous, non perforated] acute appendicitis were randomly divided in two groups. In one group the skin wound was closed with simple interrupted stitches while the other group underwent a subcuticular closure. The average skin closure time in first group was 3 min and in the other it was 4.5 min. The patients in Subcuticular closure group needed less post op analgesia, and were more pleased with the scar. The wound infection rate in both groups was same [4%]. We recommend Subcuticular closure in appendicectomy because of better cosmesis, with no added risk of wound infection

Early exploration or appendicular mass

The management of an appendicular mass has traditionally been conservative, involving a long hospital stay. The patients in whom mass resolves have to be readmitted for interval appendicectomy at a later stage. Those who develop an appendicular abscess during admission need to be operated upon for drainage of the abscess and still called later for elective appendicectomy. A prospective study was carried out to compare the merits and demerits of early exploration vs. conservative treatment of appendicular mass in the Department of Surgery, Unit-I, Lahore General Hospital attached to Postgraduate Medical Institute, Lahore. Fifty patients were admitted and divided in two equal group. One group was managed conservatively and the other underwent early exploration of the appendicular mass of five days or lesser duration. The mean hospital stay in the operated group was 3.48 days and in the other it was 5.7 days. No major complication occurred in patients who had early exploration except wound infection rate of 8 percent. We found that early exploration was not only safe and advantageous but cost effective as well. We recommend early exploration of appendicular mass of five days or lesser duration

Relapsing polychondritis: difficult to suspect, simple to diagnose, a case report

A case of relapsing polychondritis presenting with a painful goitre and odynophagia is reported. Relapsing polychondritis is an uncommon disease and its presentation to a surgeon in such a manner is rather unusual. It is a progressive inflammatory disorder of articular and nonarticular cartilages and in most cases involves the ear, larynx, trachea, eye and skin .The heart may also be affected. This condition is associated with a high morbidity and mortality. The clinical course of the disease is highly variable and the management is centred on accurate diagnosis and early institution of steroid therapy

Primary repair of colonic injuries in penetrating abdominal trauma

A study of 15 cases of colonic injuries managed with primary repair is presented. These cases were collected on the basis of strict inclusion criteria from all the patients presenting with abdominal trauma over a period of one year. All were male. Fire arm was the commonest mode of injury [53.3%]. Right colon was involved in 60% of cases. The lag period was 3-8 hours [mean 5 hours]. The commonest associated injury was small gut [46.6%]. The hospital stay was 7-15 days [mean 10 days]. Morbidity rate was 26.6%. Only one patient developed faecal fistula. However mortality remain nil. The rate of complications was directly proportional to severity of the colonic injury. Primary repair of colon in selected patients of penetrating abdominal trauma is recommended

Management of a mass Disaster: an experience at mayo hospital, Lahore

A brief account of the management of casualties of a mass disaster which resulted in a heavy loss of life and property is presented. It was one of the biggest disasters in Lahore involving 104 casualties managed by a single surgical unit of Mayo Hospital Lahore,. Ten people [9.6%] died at the spot. Most of the injured were police men [63.5%] and party workers of a political party [26%]. Seventy nine [76%] victims fell within 20 to 40 years of age. Thirty six [34.6%] underwent major surgical procedures. Eight [7.7%] had temporary disability while three [2.88%] became permanently disabled. In hospital mortality was 7 [6.7%]. Septicaemia being the commonest cause of death i.e. 3 out of 7 [42.8%]. Forty five minutes was the total time taken in triage and distribution of cases to different areas of management. The experience of the management of this mass disaster and the problems encountered during its execution are highlighted. The deficiencies and pitfalls in the management were noted and are now presented in the form of recommendations for further improvement in the major disaster plan