Procedure for prolapsed haemorrhoids versus excisional haemorrhoidectomy a systematic review and meta-analysis

To assess the efficacy of Procedure for prolapsed haemorrhoids versus excisional haemorrhoidectomy to treat haemorrhoids. Randomised controlled trials comparing EH and PPH with >/= 15 patients. This study was conducted at Nishtar Medical College, Multan from December 2011 to May 2012. All articles addressing haemorrhoidectomy were identified using the Medline and Pubmed Web sites with the period of review extending from December 2011 to May 2012. Articles addressing PPH and EH were then reviewed. The search included in English language. All randomised controlled comparative trials and patient samples of >/= 15 patients were considered for the meta-analysis. The primary endpoints assessed were pain and time taken to return to normal activity. Secondary endpoints were bleeding, complications and residual symptoms, recurrence rates and re-interventions PPH was associated with less postoperative pain, earlier return to normal activities compared with EH. There was no difference between the two procedures in terms of complications. There were more recurrences after PPH. Compared with EH, PPH is associated with less postoperative pain, earlier return to normal activity. The rate of recurrence appears higher with PPH

Rhomboid flap in the treatment of pilonidal sinus disease

The aim of our study was to present our experience with the Rhomboid flap technique in the management of pilonidal sinus disease and to evaluate the morbidity and recurrence. Cross-sectional, observational study. This study was conducted in the surgical department of Nishtar Hospital Multan Ward 4 surgical unit 1, October 2011 to March 2012. Eleven patients were included, eight had previous surgical drainage of multiple natal cleft abscesses, and three had acute disease at the time of surgery. Nine patients had complex, recurrent pilonidal sinus. By using the Rhomboid transposition flap, we were able to excise the diseased area and close the defect. Operative time, hospital stay, healing time, wound infection, wound breakdown, return to normal activity and recurrence were assessed. There were 10 males and one female with a median age of 23 years [range 17-32 years]. Mean follow-up was 6 months [range 5-6 months]. Mean operative time was 63.2 minutes [range 55-75 minutes]. Hospital stay was 3.4 days [range 2-5]. Postoperative morbidity involved superficial wound infection in two patients, superficial gangrene of wound edges in one patient and partial wound breakdown in one patient that settled with dressing in the out-patient clinic. All wounds healed and the median healing time was 15 days. There was no recurrence in our series. Median time to return to normal activity was 17.8 [range 10-27] days. Rhomboid flap is a useful technique in the treatment of advanced, difficult cases of pilonidal sinus disease. It has relatively low morbidity, allows early return to full activity and does not necessitate prolonged postoperative care. A larger series and longer follow up time is needed to assess the recurrence rate more adequately

Laparoscopic cholecystectomy with harmonic scalpel

To compare results in terms of thermal injuries and biliary complications with use of monopolar hook and ultrasonic harmonic scalpel Inlaparoscopic cholecystectomy. Quasi-experimental study. This study was conducted at Surgical Unit I and III, Nishtar Hospital Multan from November 2011 to July 2012. During a 9 months period, in a personal series of 95 consecutive patients, the Harmonic scalpel was used as the sole instrument for both division and dissection of the cystic artery and duct. The average length of inpatient stay, procedure duration, and complications were compared with the data of a homogenous control group of patients who were treated using monopolarelechosurgery and clips. Measurements of the percentage were made using SPSS 15. Statistical significance level was at p <0.001. Neither major complications nor bile duct injuries were detected in either group, and no statistically significant difference was found between the groups in terms of the incidence of postoperative complications. However, the mean operative time was significantly shorter in patients treated with the Harmonic scalpel. The Harmonic scalpel is not only a safe and effective instrument but also a reliable substitute for clips because it provides complete hemobiliary stasis. Even if the study revealed no differences with regard to postoperative complications, the Harmonic scalpel represents a viable alternative because of the shorter operation time and cost savings that are inherent in a procedure using it as a single instrument