ABSTRACT
Introduction: Achalasia cardia is a primary esophageal motility disorder of an unknown etiology, characterized by abnormal peristalsis of the esophageal body and the absence of relaxation of the lower esophageal sphincter. Laparoscopic Heller cardiomyotomy is the surgical procedure of choice for achalasia cardia. Aim: The aim of the study was to the immediate safety and long-term efficacy of laparoscopic Heller’s cardiomyotomy with intraoperative endoscopy and Dor’s anterior partial fundoplication in patients with achalasia cardia. Materials and Methods: In this prospective study, laparoscopic Heller’s myotomy with intraoperative endoscopy and anterior Dor’s fundoplication were performed in all achalasia cardia patients. Patients’ demographic, clinical features such as dysphagia grade and Eckardt score, intraoperative, post-operative parameters, and response to treatment on follow-up were analyzed. Results: In 14 patients, 10 were females (71%), the mean age was 37±14.96 years. Mean pre-operative modified Takita’s dysphagia grade was 2.93±0.73. Endoscopic classic findings and barium swallow bird beak sign were diagnostic in all cases. Preoperative Eckardt score was 8.93±1.44. Eckardt score at discharge was 0.43±0.51 and at 12th month was 0.21±0.43. On analysis, there was a significant improvement in pre-operative values of modified Takita’s dysphagia grade and Eckardt score to normal values postoperatively (P < 0.0001) and the durable effect was persistently observed in 3rd and 6th, 9th, and 12th-month follow-up. Conclusion: Laparoscopic Heller’s myotomy with intraoperative endoscopy and Dor’s fundoplication are safe and effective with significant improvement in post-operative Takita’s dysphagia score and Eckardt score.
ABSTRACT
Background: The coexistence of Wilson’s disease and autoimmune liver disease in a same patient is a rare entity. Combined treatment with steroid and D-penicillamine may be effective. Aim of the study was analyse the clinical, histological, laboratory profile for patients with chronic liver disease with aim of finding the etiology of the disease.Methods: It is an observational study. Common clinical presentations were evaluated. Laboratory investigations done include complete blood count, renal and liver function tests, prothrombin time, viral markers for hepatitis A, B, C and E, USG abdomen and pelvis, portal Doppler studies and upper GI endoscopy. Specific tests include ANA, AMA, ASMA, Anti LKM-1Ab, serum ceruloplasmin and 24hrs urinary copper were done. Liver biopsy was done in selected patients.Results: Commonest clinical presentation was abdominal distension (80%), abdominal pain (30%), pedal edema (60%), splenomegaly (40%) and upper GI bleed (40%). Laboratory investigation revealed anemia (50%), thrombocytopenia (70%), prothrombin time prolongation in (60%), normal liver function in 60%, abnormal liver function in (40%). Autoimmune markers revealed ANA strong positivity in (40%), mild positivity in (60%). AMA, ASMA, Anti-LKM-1 were negative in all cases (100%). Liver biopsy showed features of autoimmune liver disease and Periportal copper deposition in 80% of cases.Conclusions: Coexistence of Wilson’s disease and autoimmune liver disease is a rare entity and medical treatment with steroids and D-penicillamine simultaneously to be started in these patients.
ABSTRACT
Background: Tumors of the biliary tract show spectrum ranging from benign to malignant lesions. Only 20% of tumors are resectable at the time of presentation. The operative mortality was approximately 5 to 20%. The morbidity rate associated with the surgery is approximately 65%. Options for palliative therapy of biliary tree obstruction include the surgical bypass, percutaneous external drainage/stenting and endoscopic stenting. The aim was to compare the survival pattern of patients treated with biliary Self Expandable Metallic Stents (SEMS) as a palliative procedure to that of patients treated by curative surgery.Methods: This was a retrospective study. 6-months survival pattern were analysed in 20 patients treated by SEMS and compared with that of 10 patients treated with plastic biliary stents followed by curative surgery.Results: Survival pattern analysis was done for all 20 patients with SEMS. 7 patients were in >1-year survival, 5 were in >6months survival, 6 expired within 6months, 2 patients were lost to follow up. Survival pattern was compared with 10 patients who had plastic stents followed by curative surgery. Only 1 patient had survival rate >1year post-surgery, 5 patients expired post-surgery in <6months, 2 patients expired few weeks after plastic stent deployment, 2 patients were lost to follow up.Conclusions: In patients with biliary malignancies with obstruction, biliary SEMS followed up by palliative chemotherapy had better survival rate than patients who had plastic stents followed up with curative surgical procedures.
ABSTRACT
This is prospective study conducted in the department of Surgery, Mayo Hospital, Lahore over the period of four years. Comparative data was compiled on 100 patients divided in two equal groups. Efficacy of two operations was assessed in terms of morbidity and mortality. The final results were conclusive enough to show the benefits of ileostomy over the primary repair in cases of typhoid perforation