ABSTRACT
The objective of this study was to evaluate outcome of total extraperitoneal laparoscopic inguinal hernia repair with Lichtenstein open repair in terms of postoperative pain. Quasi experimental study. Surgical unit 1 Rawalpindi and Allied hospitals from January to June 2012. Sixty patients, with unilateral, primary, inguinal hernia were alternately allocated to undergo either total extraperitoneal [TEP] laparoscopic repair of inguinal hernia or Lichtenstein tension free, mesh repair of inguinal hernia. Pain scores at 12, 24, and 48 hours and at 7 days of follow up were noted using a visual analogue scale. Total number of intravenous injections of Diclofenac Sodium requested by the patient for pain relief was also noted. At 12 hours after surgery, the mean pain scores in the TEP group were 3.1 +/- 1.8 and in the Lichtenstein group they were 4.2 +/- 2.1 [p 0.031]. At 24 hours after surgery, the scores were 2.3 +/- 1.5 and 3.1 +/- 1.9 for the TEP and Lichtenstein groups, respectively [p = 0.026]. At 48 hours after surgery, the mean pain scores in the TEP group were 1.5 +/- 1.1 while in the Lichtenstein group they were 2.0 +/- 1.6 [p = 0.041]. At 7 days after surgery, the scores were 0.3 +/- 0.5 in the TEP group and 0.4 +/- 0.8 in the Lichtenstein group [0.137]. The mean number of injection of Diclofenac Sodium required by the TEP and Lichtenstein groups was 3.1 +/- 1.6 and 5.8 +/- 2.2, respectively [p = 0.011]. Less postoperative pain and requirement for analgesics were reported by patients who underwent total extraperitoneal laparoscopic repair of inguinal hernia as compared to those who underwent inguinal hernia repair by Lichtenstein tension free mesh hernioplasty
Subject(s)
Humans , Male , Laparoscopy , Peritoneum , Herniorrhaphy/methods , Patient Outcome Assessment , Pain, Postoperative , Surgical Procedures, OperativeABSTRACT
To determine frequency of perforated appendicitis in patients presenting with acute appendicitis and association of perforation with the duration of symptoms in acute appendicitis. Observational study. The study was conducted in surgical unit I at Holy Family Hospital Rawalpindi. One hundred and fifty patients diagnosed as the cases of acute appendicitis were included in the study by a non probability convenience sampling technique. Later on, patients with no signs of inflammation of appendix on operation or histopathological report were excluded from the study. In these patients frequency of perforated appendix, duration of symptoms in patients with perforated appendix and association of perforation with duration of symptoms in acute appendicitis was determined. Among 150 cases, 47 patients [31.3%] had perforated appendicitis while 103 patients [69.7%] had simple acute appendicitis. 90 patients were male while 60 patients were female. 40 patients [85.1%] of perforated appendicitis had symptoms for more than 24 hours while 7 patients [14.9%] of perforated appendicitis had symptoms for less than 24 hours. Complications were high in the perforated appendicitis as compared to non perforated appendicitis. Average stay of the patients with perforated appendicitis was 3.33 days while with non perforated appendicitis was 1.75 days. No mortality was occurred in this study. Timely diagnosis of acute appendicitis and prompt surgical intervention can decrease the frequency and high morbidity due to perforated appendicitis
ABSTRACT
To determine if intraoperative instillation of bupivacaine into gall bladder fossa would decrease early postoperative pain after laparoscopic cholecystectomy, Double-blind, randomized, controlled trial. Surgical Unit-l, Holy Family Hospital, Rawalpindi and Surgical Unit-1, Benazir Bhutto Hospital, Two year study. Fifty patients underwent laparoscopic cholecystectomy group-A. They were compared with a control group of fifty patients who had laparoscopic cholecystectomy but did not receive bupivacaine Group-B. Instillation of 10 ml of 0.5% bupivacaine into gall bladder fossa intra operatively after removal of gall bladder. Visual analogue scale [VAS] pain scores assessed 3 times post operatively, at 1, 6 and 24 hours, using similar peroperative and postoperative analgesics in both groups. Mean VAS pain scores [range 0 [no pain] to 10 [severe pain]] at 1 hour and at 6 hours after surgery were 6.5 and 4.2 respectively, in the bupivacaine group [Group-A] compared with 6.2 and 4.5 respectively, in the control group [Group-B] [p =.085 and 0.078,sd=.919 and.495]. VAS scores at 24 hours postoperatively did not differ between the two groups [2.4 VS 2.5][p=.282,sd=.636]. Instillation of bupivacaine into gall bladder fossa has no effect on post operative pain control in elective laparoscopic cholecystectomy