Postoperative outcome of early laparoscopic and open cholecystectomy for acute calculous cholecystitis

Objective: to assess the optimal timing of intervention and post-operative morbidity for acute calculous

Cholecystitis

Study design: cross sectional study

Place and Duration of study: surgical unit Hayatabad Medical Complex Peshawar, from February 2015 to January 2016

Methodology: a total of 110 patients having age range of 20-55 year were included. Patients having common bile duct stones, clinically jaundiced and associated co morbid diseases, were excluded. Patients were divided into two groups having 55 patients in each group. Group A patients underwent early laparoscopic / open cholecystectomy within 72 hours of presentation while group B patients had delayed laparoscopic / open cholecystectomy after 72 hours of presentation. In both the groups laparoscopic cholecystectomy was attempted initially but in difficult cases decision was made to convert to open procedure. Postoperative morbidity of both groups was compared

Results: mean age of the study population was 40.5+2.5 year. Male to female ratio was 1: 8.2. Biliary leak occurred in 1.8% patients in group A and 5.5% in group B. Common bile duct injuries occurred in 1.8% versus 3.6% patients and conversion rate was 3.6% against 12.7% in group A and group B respectively. Hospital stay in group A patients was 2.5 days as compared to 4.5 days in group B. Overall complication rate was 7.2% and 29.1% for groups A and B

Conclusion: early laparoscopic cholecystectomy within 72 hours significantly decreased the conversion rate, postoperative morbidity and the length of hospital stay

experience with continent urinary diversion

Objective: to find out frequency of urinary continence and surgical complications of using cecum and right colon as reservoir with appendix as a continent catheterizable conduit in various urological conditions in adults

Study design: retrospective study

Place and Duration of study: department of Surgery, Hayatabad Medical Complex and Khyber Teaching Hospital, from January 2005 and December 2015

Methodology: this is a review of records of patients who underwent continent urinary diversion. Reservoir was constructed from cecum and right colon using Le Bag technique. Appendix was used as a catheterizable port applying Mitrofanoff principle. Patients were followed up for six months at two months interval

Results: a total of 85 patients underwent continent diversion and 78 patients completed the study protocol. Four patients were lost to follow up and three died. Out of 78 patients, 48 were males and 30 females, with age range from 05 year to 68 year. Thirty-eight [48.71%] patients presented with transitional cell carcinoma, and 12 [15.38 %] had exstrophyepispadias complex. Reservoir formation using right colon with appendix for Mitrofanoff was performed in 53[67.94%] patients. Eleven [14.10%] patients underwent bladder augmentation procedure with Mitrofanoff and in 14 [17.94%] patients appendix alone was used for diversion. Thirty-two [41.02%] patients developed complications which included incisional hernia [n=7 - 8.97%], calculous formation [n=1 - 1.28%] and subacute intestinal obstruction [n=2 - 2.56%]

Conclusion: use of appendix as a catheterizable conduit is a good option in achieving continent urinary diversion

Partial cystectomy and omentoplasty for liver hydatid cyst

Objective: To evaluate the results of partial cystectomy and omentoplasty in the management of hepatic hydatid disease

Study design: Descriptive case series

Place and Duration of study: Department of Surgery, Hayatabad Medical Complex Peshawar, from March 2011 to February 2015

Methodology: The study included patients diagnosed to have hydatid cyst involving right lobe of liver using ultrasound and CT scan abdomen. Patients having hydatid cyst in the left lobe of liver or other viscera were excluded. Postoperatively complications like bile leak were noted

Results: Partial cystectomy and omentoplasty for hepatic hydatid disease produced satisfactory results with minimum complications and short hospital stay

Conclusion: A total of 26 patients with liver hydatid cyst underwent partial cystectomy and omentoplasty. Male to Female ratio was 2.7:1. Mean age of the patients was 44.51 year. The operating time was from 45-90 minutes. Postoperatively 02 [7.7%] patients had bile leak, 03 [11.5%] had wound infection and 01 [3.8%] patient developed recurrent hydatid cyst in the liver. The average hospital stay was 5.4 days. There was no postoperative mortality

Open haemorrhoidectomy versus rubber band ligation

To assess the results of open haemorrhoidectomy and rubber band ligation in terms of post operative pain and bleeding in 3rd degree haemorrhoids. A comparative study. Surgical unit Hayatabad Medical Complex Peshawar, from July 2009 to June 2010. A total of 100 patients were included. These were randomly divided in two groups; A and B and each group had 50 patients. Group A patients underwent open haemorrhoidectomy while group B patients had rubber band ligation procedure. Post operative complications like pain and bleeding between the two groups were compared. Out of 50 patients in group A, 72% [n=36] had pain and 20% [n=10] had post operative bleeding, while in group B pain was present in 08% [n=4] and post operative bleeding in 04% [n=2] patients. P values for pain [0.007] and bleeding [0.04] were significant in favour of group B. Rubber band ligation is a safe and quick procedure. It is associated with less intensity postoperative pain and bleeding as compared to open haemorrhoidectomy

Abdominal transpubic perineal urethroplasty for complex posterior urethral strictures: an experience of 10 years

To document the outcome of abdominal transpubic perineal urethroplasty for complex posterior urethral strictures. Descriptive case series Surgical unit Hayatabad Medical Complex and Khyber Teaching Hospital Peshawar, from March 1999 to February 2009. Abdominal transpubic perineal urethroplasty is an acceptable surgical approach in patients with complex posterior urethral stricture. Patients with complex posterior urethral stricture were included in this study. Pre operative evaluation included history, physical examination and laboratory investigations. Antegrade/retrograde urethrograms and cystourethroscopy were performed to evaluate bladder neck, and stricture site and length. Surgery was performed in lithotomy position through lower abdominal and perineal approaches. Patients were followed for 2 years. At each visit, ascending and descending urethrograms were performed and post operative complications were recorded. Results were graded as successful and failure based on stricture free rate at the end of 2 years A total of 28 patients were managed The age range was 14-36 year with a mean age of 27.3 + 2.4 year. Urethral stricture was associated with false passages in 17.88% cases, periurethral cavity in 10.71% and urethrocutaneous fistula in 7.14% cases. Mean operation time was 3.5 hours and mean hospital stay was 6 days. Postoperative complications were recurrent stricture [17.86%], urethrocutaneous fistula [7.14%], perineal haematoma [7.14%], impotence [10.71%] and wound infection [10.71%]. During follow up 89.29% patients were stricture free at the end of 2 years Abdominal transpubic perineal urethroplasty is an acceptable surgical approach in patients with complex posterior urethral stricture

Use of circumferential fasciocutaneous penile skin flap in the reconstruction of complex urethral strictures

To find out stricture free rate of penile circumferential fasciocutaneous skin flap use in complex urethral strictures Descriptive case series. Surgical Unit Khyber Teaching Hospital and Hayatabad Medical Complex Peshawar, from January 2000 to December 2009. All patients with complex urethral strictures, more than 4 cm long, were included. Patients were followed-up for two years and on each visit ascending urethrogram was performed. A total of 48 patients with complex urethral strictures were managed. The average length of the stricture was 06 cm [range 04-12cm]. Total operation time was 01-03 hours [mean 02 hours]. Late postoperative complications included recurrent strictures [25%], urethrocutaneous fistula [4.2%], erectile dysfunction [8.3%] and mild postmicturition dribbling [8.3%]. The overall success rate at the end of two years follow-up was 75%[n=36]. Circumfrential fasciocutaneous penile skin flap for urethroplasty is a good option for managing complex urethral strictures with acceptable postoperative morbidity

Frequency of incidental gallbladder carcinoma following cholecystectomy for symptomatic gallstone disease

To determine the frequency of incidental carcinoma of the gallbladder in specimens following routine cholecystectomy. Descriptive case series. Department of Surgery, Hayatabad Medical Complex Peshawar, from February 2008 to January 2011. All patients with symptomatic gallstone disease of either gender having age range between 12-70 year were included. Patients with diagnosed gallbladder malignancy, gallbladder mass, empyema gallbladder and gallstones associated with obstructive jaundice were excluded. Following cholecystectomy all the specimens were sent for histopathological examination. Two hundred and sixty patients including 65 males and 195 females [M: F ratio 1:4] aged 12-70 year and having a mean age of 41.7 year [ +/- SD 2.4], were studied. Commonest presentations were pain right hypochondrium and a positive Murphy's sign [87.71%] followed by dyspepsia[55%], nausea, vomiting [40%], pyrexia [31.92%] and weight loss [05%]. Eleven [4.23%] patients had a diagnosis of malignancy of gallbladder at histopathology examination. Mean age for patients with malignancy was 55.25 year with a male to female ratio of 01:10. Well differentiated adenocarcinoma was reported in 45.45% cases, moderately differentiated in 36.36%, poorly differentiated in 09.09% and undifferentiated in 09.09% patients. Routine histopathology of gallbladder following cholecystectomy is helpful in early detection of carcinoma gallbladder

Comparison of wide open excision and karydakis procedure for pilonidal sinus disease

To compare the outcomes of wide open excision and Karydakis procedure in terms of postoperative complications, hospital stay and recurrence rate. Comparative interventional study. Surgical unit Hayatabad Medical Complex Peshawar, from April 2006 to March 2009. A total of 40 patients with pilonidal sinus were admitted through OPD. Patients with osteomyelitis of sacrum, fistula with anal canal or rectum, and those who were lost during follow up, were excluded. Patients were divided into 2 groups. In group A [20 patients] wide open excision was done whereas in group B [20 patients] Karydakis procedure performed. Patients were followed up in OPD for 6 months and postoperative outcomes were recorded. Out of 40 patients, 36 [90%] were males and 4 [10%] females [M:F = 9:1]. Age range was 15 to 40 year with mean age of 26.5 year +/- 2.4 year. In group A, postoperative complications encountered were pain [75%], bleeding [10%], wound infection [25%], scar pain [30%] and numbness [15%] at the site of surgery. While in group B, postoperative morbidity included pain [25%], hematoma/seroma formation [10%], wound infection [15%], scar pain [15%], numbness [20%] and wound dehiscence [10%]. Average hospital stay was 5.6 days in group A and 2.5 days in group B. Recurrence rate was 25% following wide open excision and 5% after Karydakis procedure. Karydakis procedure is better than wide open excision in terms of less postoperative complications, reduced hospital stay and low recurrence rate

Post operative outcomes of open versus closed haemorrhoidectomy

To compare the therapeutic results of open haemorrhoidectomy with closed one in terms of post operative pain, bleeding and wound healing. This experimental study was carried out in the surgical unit, at Hayatabad Medical Complex Peshawar from March to August 2009. Fifty patients of 2[nd], 3[rd] and 4[th] degree haemorrhoids having no systemic illnesses were included in this study. Patients were randomly divided in two equal groups. Group A included patients undergoing open haemorrhoidectomy and group B catered for patient with closed haemorrhoidectomies. Post operatively these patients were followed up in the OPD for 02 months and were evaluated for post operative pain, bleeding and wound healing in addition to other complications like urinary retention and anal fissure. The mean age of the sample was 45.5 +/- 2.3 years. In group B, 08 [32%] patients had mild pain, 10 [40%] had moderate and 02 [08%] had sever pain post operatively as compared to 13 [52%] patients with mild, 11[44%] with moderate and 06 [24%] with severe pain in group A [p < 0.05]. Similarly early post operative bleeding was noted in 15 [60%] patients in group A and 06 [24%] patients in group B [p < 0.05]. Wound healing time was just over 02 weeks in group B as compared to more than 04 weeks in group A [p < 0.05]. Closed haemorrhoidectomy technique is much better than open technique for 2[nd], 3[rd] and 4[th] degree haemorrhoids