Enterocutaneous high output fistulae; octreotide an effective tool in management

Enterocutaneous fistula is an abnormal communication between epithelial lined lumen of Gl tract and epithelium of an adjacent viscous or skin. To find out role of octreotide in the management of high enterocutaneous fistula. Case study. Department of Surgery unit-ll Punjab Medical College and A and E Department of Jinnah Hospital /AIMC Lahore. From Jan 2007 to Dec 2008. 479 laparotomies were carried out due to trauma. Out of these 21 i.e. 4.38% developed high out put enterocutaneous fistula. All patients were put on similar conservative management including, TPN, antibiotics, fluid electrolyte replacement and stoma care. Patients were split into two groups alternatively. There were no statistical difference between the study groups with regard to the age [p-value=0.515]. Group I contains 11 patients [octreotide] received additionally 100mg octreotide S/C 8 hourly, showed decrease of volume from 680 to 150ml within 10 days. Spontaneous closure was observed in 8 [72.72%] patient and surgery was required in 2 [18.18%] patients. Death was 1 [9.09%]. In Group II remaining 10 patients[without octreotide], fistula discharge volume decreased form 650mg to 150ml in 20 days. Spontaneous closure was noted in 5 [50%] cases. Surgery was required in 3 [30%], while death rate was 2 [20%]. It is concluded that Octreotide, an analogue of somatostatin with longer half life is effective in treatment of high output fistula

Shouldice versus lichtenstein repair

To compare the results of tissue based Shouldice repair with the Lichtenstein tension free repair of inguinal hernia. A prospective randomized controlled trial. From Jan 2004 to Dec 2006. Surgical Unit-II, Allama lqbal Medical College /Jinnah Hospital Lahore, Pakistan. A total of 156 patients were included in this study were equally divided into two groups. The mean age was 45 years. After a follow up of upto 2 years there was significant difference in the recurrence rate. It was 5% in the Shouldice group and 1.28% in the Lichtenstein group. Similarly chronic pain was also much higher i.e. 5% in the Shouldice group compared to 1.28% in Lichtenstein Group. The rate of hematoma and seroma formation was the same [1.28%] in both groups, however infection was seen slightly more in Lichtenstein repair [3.84%] as compared to Shouldice repair [2.56%]. Tension free Lichtenstein technique was found to be superior to the tissue based Shouldice repair with respect to post operative complications and recurrence

Inguinal hernia day case surgery: study of 100 cases

This Prospective study was carried out at Surgical Department of Jinnah Hospital Lahore from January 1998 to September 1999, to evaluate the merits and demerits of day case surgery of inguinal hernia in our set up. One hundred patients of simple reducible inguinal hernia presenting in surgical out patient department were included in this study. Patients were selected after discussion with the anaesthatist. Only class I or II patients as mentioned by American society of anaesthesiologists were included. Instructions about preoperative prepration and time to come for surgery were given on non resident basis. All patients were operated under general anaesthesia early on the list. Surgical procedures performed were herniotomy in 27 patients [27%] in children and young fit adults with good inguinal musculature. Herniorrhaphy [darning] was performed in 73 patients [73%] having direct inguinal hernia or indirect inguinal hernia and week posterior wall of the inguinal canal. Main post operative stay in the hospital was eight hours. Four patients [4%] developed scrotal oedema and two patients [2%] developed scrotal haematoma relieved by scrotal support. Two patients [2%] developed superficial [subcutaneous] wound infection which was cured by drainage and dressing on outdoor basis. Five patients [5%] developed postoperative neuralgia at the site of wound which was relieved simply by use of analgesics, except in one case in which local steroid injection was given at the site of maximum tenderness. There was no single recurrence reported in one year follow up after surgery Day case surgery for inguinal hernia can be performed safely in carefully selected patients with no anaesthetic complications and minimal morbidity. The economic benefits are enhanced by short stay, low morbidity and early return to normal activities

Superficial parotidectomy: Audit of 16 cases over 2 years

Sixteen patient underwent superficial parotidectomy at Sir Ganga Ram Hospital, Lahore in Surgical Unit-II from January 1999 to December 2000. Male to female ratio was 1:1.66 while mean age was 34 years. On histopathology oncocytoma was 6.25 percent cases, Warthins tumours 6.25 percent, pleomorphic adenoma was 68.75 percent cases, mucoepidermoid carcinoma was 6.25 percent cases and adenocarcinoma was 12.5 percent. Preoperative facial nerve palsy was present in 12.5 percent of patient. Postoperatively facial nerve transient weakness was seen in 12.5 percent of the cases while permanent loss occurred in 18.75 percent cases. The cases of permanent loss were those of malignant disease. Good light, use of x2.5 loop, nerve stimulator, identification of facial nerve by anatomic parameters, good haemostasis and less traction are parameters to save the facial nerve from damage. The histopathological results of FNAC and postoperative tissue biopsy were identical pointing out towards the usefulness of preoperative FNAC in parotid tumours. Availability of intraoperative monitoring facilities for facial nerve can further improve results