ABSTRACT
Objective: To compare post operative pain and wound infection between mesh and Darn inguinal hernia repair
Study Design: A prospective comparative randomized, clinical trial
Place and Duration: The Study was conducted on 60 patients, 30 in each group during the study period of 8 months from 16th December 2006 to 16th August 2007 at Ziauddin Medical University Hospitals Karachi
Methodology: A total of 60 patients in the age range of 15-70 years with simple inguinal hernia were randomized in two groups i.e. Group A [Lichtenstein] and Group B [Darn] inguinal hernia repair. All inguinal hernias [Direct and Indirect], male patients were included while recurrent/ Obstructed / Strangulated / Irreducible Inguinal Hernia were excluded from the study. After surgery, postoperative pain was assessed using visual analogue scale [VAS]. Surgical wounds were also assessed by using Southampton wound grading score [SWGS] at 48 hours [before discharge] and 7[th] day [in the outpatient department]. Any seroma or infection at wound site if noticed within 7 days of surgery was also noted and all patient's related information was noted in pre set approved proforma from relative hospital's ethical review committee
Results: All were male patients with simple inguinal hernia, admitted through OPD in the ward. Fifty six [93%] out of 60 patients developed pain. Pain intensity was mild in [group A= 5[16.7%], group B= 2[6.6%]]; moderate in [group A= 20[66.6%], in group B=25[83%]] and severe in [group A= 3[10%] and group B= 1[3.3%]]; while no pain was seen in 2 [6.7%] patients in each group that was found statistically non significant [Chi square=2.84, P=0.42[ns]]. Ten [16.6%] out of 60 patients developed wound infection with 5[8.3%] patients of different wound grades in each group [Chi-square test of dependency [Chi square=2.891, P=0.82]]. Statistical analysis of this variable also found insignificant. Hypothesis was made that there is no significant difference in postoperative pain in both groups and Darn causes less postoperative wound infection than Lichtenstein repair
Conclusion: It is concluded that there is no difference in post operative pain and wound infection between well constructed darn and mesh hernia repair however study limitations are that it is of short duration with some shortage of sample size. A long-term study of around 10-15 years is still desirable to judge the both techniques in terms of recurrences
ABSTRACT
The purpose of this study was to assess the patient's awareness of informed consent and to evaluate the current practice of obtaining informed consent from patients proposed for elective surgery in tertiary care hospital. Cross sectional survey. This study was conducted in Isra University Hospital, Hyderabad, Sindh from 2[nd] April 2012 to 3[rd] March 2013. This study was designed as an observational investigation and no interference was made regarding the informed consent process to the patient. The selection criteria for the patients who were interviewed were convenience sampling. All adult patients of >18 years, who were undergoing various surgical procedures were interviewed after taking verbal informed consent on the second postoperative day, when they were comfortable to answer the questions. While all those patients who were uncomfortable due to pain or other reason and were unwilling to answer the questions were excluded from the study. All the patients were asked predesigned questions related to the information they were provided before the surgery as part of standard informed consent practice. Questions were asked in local language which includes the demographic data, operative details, risk, benefit, complications of surgery, type of anesthesia and alternative treatment options etc. The data was entered on SPSS version 16. Frequency and percentages were calculated to show the results. Mean age of the patients was 34.95 +/- SD 14.236 years. 220 patients were included in the study. 183[83.18%] patients were told about the indications of surgery while 136 [61.81%] patients were not told about any complication of Surgery. Type of anesthesia was discussed in only 25[11.36%] of patients while complications of anesthesia were discussed in only 18[8.18%] of patients. 165[75%] patients were not given time to ask the questions regarding their disease or surgery. Consent by the consultants was taken in only 63[28.63%] patients. The majority of the patients knew the indication of surgery but very few were informed about the possible complications and risk of the surgery and anesthesia
ABSTRACT
Background: Renal stone disease is a significant and worldwide health problem. Recent advances in stone management have allowed kidney stones to be treated using extracorporeal shock wave lithotripsy [ESWL], uretero-renoscopy [URS], and percutaneous nephrostolithotomy [PCNL]. Recently, medical expulsion therapy [MET] has been investigated as a supplement to observation in an effort to improve spontaneous stone passage rates. Patients and Methods: This study was a randomized, controlled, prospective study to determine whether the administration of Alpha-1- adrenergic receptor antagonists as an adjunctive medical therapy, increases the efficacy of ESWL to treat renal stones. Sixty patients with renal stones of 0.51.5 Cm in size [average size 1.2 Cm] were included in this study underwent ESWL followed by administration of Alpha-1-adrenergic receptor antagonists at department of Urology Liaquat National Hospital Karachi from Feb 2008 to Sept 2008. This was a comparative study and patients were divided into two groups. In group A patients received conventional treatment Diclofenac sodium, Anti Spasmodic [Drotverine HCl] as required and Proton Pump inhibitor [Omeprazole 20 mg] once daily after shock wave lithotripsy. In group B patients received alpha-1 blocker, Alfuzosin HCl 5 mg twice daily in addition to conventional treatment. All patients were instructed to drink a minimum of 2 litres water daily. Ultrasound guided Dornier Alpha Impact Lithotripter was utilised for shock wave lithotripsy. Results: Of the 60 patients, 76.7% of those receiving Alfuzosin and 46.7% of controls had achieved clinical success at 1 month [p=0.01]. The mean cumulative diclofenac dose was 485 mg per patient in the Alfuzosin group and 768 mg per patient in the control group [p=0.002]. This difference was statistically significant. Conclusion: Alfuzosin therapy as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal stones and is equally safe. It increases the expulsion rates of stones, decreases time to expulsion, and decreases need for analgesia during stone passage. Keywords: Alpha-blockers, Ureteral stones, Kidney stones, ESWL