early experience of laproscopic cholecystectomy from K.M.C / civil hospital Khairpur Mir's

Objective: To see feasibility, per operative difficulties and overall results of lap: Cholecystectomy in our newly established minimal invasive surgical setup

Study Design: Randomized Descriptive study

Place and Duration of Study: This study was conducted in Surgical Department of newly established Khairpur Medical College/ Civil Hospital Khairpur Mir's from August 2014 to May 2015

Materials and Methods: The data of all the 100 patients with the diagnosis of gall stone disease was entered in specific proforma, who were admitted at K.M.C / Civil Hospital Khairpur Mir's. The consent for laproscopic procedure was taken prior to surgery. All the base line blood and radiological investigations were done. Cardiac and general anesthesia opinion were also taken. The procedure was carried out by conventional "four port" method on scheduled elective operation list

Results: In this study male to female ratio was 1:6.1 and mean age was 38.5 years. In 52 patients gall bladder was non inflamed and callot's triangle was clear but in 48 cases various kinds of abnormalities were present. In 40% cases operative technique was modified by different means. Conversion rate remained 09%. In 56 cases operative time was 40 mints, in remaining 44 patients it was beyond 40 mints. Post operatively 26 patients developed various minor and major complications. There was no mortality in our series

Conclusion: Lap: Cholecystectomy is safe and effective procedure, applicable to any general as well as teaching hospital. Over all our results are acceptable according to the national and international studies

Abdominal tuberculosis: varied presentations

To study various clinical presentations and out come of management of abdominal tuberculosis. Prospective cross-sectional study. This study was conducted at the Surgical Unit-1 Ghulam Mohammad Maher Medical College Hospital Sukkur and Al-Khair Hospital Sukkur from January 2007 to December 2010. The 65 patients admitted throughout patient department and emergency with abdominal catastrophes. Ages ranged between 14 to 70 years. Out of 65 patients 37 were males and 28 were females. All the patients were evaluated with history, examination and investigations. 34 patients were operated and the resected tissue sent for histopathology to conform the diagnosis of tuberculosis. Out of 65 cases of abdominal tuberculosis, 37 were male and 28 female. The mean age was 30.9 years with SD 14.19 [range 14 to 70 years]. The mean duration of symptoms at presentation was 6 months [range 1 month to 24 months]. 35 [52.3%] out of 65 patients were admitted with different complications in which 10 [29.4%] presented with peritonitis due to gut perforation, 9 [26.5%] with sub-acute intestinal obstruction, 8 [23.5%] with abdominal mass, 5 [14.7%] with acute appendicitis and 2[5.9%] with umbilical fistula. Surgery was performed in all these patients, Stricturoplasty done in 13 [38.3%], Ileostomy in 8 [23.5%], resection anastomosis in 5[14.7%], Right Hemicolectomy in 5 [14.7%] and adhesionolysis and biopsy in 3 [8.8%] patients. Diagnosis in these patients was confirmed with biopsy. Morbidity and mortality in this group was 40.2% and 17.6% respectively. Early diagnosis of the abdominal tuberculosis is possible only by the specific investigations like PCR. As these are not available in the remote areas of Sindh so the general surgeons in the peripheral tertiary care hospitals have to face such patients with complications. Early diagnosis of ATB can be made by high index of clinical suspicion to symptoms of abdominal pain, weight loss, low grade fever and vague ill health of more than one month duration and refractory to conventional treatment associated with raised ESR, positive Montoux test. To above symptomatology if empirical ATT is started early many of the complications of ATB can be avoided

Comparison of fissurectomy vs lateral internal sphincterotomy in chronic anal fissure surgery

Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Although lateral internal sphincterotomy [LIS] is an effective treatment of chronic fissure in ano, it has the potential to cause serious complications, the most distressing of which is incontinence to flatus and fecal soiling. We proposed fissurectomy [F] as an alternative surgical treatment. Experimental and Comparative Study. This study was conducted at Surgical Department, Ghulam Mohammad Mahar Medical College Sukkur. One hundred twenty four patients, divided into two groups. Sixty patients underwent fissurectomy and 64 underwent lateral internal sphincterotomy. After a median follow-up of 18 months, we compared the results of the two procedures. In addition to frequent visits on a predetermined basis, a telephone inquiry into fissure recurrence and continence status was made. All patients in either group were pain-free and without bleeding within one week. In both groups, urinary retention was noted in two patients. Incontinence to flatus occurred in four patients [6.2%] in the LIS group, but no incontinence was noted in the F group. There were two patients [3.1%] with fissure recurrence in the LIS group, but no one in F group. No patient in either group was afflicted with anal stenosis or perianal infections. All wounds healed within 6 to 8 weeks. 58 patients [96.6%] in the F group and 56 [87.5%] in the LIS group reported satisfactory results. In surgical treatment of chronic anal fissures not responding to conservative management, fissurectomy may be a sphincter-sparing alternative and perhaps a preferable surgical technique