Laparoscopic assisted right hemicolectomy. An experience of laparoscopic assisted right hemicolectomy in benign disease -- tuberculosis

To assess the outcome of laparoscopic assisted right hemicolectomy in benign diseases like tuberculosis. Prospective observational study. Surgical unit-I of Jinnah Hospital Lahore. Jan 2009 and June 2010. This study included a series of twenty patients with preoperative clinical diagnosis of ileocecal tuberculosis. A three trocar technique was used to perform laparoscopic right hemi colectomy and anastomosis was performed outside the abdomen by extending the supraumbilical incision. Data of 20 patients who underwent laparoscopic assisted right hemicolectomy was analyzed. Mean age of the patients was 27.5 years with male to female ratio 4:1 [Table-I]. There was zero conversion [0%] to open surgery and no intra-operative complications [0%] were observed. Average hospital stay was 5.8 days. No patients had to be re operated. On histopathology of specimen final diagnosis was 95% ileo cecal tuberculosis and one patients [5%] turned out to be having lymphoma [Table-III]. The laparoscopic colon surgery can produce excellent results in selected patients of abdominal tuberculosis. Advantages of laparoscopic over open surgery include less postoperative pain, short-term postoperative ileus, earlier return to daily activity

Inguinal hernia repair; experience of laparoscopic total extaperitoneal approach

To evaluate early results of laparoscopic repair of inguinal hernia by totally extraperitoneal approach [TEP] performed. At Surgical unit III, Jinnah hospital Lahore. From August 2005 to July 2008. 97 patients over the age of 30 years underwent TEP repair of their inguinal hernia. Post operative assessment of the patients included pain score assessment and analgesia requirement, along with ability to walk upright comfortably, time taken to return to normal activity and early complications like seroma, haematoma, infection etc. Post-operative pain assessment at 8 hours after surgery showed 43[44.3%] patients required extra analgesia while 24 hours after surgery only 13[13.4%] patients required extra analgesia. Mean operative time was 95 min [range 55-130min] for unilateral hernia. However, as experience increased with TEP repair, mean operating time decreased to 75mins in the second half of the cases. 21[20.6%] patients at 24hrs and 51[52.6%] patients at 48hrs could walk upright without any help. Median period for return to normal activity at domestic level was 5days [range 3-23].Incidence of early complications is shown in table-Ill. Our results of TEP laparoscopic hernia repair are comparable to European experience in terms of postoperative pain, mobility of patient and rehabilitation, as well as early complications

Varicocele - laparoscopic versus open ligation

Objective: Evaluation of the advantages and disadvantages of laparoscopic varicocelectomy and its comparison with open ligation of varicocele

Design: Prospective comparative study between two techniques of varicocelectomy

Place and Duration Of Study: Surgical unit III of Jinnah Hospital, Allama Iqbal medical college, Lahore over a period of two years from January 1, 2002 through December 31, 2003. Subjects and Methods: Study comprised of two groups [A and B] with 52 consective patients fulfilling the inclusion criteria and comparative variables. Laparoscopic varicocelectomy [LPV] was performed on 26 patients [Group A] and open Palomo varicocelectomy [OPV] was performed on 26 patients [Group B]. Outcome data looked at relapse rate, postoperative hydroceles, wound complication and scrotal edema. Operating time, postoperative hospital stay and pain control were compared. In both groups operation was performed by Palomo technique i.e. ligation of both artery and internal spermatic vein in the retro peritoneum above the internal inguinal ring

Results: In LPV versus OPV group, the recurrence rate of varicocele was 3.8% in-group A versus no recurrence in-group B [p<0.001]. Postoperative hydroceles formation was 7.6% in group A versus 11.4% in group B [p < 0.003].wound complication was 3.8% in group A versus 7.6% in group B [p < 0.001]. Testicular or scrotal edema was 7.6% in group A versus 11.4% in group B.Postoperative hospital stay was 24 hours in group A versus 72 hours in group B [p < 0.001]. Operating time was 20 minutes in group A versus 30 minutes in group B [p <0.001]. Postoperative analgesia required was almost half in group A as compared to group B [p < 0.005]

Conclusion: The study shows that clinical efficacy of laparoscopic varicocelectomy is superior to traditional open varicocelectomy

Post operative urinary retention in general surgical ward

Two hundred and fifty consecutive patients who had under gone surgery under spinal and general anaesthesia were studied prospectively to determine the incidence of post-operative urinary retention. The sex and age of the patient did not affect the incidence of retention of urine. The use of long acting spinal anaesthetics and over enthusiastic treatment of post-operative pain with strong narcotic analgesics may be the important factors in post operative urinary retention

Effect of premedication on postoperative pain

Post Operative pattern of pain was studied in three groups i.e. A, B and C, of patients after giving different pre operative medications. In group A, which included 125 patients, 15 mg Medazolam [2 tabs. Dormicum 7.5 mg] was given with a sip of water one hour preoperatively. In group B, which included 123 patients, 10 mg Diazepam [2 tabs. Valium 5 mg] was given. In group C, which inlcuded 129 patients, placebo was given. All the patients were given standard general anaesthesia. Postoperatively they were nursed in the same unit and the time of requirement of first dose of analgesia was recorded. The intensity of pain and its relief was also recorded after giving analgesia. Out of the total of 377 patients 53 [18 in Group A. 16 in Group B and 19 in Group C] did not demand any analgesia postoperatively. It was observed that in group A, the patients demanded analgesia after a longer time as compared to those in groups B and C. Seventeen patients [8 in Group A. 4 in group B and 5 in Group C] asked for analgesia after 24 hours. Medazolam seems to keep the patient pain free longer as compared to diazepam. So it is recommended for pre-medication in preference to diazepam