Nutritional status of patients admitted in a general surgical ward at a tertiary hospital of Punjab

Nutritional assessment, as a method to identify malnourishment, has long been documented as an essential component of patient management which predicts adverse outcomes. The objective of the study was to find out the frequency of malnutrition and its association with the frequency of complications and deaths postoperatively. This study included all patients who were operated upon in a general surgical unit of Mayo Hospital, Lahore from June to August, 2013. Evaluation of 280 patients showed that 112 [40%] of the patients were malnourished, 90 [32%] were at risk of being malnourished and remaining 78 [28%] of the patients had normal nutritional status, according to the Subjective Global Assessment. Thirteen percent [13%] malnourished and 2 [3%] of the normally nourished patients died within 30 days of operation [p=0.001]. Incidence of complications in malnourished patients was 23 [20.53%] as compared to normally nourished patients [5.12%, p=0.006]. Malnutrition is very common in patients admitted to surgery wards of our hospitals. It adversely effects the outcome of surgical operations by increasing complications and mortality

Modified Kugel versus Lichtenstein operation for inguinal hernia repair: a prospective randomized study

Objectives: the purpose of this prospective randomized clinical study was to compare the outcome regarding pain and recurrence following Lichtenstein repair with Modified Kugel repair of inguinal hernias

Study Design: this was a prospective randomized clinical study

Materials and Methods: patients with inguinal hernia who were treated during Sep. 2010 to May 2012 using Preperitoneal Modified Kugel approach [PP group, n: 89] and the Anterior Lichtenstein approach [AL group n:87]. The operation time, hospital stay, postoperative complications and recurrence after surgery were assessed and compared statistically in both groups

Results: a total of 176 patients [173 men and 03 women] randomized to either group PP or group AL. No significant differences were observed regarding seroma and infection in both groups, however postoperative hematoma and operative time were higher in AL Group without any statistical significance [p< 0.098].The rate of recurrence and pain were significantly high with in AL group versus PP Group during period of follow up time [23.34 +/- 1.07 months Vs 23.01 +/- 0.13 months in group PP and AL respectively]. The operative time in Preperitoneal Modified Kugel Repair [PP Group] was 45.16 +/- 10.14 minutes and 52.34 +/- 07.04 minutes for Anterior Lichtenstein Repair [AL Group]

Conclusion: modified Kugel Repair of Inguinal Hernia is minimal invasive method and as safe as Anterior approach with less recurrence and pain than Lichtenstein operation

Experience of stapled haemorrhoidectomy operation at Mayo Hospital

The aim of study was to assess the outcome of treatment for 3[rd] and 4[th] Degree Haemorrhoids by a new surgical procedure- Procedure for Prolapsed Haemorrhoids [PPH] or also known as Stapled Haemorrhoidectomy [SH]. A prospective study at West Surgical Unit Mayo Hospital/ King Edward Medical University Lahore was undertaken of 32 patients between Oct.2004 and Jan.2006. The outcome studied were patients' profiles, length of operation, post-operative complications and recurrence. A total of 32 patients 13 women [44%] and 19 men [56%] had surgery. The median age was 36 [range 23-64] years. The main indications were bleeding 84.3 percent, heamorrhoidal prolapse with 4[th] degree were 59.3 percent. The median duration of operation was 19 [15- 34] minutes. Minor complications occur in two patients: bleeding in one and significant postoperative pain in an other patient. However, this is small study without any long term follow-up but our experience of stapled haemorrhoidectomy confirm it as a safe and effective procedure for prolapsed harmorroids

Presentation and management of pseudoaneurysms of femoral artery

This study reports our experience of presentation, diagnosis and management of femoral pseudoaneurysms [PSAs]. Design: Descriptive study. Place and Duration of Study: This study was carried out at South Surgical Unit, Mayo Hospital, Lahore over a 3-year period from January 2001 to December 2003. Patients and Data was collected noting patient's demographic characteristics, etiology of aneurysms, modes of presentation, management and outcome. Thirteen patients presented with femoral artery PSAs. All except 2 were young males. Nine patients had aneurysms following IV drug abuse. Three occurred following accidental trauma and one followed angiography access. Ten presented with overt external bleeding [leaking] while 3 had closed rupture. Two PSAs were initially mistaken as an abscess and incised resulting in sudden hemorrhage. All IV drug abusers [n=9] had initial proximal / distal ligation to stop bleeding. Five had no further symptoms of ischemia, one had mild claudication, one developed rest pain and had had extra-anatomical ileo-popliteal bypass through the obturator foramen. One further patient had crossover femoral grafting because of critical ischemia. Four non-infected cases were reconstructed using direct repair, 2 reversed vein grafts and one polytetrafluoroethylene [PTFE] graft respectively. One patient [11%] each had a major and a minor limb amputation respectively. One patient left against medical advice after proximal /distal ligation. There was no mortality. There was one documented instance of recurrent drug abuse of PTFE graft. Femoral PSAs in our study was mostly due to IV drug abuse. All PSAs were either leaking or had frankly ruptured on presentation. If significant ischemia develops on ligation, bypass through the obturator foramen, placing the graft in depth away from recurrent abuse, is a useful option. These patients also need dedicated psychiatric rehabilitation to prevent further IV drug abuse

Critical factors in determining mortality from penetrating abdominal vascular trauma: the Mayo Hospital experience

Mayo Hospital Lahore is a big and busy trauma center in Pakistan that receives a substantial number of patients with penetrating abdominal trauma. Vascular injuries in these patients are not uncommon. They are difficult to repair and are usually associated with a high mortality. The purpose of this study was to review treatment principles, complications and factors affecting the outcome variables in our setup in these cases, the main outcome variable being survival. Complete medical records of 411 patients with penetrating abdominal injuries, operated in our emergency over a four years period [January 1996 - December 1999], were reviewed. Amongst these 57[13.86%] had significant abdominal vascular injuries. The commonest afflicting agents were firearms [81%]. The overall mortality was 31.5%. The highest mortality was associated with retro-hepatic vena caval injuries [66.6%]. Very high mortality rates were seen in patients who were admitted with un-recordable blood pressure [72.2%] and in patients who had combined arterial and venous injuries i.e. more than one abdominal vascular injury [42.8%]. Mortality seems to be directly related to the site of the vascular injury [high for supra-renal / retro-hepatic vena caval injuries], the presence of shock on admission, free bleeding and the lack of retro-peritoneal tamponade at the time of surgery, and the presence of additional vascular injuries. The major cause of death in our patients was profound shock due to uncontrolled bleeding. Early diagnosis, prompt intervention and effective management could result in improved salvage rates