Operative notes at surgical units of a tertiary care hospital

To assess the quality of operative notes in general surgery procedures. Descriptive study. Civil Hospital Karachi. Operative notes for all procedures were typed and saved in a data retrieval system [Health Management and Information system, DOTS'78]. A proforma was designed in accordance with the standards prescribed by Royal College of Surgeons of Edinburgh [RCSE] for taking down surgical case notes. The operative notes were studied and a proforma was filled for each. These were then compared with the prescribed standard for completion of documentation. The data was analyzed on SPSS 13. Out of a total of 100 notes, 99 had operating surgeons name mentioned, however, the time of surgery was missing in all. Approximately half of the notes surveyed did not mention the incision type, while operative diagnosis was mentioned in 92% of the notes. Post operative instructions were mentioned in 89% of the notes reviewed. Standardized notes documentation was not found in the present study in most of the cases

Laproscopic versus open appendectomy: a comparative study

To compare the results of open with laparoscopic appendectomy in terms of postoperative pain, rate of wound infection and hospital stay. This quasi-experimental study was conducted in Deprtment of Surgery, Ziauddin University Hospital, Karachi, over a period of six months. Patients undergoing surgery for acute appendicitis were randomly assigned into one of the two groups [A or B] after obtaining written and informed consent. In Group-A patients underwent open appendectomy and in Group B laparoscopic appendectomy was performed. Post operatively pain chart and wound infection was recorded and, at the time of discharge, number of days in hospital was calculated. Sixty patients [38 male, 22 female], with clinical diagnosis of acute appendicitis based on Alvarado score of six and above, were included in the study. They were randomized into 2 groups of A and B with 30 patients in each group. Group-A comprised open appendectomy procedure and Group-B comprised laparoscopic appendectomy. Mean comparison of postoperative pain by visual analogue scale, was significantly low in Group B, compared with Group A, on day 0, 1 and 2. Number of days in Hospital was 4.1 +/- 0.8 days in Group A and 1.5 +/- 0.06 days in Group B. None of the patients in Group B, while 8 [26.67%] patients in-Group A, developed postoperative wound infection at 1 week follow up. Laparoscopic appendectomy is safe and effective. Wound infection and postoperative pain is significantly lower after this mode of surgery

Laparoscopic cyst-gastrostomy for pancreatic pseudocyst

Pancreatic pseudocyst Is a complication following resolution of pancreatitis. The optimum treatment for this condition has been under much debate. Laparoscopic surgery has changed the outlook of surgical management for the condition by reducing the operation related morbidity. The procedure has not been reported in local literature and is relatively new for the medical-surgical community. We report a case of pseudocyst gastrostomy and explain the procedure through laparoscopic approach

Complete androgen insensitivity syndrome

The incidence of Complete Androgen Insensitivity Syndrome [CAIS] is about 1 in 20.000. People with CAIS are normal appearing females, despite the presence of testes and a 46, XY chromosome constitution. We came across a case in which a 17 years old girl presented with the complaint of inguinal hernia and amenorrhea. Subsequent investigations were done revealing absence of female internal genitalia and the presence of abdominal mass, possibly testes. Syndrome has been linked to mutations in AR, the gene for the human Androgen Receptor, located at Xq11-12 leading to the insensitivity of the receptor to testosterone. Gonadectomy was performed and life long Hormone replacement therapy was advised

Instrument failure: a preventable cause of conversion in laparoscopic cholecystectomy

This study was done to assess the association between quality of laparoscopic instruments and the incidence of conversation from laparoscopic to open cholecystectomy. Observaional and descriptive study from October 2004 to September 2006. This study was conducted at Baqai Medical University Hospital and two other private hospitals in Karachi. All patients who underwent laparoscopic cholecystectomy, including those that had to be converted. The records of all attempted laparoscopic cholecystectomies were studied retrospectively. Apart from demographic data, the clinical diagnosis, histopathology, conversion rate and quality of the instrument i.e. old or new was studied. SPSS Version 11 was used for statistical analysis. The frequencies were drawn and association between conversion rate and quality conversion rate and quality of instruments was noted using odds ratio. Laparoscopic cholecystectomy was attempted in 93 patients during the study period. Amongst them 79 were females and 14 males, with an age range 16 to 72 years [mean 46 years]. Seven [7.53%] patients had to be converted from laparoscopic to open cholecystectomy. The causes of this conversion were instrument failure in five cases, CBD stone in one and unclear anatomy at Calot's triangle in one case. The laparoscopic instrument that failed during surgery included insufflators in two cases while monitor, camera, and clip applicator, each in one case. Fifty six surgeries were performed with old instruments and 37 with new instruments. Correlating the two variables i.e. conversion rate and quality of laparoscopic instruments revealed that only one case was converted with new instrument, while six conversions were with old instrument. All the instrument failures were with old instruments and the odds ratio was 4.32. The chances of conversion from laparoscopic to open cholecystectomy are 4.32 times more if old instruments are used compared to the new ones. The difference in conversion rate due to instrument failure is stasitically significant