Comparision of post operative chronic pain after excision of ilioinguinal nerve in lichtenstein's hernioplasty

Objective: To provide a comparative analysis of mean post-operative pain score after preservation and elective excision of ilioinguinal nerve [UN] using standard Lichtenstein hernia repair [LHR] technique

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Surgery Combined Military Hospital [CMH] Rawalpindi/ Peshawar, from 15 May 2013 to 15 May 2014

Materials and Methods: One hundred and fifty patients with diagnosis of inguinal hernia satisfying inclusion/exclusion criteria were included. Patients were divided into two groups randomly. In group A, UN was carefully protected while excision were done in group B. Demographic as well as data concerning groin pain at 03 months post operatively were collected and analyzed using SPSS

Results: A total of 150 patients were included. Mean age in group A was 37.32 +/- 10.45 years while in group B was 36.56 +/- 10.26 years [p=0.653]. Majority of the patients in both groups were male [group A 89.33% [67], 92% [69] in group-B], while female constituted only minority [8 [10.67%] in group A and 6 [8%] group-B], the difference being statistically insignificant [p=0.571]. Majority of the patients had indirect hernia and mean operation time was similar in both groups. Mean postoperative pain score was 3.76 +/- 1.11 and 2.82 +/- 0.677 in group A and B respectively, the difference being statistically significant [p<0.001]

Conclusion: Mean post-operative pain score is higher in preservation techniques compared to elective excision of UN for the treatment of inguinal hernia

Efficacy of vacuum assisted closure in management of open wounds as compared to moist wound dressing-experience at CMH Rawalpindi

Objective: To compare the efficacy of vacuum assisted closure [VAC] therapy against regular moist wound dressings in reducing the surface area of open chronic wounds by at least 5 mm2 in terms of early closure of wound

Study Design: Randomized controlled trail

Place and Duration of Study: This study was conducted at general surgery department CMH/MH Rawalpindi from Jun 2011 to Dec 2011 over a period of 06 months

Material and Methods: A total of 278 patients [139 in each group] were included in this study. Group A received VAC therapy while moist wound dressings applied in group B

Results: Mean age was 54.9 +/- 7.2 and 53.4 +/- 8.9 years in group A and B, respectively [statistically insignificant [p=0.12]. In group A, 96 patients [69.0%] and in group B 92 patients [66.2%] were male while 43 patients [31.0%] in group A and 47 patients [33.8%] in group B were female the difference being statistically insignificant [p=0.608]. In group A, 63 [45.3%] patients showed significant reduction in the size of the wound while only 41 [29.5%] patients in group B had adequate wound healing at the end of 04 weeks, the difference being statistically significant [p=0.0064]

Conclusion: VAC therapy decreases wound size more effectively than moist wound dressing technique. It definitely reduces hospital stay and ensures early return to work

Comparison of Negative Pressure Wound Therapy using Vacuum-Assisted Closure with Advanced Moist Wound Therapy in the treatment of Diabetic Foot Ulcers

Objective: To evaluate the clinical efficacy of Negative Pressure Wound Therapy [NPWT] using Vacuum Assisted Closure [VAC] compared with Advanced Moist Wound Therapy [AMWT] to treat Diabetic Foot Ulcer [DFU]

Study Design: Randomized control trial

Place and Duration of Study: Surgical Department, Combined Military Hospital [CMH] / Military Hospital [MH], Rawalpindi, from November 2010 to June 2012

Methodology: The study consisted of 278 patients, with 139 patients each in Group 'A' and 'B', who were subjected to AMWT and NPWT, respectively. Wound was assessed digitally every week for 2 weeks. Wound dimension and surface area were determined using University of Texas Health Centre at San Antonio [UTHCSA] image tool version 3.0. Efficacies of AMWT and NPWT were compared in terms of reduction in wound area over 2 weeks

Results: Mean age of presentation in group A was 55.88 +/- 10.97 years while in group B, it was 56.83 +/- 11.3 [p=0.48]. Mean duration of diabetes at presentation was 15.65 +/- 4.86 and 15.96 +/- 5.79 years in group A and B, respectively [p=0.74]. Majority of patients had Wagner's grade 2 ulcer [82% in group A and 87.8% in group B, p= 0.18]. Initial wound size in group A was 15.07 +/- 2.92 cm[2] and in group B 15.09 +/- 2.81 cm[2] [p = 0.95]. Wound size measured after 2 weeks, treatment was in group A 13.70 +/- 2.92 cm[2] and in group B 11.53 +/- 2.78 cm[2] [p < 0.001]. Wound area reduction in both groups revealed statistically significant faster healing in group B as compared to group A [p < 0.001]

Conclusion: NPWT using VAC was more efficacious than AMWT in the management of diabetic foot ulcers