Thyroid surgery complications: frequency of thyroid surgery complications and its association to the extent of procedure

Objectives: To Determine the frequency of thyroid surgery complications and its Association to the extent of procedure

Study Design: Cross sectional comparative study

Setting: Surgical and Radiological Department of District Head Quarters [DHQ] Hospital, Madina Teaching Hospital [MTH] and Allied Hospital Faisalabad

Duration: From December 2007 to December 2009

Subjects: 90 patients admitted with goiter due to benign diseases

Methods: In Group A, 30 patients underwent unilateral lobectomy. In Group B surgical procedure was Total Thyroidectomy. In Group C patients underwent Subtotal Thyroidectomy. Post operative complications were noted in each group and all three groups were compared

Results: we compared different complications like hemorrhage, respiratory distress, thyroid storm, and hypocalcaemia, injury to recurrent laryngeal or external laryngeal nerves or to cervical sympathetic chain, wound infection, and recurrence of goiter and hypocalcaemia. After excluding hypothyroidism as complication, [as all the patients in group B developed a hypothyroidism], in group A, one patient developed fore mentioned complications and in group B, ten patients developed complications. In group C complications noted in three patients were more as compared to group A but less as compared to group B

Conclusion: More extensive procedures are associated with greater number of complications in thyroid surgery

Enteric ileal perforation primary repair versus loop ileostomy

Objectives: The aim of this study was to record the outcome of enteric ileal perforation, managed by primary repair versus ileostomy in terms of post-operative complications, mortality rate and hospital stay

Design and Duration: Quasi experimental study from January, 2009 to August, 2010

Setting: Surgical Unit-V, District Headquarters [Teaching] Hospital, Punjab Medical College, Faisalabad

Methodology: During the period of study 46 patients of enteric ileal perforation were divided in two groups on consecutive sampling basis. Detailed data of each patient including presentation, operative findings, procedures performed, post-operative outcome and histopathology was entered on a specially designed proforma. The main outcome measures found significant were post-operative complications, hospital stay and mortality rate. The data was compiled and analyzed by using SPSS-1B

Results: 46 Patients of enteric ileal perforation were studied during the period of 20 months, divided equally in 2 groups, Group A [loop ileostomy] and Group B [primary repair]. An increased rate of post-operative complications was seen in Group B [primary repair] when compared with Group A [loop ileostomy] with 21.74% patients landed up in peritonitis secondary to leakage from primary repair and 17.39% ended up with controlled feacal fistula formation. Mortality rate was twice higher in Group B [primary repair] when compared with Group A [loop ileostomy]. A ratio of 1:2.75 days was observed between hospital stay of Group A [loop ileostomy] to Group B [primary repair]

Conclusion: Enteric ileal perforation still represents a disastrous complication of enteric fever and constitutes a good number of patients presenting in surgical emergency with acute abdomen. Exteriorization of perforation in the form of loop ileostomy is more appropriate option for such patients as compared to primary repair of the perforation when compared in terms of postoperative complications, hospital stay and mortality rate

Skin closure in laparotomy; delayed versus primary closure performed for generalized peritonitis

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Quasi experimental study from September, 2006 to March, 2007. Surgical floor of Allied Hospital, [Punjab Medical College] Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients [group A] were left open and closed on 4th day while that of next thirty patients [group B] closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence [16.66%]. Four belonged to group A [13.33%] and six belonged to group B[20%] [p<0.05]. In advancing age the infection rate was significantly high in the same group [p<0.01]. Regarding hospital stay of patients of two groups the difference was statistically significant. Group A [mean=7.77, std. dev=2.029 and std. error of mean=0.370]. Group B [mean=10.30, std. dev=4.822 and std. error of mean=0.880]. Regarding age the difference was not statistically significant between two groups. Group A [mean 30.47, std. dev=10.099 and std error of mean=1.844]. The data was analyzed using SPSS 17 Chi-square test was used to test the significance between qualitative variable, p<0.05 was considered significance. No matter how advanced new wound closure techniques are, wound infection is the single most important factor for wound dehiscence and it can be decreased by using delayed skin closure technique and meticulous post-operative monitoring and care

Patterns of presentation, surgical management and outcome of patients with degloving injures

To describe the patterns of degloving injuries and to identify the outcome of different management techniques in patients with degloving injuries in patients presenting at Allied and Divisional headquarters hospital, Faisalabad. Prospective case study from January, 2008 to July 2008. Surgical floor of Allied and District Headquarters [Teaching] Hospitals, Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed Proforma, compiled and analyzed by using SPSS. Between February 2008 and July 2008, a total of 50 patients were included in the study. The etiological factors were road traffic accidents in 78% [39 patients], rotatory machine accidents 16% [8 patients] and domestic trauma in the remaining 6% [3 patients]. Degloving injury more commonly occurred in the lower limb 44% [22 patients], upper limb 16% [8 patients], scalp 22% [11 patients], penoscrotal 10% [5 patients] and miscellaneous group 8% [4 patient]. Associated skeletal fracture was seen in 3 [6%] patients. With increasing road traffic accidents, there is a marked increase in patients presenting to emergency department with degloving injuries. Early recognition and well planned surgical approach is all it takes to prevent complications and salvage a limb

Incidence of abdominal tuberculosis in 186 cases of acute abdomen presenting in our surgical emergency department

Among 186 cases of Acute Abdomen, determining the frequency of abdominal tuberculosis patients with their outcome. A prospective case study from January, 2009 to June 2010. Surgical Unit-V District Headquarters [Teaching] Hospital, Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome and histopathology was entered on a specially designed Performa, compiled and analyzed. During the period of study, 186 patients presented in the surgical emergency with complaints of acute abdomen out of which 54 [29.03%] were of abdominal tuberculosis. Mean age of presentation was 27.3 years. Operative findings showed predominance of ileocaecal hypertrophic tuberculosis [tuberculous mass] in 18 [33.33%] patients, followed by tuberculous adhesions, ileal strictures and plastic gut.The surgical procedures were performed according to their intra-abdominal findings out of which right hemicolectomy with ileocolic end to end anastomosis in 18 [33.33%] patients remained the commenest procedure performed followed by segmental ileal resection anastomosis, ileostomy and stricturoplasty. 20 [37.04%] patients reported to have post-operative complications in which wound infection in 7 [12.96%] remained the highest occurring postoperative complication followed by intra-abdominal collection, anastomotic leakage and septicemia. Mortality rate among the patients of abdominal tuberculosis in this study remained 5.56%. Complicated abdominal tuberculosis is the most common pathology of acute abdomen. By proper management of pre-complicated abdominal tuberculosis, this disastrous stage of disease resulting in so morbidity and mortality can be reduced