Surgical site infection; frequency after open cholecystectomy using Southampton wound scoring system in surgical unit Khyber teaching hospital Peshawar

To assess the post operative wound complication after open cholecystectomy for uncomplicated Cholelithiasis. Cross sectional descriptive. Surgical unit of Khyber Teaching Hospital Peshawar Pakistan. 223 patients underwent elective open cholecystectomy January 2011 to July 2012. 90% patients had normal healing [grade 0 or I] ,7.5% had minor complications [grade II or III], 2.5% patients had major complication [grade IV or V] recorded during hospital stay. On follow-up in out-patient department 81%patients found to have normal healing [grade 0 or I], 15% patients had minor complications [grade II or III] and 4% patients had major complications [grade IV or V]. There was an increase noted in wound grades during follow up for surgical site infections as compared to their record during hospital stay. Southampton wound scoring system is a useful tool for detection of surgical site infection and standardization. Auditing of surgical site infection by Southampton wound scoring will help the patient, surgical team and sterilization protocol to be improved

First degree hemorrhoids; efficacy of injection sclerotherapy experience in surgical department

Traditionally the treatment of Ist, 2nd and 3rd degree haemorrhoids is conservative management with fibre rich diet and better defecation discipline. If symptoms prevail then there are a wide range of treatment modalities. To evaluate the efficacy of injection Sclerotherapy for First degree haemorrhoids using 5% Phenol in Almond oil. This case series study was conducted on 83 patients with first degree piles in Surgical-C unit, Department of Surgery, Khyber Teaching Hospital Peshawar from 01/09/2010 till 01/03/2011. After Informed consent, injection Sclerotherapy with 1-2ml of 5% Phenol in Almond oil was injected in the sub mucosal plane of each pile case above the dentate line. Patients were reviewed at 3 weeks interval for bleeding per rectum for effectiveness of the procedure. A total of 83 patients with first degree haemorrhoids included in the study out of which 62 [74.7%] were male and 21 [25.03%] were female with M: F=2.99:1. Average age 41.1 years+0.1 SD with range 20-60 years. Efficacy was observed in 68 [81.83%] patients where 15 [18.07%] patients showed no results. Injection sclerotherapy is simple, convenient and effective outdoor procedure for first degree haemorrhoids

Surgical management of hepatic hydatid cyst in children

To know the effectiveness of removal of hydatid cyst of liver along with pericyst [pericystectomy] as operative treatment, in terms of intra-operative and post-operative complications in the pediatric age group. This study was conducted on paediatric patients with liver hydatid cysts at Department of Paediatric Surgery, Lady Reading Hospital, Peshawar from January 2000 to December 2006. All patients with ultrasound findings for hydatid cyst disease of the liver were included in the study. They were evaluated according to age, clinical presentation, ultrasound and CT scan findings for operative management. After Laparatomy through right transverse incision, half of the contents of the cyst were aspirated, refilled with hypertonic saline solution of the aspirated volume and after waiting for five minutes Pericystectomy was carried out, followed by careful examination and stoppage of any leakage of blood or bile from the residual cavity. In infected cases the cavity was drained. Out of 21 paediatric patients operated for liver hydatid cysts during the study period, 11[52.4%] were girls and 10 [47.6%] were boys, with age ranging from 4 to 15 years. Cystectomy with tube drainage was performed in 20 patients while in one patient de-roofing was performed because of rupture. Hypertonic saline was used as a scoliocidal agent. There was no operative mortality. The mean hospital stay was 6.5+3.8 days. Recurrence after operation was seen in one [4.8%] patient. Hepatic hydatid cysts in children can be treated successfully by peri-cystectomy

Soave procedure versus duhamel procedure for the treatment of hirschsprung's disease

To compare the outcome and cost effectiveness of Soave's and Duhamel's procedures in patients with Hirschsprung's disease in our setup. Patients with clinical suspicion of Hirschsprung's disease were admitted to Paediatric Surgery Unit of PGMI/LRH, Peshawar from July 1998 to July 2003. Diagnosis was confirmed with full thickness rectal biopsy. Colostomy or ileostomy was performed. Stoma was utilized in all patients as a part of the pull-through operation. Staple [GIA 75TLC] was applied in Duhamel procedure with covering ileostomy or colostomy, while no covering stoma was provided in Soave procedure. Postoperative course was monitored and any complication encountered were noted. The results of the two procedures were analysed and compared. Out of 60 patients, 30 patients had Duhamel and 30 patients had Soave procedure. Age ranged form 12 months to 5 years. In Soave procedure, postoperative complications included chronic constipation [33.33%], wound infection [16.66%], anal stenosis [13.33%] and perineal soiling [13.33%]. In Duhamel procedure postoperative complications were wound infection [33.33%], chronic constipation [16.66%] and perineal soiling [13.33%]. Postoperative mortality was 3.3% [1/30] in Duhamel procedure. Hospital Stay was 5-7 days and 7-10 days and cost of the procedure Rs 2500-3000 and Rs 15000-20000 for Soave procedure and Duhamel procedure respectively. Duhamel procedure is more costly and has no better results of surgery than Soave procedure. Hence Soave procedure is more suitable in our set up

Comparison of Magpi and Mathieu repair in distal hypospadias

To compare the outcome of MAGPI and Mathieu Procedures in the treatment of distal penile hypospadias in children. Material and This prospective comparative study was conducted in the Department of Paediatric surgery Lady Reading Hospital, Peshawar from Jan 2002 to Dec 2002. A total of 40 children with distal hypospadias without chordae were selected. They were divided into two groups. Group one consisted of 20 children with glandular, coronal and subcoronal hypospadias without a groove in the glans penis. For this group MAGPI procedure was performed. Group two consisted of 20 children with coronal and subcoronal hypospadias with a groove in the glans penis. This group was managed with Mathieu procedure. of the two procedures were compared. Age of these boys ranged from one to 10 years. 32 children had coronal and subcoronal hypospadias while 8 had glandular hypospadias. Functional and cosmetic were good in Mathieu procedure but the fistula rate was more as compared to MAGPI procedure. Meatal stenosis was more commonly observed in MAGPI procedure. Observed P valve of 0.02 between two procedure is significant statistically. The MAGPI procedure was found to have better as the fistula rate was significantly less in spite of the frequent meatal stenosis