Evaluation of outcome of totally extra peritoneal laparoscopic inguinal hernia repair with Lichtenstein open repair

The objective of this study was to evaluate outcome of total extraperitoneal laparoscopic inguinal hernia repair with Lichtenstein open repair in terms of postoperative pain. Quasi experimental study. Surgical unit 1 Rawalpindi and Allied hospitals from January to June 2012. Sixty patients, with unilateral, primary, inguinal hernia were alternately allocated to undergo either total extraperitoneal [TEP] laparoscopic repair of inguinal hernia or Lichtenstein tension free, mesh repair of inguinal hernia. Pain scores at 12, 24, and 48 hours and at 7 days of follow up were noted using a visual analogue scale. Total number of intravenous injections of Diclofenac Sodium requested by the patient for pain relief was also noted. At 12 hours after surgery, the mean pain scores in the TEP group were 3.1 +/- 1.8 and in the Lichtenstein group they were 4.2 +/- 2.1 [p 0.031]. At 24 hours after surgery, the scores were 2.3 +/- 1.5 and 3.1 +/- 1.9 for the TEP and Lichtenstein groups, respectively [p = 0.026]. At 48 hours after surgery, the mean pain scores in the TEP group were 1.5 +/- 1.1 while in the Lichtenstein group they were 2.0 +/- 1.6 [p = 0.041]. At 7 days after surgery, the scores were 0.3 +/- 0.5 in the TEP group and 0.4 +/- 0.8 in the Lichtenstein group [0.137]. The mean number of injection of Diclofenac Sodium required by the TEP and Lichtenstein groups was 3.1 +/- 1.6 and 5.8 +/- 2.2, respectively [p = 0.011]. Less postoperative pain and requirement for analgesics were reported by patients who underwent total extraperitoneal laparoscopic repair of inguinal hernia as compared to those who underwent inguinal hernia repair by Lichtenstein tension free mesh hernioplasty

Cholecystectomy; laparoscopic vs open in patients with mild liver cirrhosis and symptomatic gall stones

To compare the operative time, blood loss, postoperative pain and length of hospitalization between open [OC] and laparoscopic cholecystectomy [LC] in Liver cirrhotic patients with Child -Pugh class A and B. Randomised Control Trial [RCT]. This study was conducted at Surgical department, Holy Family Hospital, Rawalpindi from Jan 2010 to Dec 2011. A total of 142 patients having Liver cirrhosis secondary to Hepatitis A and Hepatitis B, who presented in OPD and ER with signs and symptoms of gall stones were randomly allocated into two groups for open [OC] and laproscopic cholecystectomy [LC]. All of them were either in Child-Pugh class A or B. Data on the above two groups [LC and OC] was collected and analyzed for operative time, blood loss and length of hospitalization after operation. The mean blood loss in LC group was 61.33+39.64 ml vs 90.84+29.88 ml in OC group, Mean operation time was 50.49+18.26 min in LC group vs 59.22+15.66 in OC group which is statistically significant [p<.05]. In LC group, the mean hospital stay was 1.8+.97 days, while in OC group is 2.4+.91 days which is also statistically significant. LC [laparoscopic cholecystectomy] is a safe and effective approach for the treatment of symptomatic cholelithiasis in patients with mild cirrhosis with less blood loss, less postoperative pain, shorter operative time and decreased hospital stay

Innovation in medical education: implementation of problem based learning under the umbrella of a traditional curriculum - perceptions of students and faculty

To take the feedback of the students regarding the process of PBL, and of the faculty about student's performance. Descriptive study. The department of Medical education, Rawalpindi Medical College from 2007 till June 2008. The study was carried out in the first year class of 270 students at Rawalpindi Medical College. The Basic Sciences teaching was augmented by problem-based learning and integrated approach. Students of first academic year were allocated randomly to 20 batches each comprising 12-13 students. One facilitator was randomly allocated to each batch. Basic science faculty was made to participate actively in problem based learning along with clinical experts. The completed program was evaluated based on structured questionnaires. The response of students towards PBL as teaching strategy, was encouraging. Quantitative analysis showed that the mean score of the student's performance was 14.74 [SD +/- 3.255] out of 20. Most of the students [78.6%] agreed that the problem based learning facilitated their learning process whereas 6.5% disagreed and 14.9% did not comment. The study showed that it is possible to adopt problem based learning in the undergraduate medical course under a conventional curriculum

Perforated appendicitis: our local experience

To determine frequency of perforated appendicitis in patients presenting with acute appendicitis and association of perforation with the duration of symptoms in acute appendicitis. Observational study. The study was conducted in surgical unit I at Holy Family Hospital Rawalpindi. One hundred and fifty patients diagnosed as the cases of acute appendicitis were included in the study by a non probability convenience sampling technique. Later on, patients with no signs of inflammation of appendix on operation or histopathological report were excluded from the study. In these patients frequency of perforated appendix, duration of symptoms in patients with perforated appendix and association of perforation with duration of symptoms in acute appendicitis was determined. Among 150 cases, 47 patients [31.3%] had perforated appendicitis while 103 patients [69.7%] had simple acute appendicitis. 90 patients were male while 60 patients were female. 40 patients [85.1%] of perforated appendicitis had symptoms for more than 24 hours while 7 patients [14.9%] of perforated appendicitis had symptoms for less than 24 hours. Complications were high in the perforated appendicitis as compared to non perforated appendicitis. Average stay of the patients with perforated appendicitis was 3.33 days while with non perforated appendicitis was 1.75 days. No mortality was occurred in this study. Timely diagnosis of acute appendicitis and prompt surgical intervention can decrease the frequency and high morbidity due to perforated appendicitis

Role of nasogastric intubation after small bowel anastomosis

To determine advantages and disadvantages of postoperative nasogastric intubation after small bowel anastomosis. Quasi experimental. Surgical Unit-1, Holy Family Hospital, Rawalpindi, from December 2003 to December 2006. A total of 112 patients, undergoing small bowel anastomosis were equally divided in group I and II with and without postoperative nasogastric intubation respectively. Variables compared were number of patients having episodes of vomiting, change in abdominal girth, the time for onset of bowel sounds, time to begin per oral fluids, length of hospitalization and postoperative complications. In group-I, nasogastric tube was removed on an average after 3.1 days. Average postoperative nasogastric output was 357, 154 and 64 ml/day for day 1, 2 and 3 respectively. There was no statistically significant difference between two groups in abdominal girth before and after operation, frequency of vomiting, time taken for onset of bowel sounds and start of oral sips after operation, frequency of wound infection, anastomotic leak and mortality [p>0.05]. Length of postoperative hospital stay and frequency of postoperative respiratory complications were more in group-l as compared to group-II [p<0.05]. Nasogastric decompression does not provide added advantage after small bowel anastomosis

Laparoscopic cholecystectomy; randomized, controlled trial of bupivacaine injection to decrease pain

To determine if intraoperative instillation of bupivacaine into gall bladder fossa would decrease early postoperative pain after laparoscopic cholecystectomy, Double-blind, randomized, controlled trial. Surgical Unit-l, Holy Family Hospital, Rawalpindi and Surgical Unit-1, Benazir Bhutto Hospital, Two year study. Fifty patients underwent laparoscopic cholecystectomy group-A. They were compared with a control group of fifty patients who had laparoscopic cholecystectomy but did not receive bupivacaine Group-B. Instillation of 10 ml of 0.5% bupivacaine into gall bladder fossa intra operatively after removal of gall bladder. Visual analogue scale [VAS] pain scores assessed 3 times post operatively, at 1, 6 and 24 hours, using similar peroperative and postoperative analgesics in both groups. Mean VAS pain scores [range 0 [no pain] to 10 [severe pain]] at 1 hour and at 6 hours after surgery were 6.5 and 4.2 respectively, in the bupivacaine group [Group-A] compared with 6.2 and 4.5 respectively, in the control group [Group-B] [p =.085 and 0.078,sd=.919 and.495]. VAS scores at 24 hours postoperatively did not differ between the two groups [2.4 VS 2.5][p=.282,sd=.636]. Instillation of bupivacaine into gall bladder fossa has no effect on post operative pain control in elective laparoscopic cholecystectomy

Surgical audit using possum scoring system

Objectives: The objectives of this study was, to describe the efficacy of a simple scoring system [possum] for surgical audit system

Design: This was a descriptive study

Place and Duration of Study: Surgical unit-/, Holy Family Hospital Rawalpindi Pakistan from April, 2001 to October, 2001

Patients And Methods: A total of 500 cases were studied. The physiological score was calculated at the time of admission whereas operative severity score at the time of discharge. By using logistic regression analysis the mortality and morbidity rates were predicted and the outcome measured. The O: E ratio and sensitivity and specificity calculated. Significance assessed by Chi square analysis

Results: The scoring system studied, provided the assessments for mortality and morbidity, which did not significantly differ from observed rates [p < 0.001].

Conclusion: The POSSUM score provided a reasonably effective means of achieving comparison among the two-thirds of patients who underwent surgical procedure. All the data required was readily available from the patient's routine assessment, observations and investigations in all clinical settings. POSSUM provides a good assessment of the risk of mortality and morbidity in general surgical patients. This score can be effectively applied in all surgical setups in Pakistan. We stress that POSSUM should be used as an adjunct to surgical audit