Thyroidectomy with ultrasonic dissector: an early experience at Lady Reading Hospital

To find out operative times and frequency of complications for total thyroidectomy using ultrasonic dissector. This descriptive study was conducted at Department of Surgery Lady Reading hospital, Peshawar, from October, 2011 till September, 2012 and included 58 patients. The study included those patients who underwent total thyroidectomy using the Harmonic Focus[R] for benign conditions. The age range of the sample was 21-63 years with a mean age of 33.6 +/- 3.4 years. Only five of all patients included were male with female predominance and having a benign disease. The Mean operative time was 59.3 +/- 14.1 minutes. The mean hospital stay was 3.1 +/- 0.65 days and mean blood in drain at 24 hours was 65.6 +/- 17.14 ml. Persistent hypocalcaemia and hoarseness at one week was observed in two cases each [3.44%].The use of ultrasonic dissector is safe and has significantly reduced operative time. Also there was less amount of blood in the drain at 24 hours

Prognostic indicators of surgery for esophageal cancer: a 5 year experience

To assess the prognostic indicators preoperatively presenting and influencing the mortality rate following esophagectomy for esophageal cancer. This study was a retrospective cohort study, conducted at the Department of Surgery, Lady Reading Hospital, Peshawar, from 1 January 2003 till 31 December 2008. Group 1 included patients who had undergone sub-total esophagectomy and were alive at completion of 12 months; whereas Group 2 included those patients who died by the completion of 12 months. Data were recollected from the Data Bank. A list of variables common to all patients from both groups was categorized and subsequently all data related to each individual patient were placed and analyzed on the version 13.0 of SPSS R for Windows. Significant findings of a lower mean level of serum albumin from Group 2 were observed, whereas serum transferrin levels, also found lower in Group 2, were not statistically significant. Findings of serum pre-albumin, with a mean value of 16.12 mg/dl [P<0.05] and Geansler's index for the evaluation of the presence of obstructive pulmonary disease prior to surgery showed a lower reading of mean ratio in Group 2. Anastamotic leak was not a common finding in the entire study. In most cases, the choice of conduit was the remodeled stomach. Nine patients from Group 2 were observed with evident leak on the fifth to seventh post-operative day following contrast swallow studies. This was statistically insignificant [P = 0.051] on multivariate analysis. Pre-operative variables including weight loss, low serum albumin and pre-albumin, Geansler's index, postoperative chylothorax, pleural effusion, and hospital stay, are predictive of mortality in patients who undergo esophagectomy for esophageal cancer

early closure of stoma warranted in the management of temporary loop ileostomy?

To assess the outcome of closure of temporary loop ileostomies by comparing frequency of post operative complication. This was an experimental study conducted at the surgical A unit of Lady Reading Hospital between Jan 2005 and Dec 2009. All patients who were primarily operated and ended up with temporary loop ileostomy were admitted via the out-patient department. Consecutively allocated into group A whose stomae were closed at 8 weeks and group B whose stomae closed at 4 weeks. Postoperative complications including wound infection, anastamotic leak, dehiscence etc. were recorded and statistical analysis done using version 13.0 SPSS for windows. Group A included 155 patients and Group B 156 patient with male predominance in both groups [p=0.869]. The mean age in both groups was similar 33.6 years and 32.7 years respectively. Anastamotic leak rate and wound dehiscence was lower in early closure group but p value was insignificant. The frequency of wound infection was higher in the early stoma closure group [p=0.001]. The mean hospital stay was similar. Apart from wound infection the frequency of complication following early closure [4 weeks] of temporary loop stoma is similar to delayed closure. Thus delayed closure of stomae should be abandoned

Polyglactine/polypropylene mesh vs. propylene mesh: is there a need for newer prosthesis in inguinal hernia?

To compare outcomes of light and heavy weight mesh for repair of inguinal hernia. This study was conducted at the Department of Surgery; Lady Reading Hospital, Peshawar from January 1, 2007 to December 31, 2008. Patients were divided into two groups based on the type of mesh implanted for inguinal hernia repair. Group 1 included patients in whom light weight composite [VyproII] mesh is implanted: Group 2 included patients in whom polypropylene [Prolene] mesh is implanted. Data concerning the complications and post operative pain in the perioperative and postoperative period were collected and analyzed. Categorical data were presented as percentages with 95% confidence intervals and compared using a x[2] test and P < 0.05 were considered significant. Following allocation and exclusion of violating cases, 111 patients in group 1 and 138 patients in group 2 were analyzed. The mean age in group 1 was 38.20 +/- 13.34 years and in group 2 was 39.55 +/- 13.70 [P = 0.434]. In group 1, hematoma formation was observed in four cases [3.6%] while it was observed in six cases [4.2%] in group 2 [P = 0.766]. During the entire study, ten patients in all developed urinary retention, three of which required transient catheterization. One year post operation, there was a recurrence in only five cases overall, while only two patients complained of pain [P = 0.826]. The frequency of postoperative pain and complications in patients was similar in both groups

Postoperative nasogastric decompression is not warranted in elective closure of gut stomas and bilioenteric anastamosis: a randomized controlled trial

To compare the outcome of postoperative nasogastric decompression versus no nasogastric decompression in cases of elective closure of gut stomas and bilioenteric anastamosis. This randomized trial was conducted from 01-01-2006 to 31-10-3006 at Lady reading Hospital, Peshawar on 119 patients admitted for stomal closure or Bilioenteric anastamosis. Group A included 58 patients subjected to postoperative nasogastric decompression and group B included 61 patients not subjected to postoperative nasogastric decompression. Out of 119 patients, 61 [Group A=30; Group B=31] patients underwent gut stomas closure and 58 patients [Group A=28; Group B=30] underwent Bilioenteric Anastamosis. Pediatric age group, oesophagogastric disease, emergency procedures and pre-operative co-morbid conditions were excluded. The male to female ratio in group A was 4:1 and in group B was 2.85:1. The morbidity between group A [60.0%] and group B [48.38%] was insignificant [p>0.05]. No mortality was observed during hospital stay in both groups. Length of hospital stay was 7.93+1.27 days in group A versus 6.54+0.85 days in group B. The number of nasogastric reinsertions was in 6 patients; three in either group with a delay of 2.6 days for duration of 3.1 days. Abdominal distension was observed in 12 [60%] cases of stomal closure in group A versus 7 [22. 5%] in group B. In patients undergoing bilioenteric anastamosis the mean stay in group A was no more than group B. Increase hospital stay and complication rates were observed in patients receiving nasogastric decompression compared to those without NG tubes

Early outcome of Lichtenstein technique of tension-free open mesh repair for inguinal hernia

To evaluate the early outcome of Lichtenstein's technique for repair of inguinal hernia using polypropylene mesh. This was a descriptive study conducted over a period of twelve months from 1[st] July 2007 to 30[th] June 2008 in Surgical 'B' unit, Lady Reading Hospital, Peshawar. One hundred and twelve patients were received through the out patient department with diagnosis of inguinal hernia. Inclusion criteria was patients above the age of 18 years, reducible hernia, evidence of swelling in groin >2 months. Exclusion criteria was age less than 18 years, chronic constipation, chronic cough, symptoms of prostatism, irreducible hernia, obstructed hernia, strangulated hernia and patients with diabetes mellitus. All the patients were subjected to inguinal mesh repair using the Lichtenstein technique with polypropylene mesh. Mean age of patients was 48.78 +/- 14.41 years. Sixty patients [53.6%] had right sided inguinal hernia while 46 patients [41.1%] had a left sided hernia and 6 patients [5.4%] had bilateral hernia. Sixty two patients [55.4%] had indirect hernia and 43 [38.4%] cases had direct hernia. Sixteen cases [14.3%] had previous history of surgery for hernia on the same side [recurrent hernia]. Mild pain was observed in 53 cases [47.3%], moderate pain in 42 cases [37.5%], and severe pain in 17 cases [15.2%]. Four patients [3.6%] in all developed a seroma Two patients [1.8%] developed a haematoma that required drainage. Three patients [2.7%] had a prolonged recovery and presented with abdominal distension. Five cases presented with infected wounds. Lichtenstein's technique of inguinal mesh repair is a safe and effective procedure but emerging trends anticipates the implementation of day case surgery