Is there difference in chronic pain after suture and stapler fixation method of mesh in ventral hernia? a randomized controlled trial

Background and Objective: Chronic pain occurs in 20-30% of patients after hernia surgery. As a consequence of this chronic pain, almost one third of patients have limitations in daily activities. Frequency and severity of this pain varies with different techniques of hernia repair. The objective of this study was to compare polypropylene suture and skin staples for securing mesh in uncomplicated ventral hernioplasty in terms of acute and chronic postoperative pain and to compare the time taken for mesh fixation between polypropylene sutures and skin stapler in ventral hernioplasty

Methods: This study was conducted in Surgery Department of Dow University Hospital, Dow University of Health Sciences, Ojha Campus and included 53 patients from Jan 2015 to Dec 2016, after taking informed consent. All patients were operated under general anesthesia by the same surgical team. Patients were randomized into two groups; in one group mesh fixed with 2/0 polypropylene suture while in other group mesh stapler was used. Time taken to apply mesh was noted in minutes from laying the mesh over anterior rectus sheath to completion of fixation by either method. The severity of post-operative pain was measured with VAS [1-10] after one week, one month and after one year after surgery. Data was analysed using SPSS version 17

Results: Patient characteristics and operative outcome were similar in the two groups and statistically non-significant in both. Early postoperative pain was more after suture fixation but it was not statistically significant. Mean +/- SD pain score was after one week 3.47 +/- 2.7 after sutures while 2.91 +/- 1.88 after stapler. After four weeks, 0.40 +/- 0.49 after suture while 0.35 +/- 0.48 after stapler fixation. In both study groups 30-34% of the patients felt some pain in follow-up after one year. Severity of pain was 0.60 +/- 0.62 after suture while 1.65 +/- 1.94 after stapler fixation which is statistically significant as well [p<0.007]. Mean operative time was 15.33 +/- 6.33 minutes for suture fixation while 1.56 +/- 0.41 minutes for fixation by staples, p-value < 0.001

Conclusion: The method of fixation does not appear to cause significant difference in early postoperative pain but chronic pain is more after stapler fixation of mesh. However, operative time was reduced significantly in staple fixation group as compared to suture fixation group

Association between vitamin D deficiency and breast Cancer

Objective: To determine the association between vitamin D deficiency and breast cancer

Methods: This case control study included 94 female patients aged 20-75 years of any marital status and parity. Newly diagnosed 42 breast cancer patients who presented to surgical OPD of Dow University Hospital from Jan 2016 to June 2016 were included into the study as "cases" after informed consent. Age matched 52 females who presented to OPD for complain other than breast pathology were included as the "control group". The sociodemographic of both cases and controls and histopathological characteristics of cases were recorded. Serum 25-[OH]2D levels were studied by the ELISA technique and recorded in ng/ml. Vitamin D deficiency was considered at serum level less than 20ng/ml

Results: Mean age was 40.1 Years for controls and 47.6 Years for cases. Mean height, weight and BMI did not differ between cases and controls. Serum Vitamin D levels were significantly lower in cases [85.7%] than controls [55.8%]. The unadjusted and adjusted ORs for breast cancer in cases and controls showed a statistically significantly increased risk of breast cancer with low vitamin D concentration [p value0.003]. After adjustment for age, parity, BMI, sun exposure, economic status and education status the ORs [95% CIs] for breast cancer risk was 7.8 [1.99 - 30.58] for women with vitamin D concentrations <20ng/mL

Conclusion: Findings of our study conclude that vitamin D deficiency is associated with risk of breast cancer

Ultrasound findings in patients with mastalgia

Objective: To determine the frequency of different ultrasound findings in patients presenting with mastalgia

Study design: Cross sectional study

Place and Duration of study: Department of Surgery, Dow University Hospital Karachi, from January 2016 to June 2016

Methodology: This study included female patients of any marital status and parity who presented to surgical OPD of Dow University Hospital with the complaints of breast pain for more than one month duration. All patients were advised ultrasound breast after history and examination. The ultrasound findings were recorded on a performa

Results: A total of 70 female patients, aged 15-60 year, were included. Mean age of the patients was 30.07 year. Mean duration of breast pain was 5.3 months. Ultrasonographic imaging findings showed fibroadenoma in 22 [31.4%], a simple cyst in 18 [14.3%], malignancy in 1 [1.4%] and 6 [8.6%] patients had duct ectasia. Mastitis was shown in 3 [4.3%] and 1 [1.4%] had abscess on ultrasound. Other patients [n=27 - 38.6%] had completely normal breast on ultrasound, among them 81.5% had cyclic and 18.5% noncyclic breast pain. Out of 22 [31.4%] patients in whom ultrasound reported fibroadenoma; in 18 [81.8%] there was a single lump while remaining 4 [18%] had multiple lumps in single or both breasts. Ten patients had a cystic lesion reported on ultrasound, out of which 7 had 2 or more cysts while 3 had a single cyst

Conclusions: Patients presenting with mastalgia may have different pathologies. Ultrasound helps to determine the exact cause so that appropriate treatment for the cause of breast pain can be provided