Results of Primary Closure and Excision of Pilonidal Sinus Disease

Objective: The aim of this analysis was to determine the results of excision and primary closure of pilonidal sinus disease. Study Design: A Prospective Study. Place and Duration: In the Surgical department of PIMS Hospital Islamabad for the one-year duration from May 2018 to May 2019. Methodology: Eighty cases were included for excision with primary closure. Individuals having recurrent pilonidal sinus disease and with acute pilonidal sinus, abscess were excluded from the analysis. All subjects were operated in prone position under general anaesthesia. To clean the sinus tract; Methylene blue dye was injected. Postoperative complications and recurrence were recorded. All patients were followed at the outpatient department for three months and then every three months. Results: Eighty patients who met the criteria of inclusion were underwent surgery. 68 were male of the 80 patients, the female was 12, and 34 years was the mean age. Six days was the mean hospital stay and three weeks was the average duration when patients return to their work. From 80 patients; 10 (12.5%) had wound infection and 3 from them had minor wound infection. The seroma formation was noted in 5 (6.25%) which was aspirated. Only 6 patients had a recurrence, representing a 7.5% overall recurrence rate. Conclusion: It is concluded that pilonidal sinus disease primary closure and excision are related to early wound healing, short hospital stay, reduced chance of recurrence and rapid return to work.

Surgical site infection in diabetic and non-diabetic patients undergoing laparoscopic cholecystectomy

Objective: To compare the frequency of surgical site infections in patients with type II diabetes undergoing laparoscopic cholecystectomy as compared with non-diabetic patients

Study Design: Cohort study

Place and Duration of Study: Surgical Unit 2, Services Hospital, Lahore, from May to October 2012

Methodology: Patients were divided into two groups of 60 each, undergoing laparoscopic cholecystectomy. Group A comprised non-diabetic patients and group B comprised type II diabetic patients. Patients were followed postoperatively upto one month for the development of SSIs. Proportion of patients with surgical site infections or otherwise was compared between the groups using chi-square test with significance of p < 0.05

Results: In group A, 35 patients were above the age of 40 years. In group B, 38 patients were above the age of 40 years. Four patients in group A developed a surgical site infection. Seven patients in group B developed SSIs [p = 0.07]

Conclusion: Presence of diabetes mellitus did not significantly affect the onset of surgical site infection in patients undergoing laparoscopic cholecystectomy

Biodegradable synthetic polyurethane foam nasal packing after septoplasty

To determine the usefulness of biodegradable Synthetic Polyurethane Foam [SPF] nasal packing as an adjunct to day-case septoplasty. Comparative, observational case series. Aberdeen Royal Infirmary, University of Aberdeen, Scotland, UK, in the year 2011. One-hundred consecutive patients who underwent septoplasty and received SPF packing in 2010 were prospectively audited while one-hundred consecutive patients undergoing septoplasty in the year 2000 were studied retrospectively. Data collected include demographics, type of operation and duration of hospital stay. Excel and SPSS were used for data collection and analysis. In the year 2000, the average age of the patients was 40.6 years. There were 37 females and 63 males. One patient returned home the same day, 22 stayed one night, 69 spent two nights and 8 stayed more than two nights in hospital for their operation. The average length of stay was 1.84 nights. In 2010, the average age of patients was 37.86 years, with 31 patients being female and 69 male. All patients in this cohort received SPF packing postoperatively. Seventy-three patients went home the same day, 24 patients stayed one night and 3 patients spent two nights in hospital for their operation. Average length of hospital stay was 0.3 nights. Results were statistically significant [p < 0.001]. SPF was a useful nasal packing option after septoplasty and inferior turbinate surgery, which enabled the surgeons to carry out this surgery safely as a day-case procedure

Comparison of laparoscopic total extraperitoneal repair with Lichtenstein repair in inguinal hernia

Objective: To compare the laparoscopic inguinal hernia repair with Lichtenstein repair in terms of hospital stay and postoperative pain

Study design: Randomized clinical trial

Place and Duration of study: Department of Surgery Services Hospital Lahore, from September 2013 to May 2014

Methodology: Inguinal hernia patients were admitted electively. They were randomly assigned into groups A and B. The group A patients were treated with laparoscopic total extraperitoneal repair [TEP] and group B patients underwent Lichtenstein's repair. Patients were evaluated for 24 hours discharge rate and postoperative pain

Results: A total of 100 patients were included with 50 patients in each group. Group A patients had short hospital stay [discharged within 24 hours - 68.08%] as compared to group B [31.91% -p <0.001]. From 2[nd] to 6[th] postoperative week group A patients had significantly less postoperative pain as compared to group B [p <0.05]

Conclusion: Laparoscopic TEP repair was safe with early hospital discharge and less postoperative pain

Harmonic Scalpel versus electrocautery in axillary dissection in Carcinoma Breast

Objective: To compare the results between harmonics scalpel and electrocautery use in axillary dissection for carcinoma breast

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Surgery, Services Hospital, Lahore, from December 2013 to June 2014

Methodology: Eighty patients fulfilling the inclusion criteria were selected and equally divided in two groups. Axillary dissection for carcinoma breast was performed by using the harmonic scalpel in one group and by using electrocautery in the other group. Total mean axillary drain output and frequency of axillary numbness were noted in both groups and compared

Results: All the patients were females with mean age of 53.52 +/- 9.8. Mean axillary drain output in harmonic scalpel group was 167.75 +/- 43.90 as compared to 310.00 +/- 60.09 in electrocautery group while only 12.5% of patients were positive for axillary numbness in harmonic scalpel group as compared to 100% of patients who were positive for electrocautery group

Conclusion: Use of harmonic scalpel in axillary dissection resulted in decreased total mean axillary drain output and lowered frequency of axillary numbness when compared to utilizing electrocautery

Mesh fixation vs. non-fixation in total extra peritoneal mesh hernioplasty

To compare mesh fixation with non-fixation and its effect on outcome. The interventional prospective study was conducted at the National Hospital and Medical Centre, Lahore from January 2007 to December 2008. After the two-year intervention period, the patients were followed up for 5 years. The selected patients were divided into two groups. In group 1, mesh fixation was performed with metal non-absorbable tackers and in group II no fixation of mesh was performed. Patients were followed up at 6, 12, 24 and 60 months. Of the 63 patients in the study, 32[50.7%] were in group I and 31[49.2% in group II. The Mean pain score in group I was 4.7 +/- 0.683 and 4.1 +/- 0.860 in group II [p< 0.001]. Urinary retention was more common in group 1 [p>0.05], while recurrence was more common in group II [p>0.05]. Pain was significantly less in the non-fixation group, while urinary retention and recurrence were not significantly increased. Non-fixation is a viable option for total extraperitoneal mesh hernioplasty and should be preferred over mesh fixation