Total thyroidectomy for multi - nodular goitre

To assess the efficacy and safety of total thyroidectomy for benign multi-nodular goitre. Descriptive study. The study was conducted in the Department of General Surgery, Combined Military Hospital Kharian from January 2004 to December 2008. A total of 66 patients with bilateral benign multi nodular goitre [61 females and 5 males] underwent total thyroidectomy. Sixty two cases were euthyroid while 4 had hyperthyroidism Surgical dissection techniques involved identifying both recurrent laryngeal nerves through out their course, securing of parathyroid glands with their intact blood supply and ligation of inferior thyroid artery branches close to the thyroid capsule. All the patients were evaluated post operatively for signs of recurrent laryngeal nerve injury and hypoparathyroidism and other complications. All patients were put on thyroxin replacement therapy post-operatively and were followed for 9 to 12 months. There was no injury to the recurrent laryngeal nerves. One case of injury to external laryngeal nerve was found. Transient hypocalcaemia occurred in 4 patients without permanent hypoparathyroidism. All cases of transient hypocalcaemia recovered fully within 3 months. Four patients had occult malignancy diagnosed post-operatively on histo-pathology. In experienced hands total thyroidectomy is an effective and relatively safe operation for benign multi-nodular goitre and its complication rate is same as that of a sub-total thyroidectomy

Elective midline laparotomy; comparison of diathermy and scalpel incisions

To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Aprospective, experimental comparative study. Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 [ +/- 14.47] while it was 44.92 [ +/- 15.87] in diathermy group. The mean incision related blood loss in Scalpel 2 2 group was 1.53 [ +/- 0.20] ml/cm and in Diathermy group was 1.43 [ +/- 0.20] ml/cm, showing significantly less bleeding in diathermy group [p-2 2 value= 0.014]. Diathermy group, with incision related time of 6.20 sec/cm [ +/- 0.97 sec/cm], was significantly quicker [p-value= 0.003] than 2 2 scalpel incision, with incision time of 6.76 sec/cm [ +/- 0.84 sec/cm]. Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain

Vesico-vaginal fistula: interposition flap, a key to success

Vesico-vaginal Fistula [VVF] is an abnormal communication between bladder and vagina that causes continuous discharge of urine into vaginal vault. The objective of this study is to describe current trends of aetiology and repair of Vesico-vaginal Fistulae. This is a Descriptive Study, conducted at Armed Forces Institute of Urology, Rawalpindi and Combined Military Hospital, Kharian between May 2001 and May 2007. All patients diagnosed as cases of vesico-vaginal fistulae were included in the study. Their demographic profile and repair success was determined. A total of 86 patients were included in the study. The mean age of the patients was 35.5 years [range 25-46]. Total abdominal hysterectomy was the most common cause [53% of the cases] followed by obstetric causes [43.92% of the cases]. Success rate of the surgery in the study was 97.5%. The common causes of vesico-vaginal fistula in this study were total abdominal hysterectomy and obstetric causes. The success rate was high, yet the attempt should be made to prevent this socially distressing condition