Frequency of causes of mechanical bowel obstruction

Objective: To find out the frequency of different causes of mechanical bowel obstruction

Study Design: Observational / descriptive study

Place and Duration of Study: This study was carried out the Surgical B Unit of MTI, Lady Reading Hospital Peshawar from March 2015 to December 2015 Patients and Methods: All the patients presented with signs and symptoms of bowel obstruction were included in the study while those with non mechanical bowel obstruction like paralytic ileus and peritonitis were excluded from the study. Patient's demographic features and all the data were recorded

Results: Total 50 patients were included in the study. The age range of the patient was 15-80 years with mean age was 42,98 +/- 17.60 years. Thirty seven 74% patients were male and 13 [26%] were female constituting male to female ratio of 2.84:1. Out of 50 patients operated for mechanical bowel obstruction, commonest cause of bowel obstruction was post operative adhesions which accounted for 17 [34%] followed by sigmoid volulus in 10 [20%] cases and intestinal tuberculosis in 8 [16%] patients

Conclusion: Adhesions and sigmoid volvulus were the common causes of intestinal obstruction

Although patients presenting with sub acute intestinal obstruction can be treated conservatively initially, should they develop signs and symptoms of gut ischemia, when conservative treatment fails or in most cases of acute intestinal obstruction immediate surgical exploration is still required

Ileostomies and colostomies; common reasons and complications of construction: one year study

Background: An intestinal stoma is an opening of intestine on the anterior abdominal wall made surgically. The commonly performed procedures include colostomy and ileostomy. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it

Objective: To identify indications for commonly performed intestinal stomas and to study complications related to it

Study Design: Observational study

Setting: Department of General Surgery, Unit- B, Lady reading Hospital, Peshawar

Period: 1[st] Jan 2013, to 31[st] Dec 2013

Subjects and Method: A total of 106 patients who underwent surgery and ended up in intestinal stomas, ileostomy or colostomy, were included in the study. Indications, immediate and late complications of stomas were recorded

Results: A break up of 106 patients of different intestinal stomas. Majority [61.32%] of patients were males. There were 49 ileostomies and 57 cases of colostomy making a total of 106 patients. Main indications of Ileostomy were enteric perforation [55.10%], and intestinal tuberculosis [20.40%]. Main indications of colostomy were penetrating injuries [50.88%], and intestinal obstruction. In a total of 106 stomas local complications appeared in 23 [21.69%]. Skin excoriation, ulceration, lap and wound infection were the most common respectively. Seventy eight stomas including 36 ileostomies and 42 colostomies were closed on an average of 3 months after primary operation. There were 7 cases of wound infection, 2 anastamotic leak-ages and one mortality [1.3%] in the stoma reversal group

Conclusion: Common indications for intestinal stomas were abdominal penetrating trauma, enteric perforation, intestinal obstruction and intestinal tuberculosis. Main complications included local skin problems, wound infection and retraction

Frequency and causes of conversion of laparoscopic cholecystectomy into open cholecystectomy

To determine the frequency and causes of conversion of laparoscopic cholecystectomy into open cholecystectomy. Cross-sectional [descriptive] study. This study was carried out at Surgical Unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar for 14 months, from 1-11-2010 to 31-12-2011. A total of 126 patients of symptomatic gallstones disease fulfilling the inclusion criteria were subjected to laparoscopic cholecystectomy and were followed through out the procedure to see for any conversion and its cause. The mean age of patients was 40.65 +/- 10.35 with range of 20-65 years. The total no of cases converted to open cholecystectomy were 11 out of 126. Thus frequency of conversion was 11 equal to 8.7%, with commonest cause being adhesions 9 out of 11 converted cases followed by hemorrhage 2 out of 11 conversions. Moreover conversion was more in male patients. 20.8% as compared to 5.9% in females. Laparoscopic cholecystectomy is the gold standard treatment modality in the management of symptomatic gallstones disease. Its one disadvantage is the conversion into open procedure. But conversion should not be considered as complication of the procedure rather it is mature decision by the surgeons to avoid unnecessary lengthening the duration of surgery once they encounter any difficulty or interoperative complication

Frequency of diaphragmatic trauma in fire-arm injury of abdominal cases and outcome of its management

To determine frequency of diaphragmatic trauma in fire-arm injuries of abdomen and to determine outcome of its management. Retrospective study. This study was conducted at Department of Surgery, Unit B, Lady Reading Hospital Peshawar over a period of one year from January 2014 to January 2015. Record of all fire-arm injury cases, who presented during study period, was analyzed. Data were collected on pre-designed proforma from admitted patient record [patients charts] and operation theatre notes register. Demographic data, site and frequency of injury to diaphragm, operative findings, and outcome were the variables of study. Out of total 83 patients of fire-arm injuries, 14 [16.8%] patients had diaphragmatic trauma. Mean age of patient was 27.14 years. Male to female ratio was 4.9:1. Left dome of diaphragm was injured in 9 [64.28%] and right dome was involved in 4 [28.57%] of cases and in one patient [7.14%] patients central tendon of diaphragm was injured together with injury to pericardium that got expired. Diaphragmatic injury though not as common in abdominal fire-arm injury. There should be however very low threshold for suspicion in cases of fire-arm injury of abdomen, where bullet trajectory or mechanism of injury is suggestive, because missing such injury is not devoid of complications. The patient should be thoroughly examined and investigated for exclusion of diaphragmatic injury

Comparison of conventional pyodine dressing with honey dressing for the treatment of diabetes ulcers

To compare the conventional pyodine dressing with honey dressing in terms of recovery time and outcome [healed or ended up with amputation] in diabetic foot ulcers. This quasi-experimental study was performed in surgical "C" ward, Lady Reading Hospital Peshawar from November 2007 to November 2008. All Wegner's grade I-IV, unilateral diabetic foot ulcer patients were admitted and their blood sugar profile, cardiac and renal status were investigated. Patients were assigned to group A and B with simple convenience method. After ample wound debridement group A and B were treated with daily conventional Pyodine dressing and Honey dressing respectively and their recovery time, outcome were recorded during the 10 weeks follow up period. A total of 100 patients with 50 patients in each group A and B were enrolled in the study with mean age 56 +/- 8.0 years and male to female ratio of 1.7:1. Recovery time was significantly quicker in the Group B [Honey Dressing] as compared with the group A [conventional Pyodine dressing] with a p-valve of <0.0001. Healing rate was 69% and amputation rate was 31% as a whole. Healing rate was 66% in the Group A in comparison with 72% in the group B while amputation rates were 34% and 28% in the group A and B respectively with no statistical significance with a p-value of 0.6658. Honey dressing is more effective than conventional Pyodine dressing in terms of recovery time in the treatment of diabetic foot ulcer

Outcome of open versus laproscopic appendicectomy in department of surgery, lady reading hospital, Peshawar

To compare safety and benefits of laparoscopic versus open appendicectomy in a randomized control clinical trial. Between January 2008 and October 2009 one hundred and twenty patients [86 male and 34 female] with suspected acute appendicitis were assigned either to laparoscopic [n=60] or open [n=60] appendicectomy. Surgical technique was standardized for both laparoscopic and open procedure. The patients were analyzed in terms of the following aspects and findings; operation time, postoperative pain, intra and post operative complications, hospital stay and return to normal daily activities. There was no mortality. Wound infection [8.3%] and intra-abdominal abscess [11.6%] formation rate was significantly higher in open group than in the laparoscopic group [1.6%] and [3.3%] respectively. Postoperative pain scores [assessed by a pain distress variable, indicated on visual linear scale 0 to 10 and a pain activity scale, indicated on visual linear scale 0 to 10] was significantly lower in laparoscopic group. Hospital stay was significantly shorter in laparoscopic group [p<0.0353] and mean operation time was similar in both groups. One patient [1.6%] was converted from laparoscopic to open appendicectomy due to diffuse pelvic adhesions. Though operation time was same but complications, pain and hospital stay was less in the Laparoscopic group

Anatomical position of appendix in emergency care patients

To identify the anatomical position of the appendix in patients presenting at the emergency surgical ward, Lady Reading Hospital Peshawar. This descriptive study was conducted in surgical 'A' Unit, Lady Reading Hospital, Peshawar from January to June 2008. Patients coming to emergency surgical ward were examined after detailed history and investigation; and then operated. Position of appendix along with other findings was noted. 100 patients were admitted and examined. 68% were male and 32% were female. During surgery retrocaecal position was the most common [78%] followed by pelvic position in 16% of patients. Perforated appendix was observed in 06% [all retrocaecal appendixes]. Retrocaecal appendix was the commonest in patients presenting to emergency with acute appendicitis. Less symptoms/signs lead to delay in diagnosis and complications

Per-operative findings and post-operative complications with laparoscopic appendicectomy

To study the per-operative findings and post-operative complications that arise with laparoscopic appendicectomy. Material and Methods: This descriptive study was conducted in Surgical "A" and Surgical "C" Unit of PGMI, Lady Reading Hospital from April 2006 to December 2008. Patients with acute appendicitis, short history, age ranges from 15 to 50 years and recurrent appendicitis were included in this study, while patients with appendicular mass, appendicular abscess, pregnancy and with previous abdominal surgery were excluded. All the data was collected by using a proforma. Data was analyzed by descriptive statistics. Out of 60 patients admitted for Laparoscopic Appendicectomy [LA], 36[60%] were males and 24[40%] were females. Only 6[10%] patients required conversion from laparoscopic to open surgery. Problems and per-operative complications were encountered in 9[15%] patients. These were dense adhesions due to inflammation 4[6.66%], localized perforation 2[3.33%], diffuse peritonitis 2[3.33%] and bleeding during procedure 1[1.66%]. Postoperative complications were seen in 5[8.33%] cases, out of which 2[3.33%] patients developed port site infection, 1[1.66%] patient developed postoperative ileus, 1[1.66%] patient developed partial bowel obstruction and 1[1.66%] patient presented with right iliac fossa abscess. There was no mortality. All patients resumed normal activity within 6-7 days of operation and were well satisfied up to median follow-up of 5-6 months. Majority of the patients were males. Per-operative findings were adhesions, perforation and peritonitis. Post-operative complications were port-site infection, ileus and bowel obstruction. Majority recovered within a week time

Experience with the surgical management of fracture penis

To know the etiology, complications and outcome of surgical management of fracture penis. This descriptive study carried out in the surgical departments of Lady Reading Hospital Peshawar from April 2000 to March 2005. Patients with the clinical diagnosis of fracture penis were admitted and operated. All patients except those with haematuria were catheterized. Most of these patients were explored via a circumcoronal incision and the defect in the tunica of corpus cavernosum repaired with 3/0-vicryl suture. No drain was used and a light compression dressing was done in all patients. Catheter was removed on the second postoperative day. Follow up was arranged at 6 and 24 months of operation. During the study period 51 patients were operated for fracture penis. Mean age at presentation was 32 years. The commonest cause of fracture penis was manual fiddling with the organ to overcome an erection [39.2%]. The incidence of associated urethral injury was 1.96% [n=1/51]. The commonest mode of presentation was with a cracking sound, local pain and immediate detumescence [90%, 98% and 94% respectively]. Average hospital stay was 3.4 days. Immediate postoperative complication was urinary retention in 2 patients [3.92%]. Long-term complications were negligible. There was only one readmission at 6 months for urethral stricture that responded well to optical urethrotomy. The commonest cause of fracture penis is manual manipulation to overcome an erection. The best treatment option is immediate surgical repair

comparative study of various types of hemorrhoidectomy

To compare the outcome of various operative procedures of hemorrhoidectomy. This comparative study was conducted in Surgical Department, LRH, Peshawar, from March to December 2005. Ninety patients with 2nd and 3rd degree internal hemorrhoids, were randomly divided in to three groups of 30 patients each: "Group A" low ligation and excision with anal stretch. [Group B]: low ligation and excision without anal stretch. [Group C]: closed hemorrhoidectomy. Postoperative pain was present in 4 [13.33%] cases in [Group A] and 3 [10%] cases each in [Group B] and [Group C]. Postoperative bleeding per rectum was present in 2 [6.66%] cases each in Group A and Group B and 1 [3.33%] case in Group C. Postoperative urinary retention was observed in 1 [3.33%] case each in Group A and group B only. Postoperative wound infection and Postoperative peri-anal abscess were recorded in 3 [10%] and 1 [3.33%] patients respectively in Group C only. Postoperative incontinence of flatus was reported in 1 patient [3.33%] of Group A only. Postoperative skin tags were seen in 2 [6.66%] cases of Group A, 1 [3.33%] case in Group B, and none in Group C. Recurrence was not observed in patients during follow up. Mortality was not encountered in the three groups. No statistical significance was found in these three operative procedures with respect to less pain during the early postoperative period and faster wound healing with no recurrence in any group

Acute cholecystitis: immediate versus interval cholecystectomy

To compare the outcome of acute cholecystitis treated by early surgery with acute cholecystitis treated initially by conservative management and later on surgery after 6 weeks. Material and This prospective, comparative study was conducted in the surgical B unit PGMI, L.R.H Peshawar from June 1997 to-June1998. A total of 100 cases of acute cholecystitis were selected and divided into two groups. Half of the cases were selected for conservative treatment and half were treated with immediate surgery i.e. the next available list. of the two protocols were compared. Chi Square and student-t test was applied and level of significance was checked. Out of 100 cases, 50 were treated conservatively [Group B] and 50 were given the option of early surgery [Group A]. The results showed that patients of group "A" benefited more as regards early definitive treatment, less hospital stay and comparatively decreased cost of treatment. The patients of group [B] had to suffer two hospital admissions, frequent visits to hospital, double expenses and were on a constant risk of developing complications during their wait for surgery. There was no postoperative mortality and complications were few. It is concluded that patients received with acute cholecystitis at any time during the first 02 weeks should be treated by surgery as soon as possible

Sentinel lymph node biopsy in the management of axillary involvement in breast cancer

To know the efficacy of sentinel lymph node biopsy in the management of axillary involvement in breast cancer. Material and This study was conducted in Surgical "A" unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. A total of 30 patients with operable breast cancer diagnosed on fine needle aspiration cytology [FNAC] and clinically non-palpable lymph nodes in the axilla were studied. While on the operation table for modified radical mastectomy, one ml of sterilized solution of methylene blue was injected subdermally under the areola of the diseased breast. After 5-10 minutes sentinel lymph nodes were harvested via a small incision over the axilla, marked as blue nodes or blue lymphatics leading to a node. All the patients were females with mean age 45 +/- 13.48 years. Mean tumor size was 3.7 +/- 1.60 cm. The tumor was present in upper and outer quadrant in most [63.33%] of the patients. No complications were noted related to the procedure. The sensitivity of the method was found to be 85.7% and false negative rate was 7.1%. Sentinel lymph node biopsy with methylene blue is safe and cheaper and accurately predicts the axillary lymph node status in most of the patients

Morbidity and mortality in patients with colostomies - A study on 50 cases

To discuss the morbidity and mortality associated with the fashioning of colostomy and its closure. Material and This study was conducted in the Surgical 'A' unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. A series of 50 consecutive patients with colostomy for various indications were managed in surgical 'A' unit and emergency departments of LRH. Fire arm injuries [34%] were the most common indication of colostomy, followed by blunt trauma [26%], anorectal malignancy [14%] and sigmoid volvulus [12%]. Total of 20 patients suffered from 24 stoma related problems. The hospital stay was between 5-46 days. Thirty six of these patients under went colostomy closure with an average hospital stay of 11 days. There was one death. Careful stoma formation minimizes risks of complications associated with it. In our study there was no difference between single layer and double layer closure

Mortality and morbidity of abdominal inferior vena-caval injuries

To evaluate the outcome of abdominal inferior vena-caval [IVC] injuries in patients presented to Accident and Emergency Department, Lady Reading Hospital, Peshawar. Design: An observational study. Place and Duration of Study: The study was conducted at Postgraduate Medical Institute [PGMI]/Lady Reading Hospital, Peshawar, from January 1995 to January 2003, Patients and Case records of all patients operated within specified period for vascular trauma having injuries to the abdominal inferior vena cava. In all cases vascular trauma management was done mainly on clinical assessment in a low equipped set up. Data on age, gender, mechanism, nature and location of inferior vena-caval injuries, other vascular and non-vascular injuries were recorded. There were 22 patients, 77.27% male and 22.72% female. Age ranged from 10 to 40 years with mean age of 25.09 years. Majority of injuries were caused by penetrating injury [77.27%], blunt injury in 04.54% and 18.87% were iatrogenic. Majority [95.45%] were having single laceration of inferior vena cava and 04.54% were having more than one laceration. Associated vascular injuries involved aortic 9.09%, internal iliac in 4.54% and renal vein in 4.54%. Most common associated non-vascular injury involved small intestine [72.72%] and large gut [50%]. Inferior vena-caval injuries carries high mortality rate. When associated with multiple organ injuries and retrohepatic inferior vena-caval injuries are almost fatal

Surgical management of lumbar disc herniation by st and ard laminectomy in a periphery hospital; an experience with 64 patients

To study the outcome of surgical management of lumber disc hemiation by st and ard laminectomy procedure.This study was conducted in a periphery hospital, form March 2000 to July 2002. patient spresenting with bachache and leg pain were thoroughly investigated. For the confirmation of hemiated disc, myelography was performed in 50 patients, CT Scan in 10 patient and MRI in 4 patients. All patients underwent st and ard laminectomy. Patients were followed up after 3-4 weeks. Sixty four patient were operated upon for lumbar disc herniation. The youngest patient was 20 years old while the oldest was 65 years' old. All these patients underwent st and ard laminectomy. Forty six patient were males while eighteen were females. The majority of the patients were in the forth and fifth decade of life. Two patients developed discitis, four patients had dural tear during operation, two patients developed wound sepsis. Results of st and ard laminectomy for lumber disc herniation are favourable