Tibial shaft fractures: interlocking nail versus plating

Objective: To evaluate and compare the treatment results of tibial shaft fractures treated by two different methods, interlocking nail and plating

Study design: Randomized controlled trial

Place and Duration of study: Department of Orthopaedics and Traumatology, Lady Reading Hospital Peshawar, from February 2014 to February 2017.Methodology: A total of 50 patients with closed tibial shaft fractures were randomly assigned to two equal groups [one treated with closed interlocking nail and the other with plating]. Postoperative results were assessed at one year follow up with Ekeland and Thoresen criteria and graded as excellent, good, fair and poor. Complications like infection, delayed union, nonunion and knee pain were assessed and compared for each groups

Results: Mean age of interlock group was 36+/-10.6 year and plating group 35.1+/-9.9 year. Plating achieved excellent results in 72% patients while interlocking in 44% [p value = 0.04]. Postoperative infection, delayed union, knee pain and screw breakage were 20%, 24%,11% and 20% [ p value = 0.05] respectively in interlocking nail group but none in plating group

Conclusions: Tibial shaft fractures treated with plating gave excellent results with minimal postoperative complications than interlocking nail. We therefore recommend plating as a treatment of choice for treating such fractures

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

Autologous blood injection for lateral epidcondylitis of elbow

Objective: to determine the outcome after autologous venous blood injection in patients with lateral epicondylitis of elbow

Study design: descriptive case series

Place and Duration of study: Ayub Teaching Hospital Abbottabad and Saidu Teaching Hospital Swat, from August 2014 to March 2015

Methodology: patients having lateral epicondylitis of elbow were selected from the outdoor department.Two ml of autologous venous blood was drawn from the contralateral antecubital fossa of the patient and slowly injected into the site of maximum tenderness. Patients were advised to continue their normal daily activities and followed up at 2nd, 4th, 8th and 12th weeks post-procedure for assessment of intensity of pain using VAS pain score and Nirschl staging

Results: there were 38 males and 61 females with ratio of 1:1.6. The mean age was 40.91+/-8.21 year. The mean pre-injection Visual Analogue Score [VAS] and Nirschl score were 6.9+/-1.2 and 6.0+/-0.9. At follow up it decreased to 0.9+/-1.0 and 1.5+/-1.1 respectively

Conclusion: autologous blood injection is an effective way to treat patients of epicondylitis of elbow especially in refractory cases

Frequency and antimicrobial susceptibility pattern of methicillin resistant staphylococcus aureus in open fractures

Objective: to determine the frequency and antibiotic sensitivity of methicillin resistant staphylococcus aureus [MRSA] in open fractures

Study design: descriptive case series

Place and Duration of study: Orthopaedics and Traumatology Unit A Lady Reading Hospital Peshawar, from January 2014 to June 2016

Methodology: patients of both gender and all ages fulfilling the inclusion criteria were included in this study. Swabs were taken from wounds with Levine's technique and sent to the hospital laboratory immediately where standard methodology was adopted for culture and sensitivity of the pathogens in all cases and results were reported as per Clinical and Laboratory Standards Institute [CLSI] guidelines. All MRSA positive cases were isolated within 24 hours and the standard MRSA protocol implemented immediately

Result: a total of 200 open fractures were sampled over a period of two and a half years. Positive cultures of MRSA were obtained in 47[23.5%] patients. The mean age of the patient was 24 year [range 18 year to 52 year]. Males were 43[81.4%] while females 4[8.5%] in number. Open tibial fractures were highest [n=21, 44.6%] in number followed by femur [n=12, 25.5%]. Majority [n=15, 31%] of the fractures were Type IIIA. All of the isolated MRSA cultures were 100% sensitive to vancomycin, linezolid, teicoplanin, chloramphenicol and tigecycline while resistance was observed for ciprofloxacin, levofloxacin, clarithromycin, and erythromycin

Conclusion: methicillin resistant staphylococcus aureus infection in open fracture wound is not uncommon. The isolated pathogen showed a variable pattern of sensitivity and resistance to the antibiotics tested

Selection of lowest instrumented vertebra in the management of lenke 5 adolescent idiopathic scoliosis using pedicle screw instrumentation

Objective: To determine the lowest instrumented vertebra [LIV] in the management of Lenke 5 adolescent idiopathic scoliosis [AIS] patients using pedicle screw instrumentation. [PSI]

Study design: A retrospective review

Place and Duration of study: Department of Orthopedics and Spine Surgery, Ghurki Trust Teaching Hospital Lahore, from January 2014 to April 2016

Methodology: Analysis of radiographic parameters of 32 patients was done. The patients were grouped according to the LIV level; Group I [fusion to L3, n=25] and Group II [fusion to L4, n=7]. The Group I was further subdivided into IA [L3 crossed the mid-sacral line with rotation of less than grade II on bending films - n=14] and IIB [L3 did not cross the mid-sacral line or rotation was grade II or more on bending films n=11]. All the patients in the Group II had the same location and rotation of L3 in bending films as that of patients in the group IB. Patients with lowest instrumented vertebral tilt [LIVT] of more than 10[degree] or coronal balance of more than 15 mm, were considered to have unsatisfactory results

Results: LIVT was reduced from 20.8 +/- 6.3 to 5.5 +/- 2.9[degree] in group IA and from 24.1 +/- 8.2[degree] to 10.8 +/- 5.1[degree] in group IB and from 26.7 +/- 4.6 to 6.9 +/- 5.2[degree] in group II. A significantly less reduction was obtained in group IB [49.7%] as compared to group IA [88.4%] and group II [81.8%]. Unsatisfactory results were obtained in 1 [7.1%] patient of group IA, in 7 [63.3%] patients of the group IB, and in 1 [12.5%] patient of group II which was found to be statistically significant

Conclusions: For the correction of thoracolumbar / lumbar AIS with pedicle screw instrumentation, L3 can be selected as the LIV instead of L4, thus saving one distal motion segment, when preoperatively L3 crosses the midsacral line with a rotation of less than Nash-Moe grade II in both the active bending radiographs, otherwise fusion has to be extended to L4

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

Diagnostic accuracy of anterior drawer test in detection of anterior cruciate ligament tear using magnetic resonance imaging as gold standard

Objective: to determine the diagnostic accuracy of anterior Drawer test in detection of anterior cruciate ligament [ACL] tear, using MRI as gold standard

Study design: cross sectional study

Place and Duration of Study: department of Orthopaedics and Trauma, Khyber Teaching Hospital Peshawar, from March 2013 to September 2013

Methodology: patients presenting with post-traumatic knee pain and instability, were subjected to anterior Drawer test and then MRI of the involved knee was performed to match the findings of the two. The data was analyzed with SPSS version 10. Sensitivity, specificity, positive predictive value and negative predictive value were determined by taking MRI as gold standard

Results: a total of 115 patients were enrolled. There were 96 [83.48%] males and 19 [16.52%] females. On anterior Drawer test, true positive and true negative patients for ACL tear were 64 [55.65%] and 42 [36.52%] respectively while false positive and false negative patients for ACL tear were 3 [2.61%] and 6 [5.22%] respectively. The sensitivity and specificity of anterior Drawer test were 91.43% and 93.33% respectively while positive and negative predictive values were 95.52% and 87.50% respectively. The diagnostic accuracy was 92.20%

Conclusions: Anterior Drawer test has better specificity than sensitivity and high positive predictive value. It is more accurate in ruling out an anterior cruciate ligament injury

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

Non operative treatment; functional outcome of radius ulna diaphyseal fractures in children

Pediatric forearm fractures result in substantial morbidity and costs. Despite the success of public health efforts in the prevention of other injuries, the incidence of pediatric forearm fractures is increasing. Most forearm fractures occurred during the spring season. Objective of the study is to determine the functional outcome of conservatively treated radius ulna fractures in Children. Descriptive study. Department of Orthopedics and Traumatology, Khyber Teaching Hospital Peshawar. March 2009 to April 2010. Total 236 children with radius ulna fractures were manipulated and above elbow plaster Cast applied for 6-8 weeks and reviewed every second week. After plaster cast removal Pronation and supination measured with goniometer and fortnightly thereafter for 6 weeks. All the fractures united. Normal range of pronation and supination at the end of follows up period was in 182 [80.53%] children. Loss of pronation and supination of average 10 degrees were in 9[3.98%] patients. Patients having displacement of the fracture and opted for surgery were 35 [15.46%]. Closed reduction of diaphyseal fractures in children results in normal pronation and Supination in majority of the patients

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

Colorectal carcinoma; frequency of common histological types in patients below 40 years of age presenting to tertiary care hospital

Colorectal cancer is the second commonest cause of death in the world. Its incidence in young patients is on rise. To determine the common types of colorectal carcinoma in patients below 40 years of age presenting to tertiary care level hospital. Study Descriptive study It was carried out at Surgical Department, KTH, Peshawar January 2007 to January 2008. Total of 50 patients younger than forty years of age with colorectal cancer were included in study for the determination of histologic types. There were 66% males and 34% were females. The commonest affected age group was 31-35 years old having 46% cases. On history 86% patients complained of altered bowel habits and on clinical examination anemia was present in 72% patients. Left and right sided tumors were found in 70% and 30% patients respectively. Adenocarcinoma was the commonest type found in 94% cases followed by lymphoma [4%]. The incidence in young age group [

Efficacy in pain relief; fenestration technique for disc excision

To know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients with prolapsed intervertebral disc. Descriptive study. Department of neurosurgery of Hayatabad Medical Complex, Peshawar. October 2008 to September 2010. All those patients were included in whom straight leg raising [SLR] sign was less than 60 degree and prolapsed L4-5 or L5-S1 disc on MRI. Patients with multiple level discs, previous history of spine surgery, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in knee-chest position under general anesthesia. Efficacy of disc excision was measured using Dennis pain scale. Findings were documented on the day of discharge. Statistical analysis was performed with SPSS [version 10]. One hundred and nine patients were studied. Sixty were male and fifty nine were female patients. Age rang was from 19 to 52 years with mean age 34.31 years. The most common level of involvement was L 4 -L 5 [n=67] followed by L 5 -S 1 [n=42]. Sixty five patients had left sided symptoms while forty four had right sided. Majority of patients presented in Dennis pain scale 4 i.e. 66.97% [n=73]. Twenty patients [18.36%] were in P3 and 16 patients [14.67%] were in Dennis pain scale 5. Complete pain relief [P1], three weeks after disc excision, was achieved in 90 [82.57%] patients .Fourteen patients[12.85%] were in P2 and five [4.58%] patients in P3 according to Dennis pain scale. No patients in this study deteriorated after surgery. Surgical treatment provides quick pain relief in selected patients with prolapsed intervertebral disc. Fenestration with disc excision is quite a reasonable method to surgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of the offending disc. This procedure does not need greater know-how, expertise in instrumentation and techniques

Outcome of intramedullary kirschner wire fixation in children

To know the functional outcome of Intramedullary Kirschner Wire fixation of unstable Radius-Ulna fractures in children. Descriptive study. 27/03/2009 to 26/03/2010. Department of Orthopedic and Trauma, Khyber Teaching Hospital, Peshawar. All patients were admitted from OPD. Children less than 16 years with Unstable Radius-Ulna fractures were included in the study. Patients with open fractures and adults with polytrauma were excluded from the study. Unstable Radius-Ulna fractures were treated by Intramedullary Kirschner Wire fixation under general anesthesia and tourniquet control. Follow up till radiological and clinical union was done. K-wires were removed after healing of fractures. Patients were assessed functionally and radiologically and results were graded according to Price et al Criteria. A total of 64 children with unstable radius and ulna fractures were included in the study. The age range was 6 to 15 years with average age of 10.41 years. 47 were male and 17 were female. The average time of radiological union was 7 weeks and K-wires were removed at 8 weeks time. At final assessment there were 47 Excellent, 10 Good and 7 Fair results. Excellent results can be achieved by Intramedullary K-Wires fixation. In children with unstable Radius-Ulna fractures. It should be the method of choice for treating these fractures

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

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

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

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

Trauma management in a tertiary care hospital in Peshawar, Pakistan

With an increasing incidence of road traffic accidents and weapon injuries there is increasing need for improvement in trauma management. Liver being a highly vascular organ and strategically located is difficult to manage. Study was conducted in Surgical 'A' Unit, Lady Reading Hospital, Peshawar from August 2003 to September 2005. It was a descriptive study and all patients were operated in emergency department. All relevant data of patients were recorded from the emergency and admission protocols. A total of 364 trauma patients were received and among those 48 patients had liver trauma, 75% of patients had penetrating and 25% had blunt trauma. Most of the patients had grade III liver injuries. There were no grade V and VI injury. Repair with perihepatic packing for liver injuries remains the most frequently performed procedure [41% of patients]. In a stable patient blunt trauma liver can be managed conservatively by serial examinations and investigations with emergency laparotomy facilities at hand. Perihepatic packing and damage control surgery is the valuable procedure at hand. Increasing grades of liver injuries leads to increasing morbidity and mortality. The same is the case with multiple organ injuries

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