Prospective randomized study of comparative efficacy of Lichtenstein versus Darn inguinal hernia repair

Objective: To compare post operative pain and wound infection between mesh and Darn inguinal hernia repair

Study Design: A prospective comparative randomized, clinical trial

Place and Duration: The Study was conducted on 60 patients, 30 in each group during the study period of 8 months from 16th December 2006 to 16th August 2007 at Ziauddin Medical University Hospitals Karachi

Methodology: A total of 60 patients in the age range of 15-70 years with simple inguinal hernia were randomized in two groups i.e. Group A [Lichtenstein] and Group B [Darn] inguinal hernia repair. All inguinal hernias [Direct and Indirect], male patients were included while recurrent/ Obstructed / Strangulated / Irreducible Inguinal Hernia were excluded from the study. After surgery, postoperative pain was assessed using visual analogue scale [VAS]. Surgical wounds were also assessed by using Southampton wound grading score [SWGS] at 48 hours [before discharge] and 7[th] day [in the outpatient department]. Any seroma or infection at wound site if noticed within 7 days of surgery was also noted and all patient's related information was noted in pre set approved proforma from relative hospital's ethical review committee

Results: All were male patients with simple inguinal hernia, admitted through OPD in the ward. Fifty six [93%] out of 60 patients developed pain. Pain intensity was mild in [group A= 5[16.7%], group B= 2[6.6%]]; moderate in [group A= 20[66.6%], in group B=25[83%]] and severe in [group A= 3[10%] and group B= 1[3.3%]]; while no pain was seen in 2 [6.7%] patients in each group that was found statistically non significant [Chi square=2.84, P=0.42[ns]]. Ten [16.6%] out of 60 patients developed wound infection with 5[8.3%] patients of different wound grades in each group [Chi-square test of dependency [Chi square=2.891, P=0.82]]. Statistical analysis of this variable also found insignificant. Hypothesis was made that there is no significant difference in postoperative pain in both groups and Darn causes less postoperative wound infection than Lichtenstein repair

Conclusion: It is concluded that there is no difference in post operative pain and wound infection between well constructed darn and mesh hernia repair however study limitations are that it is of short duration with some shortage of sample size. A long-term study of around 10-15 years is still desirable to judge the both techniques in terms of recurrences

Histopathological Spectrum of gall bladder specimens after cholecystectomy

To determine the histopathological pattern of gall bladder specimens in patients undergoing cholecystectomy. This was a retrospective study carried out mainly at a private university hospital and two other non-teaching private hospitals of Hyderabad city over a period of three years from June 2005 to May 2008. Histopathology reports of all those patients who underwent cholecystectomy [open or laparoscopic] were analyzed. The records of these patients were scrutinized with particular emphasis on presentation, preoperative ultrasonographic findings, operative findings and histopathology results. A total of 282 specimens of gall bladder were subjected to histopathology during the study period. Among them 75 were of males and remaining 207 were of females. Chronic cholecystitis was the most dominant histopathology finding seen in about 64.5% patients followed by acute cholecystitis / empyema in 33.6% of patients whereas carcinoma of gall bladder was found in only about 1.4% of the patients. The commonest histopathological feature in this study was chronic cholecystitis

An audit of thyroid surgery: the Hyderabad experience

To make an audit of thyroid surgery performed in two private hospitals at Hyderabad. Descriptive study. This study was carried out at two private hospitals, mainly at Isra University Hospital, Hyderabad over a period of three years from April 2005 to March 2008. 140 patients with goiter were operated after complete investigative work up during the above mentioned period. Various complications of thyroid surgery and histopathology reports were noted and compared with national and international literature. The benign lesions were 89% while 11% lesions were malignant. Papillary carcinoma was the most common malignant lesion while colloid goiter was the most common benign lesion. The overall complication rate was 10.7%, hypocalcaemia being the most frequent complication followed by recurrent laryngeal nerve [RLN] injury. Colloid goiter is the most common benign lesion of the thyroid gland while papillary carcinoma is the most common malignant lesion of thyroid gland. The major complications of thyroid surgery were hypocalcaemia and RLN injury

Post thyroidectomy complications: the Hyderabad experience

Thyroidectomy is a very common surgical procedure worldwide and is performed by surgeons with varied training. The outcome and complication rates are largely dependent on surgeon's skill and experience, the extent of surgery, indication of surgery and number of thyroid surgeries performed at that particular centre. The objective of this study was to determine the frequency of postoperative complications after thyroid surgery in Hyderabad, Pakistan. It was a descriptive study and was carried out at 2 private hospitals including a teaching University Hospital over a period of 3 years from April 2005 to March 2008. All patients with goitre, who underwent any sort of thyroid surgery, were included in this study. Patients' bio-data including name, age sex, clinical status of thyroid, thyroid function tests, ultrasound, fine needle aspiration cytology and operative procedure, findings, post operative complications and histopathology reports were recorded. Data were analysed using SPSS 16.0. The overall postoperative complication rate was 10.7%. Postoperative hypocalcaemia was the most frequent complication observed in 3.5% of all patients followed by recurrent laryngeal nerve [RLN] injury noted in 2.8% patients. The less common complications were bleeding, seroma formation and wound infection. Majority of these complications were associated with total thyroidectomy, male gender, and in patients with age more than 30 years. The commonest post thyroidectomy complication was hypocalcaemia. Male gender, old age, and extensive thyroid surgery were associated with increased complication rate

Post-thyroidectomy sore throat: a common problem

To determine the frequency of postoperative sore throat after thyroidectomy under general anaesthesia with endotracheal intubation. This study was carried out at two private hospitals including a teaching University hospital i.e. Isra University Hospital, Hyderabad over a period of three years from April 2005 to March 2008. All patients who underwent different types of thyroid surgeries during above mentioned period were included in this study. All relevant data especially age, sex, weight, American Society of Anesthesiologist's [ASA] physical status of patient, type and duration of Surgery, operative duration, number of intubation attempts and size of cuffed endotracheal tube [ETT] used were recorded on a standard form. The patients were asked direct questions on first post operative day regarding sore throat. Post operative sore throat was observed in 112 [80%] patients. The ETT having diameter of 7.5 mm or more, extensiveness of thyroidectomy, age of more than 35 years and operative duration of more than one hour were the statistically significant factors contributing in the occurrence of post thyroidectomy sore throat. There was no statistically significant impact of gender and number of intubation attempts on the occurrence of post thyroidectomy sore throat. Postoperative sore throat is a common complication after thyroid surgery. Larger size of ETT, more extensive surgery, increased age and prolong operation are the main contributing factors for the occurrence of post operative sore throat

diagnostic value of fine needle aspiration cytology in thyroid nodules

The purpose of this study was to determine the diagnostic value of fine needle aspiration cytology [FNAC] for thyroid nodules. Descriptive study. This study was carried out at two private hospitals including a teaching university hospital i.e. Isra University Hospital, Hyderabad over a period of three years from April 2005 to March 2008. All patients with thyroid nodule [solitary and dominant], diagnosed on the basis of history, clinical examination and radiological investigations were included in this study. FNAC was performed by standard technique before undergoing operation for thyroid nodule and then the resected specimens were submitted for histopathology. The data was analyzed to determine the sensitivity, specificity, accuracy and positive and negative predictive values of FNAC for thyroid nodules. Overall, 142 patients underwent FNAC during the three years study period. Final histopathology confirmed benign lesions in 78 out of 84 FNAC proven benign lesions while 11 out of 12 FNAC proven malignant lesions were confirmed on final histopathology. The sensitivity and specificity of FNAC were found to be 65% and 98% respectively. The diagnostic accuracy was 92.8% whereas positive and negative predictive values were 91.6% and 93% respectively. FNAC is a highly sensitive, specific and accurate procedure for the diagnosis of the thyroid nodules. It plays a useful role in planning the surgical management of thyroid nodules as it helps significantly in differentiating between benign and malignant lesions

Thyroid scintigraphy: an overused investigation

Thyroid disorders are commonly encountered in general surgical practice. The purpose of this study was to determine how closely thyroid scintigraphy was ordered according to its indications in patients with thyroid diseases and the magnitude of its impact on the management. This cross-sectional study was carried out mainly at Isra University Hospital, Hyderabad over a period of 3 years from May 2005 to April 2008. All patients presenting with thyroid swelling and undergoing any type of thyroid operation were included in the study. Special emphasis was made on the indication of thyroid scintigraphy in these patients and its impact on the treatment. Out of 140 patients, 98 had thyroid scintigraphy done. Among these only 26 patients [26.5%] had it according the indication. In remaining 72 patients, thyroid scintigraphy did not reveal any added information to help in treatment plan. Thyroid scintigraphy is an overused investigation in thyroid patients. Routine use of thyroid scintigraphy in all goiter patients should be discouraged

Complications of laparoscopic cholecystectomy at Isra university hospital, Hyderabad

The main objective was to determine the complications of laparoscopic cholecystectomy [LC] and its causes at sra University Hospital, Hyderabad. This was a retrospective study carried out from July 2005 to June 2007. Data of all patients undergoing laparoscopic chotecystectomy during the study period and fulfilling the selection criteria was collected and analyzed retrospectively. A total of 216 patients underwent laparoscopic cholecystectomy with an overwhelming majority of females. The overall complication rate was 5%. The complications included bleeding [4/216, 1.8%] from cystic artery and gall bladder bed, port site infection [4/216, 1.8%], bile duct injury [2/216, 0.9%] and colonic injury [1/216, 0.4%]. The common causes of these complications were accidental injury to cystic artery, gross spillage of infected bile and erroneous clipping of common bile duct. Bleeding and Port site infections were the commonest complications followed by common bile duct and colonic injuries. The commonest cause of bleeding was cystic artery injury whereas the commonest cause of port site infection was gross spillage of infected bile

Etiological spectrum of obstructive Jaundice

The objective of this study was to determine the etiological spectrum of obstructive jaundice in this part of the world. This prospective study was carried out at Liaquat National Hospital, Karachi from March 1997 to February 2001 and later at Isra University Hospital, Hyderabad from January 2003 to December 2006. Sixty five patients with obstructive jaundice were included in this study. The data was collected with respect to patient's identity, age, gender and cause of the obstructive jaundice. Fifty seven percent of patient had malignant obstructive jaundice and carcinoma of head of pancreas being the leading cause of malignant obstructive jaundice. Forty three percent patients had benign causes of obstructive jaundice, choledocholithiasis being the most common benign cause. Choledocholithiasis and malignancy are the two major causes of obstructive jaundice

Appendectomy; comparison between laparoscopic and open method

The purpose of this prospective study was to compare length of hospital stay, in hospital complications and operative time between laparoscopic appendectomy [LA] and open appendectomy [OA]. This prospective study was carried out at King Khalid Hospital, Najran, Kingdom of Saudi Arabia over a period of 26 months from July 2002 to August 2004. Patients were randomly divided into laparoscopic and open appendectomy groups and length of stay, operative time and in hospital complications were noted. 60 patients underwent laparoscopic appendectomy and 65 underwent open. Operating time was longer in laparoscopic group but length of stay was shorter in laparoscopic group. Wound infection was the common complication in both group but it was higher in patients who underwent open appendectomy. Laparoscopic appendectomy can be performed with morbidity similar to open appendectomy and may actually have decreased wound infection rate

Laparoscopic cholecystectomy: Conversion rate and its causes at Isra university hospital, hyderabad

To determine the conversion rate of laparoscopic cholecystectomy [LC] and its causes at Isra University Hospital, Hyderabad, Pakistan. This was a retrospective study carried out at Isra University Hospital, Hyderabad from July 2005 to June 2007. All patients who were scheduled for LC for symptomatic gall stones were included in the study. Those with history of pancreatitis, jaundice, common bile duct dilatation, choledocholithiasis and gall bladder mass were excluded. A total of 216 patients underwent LC during the study period. The mean operating time was 45 minutes and average hospital stay was two days. The conversion rate was 4%, with commonest cause being dense adhesions. Laparoscopic cholecystectomy was a safe method of treatment with very low conversion rate

Hodgkins lymphoma in cervical lymphadenopathy

To determine the proportion of Hodgkins lymphoma in cervical lymphadenopathy. This is a prospective study conducted at Isra University Hospital, Hyderabad between January 2002 to December 2006. The data was collected for all patients presenting with cervical lymphadenopathy during the above mentioned period. All the patients with cervical lymphadenopathy were subjected to detailed history, clinical examination, investigations and histopathological examination. Out of 498 patients presenting with cervical lymphadenopathy, 40 patients were found to be having Hodgkin's lymphoma. The gender distribution was predominantly male making up about 80%. About 50% patients had mixed cellularity whereas about 37.5% patients had nodular sclerosis. Most of the patients were having stages II and III disease. The over all five years survival rate was about 75%. The proportion of Hodgkin's lymphoma in cervical lymphadenopathy is relatively low in our population as compared to the western world