Inguinal hernia; mesh repair recurrence

To find out the frequency of recurrence in inguinal hernia mesh repair in Surgical Unit, Khalifa Gulnawaz Teaching Hospital Bannu / DHQ, Bannu. 60 consecutive cases of inguinal hernia [direct/ indirect] of either side, in this study were repaired by Lichtenstein's repair. The study was conducted from January, 2010 to October, 2010 with an initial follow up of one year. Cases above 76 yrs were excluded from the study. The procedure of choice for inguinal hernia repair is tension free mesh repair

Open haemorrhoidectomy versus rubber band ligation

To assess the results of open haemorrhoidectomy and rubber band ligation in terms of post operative pain and bleeding in 3rd degree haemorrhoids. A comparative study. Surgical unit Hayatabad Medical Complex Peshawar, from July 2009 to June 2010. A total of 100 patients were included. These were randomly divided in two groups; A and B and each group had 50 patients. Group A patients underwent open haemorrhoidectomy while group B patients had rubber band ligation procedure. Post operative complications like pain and bleeding between the two groups were compared. Out of 50 patients in group A, 72% [n=36] had pain and 20% [n=10] had post operative bleeding, while in group B pain was present in 08% [n=4] and post operative bleeding in 04% [n=2] patients. P values for pain [0.007] and bleeding [0.04] were significant in favour of group B. Rubber band ligation is a safe and quick procedure. It is associated with less intensity postoperative pain and bleeding as compared to open haemorrhoidectomy

Abdominal transpubic perineal urethroplasty for complex posterior urethral strictures: an experience of 10 years

To document the outcome of abdominal transpubic perineal urethroplasty for complex posterior urethral strictures. Descriptive case series Surgical unit Hayatabad Medical Complex and Khyber Teaching Hospital Peshawar, from March 1999 to February 2009. Abdominal transpubic perineal urethroplasty is an acceptable surgical approach in patients with complex posterior urethral stricture. Patients with complex posterior urethral stricture were included in this study. Pre operative evaluation included history, physical examination and laboratory investigations. Antegrade/retrograde urethrograms and cystourethroscopy were performed to evaluate bladder neck, and stricture site and length. Surgery was performed in lithotomy position through lower abdominal and perineal approaches. Patients were followed for 2 years. At each visit, ascending and descending urethrograms were performed and post operative complications were recorded. Results were graded as successful and failure based on stricture free rate at the end of 2 years A total of 28 patients were managed The age range was 14-36 year with a mean age of 27.3 + 2.4 year. Urethral stricture was associated with false passages in 17.88% cases, periurethral cavity in 10.71% and urethrocutaneous fistula in 7.14% cases. Mean operation time was 3.5 hours and mean hospital stay was 6 days. Postoperative complications were recurrent stricture [17.86%], urethrocutaneous fistula [7.14%], perineal haematoma [7.14%], impotence [10.71%] and wound infection [10.71%]. During follow up 89.29% patients were stricture free at the end of 2 years Abdominal transpubic perineal urethroplasty is an acceptable surgical approach in patients with complex posterior urethral stricture

Frequency of incidental gallbladder carcinoma following cholecystectomy for symptomatic gallstone disease

To determine the frequency of incidental carcinoma of the gallbladder in specimens following routine cholecystectomy. Descriptive case series. Department of Surgery, Hayatabad Medical Complex Peshawar, from February 2008 to January 2011. All patients with symptomatic gallstone disease of either gender having age range between 12-70 year were included. Patients with diagnosed gallbladder malignancy, gallbladder mass, empyema gallbladder and gallstones associated with obstructive jaundice were excluded. Following cholecystectomy all the specimens were sent for histopathological examination. Two hundred and sixty patients including 65 males and 195 females [M: F ratio 1:4] aged 12-70 year and having a mean age of 41.7 year [ +/- SD 2.4], were studied. Commonest presentations were pain right hypochondrium and a positive Murphy's sign [87.71%] followed by dyspepsia[55%], nausea, vomiting [40%], pyrexia [31.92%] and weight loss [05%]. Eleven [4.23%] patients had a diagnosis of malignancy of gallbladder at histopathology examination. Mean age for patients with malignancy was 55.25 year with a male to female ratio of 01:10. Well differentiated adenocarcinoma was reported in 45.45% cases, moderately differentiated in 36.36%, poorly differentiated in 09.09% and undifferentiated in 09.09% patients. Routine histopathology of gallbladder following cholecystectomy is helpful in early detection of carcinoma gallbladder

Experience of rubber band ligation for haemorrhoidal disease

To assess symptomatic relief in haemorrhoidal disease using rubber band ligation. Surgical unit, Hayatabad Medical Complex, Peshawar from July 2007 to June 2009. All patients presenting with rectal bleeding or prolase underwent proctoscopy to determine the cause of bleeding. Only patients with 1[st], 2[nd] and 3[rd] degree haemorrhoids [bleeding and prolapse] were selected for the study and they underwent rubber band ligation in two sessions, 6 weeks apart. Patients were followed in the OPD at 3 months and one year when their subjective and objective symptoms were noted followed by rectal examination and proctoscopy. Therapeutic response was assessed by symptomatic improvement in bleeding and prolapse of hemorrhoids and any complications. A total of 105 patients underwent rubber band ligation. There were 65[62%] males and 40[38%] females with a male to female ratio of 1.6:1. Age of the patients ranged from 21-65 years [ +/- 2.4SD]. Twenty three [21.9%] patients had 1[st] degree, 50[47.6%] had 2[nd] degree and 32[30.5%] had 3[rd] degree haemorrhoids. Forty-eight patients [45.7%] presented with prolapse, 33[31.4%] had both bleeding and prolapse and 23[21.9%] had bleeding only. At 3 months of follow up rubber band ligation cured 76[72.4%] patients, improved 13[12.4%] and failed in 7[6.7%] patients. At one year follow up, recurrence of bleeding and prolapse occurred in 16[15.2%] patients having 3rd degree haemorrhoids. Overall success was achieved in 89[84.8%] cases. Complications were seen in 20[19.1%] patients which were of mild to moderate nature and no serious/ life threatening complications were noted. Rubber band ligation is a rapid and safe non operative procedure for treating 1[st], 2[nd] and early 3[rd] degree haemorrhoids on out patient basis

Surgical management of carcinoma caecum

To determine the magnitude of carcinoma caecum and its surgical management in the department of Surgery, Hayatabad Medical Complex Peshawar-Pakistan. This case series study was conducted at surgical Unit Hayatabad Medical Complex Peshawar from July 2006 to June 2009. A total of 32 patients of carcinoma of caecum were included that were admitted either through OPD as elective cases [22 patients] or in emergency [10 patients]. In elective cases, diagnosis was made on colonoscopic biopsy while those who presented in emergency either with intestinal obstruction or with the suspicion of acute appendicitis, were diagnosed on the resected specimen histopathology. Out of 32, 25 patients [78%] were male and 7 [22%] female, with a male to female ratio of 3.6:1. Their mean age at the time of presentation was 65 +/- 2.8 years. Right hemicolectomy with side to side or end to end ileotransverse anastomosis was performed in 23 cases [71.89%]. In 3 cases [9.37%] ileotransverse bypass without resection was carried out as the tumour was locally advanced. In 3 other cases [9.37%], only omental biopsy was taken as the carcinoma was so advanced that any curative or palliative resection was not possible. In emergency situation, right hemicolectomy with exteriorization of bowel ends was done in 3 cases [9.37%]. Postoperative morbidity included wound infection 12.50%, faecal fistula 9.37% and intraabdominal collection 6.25%. Majority of the patients were having operable disease, however late presentation is very common. Surgical intervention may prove to be a better option in such cases

Comparison of wide open excision and karydakis procedure for pilonidal sinus disease

To compare the outcomes of wide open excision and Karydakis procedure in terms of postoperative complications, hospital stay and recurrence rate. Comparative interventional study. Surgical unit Hayatabad Medical Complex Peshawar, from April 2006 to March 2009. A total of 40 patients with pilonidal sinus were admitted through OPD. Patients with osteomyelitis of sacrum, fistula with anal canal or rectum, and those who were lost during follow up, were excluded. Patients were divided into 2 groups. In group A [20 patients] wide open excision was done whereas in group B [20 patients] Karydakis procedure performed. Patients were followed up in OPD for 6 months and postoperative outcomes were recorded. Out of 40 patients, 36 [90%] were males and 4 [10%] females [M:F = 9:1]. Age range was 15 to 40 year with mean age of 26.5 year +/- 2.4 year. In group A, postoperative complications encountered were pain [75%], bleeding [10%], wound infection [25%], scar pain [30%] and numbness [15%] at the site of surgery. While in group B, postoperative morbidity included pain [25%], hematoma/seroma formation [10%], wound infection [15%], scar pain [15%], numbness [20%] and wound dehiscence [10%]. Average hospital stay was 5.6 days in group A and 2.5 days in group B. Recurrence rate was 25% following wide open excision and 5% after Karydakis procedure. Karydakis procedure is better than wide open excision in terms of less postoperative complications, reduced hospital stay and low recurrence rate

Postoperative outcome of mesh hernioplasty under local anaesthesia as a day case procedure

To evaluate the outcomes of inguinal hernia mesh repair under local anaesthesia as a day case surgery. Descriptive case series. Surgical unit, Hayatabad Medical Complex Peshawar, from September 2007 to August 2008. Patients having direct/indirect inguinal herniae of either side who underwent Lichtenstein repair under local anaesthesia as a day case procedure were included. Patients below 20 years of age were excluded. Similarly those patients having acute complications of hernia like obstruction and strangulation were also excluded. Patients were followed up in the OPD for 02 years and any positive findings noted during this time period, recorded. All 135 patients were male with mean age of 52.5 years [ +/- 2.4 years SD]. Fifty-eight [42.96%] patients had direct inguinal hernia [right side 35 cases and left side 23 cases]. Seventy-seven had indirect inguinal hernia [right side 45 cases and left side 32 cases]. Postoperative complications included urinary retention in 08 [5.93%] cases, seroma formation in 06 [4.44%], wound infection in 10 [7.41%], scrotal oedema in 07 [5.19%] and chronic neuralgic pain in 02 [1.48%] cases. Three [2.94%] patients developed recurrence during the follow up period. Inguinal hernia mesh repair can be performed safely and effectively under local anaesthesia with minimal postoperative complications and acceptable results

Post operative outcomes of open versus closed haemorrhoidectomy

To compare the therapeutic results of open haemorrhoidectomy with closed one in terms of post operative pain, bleeding and wound healing. This experimental study was carried out in the surgical unit, at Hayatabad Medical Complex Peshawar from March to August 2009. Fifty patients of 2[nd], 3[rd] and 4[th] degree haemorrhoids having no systemic illnesses were included in this study. Patients were randomly divided in two equal groups. Group A included patients undergoing open haemorrhoidectomy and group B catered for patient with closed haemorrhoidectomies. Post operatively these patients were followed up in the OPD for 02 months and were evaluated for post operative pain, bleeding and wound healing in addition to other complications like urinary retention and anal fissure. The mean age of the sample was 45.5 +/- 2.3 years. In group B, 08 [32%] patients had mild pain, 10 [40%] had moderate and 02 [08%] had sever pain post operatively as compared to 13 [52%] patients with mild, 11[44%] with moderate and 06 [24%] with severe pain in group A [p < 0.05]. Similarly early post operative bleeding was noted in 15 [60%] patients in group A and 06 [24%] patients in group B [p < 0.05]. Wound healing time was just over 02 weeks in group B as compared to more than 04 weeks in group A [p < 0.05]. Closed haemorrhoidectomy technique is much better than open technique for 2[nd], 3[rd] and 4[th] degree haemorrhoids

Causes of mechanical intestinal obstruction in adults

To investigate the causes of mechanical intestinal obstruction in adults at surgical C unit Lady Reading Hospital Peshawar. This case series study was conducted at surgical C unit, of Lady Reading Hospital Peshawar, Pakistan from July 2006 to June 2007. In this study a total of 93 patients were included; who underwent exploratory laprotomy. These patients were diagnosed on the basis of clinical history, examination and radiological findings. After resuscitation, exploratory laprotomy was performed to confirm the diagnosis and relieve the obstruction. Laprotomy findings were recorded and where necessary specimen was sent for histopathology for definitive diagnosis. In this study of 93 cases, 100% patients presented with pain and abdominal distension. Other symptoms were less frequent. Males were 50 [53.76%] and females 43 [46.24%] with a male to female ratio of 2:1. 72. Tuberculosis [36.55%] was the leading cause of mechanical intestinal obstruction followed by carcinoma of the large gut [22.58%] and postoperative adhesions [21.51%]. Five [5.37%] patients had obstructed herniae and four [4.31%] had malignancy of the small gut. Three [3.22%] patients were with Meckle's diverticulum while 2 [2.15%] each had appendicular adhesions, intussusception and sigmoid volvulus. The causes of intestinal obstruction are variable in different parts of the world. Tuberculosis was the leading cause of dynamic intestinal obstruction in this study

Intermittent urethral self dilatation for prevention of recurrent stricture

To find out the role of clean intermitting self dilatation [CISD] for the prevention of recurrent urethral stricture. This comparative study of patients undergoing optical urethrotomy for anterior urethral stricture was conducted in Surgical Unit Hayatabad Medical Complex, Khyber Medical Centre and Khyber Teaching Hospital Peshawar from July 2004 to June 2008. A total of 146 male patients were included in the study. They were divided into two groups of 73 each on alternate basis. Group A was control group and group B with clean intermitting self dilatation and were followed upto 8 months. Study results showed a high rate of recurrence in control group A i.e. 42 patients [57.53%] in comparison to self dilatation group B i.e. 26 patients [35.61%]. Clean intermitting self dilatation is an effective procedure in the prevention of recurrent urethral strictures for primary strictures and deep strictures between 0.5-1.5cm length after optical urethrotomy

Complicated Jejunal diverticula as surgical emergency: experience at a tertiary care hospital in Peshawar, Pakistan

Diverticula of small intestine are rare. Jejunal diverticula can be single or multiple. Diverticula in the jejunum tend to be large and multiple. Clinically they may be asymptomatic or may give rise to symptoms like pain, flatulence and borborygmi, may produce malabsorption syndrome or may present in emergency with different acute pathologies like perforation, haemorrhage, obstruction, enterolith formation and inflammation. The Objective was to see the pattern of complications in jejunal diverticula presenting as a surgical emergency. This descriptive study was conducted at Surgical Units of the 3 tertiary care Hospitals of Peshawar, for 7 years from January 1, 2002 to December 31, 2008. Study included all patients presenting to and admitted in Surgical Unit, Hayatabad Medical Complex, Peshawar with complicated jejuna diverticula during the above mentioned period. Name, age, sex, other relevant data, history and examination findings and results of investigation were recorded. Uncomplicated jejuna diverticula were excluded from study. The operative findings and the type of complication were recorded. Ten patients were admitted during 7 years of study. Out of all patients 9 were male and 1 was female. Eight out of 10 patients presented with perforation of diverticula while 1 patient had severe inflammation of diverticulum causing pain, ileus and acute abdomen. One patient had acute pain due to adhesion formation. It is seen that complicated jejunal diverticulae are quite rare and the most common complication is perforation. Inflammation and adhesion are other complications with which jejunal diverticula presented during this study

Frequency of HER-2/NEU receptor positivity and its association with other features of breast cancer

Carcinoma breast is the commonest malignancy of females all over the world and second leading cause of death due to cancer among females. In Pakistan it is more common at a young age contrary to the West where it is more common in old age [after 60 years]. The objectives of this cross sectional study were to determine the frequency of HER-2/neu receptor over-expression and its association with some of the features of breast cancer like patient age, ER/PR status, tumour size, histological grade and axillary lymph node involvement. This study was conducted at Surgical C Unit, Postgraduate Medical Institute of Lady Reading Hospital, Peshawar, from January 2007 to December 2007. Study included all patients with breast cancer admitted in Surgical 'C' unit LRH, Peshawar for Modified Radical Mastectomy [MRM]. The resected specimens were sent to histopathologist for immunohistochemical [IHC] studies [HER-2/neu receptor and ER/PR] and detailed histopathological analysis including tumour subtype, size, histological grade and involvement of axillary lymph nodes. Patients refusing HER-2/neu receptor immunohistochemistry were excluded from the study. Name, age, sex, other relevant data, detailed history and clinical examination findings and results of investigation were recorded. Data was analyzed with SPSS version 10 This study included 24 female patients of breast cancer having modified radical mastectomy [MRM]. Age distribution ranged from 32-75 years with a Mean +/- SD of age 48.3 +/- 18.2 years. Fifteen out of 24 patients [62.5%] were >40 years, while nine patients out of 24 [37.5%] were 0.05], number of axillary lymph nodes involved [p > 0.05] and histological grade [p > 0.05]. While, it was significantly associated with tumour size [P < 0.05] and negative ER/PR status [P < 0.05]. Due to high prognostic significance and frequency in Pakistani females with breast cancer, HER-2/neu receptor should be checked in all patients with breast cancer so that the positive cases should have herceptin therapy and benefit from anthracycline based chemotherapeutic agents which can improve survival in these patients

Pattern of breast cancer: experience at Lady Reading hospital, Peshawar

Breast Cancer is the commonest malignancy of females all over the world and second leading cause of death due to cancer among females. The aim of this Descriptive study was to see the various features of breast cancer in order to know the pattern of disease in the recent time. The study was conducted from Jan. 2007 to Dec. 2007 in Surgical C Unit, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan. Study included all patients presenting to and admitted in Surgical C Unit LRH, with carcinoma of breast during the above mentioned period. Name, age, sex, other relevant data, history and examination findings and results of histopathology and other investigations were recorded. Total of 46 patients was included in the study, out of which there were 46 female and 1 male patients. Most common age group was 40-49 years with 14 patients, followed by 50-59 years with 12 patients. Most common type of carcinoma was infiltrating ductal carcinoma with no specific features with 38 patients. Other types included 2 infiltrating ductal carcinomas of papillary type, 1 mucinous type and 1 medullary type; 3 invasive lobular carcinomas, and 1 mixed lobular and ductal carcinoma. The disease was left sided in 24 cases, right sided in 20 cases while it was bilateral in 2 cases. Upper outer quadrant of the breast was most commonly involved [n=26]. There were 2 cases of stage I, 16 stage II, 20 stage III and 08 cases of stage IV disease. There were 2 cases of grade I, 16 grade II, and 28 cases of grade III. Carcinoma breast is still a common problem presenting at a young to middle age group with invasive ductal carcinoma being the commonest variant with a high grade and a late stage of presentation due to lack of screening and awareness programs

Pattern of change in the frequency of Helicobacter pylori with perforated duodenal ulcer

Peptic ulcers were believed to be caused by stress, dietary factors, and gastric acid, but the link between H. pylori and peptic ulcers was identified in 1983. To see the frequency of Helicobacter pylori infection in patients with perforated duodenal ulcer and advise eradication therapy in these patients. This cross sectional study was conducted in Surgical Unit Hayatabad Medical Complex, Peshawar, during January 2007-June 2008. A total of 50 cases were included in the study. All cases presenting to our unit with acute perforated duodenal ulcer were recruited. After resuscitation and baseline investigations, all underwent emergency laparotomy via upper midline incision, after thorough peritoneal lavage, the perforation margins were freshened and closed over an omental patch. Serum from every patient was tested for H. pylori and accordingly managed. Out of the 50 cases, 45 were males, and 5 were females. Age ranged from 20- 80 years old. All patients underwent emergency laparotomy. Postoperatively, all were started on PPI treatment and serum testing for H. pylori was done. Thirty-four [68%] turned out positive and 16 [32%] were found to be negative for H. pylori. There is still a high frequency of H. pylori infection in patients with perforated duodenal ulcer. But comparing these results with the various data available, there is a significant decline in H pylori positive perforated duodenal ulcer patients

Premenstrual Syndrome: frequency and severity in young college girls

To find out the frequency of premenstrual syndrome [PMS] in young college girls and to describe the severity of emotional, physical and behavioural symptoms. An observational study was conducted at the Khyber Medical College, Peshawar by convenient sampling on 384 young girls. Data was collected over two cycles by filling a 29 items shortened premenstrual assessment form based on Moos Menstrual Distress Questionnaire after taking consent from medical students. Results were given according to both criteria i.e. ICD-10 and DSM-IV. The frequency of premenstrual syndrome was 53% according to ICD-10 criteria, among which 42% was mild, 18.2% moderate and 31.7% severe. A total of 64 girls [18.2%] met the DSM-IV criteria for severe PMS or Premenstrual Dysphoric disorder [PMDD]. The order of frequency of symptoms occurring in PMS was general body discomfort, anxiety, backache, fatigue and depression. Most frequently reported symptoms in PMDD group were anger, anxiety, stress, depression, fatigue and general body discomfort. Premenstrual syndrome is a common problem in young girls. Doctors should adopt comprehensive measures to reduce its incidence and improve the quality of life in the affected

Phloroglucinol for acceleration of labor: Double blind, randomized controlled trial

To determine the effects of Phloroglucinol in acceleration of labour and its adverse effects on mother and foetus. A double blind randomized, placebo controlled trial was conducted on 100 patients in active phase of uncomplicated labour selected by convenient sampling. Patients were given Phloroglucinol or Placebo [distilled water] intravenously. Progress of labour was plotted on Partogram. Any adverse effects of the drug on mother and fetus were noted. Student's t-test was applied for statistical analysis. In patients receiving Phloroglucinol there was a mean 34% reduction in duration of 1st stage of labour and a mean 23% reduction in 2nd stage as compared to Placebo group respectively. Blood loss >500ml was observed in 2% patients. Otherwise there were no adverse effects on mother or foetus. Phloroglucinol shortens the duration of labour, is non toxic to both mother and fetus and does not cause primary post partum haemorrhage

Early surgical intervention in penile fracture

To know the mechanism of injuries resulting in penile fractures and the of early surgical intervention in these cases. Material and 24 consecutive patients who presented with a history of blunt penile trauma and clinical signs and symptoms indicating penile fracture during a period of 03 years i.e. from Jan 2000 to December 2002, were included in the study. All of them underwent an emergency operation within 6 hours to 4 days after the incident. Vicryl 3/0 was used as a suture material for repair. Patients were followed upto one year. Among the 24 patients, 18 turned up for follow-up. Fifteen with excellent functional Results:, while 03 had penile curvature and pain during coitus. These three patients had undergone surgery more than 48 hours after the incident. Fracture penis is not very rare and manipulation resulting into blunt trauma to the penis was the commonest cause. An immediate surgical intervention is recommended to avoid serious complications

study of effectiveness of local bupivacaine infiltration of the wound in reducing the post-operative parenteral narcotic analgesic requirement

Objective: to see the effectiveness of local perfusion of the wound with bupivacaine .5% following cholecystectomy was studied

Material and Methods: a prospective randomized clinical trail involving 140 patients undergoing cholecystectomy for symptomatic gallstones, using Kocher's incision, was undertaken. Patients were randomized to receive either intermittent intravenous tramadol infusion on demand [parenteral analgesia, PA-group] or wound perfusion with local bupivacaine .5% per-operatively followed by intravenous tramadol infusion, if needed [local analgesia, LA-group]. On hundred and forty patients were recruited in the study, 70 in each group. Patient demographics were comparable in the two groups

Results: there was no statistically significant difference in post-operative pain scores at rest and with movement between the two groups, excepts for pain scores at rest on the first post-operative day [P = 0.03]. The median total amount of tramadol used was significantly greater in PA group i.e. 600 [range 500-1000] mg as compared to the amount used in LA-group i.e. 200 [range 0-400] mg

Conclusion: direct local wound perfusion of bupivacaine 0.5% provides good pain relief after cholecystectomy and reduces the requirements of parenteral narcotic analgesia with no major side effect. In other words, it is a safe and feasible alternative to parenteral opiods

Management of thoracic in juries in children

Objective: the aim of the study was to know the effective way of treatment and to sort out the measures for the prevention of various complications arising from thoracic injuries in children

Material and Methods: this is a prospective study performed on 173 children with thoracic injuries. Birth trauma was not included in this study. All these patients were received in emergency and were admitted to Paediatric surgery unit of Lady Reading Hospital Peshawar during a period of 2 years from January 2000 to December 2001

Results: blunt trauma [121 cases] was the most common cause of chest injuries seen in these children as compared to penetrating injuries [52 cases]. All of them [156 cases] except lung contusion and chest wall injuries were treated with chest tube drainage and under water seal. The clinical condition resulting from these chest injuries confirmed on X-ray chest were haemothorax [99 cases], haemopneumothorax [51 cases] and pneumothorax [6 cases]. Cardiac injuries, great vessel injuries, esophageal injuries, tracheobronchial injuries, stove in and flail chest injuries were not encountered during the course of this study. There is no mortality hm chest intubation in this study. There was no case of emergency thoracotomy however only 2 cases needed elective thoracotomies for complications after treatment with chest intubation

Conclusion: emergency thoracotomy is a lifesaving procedure in all the clinical conditions resulting from thoracic trauma. Isolated chest injuries can be treated effectively by tube drainage of the chest on the affected side, which is safe, less traumatic and associated with least morbidity and no mortality