Clinical presentation and management of adult choledochal cyst: a retrospective review

Objectives: To determine the mode of presentation and commonest surgical procedures done for adult choledochal disease in a tertiary care hospital

Methodology: A retrospective review conducted in Lady Reading Hospital, Peshawar, from January 1995 to January 2005 with one year of follow up. All patients above 13 years of age with choledochal cyst were considered for the study. Mode of clinical presentation and commonest surgical procedures were recorded

Results: Of the total 23 patients collected, 08 [34.78%] were males and 15 [65.22%] were females. Regarding mode of clinical presentation, pain right hypochondrium with raised serum bilirubin and ALT levels was found in 21.73% of patients. Complete cyst excision was possible in 69.56% of the patients. Complete cyst excision followed by Roux-en-Y common hepatico-jejunostomy was performed in 30.43% and common hepatico-dudenostomy in 26.08%

Conclusion: The most common mode of clinical presentation of choledochal cyst was pain right hypochondrium with raised serum bilirubin and ALT levels. The commonest surgical procedure was complete cyst excision with Roux-en-Y common hepatico-jejunostomy

Postoperative outcome of early laparoscopic and open cholecystectomy for acute calculous cholecystitis

Objective: to assess the optimal timing of intervention and post-operative morbidity for acute calculous

Cholecystitis

Study design: cross sectional study

Place and Duration of study: surgical unit Hayatabad Medical Complex Peshawar, from February 2015 to January 2016

Methodology: a total of 110 patients having age range of 20-55 year were included. Patients having common bile duct stones, clinically jaundiced and associated co morbid diseases, were excluded. Patients were divided into two groups having 55 patients in each group. Group A patients underwent early laparoscopic / open cholecystectomy within 72 hours of presentation while group B patients had delayed laparoscopic / open cholecystectomy after 72 hours of presentation. In both the groups laparoscopic cholecystectomy was attempted initially but in difficult cases decision was made to convert to open procedure. Postoperative morbidity of both groups was compared

Results: mean age of the study population was 40.5+2.5 year. Male to female ratio was 1: 8.2. Biliary leak occurred in 1.8% patients in group A and 5.5% in group B. Common bile duct injuries occurred in 1.8% versus 3.6% patients and conversion rate was 3.6% against 12.7% in group A and group B respectively. Hospital stay in group A patients was 2.5 days as compared to 4.5 days in group B. Overall complication rate was 7.2% and 29.1% for groups A and B

Conclusion: early laparoscopic cholecystectomy within 72 hours significantly decreased the conversion rate, postoperative morbidity and the length of hospital stay

Partial cystectomy and omentoplasty for liver hydatid cyst

Objective: To evaluate the results of partial cystectomy and omentoplasty in the management of hepatic hydatid disease

Study design: Descriptive case series

Place and Duration of study: Department of Surgery, Hayatabad Medical Complex Peshawar, from March 2011 to February 2015

Methodology: The study included patients diagnosed to have hydatid cyst involving right lobe of liver using ultrasound and CT scan abdomen. Patients having hydatid cyst in the left lobe of liver or other viscera were excluded. Postoperatively complications like bile leak were noted

Results: Partial cystectomy and omentoplasty for hepatic hydatid disease produced satisfactory results with minimum complications and short hospital stay

Conclusion: A total of 26 patients with liver hydatid cyst underwent partial cystectomy and omentoplasty. Male to Female ratio was 2.7:1. Mean age of the patients was 44.51 year. The operating time was from 45-90 minutes. Postoperatively 02 [7.7%] patients had bile leak, 03 [11.5%] had wound infection and 01 [3.8%] patient developed recurrent hydatid cyst in the liver. The average hospital stay was 5.4 days. There was no postoperative mortality

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