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

Circumcisional injuries: a neglected negligence

To describe the spectrum and management of circumcisional injuries. It was a two years [January 2006-December 2007] descriptive study. All patients with complications of circumcision, presenting immediately or late and fulfilling the inclusion criteria were included in this study. A total of 24 patients were included in this study. Common complications in order of frequency were urethrocutaneous fistula 8[33.3%], glans injury 6[25%] and bleeding 5[20.8%]. In majority of cases 20[83.33%], the circumcision was performed by unqualified circumciser. In our country majority of circumcisions are performed by traditional untrained persons with high complication rate, often disastrous one. Properly training the paramedical staff can not only reduce the physical morbidity but will also save the resources spent on management of these potentially preventable complications

Conservative treatment of appendicular mass without interval appendicectomy: is it justified?

To evaluate the justification for conservative treatment of appendicular mass without interval appendicectomy. This study was conducted at the department of surgery Postgraduate Medical Institute HMC Peshawar. It was a descriptive study including all those patients who presented with appendicular mass from January 2000 to December 2005. These patients were treated conservatively. Patients who responded to conservative treatment were sent home and were followed for months for any recurrent attack. Patients who did not respond to conservative treatment, were explored after further investigation. Patients who had recurrent attack in the follow up were offered appendicectomy. No patient was offered interval appendicectomy. Total number of the patients included in the study was 125. Patients responded to conservative treatment were 88% [n=110]. Failure of conservative treatment occurred in 12% [n=15]. Out of these abscess formation occurred in 8% [n=10] who responded well to open drainage with out appendicectomy while 4% [n=5] were explored after CT abdomen. Appendicitis was found in 2 cases [1.6%], ileoceacal tuberculosis, colonic tumour and appendicular tumour in 1 case each [0.8%]. All patients except for the 5 cases already explored were followed up for 18 months. Recurrent attack of acute appendicitis occurred only in 8.33% [n=10/120] and appendicectomy was performed on these patients. Conservative management is effective in the majority of the patients. Randomized control trial is needed to study the real need of interval appendicectomy

Complications of barium studies

The objectives of our study were to know the frequency and type of complications of Barium contrast study. Material and This study was conducted in surgical unit of Postgraduate Medical Institute Hayatabad Medical Complex Peshawar. It was a descriptive study including all those patients who had some form of barium contrast studies for gastrointestinal diseases from January 2001 to December 2003. Total number of patients was 290. Patients who developed complications were only 13 [4.17%]. Referral from other centre was 75% among the complicated cases. Different types of complications noted in this study were intestinal obstruction 1.05% [n=3], failure of ileastomy/colostomy closure 2.42% [n=8], and perforation of hollow viscera 0.69% [n=2]. Overall mortality rate was 0.69% [n=2]. Frequency rate of complications in our study is higher than international studies. Complications rate can be reduced by following a standard approach to deal with acute/chronic abdomen. Barium study should be avoided in cases where there are signs of eminent intestinal obstruction or perforation

Outcome of urethrocutaneous fistula repair after hypospadias

Analyze the outcome of urethrocutaneous fistula repair after Hypospadias surgery. It is a descriptive study carried out during 1997-2003. Patients underwent for urethrocutaneous fistula repair were included. Patients were followed for 2 weeks, 3 months, 6 months and 1 year period. 52 patients of post Hypospadias repair fistulae with 76 fistulas were operated. 71% had single fistula while 29% had more than one fistula. Simple closure was done in 68 [89%] fistulae. Success rate was 65% to 100%.While only 33% of our patients had proximal hypospadias, 44.23% were hypospadias cripples. While 4 of our patients [7.69%] had meatal stenosis needing Meatotomy and five adult patients [9.6%] had erection episode history in early postoperative period, in rest of the patients no obvious cause was found. In 37 patients [48.68%] fistula site was at corona or distal penile.Optimal results can only be achieved by adhering to the basic principals of plastic surgery including gentle tissue handling, using fine sutures, avoidance of opposing suture lines, absolute Haemostasis and tension free anastomosis

modified water proofing layer in two stage hypospadias repair: five years experience

To assess the outcome of modified water proofing fascial layer in two stage hypospadias repair.January 1999 to December 2003, Plastic surgery unit Hayatabad Medical Complex, Peshawar.Descriptive and prospective study.A modified waterproofing technique was used in two stage repair of Hypospadias. Two hundred consecutive cases were included in this study. Fifty two cases were Hypospadias cripple. Fistula was the most common major complication occurring in 18 patients. Four of these fistulae closed spontaneously while 14 underwent surgical repair. Catheter related minor complication occurred in 5 patients. 4 patients underwent revisional surgery for cosmetic reason.This modified waterproofing technique is simple, safe and versatile adjuvant to Hypospadias repair. Reduction in complication rate is significant with minimal learning curve