Diathermy incisions v/s surgical scalpel incisions; outcome in general surgery

Objectives: The objective of this study was to compare the outcome of diathermy incisions v/s surgical scalpel incisions in general surgery

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at surgical unit 7, Sindh Govt. Lyari General Hospital and Dow University of Health Sciences between January to December 2009

Methodology: 100 consecutive patients for elective general surgery were randomly assigned to either group A incision with cutting diathermy [n=50] or group B cold steel scalpel [n=50]. Data including demographic details, hospital stay, infection rate and non-infective complications like swelling, bleeding, dehiscence and seroma formation were recorded in both groups to compare the final surgical outcome compared

Results: A total of 80 patients were included in the study, placed alternatively into two groups of 40 patients each with majority being male [n = 61, 76.3%]. The mean age was 22.46 years. The positive predictive value for patients of Group A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basis of Gender for the two groups, the positive predictive value for male patients of Group A and B was 90.09% and 89.28% respectively, but for females the positive predictive value of Group A and B was 100% and 50% respectively. In Diathermy [Group A] total 20% patients developed complications and these were seroma formation [n=4, 8%], wound dehiscence [n=3, 6%] and wound infection [n=3, 6%]. In Scalpel [Group B] total 26% patients developed complications [P-value=0.370] in which seromas was noted [n=5, 10%] then wound infection [n=4, 8%], then wound bleeding [n=3, 6%] and lastly seroma formation [n=1, 2%]. Hospital stays were also almost similar with mean value 8.24 days in diathermy group and 10.54 days in scalpel group. No remarkable difference in demographics, characteristics and in other variables of patients was noted

Conclusion: We conclude that no significant difference in surgical outcome of both groups [cutting diathermy Vs. steel scalpel]. Therefore, use of either technique to create surgical wound merely depends upon preference of surgeon

Acute appendicitis; efficacy of complete clinical evaluation and modified Alvarado scoring system in diagnose

Objectives: the objective of this study was to compare the efficacy of Clinical Evaluation and modified Alvarado scoring system in diagnosing acute appendicitis

Study Design: cross sectional study

Place and Duration of Study: this study was conducted at Surgical Unit III of Civil Hospital Karachi from May 2010 to October 2010

Methodology: this study consisted of eighty patients. Patients were divided in two groups. Group A for complete clinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring system comprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea, vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively and undergoing emergency appendectomy during this period, age >12 years and both gender. Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant female patients and those who did not give written consent

Results: a total of 80 patients were included in the study, placed alternatively into two groups of 40 patients each with majority being male [n = 61, 76.3%]. The mean age was 22.46 years. The positive predictive value for patients of Group A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basis of Gender for the two groups, the positive predictive value for male patients of Group A and B was 90.09% and 89.28% respectively, but for females the positive predictive value of Group A and B was 100% and 50% respectively

Conclusion: we conclude that modified Alvarado score can be used safely and effectively in diagnosing acute appendicitis in adult males especially as the score increases from seven to nine

Sleeve gastrectomy

The aim of our work is to present Experience of Sleeve Gastrectomy at Centre of Bariatric Surgery of Dow University of Health Sciences. All patients were assessed multidisciplinary team before operation. Indications for LSG were BMI 35kg/m[2] with comorbidites and BMI >40kg/m[2] without comorbidities. Standard surgical technique adapted. Gastric division by a cutting stapler. The whole staple line was observed for bleeding and tested for leak. Total 10 patients were studied of which were four males and six females, Median age of was 40 years. Pre-operative median BMI was 52.2kg/m[2] [range from 46 to 61kg/ m[2]]. Median post-operative BMI of 9 months was 34.33kg/m[2] [range from 28 to 40]. Out of 10 patients, observed complications of bleeding was seen in one case and wound infection occurred in 2 cases. Considerable weight loss observed in LSG

Inguinal hernioplasty; laparoscopic tep with and without dissection balloon

To compare laparoscopic TEP Inguinal hernioplasty with and without dissection balloon. Observational study. Minimal Invasive Surgical Centre Jamshoro and General Surgical Department at Dow University Hospital, Ojha Campus Karachi. May 2011 and Dec 2012. Twenty [20] male patients with uncomplicated unilateral or bilateral inguinal hernia were prospectively randomized in two groups; group A Commercially available dissection balloon and group B. Telescopic dissection for creating TEP working space. We had 20 male patients for this study. The average age was 43.6 and ranging between 17 to 64 years. Only 2 patients 10% had bilateral groin hernia, 4 patients 40% had direct inguinal hernia in group A and 5 patients 50% had direct hernia in group B. Peritoneum was breached in 5 [50%] patients with telescopic dissection. One patient [10%] with bilateral groin hernia in group B had large tear in peritoneum converted to TAPP while other group normal. The incidence of scrotal edema/seroma was greater in group B then group A. 40% patient in group B developed seroma while 0nly 1 [10%] patient with bilateral groin hernia in group A developed seroma. Pain was scored on VAS at 1 and 4 hours after surgery was higher in group B. The mean operation time was 55 min [45-100] in the group with the balloon and 73 min [50-120] in the group without the balloon [p = 0.004]. TEP laparoscopic inguinal hernia repair is probably the best option amongst the two techniques used in laparoscopic inguinal hernia repair and dissection with balloon is though costly but more helpful in dissection and safer

To compare the frequency of superficial surgical site infection after laparoscopic versus open appendectomy

To compare the frequency of Superficial Surgical Site infection after laparoscopic versus open appendectomy. Randomized clinical trial study. This study was conducted at Surgical Department Jinnah Post Graduate Medical Centre Karachi and Dow University Hospital from August 2013 to January 2014. The source of data was patients admitted in emergency. Patients were selected on the basis of clinical features. The data was collected with the help of Performa attached. It included demographic data of the patient, presenting complaints, operative findings, Surgical site infection. Random patients were placed in two groups. Surgical site infection by observation of pain, redness, tenderness and purulent discharge from the wound. Patients included were of both gender and age above 13 years presented to emergency department diagnosed as acute appendicitis on the basis of history and examination and exclusion of under 12 years of age, appendicular mass, CLD, I.H.D, DM and renal failure. Out of 270 patients, 153[56.7%] patients were males and 117[43.3%] patients were female. In Present study the different operative findings with their distribution among gender are shown in table. In other findings three patients with ruptured ovarian cyst and one with Mackel's Diverticulitis in which procedure was converted to open and resection and anastomosis of small intestine was done. SSSI is found to associated with operative finding with a significant P value 0.001. Superficial Surgical Site Infection were observed in both procedure laparoscopic appendectomy allotted in 134 cases but four cases are converted to open procedure so they are excluded from the results. The reason for conversion in three cases was difficulty in mobilizing the appendix because of adhesion and in one case Mackel's Diverticulitis found which need open procedure for formal small intestine resection and anastomosis. Superficial Surgical Site Infection was observed in three cases of Laparoscopic appendectomy and in 15 cases of Open Appendectomy group with the P value 0.005. Laparoscopic appendectomy is a better choice because of its reduced frequency of SSSI when compared with open procedure. SSSI is an important complication

Compare the complications of laparoscopic versus open appendectomy

To compare the complications of laparoscopic versus open appendectomy. Retrospective study. This study was conducted at Dow University Hospital from June 2012 to June 2014. Data was analyzed by reviewing patient records, patients bills records and patient discharge sheet. Each data was double checked and thoroughly supervised by author himself to assure quality and validation of the data collected. The information reviewed of patients with diagnosis of acute appendicitis included, age, sex, time taken for bowel function restoration, use of analgesia, postoperative stay and its clinical evaluation and confirmed by USG of abdomen requiring operation and total charges. Patients included who were operated in surgical unit I. Patients who were identified with associated gynecological disease, to be at high risk for general anaesthesia, had a past history of lower abdominal surgeries, appendicular abscess were excluded. Data was analyzed through SPSS software. 73 patients who underwent appendicectomy. Out of which 24 [32.87%] patients operated laparoscopically and 49 [67.12%] patients by open method. The mean age for open appendectomy was 26.53 +/- 12.3 years whereas, for laparoscopic appendectomy it was 29.9 +/- 13.3 years. Intraoperative findings were normal appendix 4[16.66%] in OA group and 2[4.08%] in LA group, Acute appendicitis 12[50%] in OA group and 31[63.26%] in LA group, Gangrenous appendicitis 3[12.5%] in OA group and [14.28%] in LA group, Appendiceal abscess 4[16.66%] in OA group and 5[10.20%] in LA group, Peritonitis 1[4.16%] in OA group and 3[6.12%] in LA group. Post operative complications were observed in both groups. Wound infection 5[20.83%] in OA group and 2[4.08%] in LA group, Intra-abdominal abscess 1[4.16%] in OA group and 1[2.04%] in LA group, Bowel obstruction 3[12.5%] in OA group and 2[4.08%] in LA group, Respiratory infection 2[8.33%] in OA group and 1[2.04%] in LA group. This retrospective comparative assessment indicates that the patient chart reduces the incidence of complications in LA was wound infection, intestinal damage, intra-abdominal abscesses, intestinal obstruction and respiratory infections

Fast ultrasound; a basic tool to evaluate the blunt abdominal trauma patient and help to decision making for emergency surgery

Fast ultrasound is a basic tool to evaluate the blunt abdominal trauma patient and help to decision making for emergency surgery. Observational study. The King Fahad Hospital Madina Munawara, over a period between 2010 and 2011. This study consisted of 765 patients came in Emergency department The King Fahad Hospital Madina Munawara Level II, or Regional Resource Trauma Center Saudi Arabia. Detailed History was taken from all the patients with special regard to bland abdominal trauma. All patients were brought to a trauma resuscitation area where a trauma team conducted a primary survey, after an airway and adequate oxygenation/ventilation were established. The FAST examinations were performed using 4 windows: subxiphoid, right upper quadrant, left upper quadrant, and suprapubic. The critical areas for intra-abdominal bleeding were the hepatorenal space [Morrison's pouch], the spleno-renal space, and the pelvic pouch of Douglas. The FAST examinations were interpreted on the spot and results Recorded. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 73 out of 765 patients who underwent FAST ultrasound in the Emergency Room. 40 [54.79%] cases were road traffic accident [RTA] injuries followed by injury due to fall were in 33[45.20%] cases. Findings are fast ultrasound observed 49 out of 73 patients [67.12%] were considered positive FAST who had fluid [blood] in the peritoneal cavity and these patients shift to Operative Room for surgery. While 24[32.87%] patients with no evidence of intraperitoneal fluid were considered negative for FAST and these patient underwent CT scans for evidence of solid organ injury[Chart No.2]. 5 out of 24 cases of solid visceral trauma found on CT scan abdomen, but had not been detected by FAST then shift to operative room after resuscitation. We conclude that FAST ultrasound is very helpful to assessment of blunt abdominal trauma and to detect intraabdominal fluid. Fast ultrasound can help in the quick decision for surgical intervention within minutes of a patient's arrival at emergency department

Bile duct injuries; frequency during cholecystectomy procedures either open or laparoscopic

To find out frequency of bile duct injuries during cholecystectomy procedures either open or laparoscopic.Prospective observational study. This study was conducted at Surgical department, Liaquat University Hospital Jamshoro and Dow International Hospital Karachi, from July 2012 to December 2013. This study consisted of hundred patients. Patients were divided in two groups. Group A for open cholecystectomy [OC] comprising of 50 patients who underwent elective open cholecystectomy. Group B for Laparoscopic cholecystectomy [LC] comprising of 50 patients who underwent elective Laparoscopic cholecystectomy. Inclusion criteria were all patients diagnosed case of gallstones on the basis of ultrasound abdomen, any age and both gender. Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant ladies due to risk of foetal loss, carcinoma of gall bladder, stone in CBD and obstructive jaundice. Out of 100 cases of gallstone were operated for either laparoscopic / open cholecystectmy. In open cholecystectomy group 20[40%] were male and 30[60%] female. Ratio male: female ratio of 1:1.5. In laparoscopic cholecystectomy group 11[22%] were male and 39[78%] female with male: female ratio of 1:3.5. There was wide variation of age ranging from a minimum of 10 year to 70 year in both group. The mean age was 41.28+12.30 years for OC group and 38.44+13.50 years for LC group [p 0.02]. Common bile duct injury were occurred 2[4%] patients in laparoscopic cholecystectomy group while 3[6%] patients observed in open cholecystectomy group. We conclude that found bile duct injury 2[4%] patients in laparoscopic cholecystectomy group while 3[6%] patients observed in open cholecystectomy group

To evaluate the outcome of sacrococcygeal pilonidal sinus excision using karydakis technique

Objective: To evaluate the outcome of sacrococcygeal pilonidal sinus excision using karydakis technique. Study Design: Prospective case series study. Place and Duration of Study: This study was carried out in the Department of General Surgery Unit 111, Ward 26, Jinnah Post graduate Medical Centre, Karachi form March 2005 to Feb 201 2. Materials and Methods: The study included 85 consecutive patients who underwent pilonidal sinus excision by karydakis technique fulfilling the inclusion criteria. We excluded the cases of pilonidal abscess and the cases which came with acute infections. Patients under 12 years were also excluded. A prospective method of data collection was utilizes by filling in the proforma designed for the study. A complete record of the procedure, follow up was done initially on weekly basis for one month and then fortnightly for 6 months and subsequently monthly for 30 months. Results: Total of 85 patents were included in our study in which 68 [80%] were male and 17 [20%] were female. The mean age of the group was 30.56 years. All patients were followed postoperatively for 30 months. Mean hospital stay was 2.5 days. Majority 63[74.1%] of the patients underwent smoothly without major complication. In all 85 patients wound closed with prolene 210 interrupted sutures. In 9[10.6%] patients developed minor wound infection while 4[4.7%] patients develop wound dehiscence and 3[3.52%] patients develop recurrence. In all 85 patients prophylactic antibiotics amoxicillin + clavulanic acid 1.2gm was used. In infected patients accounting to a total of 13[15.3%], both major and minor infections were included and appropriate antibiotic was used as indicated in the culture and sensitivity report. Conclusion: Karydakis technique is superior to midline excision surgery. It is associated with significantly shorter complication rate, shorter hospital length of duration, rapid healing, cost effective, good cosmetic satisfaction, a high patient satisfaction rate and low rate of recurrence

Various presentation of abdominal tuberculosis in surgical patients

To see the various presentation of abdominal tuberculois in surgical patients. prospective study. This study was carried out in the Surgical Department at civil Hospital Karachi, from Oct 2011 to 31[st] May 2012. Study consisted of twenty six patients. Base line and specific investigations were done in all patients, especially mantoux test, sputum examination x-ray abdomen and ultrasound of abdomen. Inclusion criteria were that all patients diagnosed as case of tuberculosis on the basis of history, clinical examination and investigations. Exclusion criteria included unfit patients for general anesthesia, pregnant ladies due to risk of foetal loss, patients with carcinoma of colon. Data was analyzed through SPSS software. 26 cases of abdominal tuberculosis. 12 males [46.15%] and 14 females [53.84%]. Male to female ratio was 1:1.16. Age ranged from fifteen to seventy years with mean age of patients were 42.1 years. Twelve Patients [46.15%] presented in subacute intestinal obstruction, four patients [15.38%] with acute intestinal obstruction, six [23.07%] with signs of peritonism and four [15.38%] with mass in abdomen. Erythrocyte sedimentation was 2 patients [7.70%] had ESR 20 mm/hr, eight patients [30.77%] between 20 to 40 mm/hr, eleven patients [42.1%] between 40 to 60 mm/hr and five patients [19.23%] between 60 to 100 mm/hr. Liver Function Test was within normal range in all of them. Mantoux Test was found positive in fourteen [53.84%]. Plain x-ray abdomen erect and supine position showed sixteen patients [61.54%] significant findings were observed. Barium meal and Follow through examination was performed in four patients [15.38%]. Three patients [75%] showed narrowing of ileum and irregularities in the caecum and one' patient [25%] had dilated small bowel loops with narrowing of terminal part of ileum while caecum was normal. In one patient [3.84%] small bowel enema revealed delayed emptying of small bowel with dilatation of jejunum, Barium enema was performed in three cases, which revealed, filling defect in caecum and narrowing at ileocecal junction. We conclude that. The clinical features of this disease are usually non-specific, vague and diverse therefore the accurate diagnosis is some times difficult

Laparoscopic cholecystectomy; per-operative factors responsible for difficulty in performance and conversion

Objective: The objective of this study is to determine the per-operative factors responsible for difficulty in performing laparoscopic cholecystectomy and lead to conversion

Study Design: Prospective analysis study

Place and Duration of study: This study was carried out in General Surgery Department of Dow University Hospital Ojha Campus and Civil Hospital Karachi, from Jan 2011 to July 2012

Methodology: This study consisted of one hundred and forty six patients with gallstone disease. All patients had full clinical examination and right hypochondrium was especially examined for assessment of murphy's sign, palpable mass and visceromegaly. Base line and specific investigations were done in all patients especially ultrasound of abdomen as diagnostic modality and for assessment of gallstone disease. Inclusion criteria was that all patients diagnosed as case of gallstone disease. LC procedure was not attempted in patients with history of abdominal surgery, pregnant ladies due to risk of foetal loss, carcinoma of gall bladder acute pancreatitis, obstructive jaundice and unfit patients for general anesthesia

Results: Out of 146 patients included in this study 133 were female [91%] and 13 male [9%]; with female to male ratio of 10.2:1. The mean age was 39.21+6.20 years. Per Operative findings were adhesions in calot's triangle 24[16.43%] cases, severe and tight adhesions around gallbladder and calot's triangle 21[14.38%] cases, obscured anatomy in calot's triangle 17[11.64%] cases, intrahepatic gallbladder 11[7.53%] cases, adhesions around gallbladder 26[17.80%] cases, empyema 13[8.90%] cases, mucocele 9[6.16%] and anatomical variation 14[9.58%] cases. We observed out of 21 patients who had Severe and tight adhesions around gallbladder and calot's triangle, lead to difficulty in performing laparoscopic cholecystectomy in 11[52.38%] cases followed by 17 cases of obscured anatomy in calot's triangle and 14 cases anatomical variation also lead to performing difficult laparoscopic cholecystectomy in 6[35.29%] and 5[35.71%] cases respectively. Four [2.73%] cases out of 146 had to be converted to the open cholecystectomy procedure

Conclusions: We conclude our study revealed that various peroperative factors which make the difficult laparoscopic procedure and lead to open cholecystectomy are severe adhesions in calot's triangle, severe and tight adhesions around gallbladder and obscured anatomy in calot's triangle

Rural surgery; experience at rural and backward desert region of Pakistan

To study the pattern of Urological and Non-Urological cases and their management at rural hospital. Descriptive and case series study. All surgical patients managed at civil hospital Mithi, from 3rd June 2009 to 3rd June 2012. In this study 4657 patients were enrolled. All patients presented with symptoms suggesting surgical disease and managed as surgical cases were included in the study. These patients were either admitted via outpatient department [OPD], emergency department or operated as OPD cases. The patients who received 1st aid medication and referred to tertiary care were not included. The variables noted and analyzed were patient's demographic data, provisional and final diagnosis, disease pattern, presentation, mode of admission, mode of treatment, nature of operation, complications and final outcome. All the data was analyzed by SPSS version-16 on computer. During three year study period, 4657 patients were managed either conservatively or operated upon. Out of total, 2591[55.6%] were emergency and 2066[44.36%] were elective admissions. The male female ratio was 4:1 .The mean age of patients was 36.5 Years. Urinary tract diseases were responsible for 1638 [35.17%], alimentary tract diseases 1242 [26.6%], trauma 932 [20.01%], soft tissue infections 546 [26.9%], superficial lumps 367 [18.13%] admission. Most common operative procedures for urinary tract diseases 409 [20.20%], soft tissue infections 546 [26.9%]. superficial lumps 367[18.13%], alimentary tract diseases [15.06%] 305, trauma [soft tissue repair and fractures 14.9%[303], were major bulk for operations. Regarding procedures Abscesses incision and drainage in 197 [22.6%] patients, cystolithotomy in 153 [17.6%], Hernioraphy [130] 14.9%, appendecectomy 105 [12.09%], haemorrhoidectomy 51[5.8%],breast abscess 38 [4.3%] breast lump [fibroadenoma] 25 [3.6%], hydrocele23 [2.6%], Ureterolithotomy 22 [2.5%] laparotomy 15 [1.7%], pyelolithotomy12, [1.3%] fissure in ano 13, [1.4%] undecended testis 12 [1.3%] Orchidectomy11 [1.3%] and abscesses psoas, perinal, scrotal 13 [1.4%], 18 [2.07%], 12 [1.3%] respectively. The concluded that the most common cause of seeking surgical care at back ward rural Tharparker was urinary tract diseases. Presence of surgical specialist at remote and back ward region Tharparker is candle in the dark. Main reason of patient referral to tertiary care was deficient in skill medical and surgical professionals, paramedic staff and medical equipments

Hepatitis and AIDS fear and misconceptions; Are our students ready for contact with these patients?

Blood born infection is also one of the medical profession hazard which is added due to virus transmission by needles and medical instruments and Hepatitis and HIV viruses are leading viruses in this hazard. Medical students who are actively participating in clinical practices and due to contact with patients, face exposure of patient's needles, instruments, and blood and this exposure starts in clinical posting of third year when their clinical knowledge and professional skills are in early phases. To assess and evaluate the existing level of knowledge about these blood born infections [Hepatitis B, C and AIDS] to ensure their participation in clinical activities during their clinical posting. An observational cross sectional study with prospective data. Dow lnternational Medical College. From 2010 to 2011. This is an observational cross sectional study with prospective data, done through a questionnaire survey on third year MBBS students. 47% of the students have fear about to be infected by patient's examination during clinical posting and majority of students have misconceptions about transmission of these infections. Students have more knowledge about HIV compare to hepatitis but there is no relation in knowledge score and student's fear as shown by p value of 0.3 and 0.73 for HBV and HIV but for HCV [p= 0.035] during this study. Up to half of the students have fear to be infected by these infections during patient's examination and this perceived risk of infection is due to lack of knowledge and these misconceptions and attitude to these patients are the sources to make them reluctant in active participation of clinical activities directly related to patient.

Suprapubic cystolitholapaxy: a variable option for paediatric bladder stones

To assess the complications of suprapubic cystolitholapaxy as an alternative procedure for bladder stones in pediatric age group. Prospective analystical study. This study was carried out in Department of Urology, University of Medical and health sciences Jamshoro from May 2006 to December 2010. this study consisted of 148 patients admitted though the outpatient department of Liaquat University Hospital Jamshoro/Hyderabad. All patients underwent base line and specific investigations especially ultrasound of abdomen and pelvis as diagnostic modality for assessment of bladder stones. Inclusion criteria were all these patients who after counseling for this study and gave written consent parents. Irrespective of their sex and age < 12 years of age presented with bladder stone of < 3cm. Exclusion criteria included were patients having history of previous surgery, posterior urethral valves, stricture urethra and stone > 3 cm were excluded from the study. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 148 patients, 124 [83.78%] were boys and 24 [16.21%] were girls with ratio 5.1:1 respectively. Mean age of the patients was 5.3 years with range from 1 to 11 years. Twelve [8.1%] patients presented with retention of urine due to impacted stone at bladder neck or prostatic urethra while 16 [10.81%] patients had coexisting renal stones. The mean size of the stones was 1.9 cm with range from 1.1 to 2.8 cm. Total operative time ranged from 25 to 40 minutes. Patients were discharged after observing first void on 2[nd] post-operative day 136 [91.89%] while twelve [8.11%] patients required further stay due to either suprapubic urinary leakage in 5[3.37%] or urinary retention in 7[4.72%] patients. Percutaneous suprapubic cystolitholapaxy is safe and cost-effective alternative to open surgery in children with

Port site complications in patient after laproscopic cholecystectomy

To assess the frequency of port site complications in patient after laproscopic cholecystectomy. Observational study. This study was carried out in the Department of Minimal Invasive Surgical Centre [MISC] at Liaquat University of Medical and Health Sciences Jamshoro Pakistan, from Oct 2009 to 31[st] May 2011. This study consisted of Four hundred and fifty patients, admitted for laparoscopic cholecystectomy. Base line and specific investigations were done in all patients, especially ultrasound of abdomen for assessment of gallstone disease. Inclusion criteria were that all patients diagnosed as case of gallstone disease on the basis of history, clinical examination and investigations specially ultrasound of abdomen. Exclusion criteria included complicated gallstone disease, unfit patients for general anesthesia, pregnant ladies due to risk of foetal loss, patients with carcinoma of gall bladder, patient with acute pancreatitis and patients with obstructive jaundice. Postoperatively the patients were followed for up to 6 months and observed port site complications. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 315[70%] were female and 135[30%] male. Ratio male: female ratio of 1:2.3. Age ranging from a minimum of 20 year to 65 year with mean age was 38 + 3.4 years. Complications were port site infection in 4 [0.88%] cases, followed by port site bleeding in one [0.22%] case and epigastric port site diathermy burn in one [0.22%] case. In conclusion, we recommend all 10 mm trocar sites be closed care fully. Over stretching of infra / supra umbilical port should be avoided. Gallbladder should be removed in endo-beg

Extracorporeal shock wave lithotripsy; can alpha blocker improves stone clearance?

To determine the efficacy of Alpha blocker as adjunctive medical therapy, which increases the stone clearance after extracorporeal shock wave lithotripsy [ESWL] to treat renal stones. Quasi Experimental study. Department of Urology, Liaquat National Hospital, Karachi. September 2010 to March 2011. Ultrasound guided Dornier Alpha Impact lithotripter was used for shock wave lithotripsy. Study was carried out on 60 patients who underwent single session of ESWL for renal calculus. Patients were divided in two groups, Group A [n=30] received conventional treatment and Group B [n=30] received Alpha-1 Blocker in addition to conventional treatment. All patients were evaluated with X-ray and Ultrasound [KUB] after 2 weeks and repeated at the end of month. Failure is defined as unsuccessful expulsion after 4 weeks and patient desire to remove the stone before day 30. Out of 60 patients, 45[75%] were males and 15[257%] were females with male to female ratio was 3:1. The average age of the patients was found 36.32 +/- 14.8 [Ranging from 15 to 75] years. Complete clearance was achieved in 76.7% of those receiving Alpha-1 Blocker and in 46.7% of controls at 1 month [P = 0.001]. This difference was statistically significant. The results of my study demonstrate that Alpha-1 Blocker therapy, as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal stones and is equally safe

out come of transvaginal repair in 50 cases of vesico-vaginal fistula

To see the out come of transvaginal repair of vesico-vaginal fistula. A consecutive case series study. This study was conducted in the department of Urology and Dialysis Unit Peoples Medical College Nawab Shah, from Jan 2007 to the Dec 2009. Patients were collected from the urology out patient department and the department of gynecology People's Medical College Nawab shah. Total 50 females were operated for the vesico-vaginal fistula trans-vaginally. After the admission care full history and examination were done to demonstrate the incontinence subjectively and objectively. Before surgery all subjects were diagnosed by the cystoscpic examination. All subjects were operated transvaginally. The total 50 females were operated for the vesico-vaginal fistula trans-vaginally. In 35 cases obstructed and prolonged labour and in 15 cases pelvic surgery was the cause of vesico-vaginal fistula. Cystoscopically all fifty fistulae were divided according to their site in the bladder. Supra trigonal 07, trigonal 35 and Marginal 08. All were repaired transvaginally. After two weeks catheter was removed, the leakage occurs in four [04] cases in supra-trigonal cases. In trigonal variety of vesico-vaginal fistula all thirty five [35] cases only three [03] fistulae were leaked. In third variety of vesico-vaginal fistula was marginal variety. Total eight [08] fistulae were and three [03] out of eight fistulae were leaked. We conclude that transvaginal is an excellent approach for the vesico-vaginal fistula, especially in trigonal, solitary and smaller i.e. <4cm variety of fistulae. Careful selection of the patient and the time of repair are the important mile stones for the successful out come.

Appendecectomy during pregnancy. a comparison of laparoscopic with open appendicectomy in respect of safety and morbidity to mother and fetus

Acute appendicitis is the most frequent non-obstetric emergency that require surgery for the period of pregnancy. The aim of the study was to assess Laparoscopic versus Open method of appendicectomy in pregnant patients in respect of benefits and hazards to patients and fetus. Comparative Study. This study was conducted at Alrass General Hospital Saudi Arabia from 1[st] March 2008 to 1[st] June 2010. Pregnant women having acute appendicitis admitted in Alrass General Hospital Saudi Arabia and underwent open or laparoscopic appendicectomy were studied. A total of 118 pregnant women were operated for acute appendicitis. 66[55.9%, n = 118] patients underwent open and 52[44.1%, n = 118] patients underwent Laparoscopic appendicectomy. Mean age +/- SD [range] of patients 23.45 +/- 4.5 years [18-38] in OA [open appendicectomy] group and 22.00 +/- 2.94 years [17-37] in LA [Laparoscopic appendicectomy] group. Mean gestational age was 16.51 +/- 4.17 weeks [11-26] in OA and 18.28 +/- 4.61 weeks [10-27] in LA group. There were no fetal loss in any group. Pre-term delivery occurred in 6[9.1%] patients in OA and in 4[3.7%] patients of LA group. In laparoscopic surgery there is no increased risk to mother and fetus as compare to open surgery

Haemorrhoids

The objectives of the study are to compare the outcome of the Doppler Guided Haemorrhoidal Artery Ligation and open Haemorrhoidectomy in 2nd and 3rd Degree Haemorrhoids. Comparative study. Study was carried out at the General Surgical Department at Liaquat University Hospital, Jamshoro and private hospital Hyderabad from 2008-2009. Study consisted of 50 patients of diagnosed cases of heamorrhoid. Patients were divided in two groups. In Group A Standard open Haemorrhoidectomy and Group B we used Doppler Guided Haemorrhoidal artery ligation. Detailed history was taken from all the patients with special regard to the bleeding per rectum or some thing coming out during defecation and Clinical examination of anal canal DRE and Proctoscopy was done. In both groups male were 37 [74%] and female 13 [26%] with male: Female Ratio of 2: 8:1. Age ranging from 20 to 60 years in both group, mean ages of patients were 38.28 + 10.355 years. 3rd degree haemorrhoid 31[62%] while 2nd degree 19[38%]. Complications were mild to moderate pain 24[96%] patients in DG -HAL group while moderate to severe pain 23[92%] in excisional heamorrhoidectomy group. Anal stenosis in 2[8%], patients, anal fissure 1 [4%] patients and feacal incontinence 1[4%] patients were observed only in excisional heamorrhoidectomy. Recurrence occurred in one case [4%] in each group. DG-HAL procedure has a low rate of complications, earlier mobilization, implies a shorter hospital stay and offers the patient a more comfortable postoperative period than Excisional heamorrhoidectomy procedure

Presentation and outcome of surgical management of strangulated inguinal hernia at Liaquat university hospital Hyderabad

The objectives of the study are to determine the incidence of strangulated inguinal hernia in patients presenting with irreducibility and obstruction, evaluate the age and sex incidence, see the duration of hospital stay in our setup and see the post operative morbidity and mortality. Experimental Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Jamshoro, from 2007 to 2009. 100 cases of obstructed hernia were selected out of which 85 with strangulation were included in this study. These patients were admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro/Hyderabad. All these patients were admitted in emergency. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 140 patients presenting with obstructed hernia were selected of which 85 were found to have strangulated hernia. There was wide variation of age ranging from a minimum 15 to 70 years with the mean age 42 years. 55 patients had Right sided hernia 64.7% and 30 patients had Left sided hernia 35,2% and no patient with bilateral strangulated inguinal hernia reported 0%. During surgery of 60 patients [70.5%] had gangrenous omentum while 23 cases [27%] ileum was non viable so we had to resort to resection and anastmosis, two cases [2.3%] Ileum was so much contaminated so we had to resort to Ileostomy and two case [2.3%] sigmoid colon was involved so we had to resort to colostomy. Postoperatively majority of them developed wound infection 14 [16,4%] followed by chest infections 10 [11.7%] Haematoma formation was reported in 5 [5.8%] and retention of urine in 3 patient [3.5%]. Good pre-operation assessment and early management will decrease the morbidity and mortality in strangulated inguinal hernia