Carcinoma Involving Gallbladder: A Four Year Study in a Tertiary Care Hospital in Kashmir Valley/Gallbladder Carcinoma

Background: Carcinoma of gall bladder clinically mimics benign gall bladder diseases and often escapes detection untiladvanced stage. Careful attention to any evidence of wall thickening, thorough sampling and close examination of any deeplysituated glandular structures are critical.Aims: To study the clinicopathological pattern of gall bladder malignancies.Materials And Methods: This was a 4 year retrospective study and carried in Department of Pathology, Government MedicalCollege, Srinagar, Kashmir, between January 2015 and December 2018. Our study included 57 cases of gall bladder malignanciesincluding incidental detected cases.Results: During this four year study, a total of 57 patients were studied. Male to female ratio of 0.78:1 was seen. The age ofthe patients ranged from 27-85 years and peak age incidence was seen in sixth decade of life. The most common presentingsymptoms were pain abdomen followed by anorexia and dyspepsia. Grossly evident tumor was seen on initial pathologicexamination in 49 cases (85%) while 8 cases grossly presented no visible tumor (i.e. incidental gall bladder carcinomas havingonly mild wall thickening undetected by imaging).The most common tumor sites were in the body and the fundus of gallbladder.The most common histologic type was adenocarcinoma NOS in 47 cases followed by papillary adenocarcinoma in 2 cases,mucinous adenocarcinoma in 2 cases, primary squamous cell carcinoma in 3 cases, and a single case each of neuroendocrinetumor and adenosquamous carcinoma. Immunohistochemistry was done, wherever needed, for confirmation.Conclusion: GBC is not an uncommon clinical entity in Kashmir valley, unlike western countries. In spite of the advancedimaging techniques, early gall bladder carcinoma is not efficiently detected. Therefore, every gallbladder should be subjectedto routine histopathological examination because with identification of an early gallbladder carcinoma a curative resection maybe possible and these patients have a good long term survival.

Three-port versus four-port laparoscopic cholecystectomy - a two years experience at combined military hospital Malir cantt Karachi

Objective: To compare the safety, outcome and advantages of three port laparoscopic cholecystectomy vs. four port laparoscopic cholecystectomy

Study Design: Prospective descriptive study

Place and Duration of Study: The study was done at Combined Military Hospital Malir Cantt Karachi starting, from Mar 2013 to Oct 2015

Material and Methods: Total 200 patients who had undergone gall bladder removal laparospically were studied. Complication rate, duration of operation, insertion of 4th port, converting laparoscopic method to open, duration of hospital admission, early return to work and need of analgesics were studied in patients with three ports laparoscopic cholecystectomy [LC] vs. four ports LC

Results: A total of 200 patients who had removal gall bladder laparospically, three-port LC were performed in 117 [58.5%] patients and four-port LC was performed in 83 [41.5%] patient. There was no significant difference with respect to complication rate, converting to open technique and duration of operation were comparable to four ports LC. One patient required 4th port in left hypochondrium for liver retractor to retract enlarged left liver lobe

Conclusion: LC using thee ports can be performed safely when done by experts in this method. The said procedure has significant benefits over the conventional four-port method with respect to decreased use of pain killers and duration of hospital admission

Fistulotomy vs. fistulectomy in the treatment of simple low anal fistula of male patients

Objective: To compare the efficacy of fistulotomy versus fistulectomy in the treatment of low lying anal fistula in male patients

Study Design: Randomized clinical trial

Place and Duration of Study: Surgery Department, CMH Multan and CMH Malir, from Aug 2008 to Oct 2013

Patients and Methods: Study was done on 262 patients. Patients with anal fistula were divided by simple random allocation into groups A [fistulotomy] and B [fistulectomy]. The patients with simple low anal fistula without any comorbids were included in the study and the patients with recurrent fistula, high fistula or those having any comorbid were excluded from the study. Data was analysed using SPSS 17. Descriptive statistics applied for both quantitative and qualitative variables. Mean and standard deviation for quantitative and frequencies and percentages for qualitative data

Results: Total 262 patients were selected having low lying anal fistula and operated as group A - fistulotomy and group B - fistulectomy, each group constituted of 131 patients each. The operating time was found to be shorter for group A [14.29+3.24 minutes] and group B [25.92 +3.60 minutes]. The group A patients were discharged earlier [3.73 + 0.65 days] than group B [4.88 + 0.35 days]. In group A incidence of postoperative bleeding [0.8%], infection [2.2%] and recurrence was [10.7%]. While in group B bleeding [3.1%], infection [3.8%] and recurrence was [15.3%]. Severity of postoperative pain [as assessed by Numeric Rating Scale] was higher in group B as compared to group A. The healing time was shorter in group A [4.04 + 0.33 weeks] as compared to group B [4.57 + 0.497 weeks] and the patients of group A returned to normal activity earlier [10.9 + 2.05 weeks] than group B patients [15.54 + 0.51 weeks]

Conclusion: In male patients suffering from simple low lying anal fistulas, fistulotomy has a definitive superiority over fistulectomy and is recommended to be adopted as primary surgical modality for the treatment

Torsion of appendix of testis

An case of torsion of the appendix of testis is described in a 10 years old boy. He presented with sudden onset of severe pain in the left testis of 3 days duration. Emergency exploration of the left testis revealed a gangrenous appendix of the left testis. The appendix of the testis was excised and the wound was closed. The patient made a smooth post-operative recovery

Damage control laparotomy for exsanguinating penetrating abdominal trauma

Damage control, defined as initial control of haemorrhage and contamination with intra-peritoneal packing and rapid closure, allows the resuscitation to normal physiology in the intensive care unit and subsequent definitive re-exploration. A case of penetrating abdominal trauma with extensive hepatic, interior vena cava and pancreatico-duodenal injuries, was managed on the principles of damage control on the first laparotomy and definitive procedure of pancreaticoduodenectomy was delayed and performed after 48 hours