Primary closure a prefferd technique for pilonidal sinus

Objectives: To compare the efficacy of excision with primary closure versus open excision of the pilonidal sinus of natal cleft. The rationale of this study is to develop a single operative technique that will allow early healing and early return to work after getting surgical treatment of the pilonidal sinus of the natal cleft

Study Design: Comparative cross sectional study

Place And Duration: One year from 01-02-2011 to 31-01-2012, General surgical Department, Nishtar Hospital, Multan

Methodology: The study was conducted at General Surgical Department Nishtar Hospital Multan. 60 patients were divided in two groups, 30 in each group. Patients in group A were subjected to Primary closure and group B were subjected to open healing after excision of the pilonidal sinus. Follow up was done at 4 weeks and 8 weeks after operation

Results: Primary closure proved to be satisfactory in terms of Wound Healing time [p < 0.05] than open excision. In terms of time to return to work, return to work was early in group A [p < 0.05] as compared to group B

Conclusion: Primary closure after excision of the pilonidal sinus is much better and simple method in terms of early healing and early return to work as compared to the excision and open healing of the pilonidal sinus of the natal cleft

Comparison of rubber B and ligation versus injection sclerotherapy in second degree haemorrhoids

The objective of this study was to compare the efficacy of rubber band ligation versus injection scierotherapy in second degree haemorrhoids. This randomized control study has been conducted at Surgical O.P.D Nishtar Hospital Multan from 3rd April 2008 to 3[rd] October 2008. The study included 70 patients divided randomly in two equal groups. Patients in group A were subjected to injection sclerotherapy while patients in group B were treated with rubber band ligation. The patients were followed up at two weeks after the treatment and history regarding bleeding and pain was taken and proctoscopy was done to see pile core sclerosis. No patient was below 20 years of age in each category. Males were affected more than females. Only 31.43% of patients complained of mild pain after RBL while 60% of the patients had no pain at all. 91.43% and 88.57% of patients were free from the cardinal symptoms of bleeding and prolapse respectively, after RBL, at the end of 2 weeks of follow up 62.86% and 65.71% of patients were free from the cardinal symptoms of bleeding and prolapse while 34.29% of patients complained of mild pain after injection scierotherapy at 2 weeks. Rubber band ligation showed better results and good efficacy as compared to injection scierotherapy and should be considered as a procedure of choice for outpatient treatment of second degree haemorrhoids

Criteria for Early Laparotomy in abdominal stab wound

Patients with an abdominal stab wound presenting with shock, peritonitis or eviscerarion are usually subjected to early laparotomy, although very few studies have been done to validate the criteria. To validate that early laparotomy for stab wounds is compulsory or other diagnostic methods may be helpful to prevent unnecessary laparotomy in certain cases. The study was carried out in surgical unit-1, Nishtar Hospital, Multan during the period from January 2003 to June 2008. A total of 110 patients with stab wounds of the anterior abdomen, flank or lower chest were evaluated for their accuracy in predicting the presence of significant abdominal organ injury. Overall, 47 patients had a significant abdominal injury [42.7%]. The signs of peritoneal penetration including omental evisceration, air under the diaphragm or free fluid in the abdomen were not the independent predictors of significant injury. Signs of major internal haemorrhage or generalized peritonitis are reliable criteria by themselves for early laparotomy. Peritoneal penetration is a poor indicator of significant organ injury and warrants direct organ specific evaluation, such as computed tomography or laproscopy, to identify, patients who can safely be treated without operation

Comparison of complications between mayo's repair and mesh repair [pre-peritoneal approach] for para-umbilical hernia

To compare the complications of Mayo's technique of repair of para umbilical hernia with mesh repair.This study was conducted in the Department of Surgery at Nishtar Hospital, Multan. Fifty patients were recruited into study randomly. Two groups of 25 each, were made. Routine investigations were performed. All patients underwent surgery under general anaesthesia. Standard technique of repair was used in either groups. Complications were noted on a proforma designed for that purpose. Spearman's rank correlation coefficient test. A 'p' value of<0.05 was considered significant. Ten [20%] complications were observed. The main complications were wound haematoma in four patients [8.0%], wound infection in two patients [4%], seroma formation in two patients [4%], sinus formation in one patient [2.0%], mesh infection in one patients [2.0%] and no recurrence in any patients. Out of these 10 patients who developed complications, eight [16.0%] were in group-I [Mayo's technique] and two [4.0%] were in group-II [Mesh repair]. All were managed conservatively. Mesh repair found to be superior to the Mayo's technique in terms of complications

Comparison between hartmann's Paul-Mikulicz and primary resection and anastomosis in sigmoid volvulus

To compare the results of three procedures used in the management of gangrenous sigmoid volvulus [Paul-Mikulicz procedure, Hartmann's procedure and resection and primary anastomosis]. This study was conducted at Nishtar Hospital, Multan. Study included 30 patients with gangrenous sigmoid volvulus, admitted through the emergency department. The details of history, physical examination, investigations and surgical procedures done was noted in the collection form. In present study 20 [66.7%] patients were between 40-65 years, 10 [33.3%] patients were between 35-40 year. Mean age was 48 years. Out of 30 patients, 22 [73.3%] patients were male and 8 [26.7%] patients were females. As regards predisposing factors, 15 [50%] patients used high fiber diet, 5 [16.7%] patients had history of chronic constipation, 3 [10%] patients were hospitalized, 2 [6.7%] patients had long mesentery of sigmoid. Abdominal distension with delayed abdominal pain, indicting large bowel obstruction presented in 66.7% patients 60% had generalized abdominal pain and 83.3% had absolute constipation. While 16.7% patients had frank peritonitis and 23.3% patients had fever. Preoperatively diagnosed cases of gangrenous sigmoid volvulus were 66.7% and patients diagnosed on laparotomy were 33.3%. gangrenous sigmoid is an important cause of intestinal obstruction. More cases occur in males. In upto 80% cases diagnosis is based on the findings of an AP plain film. Hartmann's operation had least morbidity and mortality

Fistulae in ano following anorectal abscesses

This study was carried out to determine whether primary fistulotomy should be performed at the time of incision and drainage of anorectal abscesses and what% age of patients would develop fistula-in-ano or recurrent abscess. The record of 77 patients was reviewed who underwent incision and drainage of anorectal abscesses. Out of 77 patients, thirteen [16%] developed recurrent abscesses and 26 [34%] developed persistent fistulain-ano, with combined recurrence rate of 51%. This supports the policy of fistulotomy in the second sitting especially to prevent any complications and also of the fact that 59% would not need it

Lateral internal anal sphincterotomy for anal fissure: with or without associated anorectal procedures

To confirm or refute the validity of the fear associated with anal sphincterotomy for anal fissure, particularly when performed with other anorectal procedures. Design: Descriptive study. Place and Duration of Study: Surgical Wings - Medicare Hospital and Fatima Medical Center, Multan, over a period of 8 years from January 1994 to December 2001. Subjects and Records of 112 anal fissure patients, 46 [41.0%] males and 66 [58.9%] females, ranging in age from 12-95 years [mean 39] were studied. All patients with acute or chronic anal fissures with or without other anorectal pathologies were included. Seventeen patients who had anal dilatation and 2 recurrent fissures were excluded. 'Open' technique of anal sphincterotomy was employed in all cases. Results were recorded and analyzed. Fissures were acute in 16 [14.2%] and chronic in 96 [85.7%] patients. Anterior fissure was present in 20 [17.8%], posterior in 80 [71.4%], both in 9 [8.0%] and lateral or multiple fissures in 3 [2.6%] cases. Commonest associated pathology was haemorrhoids; encountered in 64 [57.1%] patients. Minor complications, taken together, occurred in 20 [17.8%] patients. Urinary retention was seen in 3 [2.6%] with lateral internal anal sphincterotomy [LIAS], and in 6 [5.3%] where haemorrhoidectomy was added. Haemorrhage in 2 [1.7%], temporary loss of flatus control in 3[2.6%] and soiling of clothes in 2 [1.7%] patients was encountered. No permanent loss of flatus or faecal control and recurrence has been reported to-date. Anal sphincterotomy with or without other anorectal procedures can be safely practiced in properly selected patients. Postoperatively, ablution with mild antiseptic added to plain water is adequate in maintaining hygiene to promote healing