Tracheal resection and end-to-end anastomosis for tracheal stenosis: etiology and outcome

To know the etiology of tracheal stenosis and asses outcome of tracheal resection and end-to-end anastomosis for tracheal stenosis. Descriptive prospective case series. Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi and Quetta from May 2005 to March 2010. Twenty two patients were included in the study who underwent tracheal resection followed by primary tracheal reconstruction by same surgical team. Etiology was ascertained on the basis of available history and per-operative findings. End-to-end tracheal anastomosis was done using vicryl 3/0. Outcome of surgical technique was assessed using peak expiratory flow rate [PEFR] and flexible bronchoscopy. Twenty two patients were managed over a period of five years, of which 17 [77.3%] were male and 5[22.7%] female. Mean patient age was 27.31 +/- 9.61 years. Seven [31.8%] patients had New York Heart Association grade [NYHA]-III and 15 [68.2%] had NYHA grade-IV dyspnoea. Seventeen [77.3%] had stridor. All patients were already being managed by pulmonologists, ENT specialists or intensivists. Twelve [54.5%] had grade-V stenosis [91-100% luminal obstruction] and 9 [40.9%] had cervical tracheal stenosis and 3[13.6%] had mediastinal tracheal stenosis. Six [27.3%] patients had partial cricoid resection followed by thyrotracheal anastomosis, 13[59.1%] patients underwent cervical tracheal anastomosis and 3 [13.6%] patients required mediastinal tracheal anastomosis. Patients were followed up post-operatively for the development of immediate and delayed complications. The follow up was carried out for a minimum period of 6 months to a maximum period of 2 years. Postoperative complications included neck pain, lung collapse, and superficial skin infection. Tracheal resection with end-to-end anastomosis is a safe, reliable and permanent procedure for the treatment of tracheal stenosis

Management of primary spontaneous pneumothorax by video assisted thoracoscopic surgery [VATS]

To evaluate the outcome of treatment of primary spontaneous pneumothorax by VATS. Case Series. Dept. of thoracic Surgery Combined Military Hospital Rawalpindi between April 2007 to Dec 2009. This study included 20 patients with primary spontaneous pneumothorax who were treated by VATS apical stapling and pleural abrasion/ pleurectomy. All patients were operated under one lung ventilation. Three ports of 10mm were used and apical stappling / bullectomy was done with linear cutting stapler [ethicon, autosuture]. This was combined with pleural abrasion/ pleurectomy, Chest was drained via a single chest tube. We had 21 procedures on 20 patients. There were 18 males and 2 females [9:1]. Mean age was 26.4 years. Indications included persistent air leak 7, recurrent attack 12, contralateral recurrence 1 and professional hazard 1. Mean hospital stay was 3.2 days. Complications included minor port site infection 5, intercostals neuralgia 3, delayed lung expansion 2 cases and persistent apical space in 1 case. There is no recurrence. VATS was a reliable approach for managing primary spontaneous pneumothorax with low morbidity

Day case management of varicocele

To evaluate the outcome of treatment of varicocele by low ligation under local anaesthesia and to establish the low ligation as a mode of treatment for early mobilization of the patient and early return to work. Descriptive study. Department of Surgery Combined Military Hospital Rawalpindi from June 2002 to Dec 2002. This study included 50 patients with varicocele irrespective of their age treated by low ligation under local anaesthesia in day case settings and were followed for 3 months. The results of the procedure on the symptoms were quite satisfactory. Post operatively complications were seen in only 8 [16%] patients. Post operative hematoma formation occurred in only 1 [2%] patient, wound infection in 2 [4%] patients, transient pain at the site of operation was present in 2 [4%] patients, transient hydrocele developed in 1 [2%] patient, permanent hydrocele developed in 1 [2%] patient, in 1 [2%] of the patient the dilated veins persisted after the operation even at 3 month follow up. This study concludes that low ligation of varicocele as day case surgery is a very useful day case procedure in the treatment of varicocele that can be very safely carried out under local anaesthesia with a very high healing rate and minimal complications