Wound infection and length of hospital stay with and without placement of drain in patients with complicated appendicitis

Objective: To compare the outcome, in terms of wound infection and length of hospital stay, with and without drain placement in patients with complicated appendicitis

Study design: Randomised controlled trial

Place and Duration of study: Department of General Surgery, Jinnah Postgraduate Medical Centre Karachi, from August 2015 to February 2016

Methodology: A total of 60 patients with complicated appendicitis were included in this study. Patients were randomly allocated into two groups and had placement of drain or no drain. Final outcome was measured in terms of wound infection and hospital stay at the end of 5[th] postoperative day. Chi square test was used for analysis

Results: There were 42 [70%] male and 18 [30%] female patients. The mean age of the study subjects was 25.63 +/- 4.13 year. Rate of wound infection and hospital stay [>4] were significantly high in patients where intraoperative drain placement was done [p=0.008 and p=0.005 respectively

Conclusions: Routine placement of the drain after complicated appendicitis is not indicated. Drain placement was associated with increased morbidity

Right-sided diaphragmatic hernia in an elderly male

Diaphragmatic hernia is rarely reported in elderly. Here we present a 90-year-old male patient suffering from respiratory symptoms with no prior history of trauma. Investigations showed diaphragmatic hernia on the right-side. Defect was anteromedial in position. The contents of the hernia were small and large gut. Considering multiple co-morbid it was decided not to operate on this patient

Ileosigmoid knotting: an unusual cause of intestinal obstruction

Ileosigmoid knot is also known as compound volvulus or double volvulus. It consists of either an intertwining or a knot forming between a loop of ileum and sigmoid colon. This lead to a complex intestinal obstruction and may result in strangulation of one or both the segments of bowel loop. We report a case of pregnant woman who presented with acute abdominal pain. Following resuscitation she was operated and Ileosigmoid knotting was found. Loops of ileum and sigmoid colon were found gangrenous. Resection of ileal loop and stoma was fashioned while resection and anastomosis of sigmoid colon loop was performed. Recovery was uneventful

Incision pain: a comparison between use of diathermy versus scalpel in patients undergoing elective abdominal surgery

Objective: to compare the mean postoperative wound pain score in diathermy [cutting] versus scalpel made skin incisions in patients undergoing elective abdominal surgery

Study design: Randomized clinical trial

Place and Duration of study: department of Surgery Jinnah Postgraduate Medical Center Karachi, From February 2015 to August 2015

Methodology: patients who underwent clean elective abdominal surgery were randomly assigned into either group A [diathermy incision] or group B [scalpel incision]. Antibiotic prophylaxis was given at the time of induction of anesthesia. Postoperatively 20ml bupivacaine [0.25%] was infiltrated into the wound and regular dose of diclofenac sodium was given. Patients were assessed for pain by numerical analogue scale at the end of 48 hours after surgery

Results: a total of 60 patients were included. They were divided into group A and B with 30 patients in each group. Mean postoperative wound pain score was significantly low in group A than groups B [1.30+/-0.98 vs. 1.97+/-0.81; p=0.0006]

Conclusion: cutting diathermy is safe and effective method to make skin incision in elective abdominal surgeries and has significant advantage over scalpel skin incision in relation to postoperative pain

Excision with Z-plasty in pilonidal sinus

To measure the outcome of the pilonidal sinus exicision with Z-plasty in terms of postoperative hospital stay, recurrence, wound infection and patient's time off work. Cross sectional study. Department of General Surgery, Ward-26, Jinnah Postgraduate Medical Centre Karachi, from January 2008 to January 2009. Patients with pilonidal sinus above 12 years of age were included in this study. They were diagnosed clinically. Those with abscesses and recurrence of disease were excluded. A total of 40 patients were operated. There were 28 [72%] males and 12 [28%] females. Majority were in the age group of 21 - 30 years [64%]. The operating time ranged between 30-45 minutes [mean 35 + 2]. Mean postoperative stay was 3.5 days [2- 5 days] and return to work was between 7-18 days [mean 12.5 days]. Three patients [7.5%] patients developed wound dehiscence, 6 [15%] had wound infection and recurrence occurred in 2 [5%]. 95% confidence interval[C.I] of overall complication was 13.4-40.1. Excision of pilonidal sinus followed by primary closure with Z-plasty technique had the advantage of early wound healing, short postoperative stay and low risk of recurrence