Résumé
Ventral hernias are defects in the abdominal wall. They are normally classified by aetiology and location. The main reason of ventral hernias can be prior surgery [incisional] or spontaneously [umbilical, epigastric, spigelian, or lumbar hernias]. Ventral hernia repair is one of the most common operations performed by general surgeons. The purpose of this study was to compare the complications rate, post-operative pain, hospital stay and time to return to normal activity in laparoscopic and open mesh repair of ventral hernias. The study was conducted from October, 2010 to February, 2011 in surgery department Holy Family Hospital, Rawalpindi. In this randomised clinical trial a total of 160 patients were selected by taking approval from hospital ethical committee and informed written consent from each patient. The admitted patients for elective surgical repair of ventral hernia were randomly allocated to Group A [laparo-scopy] and B [open repair] including 80 patients in each group. Information regarding study parameters was recorded on a predesigned perfonna. The mean age in laparoscopic group was 41.20 +/- 5.44 years and in open repair group it was 43.32 +/- 4.31 years. In laparoscopic group there were 61 females [76.25%] and in open mesh repair group there were 63 [78.75%] females. The post-operative pain was significantly [p-value = 0.000] less in laparoscopic group [3.59 + 1.58] as compared to open repair group [5.49 +/- 1.59]. The mean hospital stay was also significantly greater in open mesh repair group [31 +/- 5.8 vs. 39 +/- 7.36, p-value = 0.001]. The time to resume work activities for the laparoscopic group was significantly [p-value = 0.046] shorter [median, 21.0 days; inter-quartile range, 24 days] compared with that for the open repair group [32.5 days; 36 days]. There was significantly greater complication rate in open mesh repair group [48.75% vs 33.4%, p-value = 0.032] as compared to laparoscopic group. Intra-operative complications were noted higher in laparoscopic group as compared to open mesh repair group. The laparoscopic management of ventral hernia repair has less post-operative pain, less complications, shorter hospital stay and shorter time of return to normal activity work
Résumé
To compare the operative time and post-operative pain in laparoscopic and open mesh repair of ventral hernias. From October, 2010 to February, 2011 in surgery department, Holy Family hospital, Rawalpindi. In this Randomized Clinical Trial a total of 160 patients were included after taking approval from hospital ethical committee and informed written consent from each patient. The admitted patients for elective surgical repair of ventral hernia were randomly allocated to Group A [laparoscopy] and B [open repair]. Information regarding operative time and pain scores after 12, 24 and 72 hours of surgery was recorded. In group A, the mean age was 41.10 +/- 8.98 years and in group B 41.23 +/- 9.18 years. There were 36 [22.25%] male patients. There were 18 [11.3%] patients of Incisional, 107 [66.9%] patients of umbilical/paraumbilical and 35[21.9%] patients of Epigastric hernia in this study. In group A, the mean operative time was significantly [p-value= 0.000] less [66.56 +/- 16.14 minutes vs. 71.21 +/- 12.91 minutes] as compared to group B. There was no difference in mean pain score at 12th hour [p-value= 0.797]. At 24th hour and 72nd hour the mean pain score in Laparoscopic group was significantly [p-value = 0.000] lower. Laparoscopic management of ventral hernia resulted in short operative time, less pain at 24th and 72th hours. So it should be considered as the procedure of choice for ventral hernia repair
Résumé
To assess knowledge, attitude and practices about needle stick Injuries in health care workers. Hospital based study carried out at Pakistan Institute of Medical Sciences, Islamabad, from August 2010 to November 2010. A self administered 19 items questionnaire was prepared which contained information about needle stick injuries, its awareness, frequency of injury and the protocols that were followed after an injury had occurred. These questionnaires were given to 500 health care workers working in different wards and theaters of the hospital after obtaining their informed written consent. The health care workers included doctors, nurses and paramedical staff of Pakistan Institute of Medical Sciences, Islamabad. The data was entered and analyzed using SPSS version 15. A total of 500 health care workers filled the questionnaire and returned it. Out of these 416[83.2%] reported ever experiencing needle stick injuries in their professional life. Health care workers working in Emergency department were most frequently affected [65%] followed by those working in different wards [27%] and operation theatre [8%]. Most [93.6%] workers had knowledge about needle stick injuries and only 6.4% were not aware of it. Needle stick injury occurred from a brand new [unused] syringe in 51.2% cases, while in 32.8% cases, the needle caused an injury after it had been used for an injection. In 5% cases, injury occurred with blood stained needles. The commonest reasons for needle injury in stick injuries were heavy work load [36.8%] followed by hasty work [33.6%] and needle recapping [18.6%]. About 66% health care workers were already vaccinated against hepatitis B. Only 13% workers followed universal guidelines of needle stick injuries and no case was reported to hospital authorities. Health care workers had inadequate knowledge about the risk associated with needle stick injuries and do not follow standard preventive measures. A standard protocol regarding the training and compliance to follow preventive measures should be followed in all health care institutions