Haemorrhoidectomy with internal sphincterotomy: a useful method to relieve post operative pain

OBJECTIVE: This study was designed to compare short term outcome of post operative pain in patients operated for haemorrhoidectomy alone and haemorrhoidectomy with internal sphincterotomy

METHODOLOGY: This comparative observational study conducted at Liaquat University Hospital Jamshoro during August 2012 to July 2014. One hundred and sixteen patients of 3rd or 4[th] degree hemorrhoids were enrolled in the study. Patients were divided into two comparable groups. Group A underwent open haemorrhoidectomy along with lateral sphincterotomy whereas group B was operated for open haemorrhoidectomy alone. Postoperative pain was analyzed by using visual analogue score at 24 hours, 48 hours and on 10th post operative day

RESULTS: Total 116 patients were included in the study. Fifty eight patients in each group

The mean age of the patients was 42+/- 10.2. Male were 77 [66.4%] and 39 [33.6%] were female. Male to female ration was 2:1. During follow-up periods, patient in group A experienced less postoperative pain as compared to group B [p value is

CONCLUSION: Lateral internal sphincterotomy combined with haemorrhoidectomy significantly reduces postoperative pain without increasing morbidity

evaluation of Milligan-Morgan and Ferguson procedures for haemorrhoidectomy at Liaquat university hospital Jamshoro, Hyderabad, Pakistan

To compare the outcome of Milligan-Morgan [MMH] and ferguson [fH] techniques for haemorrhoidectomy with regard to postoperative pain, control of bleeding, early mobilization of patients and wound healing. In this prospective, randomized clinical study conducted between January 2005 to December 2008, 213 patients with late 2[nd] degree; third or fourth degree hemorrhoids were assigned to two groups. One hundred ten patients in group A were operated by an open method and 103 patients in group B were operated by closed method. Age ranged from 22-70 years with mean age of 45.5 years. peak incidence was between 41-50 years. Out of 213 patients, 170 [79.81%] were male and 43 [20.18%] were females. The mean +/- SD operating time was significantly more in group B [31.3 +/- 4.8 min] than group A [25.2 +/- 5.6]. The duration of hospitalization and duration off from work was more in group A than the group B. Wound healing was quicker in group B than the group A. Post operative pain scores were significantly low in the Group A than Group B during first 24 hours and at first bowel movements. Reactionary hemorrhage occurred in 4 [3.63%] patients of group A, no patient in group B developed this complication. Retention of urine was seen in 13 [11.81%] patients in group A and 4 [3.88%] in group B. No patient in group A developed anal stenosis, while 3 [2.91%] patients in group B developed anal stenosis. Wound infection was one [0.9%] in group A and two [1.9%] in group B. Two [3.63%] patients in group A came with recurrent hemorrhoids and in group B, only one [0.97%] patient reported recurrence. The closed technique is more beneficial with respect to postoperative pain, control of bleeding, early mobilization of patients and wound healing

Evaluation of various causes and treatment of obstructive jaundice at Liaquat university hospital

The purpose of this study is to evaluate various causes of obstructive jaundice and its available treatment modalities in this area. Descriptive study. This study was conducted at Liaquat University Hospital Hyderabad/Jamshoro from January 2010 to december 2010. All the patients above 15 years of both sexes were included in this study having obstructive jaundice diagnosed on the basis of clinical grounds and supported by LFT and ultrasonography. A uniform system of history taking, physical examination, investigation and treatment was adopted for all the patients and information was recorded on the pre-designed proforma. Comprises 80 cases of obstructive jaundice, average age was 50 years with the female to male ratio1.5:1. The most common cause was carcinoma of head of pancreas in 27 [33.75%] followed by bile duct stone disease in 24 [33%] cases of carcinoma of gallbladder were in females. Jaundice with weight loss, itching [46%] and mass [28%] were the presenting features in malignant obstruction while pain [83.33%] and fever [25%] was mostly seen in patient with choledocholithiasis. Gallbladder was palable in malignant obstruction only. Anemia was the common associated problem [60%] especially in malignant cases [83%] only biopsy was preferred in 30 [37.50%] of cases, while choledochoduodenustomy in 14 [17.5%]. Postoperative complications were only in 28 [35%] of patients with wound sepsis in 17 [11.25%]. The mortality rate was [11.25%]. Maximal survival for carcinoma of pancreas was 9 months. The average post operative stay was 12 days. Cholecystectomy with supraduodental choledochotomy and T-tube insertion is effective treatment for bile duct stones whereas internal drainage of billary system is good for advanced malignant cases

Appendecectomy during pregnancy. a comparison of laparoscopic with open appendicectomy in respect of safety and morbidity to mother and fetus

Acute appendicitis is the most frequent non-obstetric emergency that require surgery for the period of pregnancy. The aim of the study was to assess Laparoscopic versus Open method of appendicectomy in pregnant patients in respect of benefits and hazards to patients and fetus. Comparative Study. This study was conducted at Alrass General Hospital Saudi Arabia from 1[st] March 2008 to 1[st] June 2010. Pregnant women having acute appendicitis admitted in Alrass General Hospital Saudi Arabia and underwent open or laparoscopic appendicectomy were studied. A total of 118 pregnant women were operated for acute appendicitis. 66[55.9%, n = 118] patients underwent open and 52[44.1%, n = 118] patients underwent Laparoscopic appendicectomy. Mean age +/- SD [range] of patients 23.45 +/- 4.5 years [18-38] in OA [open appendicectomy] group and 22.00 +/- 2.94 years [17-37] in LA [Laparoscopic appendicectomy] group. Mean gestational age was 16.51 +/- 4.17 weeks [11-26] in OA and 18.28 +/- 4.61 weeks [10-27] in LA group. There were no fetal loss in any group. Pre-term delivery occurred in 6[9.1%] patients in OA and in 4[3.7%] patients of LA group. In laparoscopic surgery there is no increased risk to mother and fetus as compare to open surgery

Outcome of the rubber band ligation with Milligan Morgan haemorrhoidectomy

Haemorrhoids is a common anorectal disease seen in our society. Conservative management is usually adopted for 1[st] and 2[nd] degree haemorrhoids. Patients who do not respond to above management are the candidates for other modalities of treatment which includes sclerotherapy, rubber band ligation, cryosurgery and stapler gun or open haemorrhoidectomy. The purpose of study was to compare the outcome of the Rubber band ligation with Milligan Morgan haemorrhoidectomy in patients with 2[nd] and 3[rd] degree haemorrhoids. Hundred diagnosed admitted patients of uncomplicated 2[nd] and 3[rd] degree piles were treated either with rubber band ligation [RBL] or open method of Milligan Morgan [OH] for the period from January 2007 to December 2007 were included in the study. Both procedures were evaluated regarding effectiveness, safety, complications after procedures, hospital stay and return to work on a written Performa. Patients with 1[st] and 4[th] degree haemorrhoids, below the age of 12 years, bleeding diathesis, associated local anorectal conditions requiring surgery, complicated haemorrhoids, recurrent and secondary haemorrhoids were excluded from the study. Follow up of all these patients was done in OPD to assess any complication and recurrence. Data was analysed through SPSS-16.0. One hundred indoor patients with 2[nd] and 3[rd] degree haemorrhoids were treated either with rubber band ligation or open technique. Most [>90%] of the patients were males. Majority of the patients were in 30-33 years age group. Fresh bleeding [90%] and constipation [45%] were the commonest symptoms followed by prolapsed, discharge and irritation. Second degree was more common than 3[rd] degree haemorrhoids. Intensive pain was the commonest complain after both the procedures, however faecal incontinence was not reported in either group. Hospital stay was longer in open technique [70%] compare to few hours to one day in rubber band ligation group. Return to work was earlier in patients treated with rubber band ligation. Rubber band ligation is safe and effective method compare to open technique in 2[nd] and 3[rd] degree symptomatic haemorrhoids

Management of giant inguinal hernia

Objectives: to determine the frequency and evaluate the clinical presentation and management policies of giant inguinal hernia

Design: descriptive study

Place and duration of study: this study was conducted in the department of surgery at Liaquat University of Medical and health Sciences Jamshoro / Hyderabad and Rajputana Hospital Hyderabad from October 2000 to September 2002 [two years]

Material and methods: male patients of all ages with giant inguinal hernia diagnosed clinically were included in the study. A uniform system of history taking, physical examination, investigations and treatment was adopted for all patients and information was recorded on predesigned proforma

Results: all 30 patients were male with age ranging from 50 to 70 years. Average age being 54.33 +/- 5.62. Most of the patients 60% were farmers by occupation and having right sided giant inguinal hernia. Ninty percent of patients presented as an uncomplicated case with complaints of giant inguinoscrotal swelling causing difficulty in walking, sitting and difficulty in voiding. Only 3 cases [10%] were admitted with features of intestinal obstruction. Out of 30 cases, 14 [46.66%] underwent basini repair while 8 [26.66%] underwent repair with mesh and orchidectomy. Right hemicolectomy including resection of half portion of ileum with orchidectomy and mesh repair was done in 8[26.66%] patients. Two patients of 70 years died due to cardiorespiratory failure while one patient died because of renal failure. Clinically maximum number of patients [46.66%] belonged to MHL grade-I while only one patient belonged to MHL grade-IV. Postoperative complications, hematoma in 5 patients[41.6% cases] and wound infection in 4 patients [33.33%] were the most common complications followed by chest infection developed in 3 [10%]. Twenty cases [66.66%] had hospital stay of 7 to 9 days while others were discharged late due to postoperative complications

Conclusion: the frequency of giant inguinal hernia is more among patients of old age, labour class and from rural areas. It is common in our population because of ignorance of hernia, living in remote areas and unawareness of complications of the disease

Volvulus of caecum

This case report describes volvulus of caecum in a young boy of 18 years, who presented with symptoms of acute abdomen. The condition was diagnosed at laparotomy and the patient was treated with right hemicolectomy