Effectiveness of non-mesh [shouldice] versus mesh [lichtenstein] repair in inguinal hernia

To evaluate the optimum method of repair for inguinal hernia with respect to low rate of recurrence, minimum postoperative pain and cost effectiveness. Retrospective and Comparative study. This study was conducted between 2004-2007 in the surgical department DHQ Hospital Karak from. Either 320 patients were randomly allotted to mesh or non-Mesh repair. They were followed up at the 1[st] week and then 1, 6,12,18,24 and 36[th] month. Clinical outcome that is, recurrence rate, quality of life, Post-oparative pain etc were noted. After 3 year, the recurrence rates were significantly different for the two types of repairs. The Shouldice is usually suited in primary and unilateral inguinal hernial repair in adult males. In addition, The Lichtenstein is best for bilateral and recurrent inguinal hernial repair in old patients [>60 Yrs] and in elective states of repair

Fistula in ANO; presentation and postoperative outcome of the different surgical procedures in low type

This study was planned to find out the clinical presentation and postoperative outcome of different surgical procedure in low type in low fistula in Ano. Prospective observational study. Study was conducted in teaching hospital setting at LUMHS Jamshoro, Zia ud Din Teaching Hospital Karachi and DHQ JMC Teaching Hospital Charsadda. Liaquat University in Surgical Unit-1 Jamshoro from May 2010 to June 2012. One seventy cases of low type fistula in Ano with single external opening, irrespective of age and sex admitted in surgical unit-l, were examined. Mean age was 37 years, patient's rages from [15-60 years]. Patients having high type fistula in ano identified pre and per operatively excluded from the study. A detailed history physical examination including local examination of anorectum focusing on the level of internal opening. Investigation like fistulogram done in selected case. Fistulectomy and fistulotomy performed in all these cases and patient followed up minimum upto the 6 months time. Maximum Number of cases were seen in 3rd,4th, decade of life 50 [29.6%] and 64 [37%] respectively. Mean age was 37 ranges from 15 to 60 years. Out of 172 patients 142 [85.7%] male and 24 [14.3%] female. Male to female ratio was 6.1:1. Majority of patients one forty two [82%] presented with discharge. Discharge along with swelling in 132 [76.7%]. Hundred twelve [65%] underwent fistulectomy, 38 [22%] of the patients got fistulotomy and [12%] of patients underwent fistulectomy along with haemorrhoidectomy and fissurectomy. A total of 72 [41.4%] patients experience different post operative, surgical and anesthetic complications. Conclusions: Incidence of low type fistula in ano is higher in 3rd and 4th decade of life. The disease was found more common in male, discharge, pain, itching are common symptoms of low type fistula in ano. In low type fistula in ano fistulotomy is safe procedure. Post operative complications can be prevented by careful treatment efforts