experience with mesh versus darn repair in inguinal hernias

Background and Objective: The inguinal hernia accounts for 50 percent in old age males. A Lichtenstein type of operation has now become the method of choice in most developed countries but in the developing world traditional simple suture repair is still in common practice in resource limited hospitals due to the scarcity and expensive nature of the commercial prosthetic mesh. Our objective was to compare the rates of complications in Lichtenstein repair to tension free Darn repair

Methods: Ninety two male patients from 20-60 years of age reported for direct or indirect inguinal hernia with open Mesh/Lichtenstein or darn repair in emergency or electively from January 2014 to December 2015 were enrolled in this prospective randomized control trial [RCT]. The primary end point was to compare the surgical site infection, length of hospital stay and hernia recurrence with different techniques

Results: The hospital stay was higher in patients who had Lichtenstein repair, Superficial surgical site infections in cohort A [6.5%] and cohort B [4.36%] were noted. Complications of recurrence in Group-A were [1.5%] as compared to Group-B which had a recurrence of 6.52%

Conclusion: Lichtenstein is more promising in comparison to Darn repair in terms of recurrence in inguinal hernia

Pattern of intestinal obstruction in infants and children

To find out causes of intestinal obstruction in infants and children and their relation to age and sex distribution. This descriptive study was conducted at Peadiatric Surgery departments of Peoples University of Medical and Health Science for women Hospital Nawab Shah and Liaquat University of Medical and Health Sciences Hospital Jamshoro, from January 2010 to December 2010. All infants and children presenting with symptoms and signs of intestinal obstruction, and patients having advanced appendicitis with intestinal obstruction, were included in this study. Surgical intervention was carried out, where indicated, otherwise patients were managed conservatively. Patients were divided into two groups: Infants were enlisted in group A, while toddlers and older children were put together in group B. Data was analyzed by using SPSS version 10 for percentage and frequencies Total 67 patients were included in the study. Among these 44 were Males and 23 Females with M: F ratio of 1.9:1. There were 24 patients in group A, among these, 15[62.5%] cases had intussusception, while other conditions, namely incarcerated inguinal hernia, colonic web, post operative adhesions, ileal web and inflammatory bands constituted 37.5% cases of bowel obstruction. In group B there were 43 patients. These included, post operative adhesions in 6[13.95%] patients, while tuberculosis of intestine in 5[11.63%], Meckel's diverticulum with band 5[11.63%], perforated appendix in 5[11.63%], intussusception in 3[6.97%], Volvulus of small intestine in 3[6.97%] and Inflammatory bands and adhesions in 3[6.97%] patients. Malrotation, Hirschsprung's disease, Trichobezoar and faecal impaction each one occurred in 2[4.65%] patients. Ovarain teratoma, lymphoma, caecal Volvulus, duodenal web and duplication of colon of each one of these conditions occurred in one [0.43%] patient each. Resection of gut and anastomosis was carried out in 18[26.86%] patients [8 from group A and 10 from B]. Two patients from group B died. Pattern of intestinal obstruction varies at different age groups in terms of etiology as well as in relative incidence. Intussusception was the commonest cause in group A, while post operative adhesion had predominance in group B. Outcome depends upon the underlying condition and associated morbidity

Reasons for conversion from laparoscopic to open cholecystectomy

To determine the frequency and reasons of conversion of laparoscopic cholecystectomy [LC] to open cholecystectomy [OC]. This prospective study was carried out in the Surgical unit III, Peoples Medical College Hospital from April 2006 to October 2009 male and female] were included in the study, all were evaluated fully preoperatively in respect to disease and general fitness of the patient for surgery and counseled regarding possibility of conversion from LC to OC. 6 patients [8.8%] were converted to open procedure. Obscure anatomy of Calot's triangle, bleeding and bile duct injury were common reasons of conversion. Even in difficult cases LC is a safe procedure with low incidence of conversion and complications in hands of experienced laparoscopic surgeon, where as junior surgeons being in learning curve are less confident and skillful, so are prone to more complications. Therefore they are advised to convert to open procedure earlier according to the criteria laid down, before complication occurs

unusual foreign body in the urinary bladder

Foreign body in urinary bladder being unusual in clinical setting presents as a diagnostic dilemma with vague history. Bladder calculi are uncommon in adults and usually result either from obstruction or foreign bodies. The present case report describes a young girl presenting with cysticism. Investigations revealed a bladder calculus encrusted on trans-urethrally inserted abortion stick in the urinary bladder that warranted surgery. Endoscopic manipulation was successful. Postoperative period was uneventful