Comparison of inguinal hernia repair under local anesthesia by surgical trainees and consultants

To evaluate the outcome of Lichtenstein repair under local anesthesia in term of safety, efficacy and complications and to compare the results of surgical trainees with their consultants. All Consecutive patients with primary inguinal hernia undergoing Lichtenstein repair under local anesthesia by our trainees and consultants over a 05 year period were included into the study. Operative time, hospital stay and complications were assessed. Data was analyzed using SPSS version 17. A total of 298 patients were included in the study; 15 patients were excluded from the study due to loss of follow up. Data analysis has been done for 283 patients. All the study subjects were male with a mean age of 39.28 +/- 12.61 years. Indirect inguinal hernia [91%] was the commonest, followed by direct inguinal hernia [6.7%] and sliding hernia was only in 1.6% of the patients. Majority of the hernia repairs 221[78%] were performed by the residents and only 62[21.9%] were performed by the consultants. The operative time was slightly more for residents 46.8 versus 42.8 minutes [P<0.05]; whereas hospital stay was comparable between the two groups1.23 versus 1.27 days [P=0.562]. Minor postoperative complications occurred in 24[8.5%] patients. Wound infection, scrotal hematoma and chronic pain were the most common complications in 1.4% patients. All these complications were managed conservatively including wound infection. However recurrence occurred in 2[0.7%] patients of residents group. Inguinal hernia can be safely repaired under local anesthesia and it is one of the procedures that can be safely delegated to surgical trainees with comparable results with consultants

Extremity vascular trauma. A 7-year experience in Lahore, Pakistan

To determine the outcome of various techniques of vascular repair in terms of repair related complications and limb salavagibility. From January 1999 to December 2005, this retrospective study was conducted in the Department of General Surgery, Lahore General Hospital, Lahore, Pakistan. The patients, who underwent various surgical interventions for extremity vascular trauma, were included in this study. Those, who underwent primary amputation due to non-salvageable injuries or who presented with late complications of vascular injuries were excluded. Ninety-three patients underwent different surgical procedures for extremity vascular trauma. Majority of the patients were young, mean, 29.4 years male 91.3%. Penetrating trauma was the most common mode of injury 77.4%. The median time interval between injury and repair was 4.5 hours. Superficial femoral artery was the most frequently injured artery 26.8%. Graft repair was carried out in 41 patients 46.6%, while 34.1% of the patients had end-to-end anastomosis. Wound infection was the most common complication 18.2%. Seven patients 7.5% had secondary amputations and 3 3.2% died from other injuries. Vascular reconstruction was successful in 89.3% of the patients. Early revascularization by employing simple repair or interposition autogenous vein graft repair results in successful limb salvage with acceptable complication rate

Outcome of primary repair in penentrating colonic injuries

To assess the outcome of primary repair in penetrating colonic injuries in terms of regional/local morbidity [suture line breakdown, intra-abdominal abscess] and mortality. Design: Prospective, interventional study. Place and Duration of Study: Surgical Unit II at Lahore General Hospital, Lahore, over a period of 3 1/2 years from June 1999 to December 2002. Patients and Out of 38 consecutive patients with penetrating colon injuries, a selective group of 25 patients [65.7%] undergoing primary repair [simple suture, resection and anastomosis without covering colostomy and right hemicolectomy] were included in this study. The morbidity and mortality variables were recorded and statistically analyzed. Majority of our patients were of younger age group [mean 25 years]. Twenty patients [80%] were male. The commonest mode of injury was firearm injury [72%]. The time interval between injury and repair was 3-11 hours [mean 7 hours]. Simple repair of colon with interrupted stitches was the commonest procedure performed [44%], followed by right hemicolectomy [32%]. Colon related complications developed in 3 patients [12%], which included two fecal fistulae and one intra-abdominal collection. One patient died of septicemia [4%]. Hospital stay ranged between 6-16 days [mean 8 days]. Primary repair is a safe method of managing penetrating colon injuries in carefully selected patients