Outcome karydakis procedure for pilonidal sinus

To analyze the Outcome of karydakis procedure for pilonidal sinus. Prospective interventional Lahore General Hospital, Lahore from January 2001 to December 2004. Patients with chronic pilonidal sinus and Karydakis procedure was adopted. Total No of 60 patients underwent excision and asymetrical primary closure. Six patients required intravenous analgesia minor wound infection was present in twelve patients [20%]. Forty eight [80%] patients were able to resume normal household activities with in two weeks while full outdoor activities were possible in two to three weeks in nearly 100% of cases conversion to open methods was zero with recurrence rate 5% [3 Cases] patients acceptability was 90% [54 Cases]

Management of acute pancreatitis: an experience at Mayo hospital, Lahore

This is a retrospective as well as prospective study of 46 patients with acute pancreaitis who were managed in North Surgical Unit of Mayo Hospital, Lahore. This study was carried out with special emphasis on need of surgical treatment and its outcome. No age group or sex was found immune to this disease. It was more common in 3rd to 4th decade of life and female sex. The commonest etiology is gall stones [54%] followed by alcohol [8%] and idiopathic [15%]. Pain epigastrium is a constant symptom. Judicious use of serum amylase urinary amylase and ultrasonography can help in early diagnosis of the acute pancreatitis. Complications are best diagnosed on CT scan. Majority of patients were treated successfully by conservative measures [44%] but developed complications which carried high morbidity and mortality. Surgical treatment of associated gall stones has prevented recurrent attacks of acute pancreatitis. Hence cholecystectomy for associated gall stones is recommended during same admission for mild to moderate pancretitis after resolution of symptoms

Carcinoma gall bladder-our experience

Carcinoma gallbladder is highly lethal disease and most common malignant lesion of biliary tract which continuously gives rise to diagnostic and therapeutic challenges. A prospective study of 18 cases of carcinoma gallbladder admitted in North Surgical Unit of Mayo Hospital, Lahore in two years [1997-98] is presented. The majority of the patients were females in 5th and 6th decade of life and admitted through OPD[73%] and [27%] through emergency. Preoperative suspicion of carcinoma was made in 83% of cases. Most of the cases presented in Stage IV and V Eighty three% of the patients had gall stones. Various operative procedures performed wt-re cholecystectomy [2] extended cholecystectomy [6], open biospy of the tumour only [4], biopsy and stenting of CBD [2], biopsy and hepaticogastrostomy [2], fine needle aspiration cytology only [2]. The mean hospital stay was 9 days. The operative mortality was 5.5% in this series

Hyperparathyroidism -10 Years experience

A study of 9 patients of Hyperparathyroidism over a period of 10 years is presented. The mean age of the patients was 35 years. Six of them were female, four patients presented with renal calculi, 3 with pathological fractures and two with grey tumour. Seven cases were of single adenoma and two were of hyperplasia. Parathyroid III was the more common site. The parathyroid adenoma was found in the tissue of right lobe of thyroid gland in one case. Meticulous dissection and bloodless field are keys to success. Inferior thyroid arteries should be followed to their ramification on thyroid for identification of parathyroid gland

Management of hepatic trauma

A review of 32 consecutive patients with liver trauma admitted in two surgical units of Mayo Hospital, Lahore in the year 1994 is presented. Majority of patients were young [mean age 26.5 years] male [90.6%]. Penetrating injuries [81%] were far more common than blunt trauma. Firearm injury was later confirmed at laparotomy except in two stable patients where diagnosis was confirmed on ultrasonography. These patients were managed conservatively. Right lobe [59.4%] was primarily involved in trauma. According to Moore's classification of liver trauma, twenty two patients had Grade-1 and II injuries 9 had Grade III and IV and one had Grade V injury. Eighty percent of patients had associated injuries to other organs. Hepatorrhaphy [64.3%] was the commonest amongst the procedures carried out, others were Hepatoomentorrhaphy, [10.7%] resectional debridement with selective ligation of the vessels [14.3%] perihepatic packing [7.1%] and hepatic lobar resection [3.6%]. Morbidity in this series was 59.5% and mortality 12.5%

Ureteral injuries: a complication of hysterectomy

Ureteric injury is an important complication following hysterecotomy which a General surgeon or Urologist is called upon to deal with. A prospective study of nine such patients referred to the authors for management is presented. The mean age of patients was 36 years. Commonest [66.7%] presentation was postoperative anuria, the rest [33.3%] presented with urinary fistulae. All these injuries followed either elective abdominal or caesarian hysterectomies. Majority [89%] of these were operated by relatively junior gynaecologists. All these patients were operated upon. In five patients who had suture entrapment of both ureters, delegation with or without stenting was done. In four patient ureteroneocystostomy was done for ureteric transection. All patients were cured and discharged from the hospital with a mean stay of 11 days

Changing pattern of abdominal tuberculosis

Abdominal Tuberculosis continues to give rise to diagnostic and therapeutic challenges. The population at risk, the pattern of presentation and epidemiology is changing with time. A review of all [46] cases of abdominal tuberculosis admitted in two surgical units of Mayo Hospital Lahore [MHL] in a single year [1994] is presented. The majority of patients were female, in their second or third decade of life, admitted through emergency with acute presentation. Only 41.3% were elective cases with subacute clinical features. Active pulmonary lesion was present in 19.6% cases. Diagnosis was established at laparotomy in 95.65% patients. Only in two patients diagnosis was made through less invasive means. Intestines were the most commonly involved organ in the disease process, resection of diseased segment with end to end anastomosis was the most commonly performed procedure [47.8%]. Other surgical procedures were mesenteric lymph node / omental biopsy, closure of perforation with or without proximal bypass, adhenolysis, transverse colectomy and salpingo oopherectomy. Morbidity in this series was 18% and mortality 6.5% with mean hospital stay of 9 days