Procedure for prolapsed haemorrhoids versus excisional haemorrhoidectomy a systematic review and meta-analysis

To assess the efficacy of Procedure for prolapsed haemorrhoids versus excisional haemorrhoidectomy to treat haemorrhoids. Randomised controlled trials comparing EH and PPH with >/= 15 patients. This study was conducted at Nishtar Medical College, Multan from December 2011 to May 2012. All articles addressing haemorrhoidectomy were identified using the Medline and Pubmed Web sites with the period of review extending from December 2011 to May 2012. Articles addressing PPH and EH were then reviewed. The search included in English language. All randomised controlled comparative trials and patient samples of >/= 15 patients were considered for the meta-analysis. The primary endpoints assessed were pain and time taken to return to normal activity. Secondary endpoints were bleeding, complications and residual symptoms, recurrence rates and re-interventions PPH was associated with less postoperative pain, earlier return to normal activities compared with EH. There was no difference between the two procedures in terms of complications. There were more recurrences after PPH. Compared with EH, PPH is associated with less postoperative pain, earlier return to normal activity. The rate of recurrence appears higher with PPH

Diabetic foot; surgical management

Diabetic foot is one of challenging diseases based on uncontrolled diabetes mellitus. The aim of this study was to evaluate the surgical management in diabetic foot patients presenting with different grades of infection. Descriptive study. Place and duration of study: Surgical unit I, Department of Surgery at Nishtar Hospital Multan for a periods of two years from January 2009 to December 2010. Patients and A total of 120 diabetic patients with different severity of foot infections who presented in causality and surgical outpatient department Nishtar Hospital Multan, where included in this study. Patients included in this study were above age of twelve years and were of both sexes. A detailed history was taken followed by the clinical examination. Routine investigations including complete blood examinations, complete urine examination, renal parameters, X-ray foot, CXR, ECG and pus for culture and sensitivity were recorded. Lesions were raded according to Wagner classification and appropriate medical and surgical treatment carried out. This study was carried out on 120 diabetic patients, out of which ninety six [80.0%] were male and twenty four [20%] were female. Male to female ratio was 4:1. Majority of the patients [n=66] were between the age group of 50 to 60 years. In majority of these patients forefront was involved, mostly big or little toe,. Patients were grouped into five grades according to the severity of infection. Twenty six [21.6%] patients were managed with antibiotics and dressings, thirteen [10.8%] patients needed debridement and skin grafting while eighty-one needed amputations of different types. Staphylococcus aureus was the commonest organism isolated. Majority of the diabetic foot lesions were in grade II to V. Lesser grade lesions responded well to conservative management with antibiotics, dressings and debridement. While those with higher grades needed amputations. Basic principles of management include early detection of diabetic foot, proper control of infection, control of diabetes mellitus and wound care. Delayed and improper treatment leads to osteomyelitis resulting in amputation and permanent disability of deformity

Diagnostic value of fine needle aspiration cytology in the diagnosis of solitary thyroid nodule

To evaluate usefulness of the FNAC in diagnosing solitary thyroid nodule. Interventional study. This study was carried out in the Department of General Surgery, Nishtar Medical College, Multan from January 2010 to July 2010. A total of 100 patients were included in the study. Majority of the patients i.e. 40 [66.7%] patients were between the 21-40 years. Of the 60 patients, 10 [16.7%] patients were male while 50 [83.3%] patients were female. Thirty five [58.3%] patients belonged to district Multan while 10 [16.7%] patients were residents of district Muzaffargarh. Mild pain was noted in 6 [10%] patients 3 [5%] patients had change in voice and 3 [5%] patients had palpitation. Thirty patients [50%] presented within one year of the start of their disease. Right lobe of the thyroid gland harboured swelling in 45 patients [75%]. Only 3 patients [5%] were diagnosed as papillary carcinoma. Cold thyroid nodule is a common problem and has gained much significance due to its potential for malignancy

Rhomboid flap in the treatment of pilonidal sinus disease

The aim of our study was to present our experience with the Rhomboid flap technique in the management of pilonidal sinus disease and to evaluate the morbidity and recurrence. Cross-sectional, observational study. This study was conducted in the surgical department of Nishtar Hospital Multan Ward 4 surgical unit 1, October 2011 to March 2012. Eleven patients were included, eight had previous surgical drainage of multiple natal cleft abscesses, and three had acute disease at the time of surgery. Nine patients had complex, recurrent pilonidal sinus. By using the Rhomboid transposition flap, we were able to excise the diseased area and close the defect. Operative time, hospital stay, healing time, wound infection, wound breakdown, return to normal activity and recurrence were assessed. There were 10 males and one female with a median age of 23 years [range 17-32 years]. Mean follow-up was 6 months [range 5-6 months]. Mean operative time was 63.2 minutes [range 55-75 minutes]. Hospital stay was 3.4 days [range 2-5]. Postoperative morbidity involved superficial wound infection in two patients, superficial gangrene of wound edges in one patient and partial wound breakdown in one patient that settled with dressing in the out-patient clinic. All wounds healed and the median healing time was 15 days. There was no recurrence in our series. Median time to return to normal activity was 17.8 [range 10-27] days. Rhomboid flap is a useful technique in the treatment of advanced, difficult cases of pilonidal sinus disease. It has relatively low morbidity, allows early return to full activity and does not necessitate prolonged postoperative care. A larger series and longer follow up time is needed to assess the recurrence rate more adequately

Management of penetrating injuries of colon

Types of operative measures adopted and prognosis of patients with perforating injuries to colon. Descriptive Study. This study was carried out in the Surgical Unit-I, Nishtar Medical College, Multan during the period from July 2011 to December 2011. All 60 patients were admitted in emergency ward with trauma to abdomen, and routine investigations were carried out. Majority of the patients i.e. 51 [85%] were injured by gunshot. Fifty five [90%] patients were male. For more extensive contamination colostomy gave complication rate 20% in grade 2 and 25% in grade-3. Patients who were anastomosed, 15% developed leakage. Out of 60 patients, 15 [25%] patients had injury at right colon, 16 [28%] had at transverse colon, 28 [46%] patients at left colon and remaining 11 [18%] patients had injury at sigmoid colon. Out of 60 patients, l0 [16%] patients were found in injury grade-1, 44 [74%] patients in grade-2 and 6 [10%] patients in injury grade-3 were involved. Majority of the patients i.e.44 [74%] had more complications. There was no difference between these two groups with respect to grade of colon injury according to the colon injury severity scale or location of injury. It was observed from data that selective primary repair may be used in a significant proportion of colon wounds. It was based on classification system that employs an assessment of the extent of tissue injury, degree of fecal contamination, assessment of associated injuries; estimates of the influences of delay between injury and definitive therapy and hemorrhagic shock

Laparoscopic cholecystectomy with harmonic scalpel

To compare results in terms of thermal injuries and biliary complications with use of monopolar hook and ultrasonic harmonic scalpel Inlaparoscopic cholecystectomy. Quasi-experimental study. This study was conducted at Surgical Unit I and III, Nishtar Hospital Multan from November 2011 to July 2012. During a 9 months period, in a personal series of 95 consecutive patients, the Harmonic scalpel was used as the sole instrument for both division and dissection of the cystic artery and duct. The average length of inpatient stay, procedure duration, and complications were compared with the data of a homogenous control group of patients who were treated using monopolarelechosurgery and clips. Measurements of the percentage were made using SPSS 15. Statistical significance level was at p <0.001. Neither major complications nor bile duct injuries were detected in either group, and no statistically significant difference was found between the groups in terms of the incidence of postoperative complications. However, the mean operative time was significantly shorter in patients treated with the Harmonic scalpel. The Harmonic scalpel is not only a safe and effective instrument but also a reliable substitute for clips because it provides complete hemobiliary stasis. Even if the study revealed no differences with regard to postoperative complications, the Harmonic scalpel represents a viable alternative because of the shorter operation time and cost savings that are inherent in a procedure using it as a single instrument

Outcome of stricturoplasty in patients with intestinal tuberculosis

Abdominal TB is one of the most prevalent forms of extra-pulmonary disease and is prevalent all over the world. Gastrointestinal involvement had been reported to be 55-90%. This study aimed to determine the outcome of stricturoplasty in patients with intestinal tuberculosis. To determine the outcome of stricturoplasty in patients with intestinal tuberculosis. Descriptive case series. Department of General Surgery, Nishtar Hospital Multan. Three years from January 2009 to December 2011. 120 patients of intestinal TB, who presented with intestinal obstruction in emergency and with signs and symptoms of intestinal TB in outdoor patient department were selected. History of contact, family history of tuberculosis immunization, past history of tuberculosis was taken. Diagnosis was confirmed by histopathology. Laparatomy was done in all cases and stricturoplasty was performed. Patients were followed up during hospitalization. Postoperative complications were noted. All information were recorded on a proforma. Out of 120 patients, 56.7% were male and 43.3% were female having age between 14 to 70 years. Main presenting symptoms were pain abdomen, vomiting, distension of abdomen, weight loss, anorexia and low grade fever with sweats. Main complications after stricturoplasty were chest infection 40[33.3%], wound dehiscence in 16[13.3%], leakage in 12[10%], recurrence in 20[16.7%], scar pigmentation in 12[10%], keloid in 12[10%] patients and herniation in 8[6.7%] patients. Stricturoptasty is a safe, simple and easy operation, particularly useful at small peripheral hospitals with limited staff and resources

Management options of basal cell carcinoma in surgery

To describe the prevalence, mode of presentation and various surgical options of reconstruction in the management of basal cell carcinoma. Descriptive Study. This study was conducted at Nishtar Hospital, Multan from 2006 to 2009. 60 patients were taken in this study. A separate file was maintained for each patient. A thorough history and full physical examination was conducted, relevant investigations were carried out. Out of sixty cases, 50 [83%] were male and 10 [17%] were female. Majority of the patients presented to us above the age of 45 years and the incidence of BCC increases with the age. The male to female ratio was 5:1. Out of 60 cases 26 [20 male, 6 female] 43.3% were farmer, 16 [all male] 26.6% wee construction workers, 10 [8 male, 2 female] 16.6% were unemployed and 8 [all female] 13.3% were household. No patient presented before 5 years after the development of the lesion. 34 [30 male, 4 female] 56.6% for the last 6-10 years, 20 [16 male, 4 female] 33.3% for the last 11-15 years, 2 [all male] 3.3% for 16-20 years and 4 [2 male, 2 female] 6.6% had lesions for > 20 years. Delay in presentation has an overall negative effect on the outcome

Which is better in care of volvulus sigmoid colon? primary repair or double barrel colostomy

Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. Sigmoid volvulus is the most common form of volvulus of the gastrointestinal tract and this condition is responsible for 8% of all intestinal obstruction. Sigmoid volvulus is particularly common in elderly persons. To compare the outcome of double barrel colostomy versus primary repair after on table lavage in cases of volvulus of sigmoid colon. Comparative study. This study was conducted in the Department of Surgery, from April 2010 to September 2010 in Nishtar Hospital, Multan. This study was conducted in the Department of Surgery, from April 2010 to September 2010 in Nishtar Hospital, Multan. A total of 100 patients were included in the study. Majority of the patients in the age group 41-50 years. Out of 100 patients, 80 [80%] were male and 20 [20%] were female. Out of 100 patients, 40[40%] belonged to Baluchistan, while 30 [30%] from DG Khan, 10 [10%] from Sindh and remaining 20 [20%] from Multan. It is concluded from the study that morbidity and hospital stay was significantly lower in patients with Group-A [sigmoidectomy and primary anastomosis after on table lavage] as compared to group-B [sigmoidectomy + double barrel colostomy], so economic burden and morbidity related to colostomy can be prevented

"Sooner the better" it is true for peripheral vascular injury a study of 100 cases at Nishtar hospital, Multan

A descriptive study of 100 cases to compare the early intervention [within 6 hours] with late intervention in outcome of peripheral vascular injury conducted in Nishtar Hospital, Multan over a period of 2 years extending from December 2001 to December 2003. No age was found to be safe yet peak occurrence was noted in 21-40 years of age i.e. 66%. Out of 100 cases of peripheral vascular injuries 82 patients [82%] were male and 18 patients [18%] were male. Firearm injury was seen in 61 cases [61%] of peripheral vascular injury. Second common cause was road traffic accidents i.e. 25%. Most of the cases of peripheral vascular injury reached hospital within 6 hours. Cases of peripheral vascular injury from area were 70 [70%] whereas from urban areas only 30 [30%] cases were seen. Revascularization was restored within 6 hours in 50 patients and none of them required amputation. Forty-five reached hospital between 6-12 hours and 15 patients [33.3%] required amputation whereas 5 patients arrived hospital beyond 12 hours and 4 patients [80%] of them required amputation. All cases of peripheral vascular injuries should be surgically explored. Every effort should be made to achieve revascularization within 12 hours. Patients presenting late or with crush injury should undergo amputation

Comparison of incidence of injury of hollow viscus versus solid organs in blunt abdominal trauma

Fifty patients were chosen for this study who were between 13-50 years of age and had only abdominal injury; laparotomy was done in all the cases. Road side accident was the major cause in 48% patients of blunt abdominal trauma followed fall height, animal kicks, direct blow and fall of heavy objects. Most of the patients injured were males [82%]. Diagnosis was made on clinical grounds in 72% patients. Diagnostic peritoneal lavage was done in 38% cases. Its accuracy was 89.5%. Solid organs were injured more but intestine was the commonest organ [22%]. Reason for the slight disparity between the percentage of organ injury in this study and international studies is prolong transit time taken by the patients to reach the hospital. Average transit time was 18 hours. Since intestinal injuries were not immediately fatal whereas splenic and hepatic injuries were many times fatal before they reached the hospital; this explains the higher incidence of intestinal injuries in this region

Sooner the better: it is also true for perforated duodenal ulcer; a study of 100 cases at Nishtar hospital, Multan

A retrospective study of 100 cases to describe the effect of perforation on operation interval on the prognosis of perforated duodenal ulcer was conducted in surgical wards of Nishtar Hospital, Multan. An overall mortality of 16% in 100 patients who under went surgery. Mortality occurred only in group-B and C. Interval between perforation and operation increases the hospital stay like group-A patients stayed in hospital for 8 days, patients of group-B who stayed in hospital for 10 days, whereas stay of group-C patients was 23 days. Number of complications in patients presenting with delay were much more than in patients presenting early. Morbidity also rises with delay. Patients with perforated duodenal ulcers should be operated as soon as possible. Simple closure of perforation is simple and safe wit hrelatively low mortality and short stay in hospital

Mini-cholecystectomy versus standard cholecystectomy

Gall bladder diseases are very common and their established treatment is cholecystectomy. Removal of the gall bladder can be accomplished with less amount of trauma depending upon the approach to gall bladder area [laparoscopic, mini-cholecystectomy and conventional cholecystectomy]. Study included two hundred patients who were randomized after informed consent into two groups; group-I [100 patients] and group-II [100 patients] and they were respectively subjected to mini-cholecystectomy and standard cholecystectomy. Results showed same operative time with its added advantage of lower analgesic requirements, shorter hospital stay, and early return to work and reduced early and long term complications in patients who underwent mini-cholecystectomy as compared to standard cholecystectomy. In conclusion, mini-cholecystectomy is better alternative to standard cholecystectomy where laparoscopic facilities are not available because it does not need specialized training and costly equipment along with acquisition of new skill

Use of 12.5 mm poly venyl ethylene [Pve ] hose pipe as a traction stent for palliation of dysphagia in advanced/ inoperable carcinoma esophagus

From March 2000 to November 2003, 39 PVE funneled hose pipe pieces were inserted as esophageal stents in 27 males and 12 females with mean age of 60 years [range=42-82 years]. Average hospital stay was 7 days [range = 5-20 days]. Procedure related morbidity was 40% while mortality was 10.25%. There was little effect of age, sex, type and level of tumor on morbidity and mortality. In patients who could be discharged home, dysphagia score improved form average of 4.2 to 2.5. Average post procedural survival was 4.2 months. 7 [20%] patients required readmission for stent malfunction. Only five of them required a second procedure to re-establish the passage. Slipping of stent occurred in only one case where a second stent was inserted. Our technique for manufacturing and insertion of the stent is described. Review of literature and a discussion to support our practice is included. We conclude that although self expanding metallic stents are the current gold standard world wide for palliation of dysphagia due to advanced carcinoma of esophagus, a molded PVE stent can be used in place of conventional traction and pulsion tubes where affordability is a problem. Using the described technique a reliable relief of dysphagia with acceptable morbidity and mortality rates can be achieved

Evaluation of initial, mid-stream and terminal urinary sample for cytology in follow up of bladder cancer and its comparison with cystoscopy

Study was carried out with a view to know which sample of urine [initial, midstream or terninal] is more useful in detecting the malignant cells. Cytological examination of the voided urine is the only non- invasive method of detection, diagnosis and follow up of tumours of the bladder. A pilot project of 75 patients with biopsy proven carcinomas of the bladder was carried out. Each patient provided fractionated urinary samples [initial, midstream. terminal]. The diagnostic value of each group was assessed and the results' were compared with cystoscopic examination. Twenty four [32%] of patients had both positive cytology and cystoscopy. Twenty-seven [36%] of patients had both negative cytology and cystoscopy. The false neative results were 24% and 0.75% were false positive. The fractionated sampling results showed that 93.33% of the urinary samples including initial, midstream and terminal had yielded cytological results, however, in our experience fractionated urinary sampling does not add to the routinely taken sample of urine for cystology. Study confirms that any sample of urine is satisfactory for diagnostic purpose

Management of fistula-in-ano; a common clinical problem

Study design A prospective study of 54 patients [age ranging from 18-54 years] operated for perianal fistula. Place: First Surgical Unit Nishtar Hospital Multan. Duration: January 2000 to July 2001. To determine the incidence of low or high anal fistula, recurrence rate following surgery and effect of surgery as well as effect of previous procedures on the incontinence. Material and methods: The fifty four patients [54] were subdivided into two groups' i.e. low and high anal fistulae and were operated by laying open technique [fistulotomy] for low fistulae and by two-stage fistulotomy, seton "cut-through technique and Re-routing of the tract for high fistulae. Patients were followed to see the incidence of recurrence, effect of surgery on continence as well as effect of previous surgery on continence. Overall recurrence was only 4.44% for low fistulae and 11.11% for high fistula in-ano. Minor incontinence was observed only following surgery for high variety. No such complication occurred in low variety. Low fistulae can be laid open with minimal loss of sphincter muscle but as for as the high variety is concerned it is safer to place a seton or stage the procedure