Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus open Lichtenstein technique

To compare the outcome and cost of laparoscopic inguinal hernia repair versus open repair. This was a randomized controlled study conducted on 100 patients from January 2011 till April 2012, in Surgical 'A' unit, Lady Reading Hospital, Peshawar. A total of 100 patients were randomized and were allocated into two groups i.e. open repair [Lichenstein procedure] and laparoscopic repair [Trans-abdominal pre-peritoneal mesh repair, TAPP] group using lottery method. Type of hernia, type of procedure done, total cost of surgery, duration of hospital stay, post operative pain rating by visual analogue score and post operative complications were assessed. Significant difference was observed between the two groups in relation to the perioperative complications. Mean operative time was short in open repair 55.40 +/- 10.73 minutes compared to TAPP 87.10 +/- 11.60 minutes but the mean length of hospital stay was less in TAPP [2.78 +/- 0.64 days] compared to open [3.5 +/- 0.67 days]. Regarding postoperative complication urinary retention was 22% and 10%, wound discharge was 20% and 08%, recurrence was observed in 12% and 06% in open repair and TAPP respectively. The difference was statistically insignificant. Laparoscopic repair showed significantly less post operative surgical pain compared to open repair. This trial showed no statistical difference between the open and laparoscopic procedures regarding post operative complications but laparoscopic repair showed statistically lower post surgical operative pain and hospital stay with greater operative time and cost. This study supports the use of the laparoscopic repair techniques for the treatment of inguinal hernia

Various surgical options for emergency management of sigmoid volvulus

The objective of this study was to compare the outcome of various surgical options for the emergency surgical management of sigmoid volvulus. This comparative study was conducted in emergency department of postgraduate medical institute Lady Reading Hospital, Peshawar over a period of one year from February 2007 to January 2008. Study comprised of hundred cases to have sigmoid volvulus on clinical and radiological grounds operated in casualty department with various surgical options and outcomes of these procedures were determined postoperatively. Out of 100 cases, 79% were males and 21% females. Majority 51% patients were in the age range of 41-60 years, 36% patients were in age group of 61-80 years. Resection and Hartman's procedure was performed in 52% cases, resection with primary anastomosis with covering colostomy in 18% cases, resection and primary anastomosis in 15% cases, and resection with double barrel colostomy [Paul Mikulicz] in 15% cases. Wound infection/ dehiscence occurred in 21% cases, intra-abdominal abscess in 9% cases, anastomosis leakage in 6% cases. Colostomy complications included bleeding in 7% cases, retraction in 7% patients, prolapse in 4% cases. Resection and Hartmann procedure was performed in majority of patients. Wound infection/dehiscence, intra-abdominal abscess, anastomosis leakage were common postoperative complications with various frequencies

frequency and management of intestinal Tuberculosis; a hospital based study

To determine the frequency of clinical manifestation of intestinal tuberculosis and outcome of different treatment modalities. This descriptive study was conducted at Lady Reading Hospital Peshawar from July 2005 to June 2006. Fifty cases having radiological evidence of tuberculosis in the intestines were included in the study. Various parameters like age, sex, presentation, investigation and various treatment modalities were studied. Twenty three [46%] patients presented with subacute and 13 [26%] with acute intestinal obstruction and 12 [24%] with signs of peritonism. Presenting symptoms were: pain abdomen and anorexia in 47[94%] patients, nausea / vomiting in 30 [60%] patients and constipation in 28 [56%] patients. Tenderness was present in 48 [96%] patients and distension of abdomen in 35 [70%]. Two [4%] patients were treated conservatively and 48 patients [96%] were managed by surgery [emergency surgery 34 cases, semi-elective surgery 14 cases]. In 47 [94%] patients, diagnosis was confirmed by characteristic caseating granuloma. Resection of the small bowel with ileo-ileal anastamosis was done in 16 cases and limited right hemicolectomy with ileo-colic anastamosis in 14 cases. Two staged procedures were performed in 8 cases. Only three [6%] cases needed re-admission for complications, two [4%] for sub-acute obstruction and one [2%] for ileostomy prolapse. Abdominal tuberculosis presents with pain abdomen, anorexia, vomiting and with signs of intestinal obstruction. The surgical procedures like resection with primary anastomosis have satisfactory outcome. Two stage surgical procedures are advisable if the risk of anastamotic leakage and faecal fistula formation is high