RESUMO
Background and Objective: Patients who undergo Total thyroidectomy are at higher risk for postoperative hypocalcaemia, which can lead to significant short and long term morbidity. The aim of this study was to determine the frequency of postoperative hypocalcaemia undergoing Total thyroidectomy
Methods: A total of 854 patients who underwent Total thyroidectomy and completion thyroidectomy between January 2003 to December 2016 at Endocrine Surgical unit, Jinnah Postgraduate Medical Centre, Karachi, were included in this retrospective study. Data were obtained for demographics, preoperative diagnosis, postoperative calcium levels, extent of surgery and final surgical pathology
Results: A total of 854 patients underwent Total thyroidectomy. Of these 87.58% [n=748] were malignant and 12.41% [n=106] were benign. Among the malignant and benign patients, 47.3% [n=404] underwent Total thyroidectomy and 52.69% [n=450] underwent completion thyroidectomy. Overall incidence of transient hypocalcaemia was 7% [n=60] and that of permanent hypocalcaemia was 0.11% [n= 1]
Conclusion: Hypocalcaemia is one of major concern following total- thyroidectomy. Meticulous surgical techniques, identification and preservation of vascularity of parathyroid glands are essential in preventing postoperative hypocalcaemia following total thyroidectomy
RESUMO
Objective: To assess World Health Organization [WHO] Surgical Safety Checklist [SSC] compliance and its effectiveness in reducing complications and final outcome of patients
Methods: This was a prospective study done in Department of General Surgery [Ward 02], Jinnah Postgraduate Medical Centre [JPMC], Karachi. The study included Total 3638 patients who underwent surgical procedure in elective theatre in four years from November 2011 to October 2015 since the SSC was included as part of history sheets in ward. Files were checked to confirm the compliance with regards to filling the three stage checklist properly and complications were noted
Results: In 1st year, out of 840 surgical procedures, SSC was properly marked in 172 [20.4%] cases. In 2[nd] year, out of 857 surgical procedures 303 [35.3%] cases were marked which increased in 3rd year out of 935 surgical procedures 757 [80.9%] cases and in 4th year out of 932 surgical procedures 838 [89.9%] cases were marked. No significant change in site and side [left or right] complications were noted in all four years
Surgical Site Infection [SSI] was noted in 59 [7.50%], 52 [6.47%], 44 [4.70%] and 20 [2.12%] cases in 1st, 2nd, 3rd and 4th year respectively. SSI in laparoscopic cholecystectomies was 41 [20.8 %], 45 [13%], 20 [5.68%] and 4 [1.12%] in 1st, 2nd, 3rd and 4th year respectively. No significant change in chest complications were noted in all four years. Mortality rate also remained same in all four years
Conclusion: WHO SSC is an effective tool in reducing in-hospital complications thus producing a favorable outcome. Realization its efficacy would improve compliance
RESUMO
Objective: To find out the short term outcomes of effectiveness and safety of laparoscopic ventral rectopexy for rectal prolapsed
Methods: It was a descriptive case series study of 31 consecutive patients of rectal prolapse in Colorectaldivision of Ward 2, Department of General surgery, Jinnah Post Graduate Medical Center, Karachi, from November 2009 to November 2015. These patients were admitted through outpatient department with complains of something coming out of anus, constipation and per rectal bleeding. All patients were clinically examined and baseline investigations were done. All patients underwent laparoscopic repair with ventral mesh placement on rectum
Results: Among 31 patients, mean age was 45 years range [20 - 72]. While females were 14[45%] and males 17[55%]. We observed variety of presentations, including solitary rectal ulcers [n=4] and rectocele [n=3] but full thickness rectal prolapse was predominant [n=24]. All patients had laparoscopic repair with mesh placement. Average hospital stay was three days. Out of 31 patients, there was one [3.2%] recurrence
Port site minor infection in 3[9.7%] patients, while conversion to open approach was done in two [6.4%], postoperative ileus observed in two [6.4%] patients
One[3.2%] patient developed intractable back pain and mesh was removed six weeks after the operation. One[4.8%] patient complained of abdominal pain off and on postoperatively. No patient developed denovo or worsening constipation while constipation was improved in 21 patients [67%]. Sexual dysfunction such as dysperunia in females and impotence in males was not detected in follow up
Conclusions: This study provides the limited evidence that nerve sparing laparoscopic ventral rectopexy is safe and effective treatment of external and symptomatic internal rectal prolapse. It has better cosmetic and functional outcome as advantages of minimal access and comparable recurrence rate