RESUMO
Objective: To profile the spectrum of injuries and management of casualities treated in forward treatment centre [FTC] Wana over a period of one year by optimizing the available resources of a Field Hospital
Study Design: Descriptive cross sectional study
Place and Duration of Study: Forward treatment center Wana South Waziristan Agency, from 21 Jan 2014 to 08 Dec 2014
Material and Methods: A total of 62 cases brought in FTC were included in the study. Cases were managed according to Advanced Trauma Life Support [ATLS] protocol. A policy of aggressive resuscitation, early primary repair of injuries and evacuation was followed at our setup
Results: All patients were male with a mean age of 28.1 +/- 4.443 yrs. The majority of casualties were military [52 cases, 83.9%] and the major cause of injury was found to be improvised explosive device [33 cases, 53.2%]. Extremities were involved in majority of casualties [38 cases, 50.7%]. A total number of 91 operations were performed in 62 cases which included 14 laparotomies [15.4%], 21 chest intubations [23%], 9 amputations [9.9%], 19 cases of debridement [20.9%], 10 fasciotomies [11%], 1 tendon repair [1.1%], 10 closed reduction of fractures [11%], 5 closed reduction of dislocations [5.5%] and 2 cases of extremity vascular repair [2.2%]
Conclusion: Optimal utilization of limited resources warrants a responsible approach of surgeons towards injured brought at FTCs. A variety of injuries may be encountered by the forward surgical team who can significantly contribute by providing life and limb saving surgery
RESUMO
Objective: To assess the safety of direct trocar insertion [DTI] before creating pneumoperitoneum in laparoscopic procedures
Study Design: An observational study
Place and Duration of Study: Combined Military Hospital [CMH] Kohat, Pakistan from November 2013 to January 2015
Methodology: All the cases undergoing laparoscopy at the study centre in the above duration were included in the study after approval from the Hospital Ethical Committee and informed written consent. Out of the 200 cases, DTI was successfully used to establish peritoneal access in 190 cases, while open Hassen's technique [OL] was used in ten cases. Body mass index [BMI] of all the patients was calculated before surgery. All the cases were performed under general anaesthesia with adequate relaxation. A 10 mm permanent re-useable sharp metallic trocar was inserted through umbilical scar after lifting the abdominal wall using towel clamps. Studied variables included age, gender, BMI, operations, history of previous surgery, number of attempts for DTI and complications
Results: Mean age of the patients in DTI group was 46.58 +/- 13.94 years, while 48.70 +/- 10.08 years in OL group. Female to male ratio in DTI group was 1.43:1; and 2.33:1 in OL group. Increase in BMI had a relation with number of unsuccessful attempts of DTI, so obesity was the main reason of failure of DTI
Conclusion: DTI is a safe and effective method of peritoneal access for laparoscopy with very low failure rate related to BMI and minimal complications