audit of information provided during preoperative informed consent

To find out preoperative informed consent practice in a tertiary care public sector teaching hospital. General Surgical Units of Civil Hospital Karachi Prospective observational study. January 2005 to March 2005 Patients who had undergone elective surgery were interviewed randomly during the study period under routine practice conditions. All the patients were asked a set of standard questions post operatively related to the information they were provided before the procedure as a part of standard informed consent practice. Questionnaire included the patient's knowledge about pathology, operative risks, type of anaesthesia given with its risks, alternate treatment option, results of no treatment, patient's satisfaction about the information given and whether consent form was signed. A total of 200 randomly chosen patients [121 males and 79 females] were included in the study. In 16 [8%] of patients the operative surgeons were involved in taking consent themselves. Only 90 [45%] of patients were told about the nature and purpose of procedure and 89 [44.5%] of patients knew about the possible complications of surgery. 143 [71.5%] of patients were told about the type of anesthesia required but only 30 [15%] were informed about the risks of anaesthesia. 40 [20%] of patients were allowed questions to be asked while taking consent. Interestingly, most of the patients 156 [78%] were still satisfied by the information provided to them during informed consent. This study highlights the poor quality of patient knowledge about surgical procedures and the scarce information provided. The current informed consent practice which is being practiced by the doctors in a public sector teaching hospital of Karachi is below standard to international and ethical acceptability. Yet, a large number of patients were satisfied by the information provided during the informed consent process

Extra Hepatic portal vein obstruction leading to variceal bleed due to portal hypertension

Portal Hypertension can be due to many causes other than cirrhosis. We report a case of extra hepatic portal vein obstruction leading to portal hypertension and varices, managed successfully by creating a Porto Caval shunt

Management of hilar malignant biliary strictures

To determine the etiology of Hilar malignant biliary strictures and the efficacy of hepaticojejunostomy in it's management with or without segmental liver resection. A retrospective study of 33 patients was carried out at Civil Hospital and Lyari General Hospital Karachi. They presented with signs and symptoms of mechanical cholestasis. Study was conducted to find the etiology, level of obstruction and the extent of the disease together with approaches to either cure the disease or to relieve the symptoms. Curative resection was attempted where possible in all 33 patients but decision of curative resection or palliative bypass with or without liver resection was made per operatively after accessing the level of obstruction and extent of local, parenchymal or vascular infiltration. Of the 33 patients studied, 72.73% [n=24] had cholangiocarcinoma and 27.27% [n=9] had gall bladder Ca with local bile duct extension. Four different sites of biliary tree [i] common hepatic duct [CHD], [ii] confluence of common hepatic duct [CCHD], [iii] right and left hepatic duct [R and LHD] separately, and [iv] left hepatic duct [LHD] were anastamosed with jejunum. Normal liver functions with complete relieve from symptoms was achieved where CHD or CCHD was anastamosed whereas only a significant decrease was observed when R and LHD and only LHD were anastamosed with jejunum. Surgical resection of the tumor together with biliary decompression using different approaches of hepaticojejunostomy is an effective way of managing malignant Hilar bile duct obstruction as well as significantly decreasing the severity of symptoms in irresectable tumours