Shouldice versus lichtenstein repair

To compare the results of tissue based Shouldice repair with the Lichtenstein tension free repair of inguinal hernia. A prospective randomized controlled trial. From Jan 2004 to Dec 2006. Surgical Unit-II, Allama lqbal Medical College /Jinnah Hospital Lahore, Pakistan. A total of 156 patients were included in this study were equally divided into two groups. The mean age was 45 years. After a follow up of upto 2 years there was significant difference in the recurrence rate. It was 5% in the Shouldice group and 1.28% in the Lichtenstein group. Similarly chronic pain was also much higher i.e. 5% in the Shouldice group compared to 1.28% in Lichtenstein Group. The rate of hematoma and seroma formation was the same [1.28%] in both groups, however infection was seen slightly more in Lichtenstein repair [3.84%] as compared to Shouldice repair [2.56%]. Tension free Lichtenstein technique was found to be superior to the tissue based Shouldice repair with respect to post operative complications and recurrence

Enterocutaneous high output fistulae; octreotide an effective tool in management

Enterocutaneous fistula is an abnormal communication between epithelial lined lumen of Gl tract and epithelium of an adjacent viscous or skin. To find out role of octreotide in the management of high enterocutaneous fistula. Case study. Department of Surgery unit-ll Punjab Medical College and A and E Department of Jinnah Hospital /AIMC Lahore. From Jan 2007 to Dec 2008. 479 laparotomies were carried out due to trauma. Out of these 21 i.e. 4.38% developed high out put enterocutaneous fistula. All patients were put on similar conservative management including, TPN, antibiotics, fluid electrolyte replacement and stoma care. Patients were split into two groups alternatively. There were no statistical difference between the study groups with regard to the age [p-value=0.515]. Group I contains 11 patients [octreotide] received additionally 100mg octreotide S/C 8 hourly, showed decrease of volume from 680 to 150ml within 10 days. Spontaneous closure was observed in 8 [72.72%] patient and surgery was required in 2 [18.18%] patients. Death was 1 [9.09%]. In Group II remaining 10 patients[without octreotide], fistula discharge volume decreased form 650mg to 150ml in 20 days. Spontaneous closure was noted in 5 [50%] cases. Surgery was required in 3 [30%], while death rate was 2 [20%]. It is concluded that Octreotide, an analogue of somatostatin with longer half life is effective in treatment of high output fistula

Laparoscopic cholecystectomy; outcome in patients with co-morbidity

To determine the frequency of bleeding, surgical site infection and common bile duct injury after laparoscopic Cholecystectomy in patients with co-morbidity. Descriptive Study. [Case series]. Department of Allied and D.H.Q hospital Faisalabad. July 2006 to December 2007. It comprised of 30 consecutive patients of cholelithiasis with co-morbidity presenting in surgical department. Patients having uncontrolled hypertension, chronic obstructive airway disease and malignancy were excluded. Detailed history and physical examination was carried out as per protocol. It was followed up by relevant investigations. All the cases underwent laparoscopic cholecstectomy. The age of the patients ranged from 23-68 y, with mean age of 40-56 y. Among these 14 cases were having D.M [46.66%], 06 patients were cirrhotic [20%], 06 patients had acute cholecystitis [20%], 02 patients were having H.T.N [6.6%] and 02 patients were > 70 years [6.6%]. All the patients were females. Out of diabetic patients undergoing laparoscopic cholecystectomy, SSI was noted in 02 [6.66%] patients. While mild postoperative bleeding was noted in 01 [16.6%] of cirrhotic patients after laparoscopic cholecystectomy.No untoward event was noted in patients with H.T.N ac, Cholecystitis and advanced age. In high risk patients undergoing laparoscopic cholecystectomy, very few complications were noted. Postoperatively, Morbidity following above procedure was quite low as compared to conventional one. Laparoscopic cholecystectomy should be the preferred option in high risk patients for better outcome

Agricultural machines injuries; incidence

[1] To determine the extent of agricultural injuries in term of their site severity, management and type of agriculture machine. [2] To determine the techniques that can decrease the morbidity and mortality caused by agricultural injuries. Descriptive study. This study was conducted in surgical department of Allied and DHQ hospital Faisalabad. January 2007 to December 2007. This descriptive study was performed in 40 consecutive patients in surgical department DHQ/Allied hospital Faisalabad during Jan. 2007 to Dec. 2007. All people who got agricultural injuries were included. People who got traumatic injuries other than agricultural machines were excluded. All injuries were noted with respect to the age and sex of the patient, site, size, and severity of injury, and type of agricultural machine. Management was done accordingly. Out of 40 cases 34 [85%] were male and 06 [15%] were female. In 25 cases [67.5%] fodder cutter were involved In 10 cases [25%] pinching machines [gears, belt, chain machines] were involved. 03 cases [75%] run over by machine 02 cases [05%] by harvesting machines. In 30 cases [75%] upper limb was involved. In 05 [12.5%] cases scalp injuries were noted. In 02 cases [05%] genitalia were avulsed. In 03 cases [7 5%] lower limb was involved Injuries range from simple lacerations, degloving injuries tendons and vessels injuries and finally amputations. Mostly young male population is involved in agricultural machine injuries. Morbidity of agricultural machine injuries can be reduced, by modifying design of agriculture machines by training farm workers and by their proper treatment

Open prostatectomy

To study the morbidity of open prostatectomy. To assess the frequency of complications after open prostatectomy. Descriptive cross sectional. Surgical Unit-IV, DHQ Hospital, Faisalabad. 01-01-2003 to 31-12-2003 [One Year]. Patients of bladder outlet obstruction due to benign prostatic hyperplasia [PBH] were operated by open surgery [Transvesical or retropubic prostatectomy]. Open prostatectomy was performed in 54 cases. In 38 cases, suprapubic transvesical prostatectomy was performed, while in 6 cases, retropubic prostatectomy was done. Our youngest patient was 42 years old and oldest 90 years. Mean age was 62 years. In our study, the most common complications were wound associated seen in 7[12.96%] cases. They included cellulites in 3[5.56%] cases, stitch abscess in 1[1.85%] cases, seroma in 1[1.85%] cases, and abscess in 2[3.70%] cases. Other complications were bleeding in the form of reactionary haemorrhage/clot retention in 2[3.70%] cases and secondary haemorrhage in 3[5.56%] cases. Urinary fistula was seen in 5[9.26%] cases while retrograde ejaculation in 6[11.11%] cases, stricture urethra in 3[5.56%] cases, urinary incontinence in 4[7.41%] cases and urinary tract infection in 5[9.26%] cases. Epididimo-orchitis, deep vein thrombosis and osteitis pubis were not seen in our study. The average duration of hospital stay was 6 days. Most cases were discharged within five days of operation, while stitches were removed on the eighth postoperative day. The morbidity of open prostatectomy is higher than transurethral resection [TURF], as TURP is better procedure due to lower complication rate, short hospital stay, cost effectiveness and better tolerated by old and unfit patients, presenting with small fibrotic prostate. Open prostatectomy is still a good option for BPH where TURP facilities are not available