Deep venous thrombosis; mean platelet volume, D-Dimer and doppler sonography. patients of surgical wards of liaquat university hospital

Objectives: To study mean platelet volume [MPV] in deep venous thrombosis [DVT] as evaluated by D-Dimmer and Doppler sonography. Study Design: Case control study. Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from May 2013 to April 2014

Subjects and Methods: A sample of 106 subjects; 50 controls and 53 diagnosed patients of DVT were studied. DVT patients were included according to inclusion and exclusion criteria and after results of Sonography and D-Dimer were available. The Blood samples were collected in bottles containing sodium citrate as anticoagulant. MPV was generated by Sysmex KX 21 hematology analyzer. Informed consent was sought from the volunteer subjects. The Data was analyzed using SPSS version 21.0. Statistically significance was defined at p-value of

Results: Mean platelet volume was elevated in deep venous thrombosis patients which were confirmed by clinical examination, sonography and D-Dimer. MPV was elevated in cases; 10.0 +/- 0.7fl compared to controls; 9.55 +/- 0.63fl [p=0.001]. D-Dimmer was elevated in deep venous thrombosis patients [p=0.0001]. Age, gender and platelet counts did not revealed any significant differences between cases and controls [p>0.0.05]

Conclusion: The present study reports elevated MPV in patients suffering from deep venous thrombosis and it is concluded that MPV may be considered as a risk factor for DVT

Inguinal hernioplasty; laparoscopic tep with and without dissection balloon

To compare laparoscopic TEP Inguinal hernioplasty with and without dissection balloon. Observational study. Minimal Invasive Surgical Centre Jamshoro and General Surgical Department at Dow University Hospital, Ojha Campus Karachi. May 2011 and Dec 2012. Twenty [20] male patients with uncomplicated unilateral or bilateral inguinal hernia were prospectively randomized in two groups; group A Commercially available dissection balloon and group B. Telescopic dissection for creating TEP working space. We had 20 male patients for this study. The average age was 43.6 and ranging between 17 to 64 years. Only 2 patients 10% had bilateral groin hernia, 4 patients 40% had direct inguinal hernia in group A and 5 patients 50% had direct hernia in group B. Peritoneum was breached in 5 [50%] patients with telescopic dissection. One patient [10%] with bilateral groin hernia in group B had large tear in peritoneum converted to TAPP while other group normal. The incidence of scrotal edema/seroma was greater in group B then group A. 40% patient in group B developed seroma while 0nly 1 [10%] patient with bilateral groin hernia in group A developed seroma. Pain was scored on VAS at 1 and 4 hours after surgery was higher in group B. The mean operation time was 55 min [45-100] in the group with the balloon and 73 min [50-120] in the group without the balloon [p = 0.004]. TEP laparoscopic inguinal hernia repair is probably the best option amongst the two techniques used in laparoscopic inguinal hernia repair and dissection with balloon is though costly but more helpful in dissection and safer

Role of laparoscopy in peritonitis

Laparoscopy has gained clinical acceptance in many subspecialties in the last decade. The conventional open surgery for peritonitis carries significant morbidity and mortality. The present study was done to extend and evaluate benefits of minimally invasive surgery in this subset of patients. This was a prospective study spanning over a period of four years. All those patients diagnosed as having peritonitis on clinical assessment and preoperative investigations and those who were stable enough haemodynamically were included in this study. After initial resuscitation for few hours, they underwent diagnostic and therapeutic laparoscopy to identify the cause of peritonitis and to confirm the pathology. All cases were done under general anesthesia, using three standard ports at appropriate sites according to pathology. Patients were treated by different procedures either laparoscopically or with laparoscopic assistance after diagnosis. Operative and post operative data was collected and analyzed. Ninety two cases of peritonitis underwent diagnostic and therapeutic laparoscopy. Mean age of patient was 46.5 years. 24 patients were diagnosed as perforated duodenal, in 14 [58.3%] patients laparoscopic suture repair was done and in 8 [33.3%] small upper midline incision was given and perforation was repaired. Out of 32 patients having perforated appendix, 25 [78.1%] patients laparoscopic appendectomy was done while in 7 [21.8%] perforation was dealt by laparoscopic assistance. Out of 14 patients of ileal perforation 6 [42.8%] with minimal contamination laparoscopic suture was applied, while in 8 [57.1%], perforated loop was brought out by making small window and perforation was closed. All 22 patients with pelvic sepsis needed only aspiration of pus and peritoneal lavage. Only one patient died post operatively and 2 [2.1%] patients developed fistula. 6 [6.5%] patients developed port site infection. Laparoscopic management is feasible, safe and effective surgical option for patients with peritonitis due to different abdominal emergencies in properly selected cases with higher diagnostic yield and a faster postoperative recovery

Haemorrhoids

The objectives of the study are to compare the outcome of the Doppler Guided Haemorrhoidal Artery Ligation and open Haemorrhoidectomy in 2nd and 3rd Degree Haemorrhoids. Comparative study. Study was carried out at the General Surgical Department at Liaquat University Hospital, Jamshoro and private hospital Hyderabad from 2008-2009. Study consisted of 50 patients of diagnosed cases of heamorrhoid. Patients were divided in two groups. In Group A Standard open Haemorrhoidectomy and Group B we used Doppler Guided Haemorrhoidal artery ligation. Detailed history was taken from all the patients with special regard to the bleeding per rectum or some thing coming out during defecation and Clinical examination of anal canal DRE and Proctoscopy was done. In both groups male were 37 [74%] and female 13 [26%] with male: Female Ratio of 2: 8:1. Age ranging from 20 to 60 years in both group, mean ages of patients were 38.28 + 10.355 years. 3rd degree haemorrhoid 31[62%] while 2nd degree 19[38%]. Complications were mild to moderate pain 24[96%] patients in DG -HAL group while moderate to severe pain 23[92%] in excisional heamorrhoidectomy group. Anal stenosis in 2[8%], patients, anal fissure 1 [4%] patients and feacal incontinence 1[4%] patients were observed only in excisional heamorrhoidectomy. Recurrence occurred in one case [4%] in each group. DG-HAL procedure has a low rate of complications, earlier mobilization, implies a shorter hospital stay and offers the patient a more comfortable postoperative period than Excisional heamorrhoidectomy procedure

Laparoscopic management of hydatid cysts of the liver at a tertiary care hospital

To evaluate the feasibility and safety of laparoscopy in the management of hydatid cysts. All consecutive patients diagnosed with liver hydatid disease were offered laparoscopic management. We performed select conservative procedures using standard laparoscopic instruments after sterilization of the cysts with 20% hypertonic saline. Deroofing, evacuation and partial cystectomy were performed. Omentoplasty was performed, and a drain was placed in the cyst cavity. A total of 63 patients [M:F=48:15] with 75 cysts were managed successfully by laparoscopy. The mean age +/- SD of the patients was 38.59 +/- 11.46 years old. The mean operative time +/- SD was 88.24 +/- 23.52 minutes [range: 52-145 minutes]. The mean size of the cysts was 9.2 cm [range: 5.8-16.5cm]. The mean hospital stay +/- SD was 3.49 +/- 1.16 days [range: 1-7 days]. There was no disease or procedure related mortality. Recurrence of a cyst was observed in 3 [4.76%] cases. Open surgery had to be performed on four patients. There were no major complications; minor biliary leaks were observed in 7 cases and cavity infections in 5 cases. The mean follow-up +/- SD in 51 patients was recorded as 28.9 +/- 31 months. Laparoscopic treatment of hydatid cysts of the liver is safe and effective, with low morbidity and a low recurrence rate in uncomplicated cysts. Despite some of its limitations, the procedure is a good alternative to open surgery in select cases.

Port site complications in patient after laproscopic cholecystectomy

To assess the frequency of port site complications in patient after laproscopic cholecystectomy. Observational study. This study was carried out in the Department of Minimal Invasive Surgical Centre [MISC] at Liaquat University of Medical and Health Sciences Jamshoro Pakistan, from Oct 2009 to 31[st] May 2011. This study consisted of Four hundred and fifty patients, admitted for laparoscopic cholecystectomy. Base line and specific investigations were done in all patients, especially ultrasound of abdomen for assessment of gallstone disease. Inclusion criteria were that all patients diagnosed as case of gallstone disease on the basis of history, clinical examination and investigations specially ultrasound of abdomen. Exclusion criteria included complicated gallstone disease, unfit patients for general anesthesia, pregnant ladies due to risk of foetal loss, patients with carcinoma of gall bladder, patient with acute pancreatitis and patients with obstructive jaundice. Postoperatively the patients were followed for up to 6 months and observed port site complications. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 315[70%] were female and 135[30%] male. Ratio male: female ratio of 1:2.3. Age ranging from a minimum of 20 year to 65 year with mean age was 38 + 3.4 years. Complications were port site infection in 4 [0.88%] cases, followed by port site bleeding in one [0.22%] case and epigastric port site diathermy burn in one [0.22%] case. In conclusion, we recommend all 10 mm trocar sites be closed care fully. Over stretching of infra / supra umbilical port should be avoided. Gallbladder should be removed in endo-beg

outcome of well's operation in the surgical management of rectal prolapse

To see the outcome of Well's operation in the surgical management of rectal prolapse. Quasi Experimental study. This study was carried out in Department of surgery, Liaquat University of Medical and Health Sciences, Jamshoro from 11-5-2006 to 10-05-2009. This study consisted of 30 cases of rectal prolapse admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro. Detailed History was taken from all the patients with special regard to the rectal prolapse. Inclusion criteria were that all the adults patients [Male and female] of rectal prolapse on the basis of history and fit for anesthesia and surgery were included in the study. Exclusion criteria included unfit patients for general anesthesia, another local pathology like haemorrhoids or rectal tumor. Data was analyzed through SPSS software. Out of 30 cases, 14[46.7%] were males and 16[53.3%] were females. There was wide variation of age with mean age + SD was 40.67 + 12.4 years. Most of the patients had constipation 23[76.7%] cases, 20[66.6%] cases were presented with Mucus discharge, 11[36.6%] cases had urinary incontinence, 09[30.0%] cases had Diarrhoea and 07[23.3%] cases had bleeding. Co-morbidity factors were diabetes mellitus in 07[23.3%] cases, hypertension was present in 09[30.0%] and IHD was found only in 02[6.7%]. Ten [33.3%] cases were anemic, 05[16.66%] cases with HBsAg, 07[23.3%] had Hepatitis C and only 1[3.3%] case had duel viral infection. Complications were seen in all the cases, 28[93.3%] cases were found in majority who had pain after the procedure, 08[26.7%] cases developed the wound infection associated with retention of urine, 05[16.7%] had urinary incontinence associated with reactionary haemorrhage, 07[13.3%] had anal stenosis associated with incisional hernia, 01[3.3%] were found with ureteric damage, 03[10.0%] cases had sexual dysfunction and only 1[3.3%] case had Rectal stricture. Recurrence of rectal prolapse occurred in only 1[3.3%] patient. In conclusion, this study suggests that Wells operation may be a good choice for treatment of complete rectal prolapse, in view of its low complication and recurrence rates

Compare the outcome of open versus laparoscopic varicocelectomy

To compare the outcome of the laparoscopic surgery with open varicocelectomy. It is also assess the operative time, postoperative pain, postoperative recovery of patients and postoperative complications of both procedures such as, bleeding, haematoma, wound infection, hyderocele, laparoscopic related complications and recurrence. Observational Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Jamshoro, from January 2009 to December 2010. This study consisted of 80 patients of varicocele grade III were admitted and divided in two groups. Group A for open varicocelectomy and group B for laparoscopic varicocelectomy in which each group consist of 40 patients. The ages of patients ranged between 11 years to 50 years. The mean age of LV group was 25.72 +/- 6.026 years and for OV group was 27.58 +/- 6.694 years. In OV group 92.5% of patients were having left varicocele, 5% right varicocele and 2.5 bilateral disease where as in LV group 90% of cases were having left, 7.5% right and 2.5% bilateral varicocele. The mean time in OV group was 29.70 +/- 8.498 minutes and 25.08 +/- 5.558 minutes in LV group [p 0.005]. the mild pain was observed in 7 [17.5%] patients of OV group and 16 [40%] patients of LV group. Whereas, severe pain was described by 10[25%] patients in OV group and 4 [10%] patients in LV group [p0.032]. The wound infection was found in 6 [15%] patients of OV group and 2 [5%] patients of LV group. The hydrocele was seen in 5[12.5%] cases of OV as compared 2 [5%] cases of LV group. Residual varicocele and recurrence of varicocele was observed in two cases [2.5%] of OV group and 3 cases of LV group with value p<0.359. It was longer about 2-3 days in 34[855] of OV patients as compared to LV cases where majority 36[90%] were discharged within 1 to 2 days. The results shows that LV is superior than OV in terms of better cosmesis, less operative time, less complications, short hospital stay and early return to work