Surgical excision with secondary healing versus limberg transposition flap in the management of sacrococcygeal pilonidal disease

Objective: To compare the outcome of Open excision and secondary healing with rhomboid excision and Limberg flap in the management of sacrococcygeal pilonidal sinus disease

Methods: A comparative study using randomized controlled trial [RCT] was conducted at Nishtar Hospital Multan and Ghazi Khan teaching Hospital DG khan from November 2012 to July 2016. In total 49 patients, who either underwent open excision and secondary healing [group A: 25 patients out of which 4 patients did not reported during follow up so actual figure of 21 was included in this group] or rhomboid excision and Limberg flap [group B: 24 patients], were enrolled in the study. Duration of operation, postoperative pain, duration of hospital stay, postoperative complications, and time to recurrence were noted. The inclusion criteria were all patients with primary or recurrent Disease. Diabetics, patients with other co morbid condition, patients with poor follow up and patients with incomplete record were excluded from study

Results: Duration of operation was longer in group B patients [p=0.004] but pain perception was markedly reduced in this group [p=0.003]. Total hospitalization period was shorter in patients in group B [p=0.002] and so was the time for complete healing of the wound [p=0.002]. The recurrence rate was also significantly lower in patients who underwent Limberg rotation flap [p=0.005]

Conclusion: Limberg flap is advantageous over simple excision and secondary healing in the management of pilonidal disease

Clinical presentations, diagnosis and pattern of intestinal tuberculosis our experience, Nishtar hospital Multan, Pakistan

To discuss clinical presentations, diagnosis and pattern of intestinal tuberculosis of the patients presenting in surgical department. Design. Retrospective study. Place and duration of study. Nishtar Hospital Multan, Pakistan during the period of January 2002 to August 2004. Patients and methods. 109 diagnosed cases of intestinal tuberculosis were included in this study. Patients with intercurrent illness and patients proved to have other diagnosis after full work up were excluded from the study. A detailed history and full physical examination of all patients was recorded. Later on various investigations, operative findings were also noted. Results. The ages of patients were in range of 12-54 years. Male to female ratio was approximately 1:2. Clinical presentation was quite variable ranging from abdominal pain present in 100 patients [91.74%] to weight loss noted in 54 patients [49.54%]. Endoscopic biopsy and PCR analysis were most useful in diagnosing intestinal tuberculosis in elective ca ses. Strictures of the small bowel were commonest pattern noted. Past history of pulmonary tuberculosis was present in 8 patients [7.33%] while 18 patients [16.51%] had previous history of intestinal tuberculosis. 35 patients [32.11%] had positive family history of tuberculosis. 18.34% of the patients had secondary tuberculosis. Conclusion. Intestinal tuberculosis is a common disease in third decade in the developing countries. Females are more affected than males. Primary tuberculosis is more common than secondary tuberculosis. Intestinal tuberculosis may present with a variety of abdominal symptoms and signs. Endoscopy and PCR analysis can be considered as reliable investigation in elective cases. Strictures, mass abdomen and intestinal perforation are the most common pattern observed

Outcome of different treatment options for periampullary carcinoma

To study the outcome of different treatment options for periampullary carcinoma. This study included 30 patients with periampullary carcinoma. A standard protocol was prepared for every patient comprising thorough history and full physical examination and relevant investigations. All this was recorded in data collection form. Later on outcome of different treatment options for periampullary carcinoma was discussed. All the patients were between 45-70 years. Most patients were male and belong to low socioeconomic class. The diagnosis was based on history, clinical examination and relevant investigations. The treatment options were divided into two groups. Curative resection [pancreaticoduodenectomy] was done in 18 [60%] patients. 12 [40%] patients had unresectable disease. These patients were treated by palliative procedures. Endoscopic stenting was done in 8 [66.7%] cases and 4 [33.3%] underwent surgical bypass. The morbidity noted in curative resection was [wound infection 20%, anastomotic leakage 15%, respiratory infection 10%, cholangitis 7.5% and renal failure 6.7%]. Six months survival after curative procedure was 90%. Morbidity of endocsopic stenting being blockage 20% and cholangitis in 75% of cases. Six months survival after stenting was 78%. Morbidity noted in surgical bypass included 15%[wound infection], chest infections 15% and six months survival being 75%. It was concluded that periampullary carcinoma is common in male predominantly with low socioeconomic class. Most patients were having resectable disease with relatively high morbidity

Comparison of complications between Mayo`s repair and Mesh repair [pre-peritoneal approach] for para umbilical hernia

Objective: The purpose of the study is to compare the rate of complications in Mayo`s repair with mesh repair. [Preperitoneal approach]

Design: Comparative study

Place and Duration of Study: Nishtar Hospital Multan during the period of January 2001 to August 2003

Patients and Methods: Only patients with fully reducible hernias were included in the study. Unfit patients having serious cardiac and respiratory illness, patients with obstructive and strangulated paraumbilical hernia were excluded from study. Two groups comprising of 25 patients each were made on random basis and operated [Mayo`s repair in-group one and mesh repair in-group two] randomly by surgical team. A separate file was kept for each patient. A detailed history and full physical examination and various investigations of all patients were carried out. Later on, operative findings and complications were also noted

Results: The age of the patients ranges from 20 to 60 years [mean 40 years]. 80% were female while remaining 20% were male The commonest mode of presentation was swelling in the umbilical region [100%] and dragging pain in the umbilical region during heavy working [60%]. On physical examination positive cough impulse was present in [80%]. There was significant difference between postoperative complications in two groups. As seroma formation [8% vs 0%], wound infection [8% vs 0%], wound haematoma [12% vs 4%] was seen more in group I. However mesh infection was present in-group 2 only

Conclusion: It is concluded that recurrences after open tension free repair are rare, complications are few, and the operation is simple to perform. Optimally hernias should be repaired using mesh repair

Role of open surgery in the management of staghorn calculus

Objective: To evaluate the role of open surgery in the management of staghorn calculi by comparing it with other available modalities of treatment i.e. percutaneous nephrolithotomy [PCNL] and extracorporeal shockwave lithotripsy [ESWL] and assessing improvement in the renal function [parenchymal thickness and glomerular filteration rate [GFR] after stone removal

Design: Institutional- based prospective study

Place and Duration of study: This study was conducted at the department of Urology, Nishter hospital, Multan from January 2000 to February 2002 [2 years]

Subjects and Methods: A total of fifty patients with staghorn calculi who underwent open surgery in the department and completed a three-month follow-up were included in the study. All patients had a complete blood examination [CBE], complete urine examination [CUE] [including culture and sensitivity [CIS], renal parameters [urea and creatinine], renal tract ultrasonography [USG] preoperatively and at first, second and third month of follow-up to assess the improvement in heamoglobin, control of urinary tract infection [UTI], parenchymal thickness and postoperative complications. Tc99m DTPA scan was employed before surgery and at third month of follow-up to evaluate the improvement in GFR for operated kidney

Results: The male to female ratio was 2.1:1, with a mean age of presentation of 42.70 years. Pain in the lumbar region [58%] was the most common presentation followed by lower urinary tract symptoms [LUTS 32%] and renal insufficiency [16%]. Fever [36%] was the most common postoperative complication. The mean cortical thickness increased to 10.68 mm at third month of follow-up, compared to 9.26mm before surgery. The mean preoperative Hb was 10.84gm/dl. It fell to 10.21 gm at first month of follow-up but increased to 11.89 gm by the third month. . The mean GFR before surgery was 77.18ml/min, which increased to 81.56ml/min after surgery at third month of follow-up. The mean GFR of the kidney with stones was 32.46 ml/min before surgery, which increased to 39.84-ml/ min after surgery

Conclusion: Staghorn stones if left untreated lead to chronic UTI and renal insufficiency. Removal of the stone is the only way these consequences can be avoided. Nonavailability of resources, a poor health care system, the lack of PCNL and ESWL facilities and/or expertise, the cost and need for multiple sessions and/or ancillary procedures in these minimally invasive techniques and the vigorous follow-up required still make open surgery a viable and an applicable option in our socioeconomic setup

Comparison of FNAC and open Biopsy in palpable breast lumps

To compare the results of FNAC and open biopsy in patients presented with palpable breast lump. Comparative study. Nishtar Hospital, Multan, during the period of October 2001 to October 2003. All female patients, irrespective of their age, who presented with breast lump were included in the study. The patients were divided into two groups, group I and II of clinically benign and clinically malignant respectively. Both groups underwent FNAC. The patients with suspicious FNAC were subjected to excision biopsy in group I patients. Group II patients were advised surgery and final report was made on histopathology. Sensitivity and specificity of the FNAC was determined. A total of 89 cases were included in whom both FNAC and histopathology results were available for comparison. Clinically, 54 were benign and 35 were malignant. The cytological diagnosis was unequivocally malignant in 29 patients, suspicious in 3 cases, unequivocally benign in 44 patients and probably benign in 7 patients while specimen was inadequate in 6 patients. Histological diagnosis of these 89 patients showed 55 patients with benign disease and 34 patients having malignant disease. In malignant disease, sensitivity of the FNAC was 85.29% with 100% specificity, 14.7% false negative rate, 100% positive predictive value and 98.79% negative predictive value. FNAC has good sensitivity [85.29%] and very high specificity [100%]. It can replace the open biopsy in majority cases of clinically malignant disease. Although FNAC is slightly less sensitive [80%] in benign diseases, it is highly specific [100%], so it can help to reassure and relieve the anxiety of the patients