Outcome of stapled haemorrhoidectomy versus Milligan Morgan's haemorrhoidectomy

To compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's open haemorrhoidectomy. Comparative study. Surgical Unit 1, Ward-3, Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, from March to September 2006. Sixty patients of late 2nd, 3rd and 4th degree haemorrhoids were selected for admission from the outpatient department after taking informed consent. Patients with concomitant anal disease [e.g. fissure, abscess, fistula, ano-rectal cancer etc.] were excluded. Two groups of thirty each were made, one for Milligan-Morgan open haemorrhoidectomy and another for stapled haemorrhoidectomy, in which excision of a ring of mucosa proximal to the haemorrhoid[s] was done thus, interrupting the blood supply but maintaining continuity of the rectal mucosa. The operative time was measured in minutes. Postoperative pain was assessed through VAS. Bleeding was measured as no, mild, profuse. Other post-operative complications during hospital stay like urinary retention, anal stenosis etc. were noted. Student t-test, chi-square test and repeated measured analysis of variance were applied to compare the variables. The mean age was 40.7 +/- 11.6 years. A majority [53.3%] of patients [combined% in both groups] had third degree haemorrhoid. The mean length of operative time was found statistically insignificant between open and stapled groups [19.6 +/- 5.9 vs. 22.4 +/- 7.2 minutes, p=0.974]. However, the mean length of postoperative hospital stay was significantly less in the stapled than open haemorrhoidectomy group [3.37 +/- 2.2 vs. 2.03 +/- 0.81 days, p=0.003. Mean postoperative pain [observed by VAS] in the stapled group was significantly less than the open haemorrhoidectomy group [4.43 +/- 1.25 vs. 7.37 +/- 0.72]. The proportion of postoperative bleeding, infection, anal tag, urinary retention, tenderness on digital rectal examination and wound discharge was higher in open than stapled haemorrhoidectomy group, but statistically insignificant [p < 0.05]. There was a significant difference between Milligan Morgan's and stapled haemorrhoidectomy for postoperative pain and hospital stay. However the mean length of operative time was insignificantly different

case of pseudotumorous form of ascaris

A 35-year-old woman presented with lower abdominal pain and amenorrhoea. CT showed a thick walled lobulated mass with Ascaris adjacent to caecum along with the presence of a left ovarian mass. The peroperative findings were a tubular mass with central tunneling containing an Ascaris lumbricoides. Left ovary showed a haemorrhagic cyst. Biopsy of the mass showed acute on chronic granulomatous inflammation and the worm was found to be female. This was a rare case of Ascaris lumbricoides presenting as a pseudotumorous mass

Darning Versus Prosthetic Mesh Repair In Cases Of Inguinal Hernia

To compare the results of Darning versus Mesh Repair in cases of Inguinal Hernia.Prospective, comparative study over a span of 11 months i.e. from Feb. 2002 to Dec.2002. Setting: Department of General Surgery, K.V. SITE Hospital, Karachi.One hundred patients who underwent Inguinal Hernia repair.All patients had a detailed history taken and thorough examination done, followed by relevant investigations. The patients were divided into two groups randomly, half i.e. 50 patients underwent repair by darning while the other 50 underwent repair with polypropylene mesh. The patients were followed for a minimum period of two years, and the outcome of both the procedures was compared on the basis of recurrence and other complications. All the inguinal hernia patients were male with ages between 16 and 64 years, majority being in the 3545 years age group. In 20 patients the inguinal hernia was direct and in 13 patients it was complete. Assessment for post-operative pain with the help of a visual scale revealed mild pain in 44% patients with darning repair and 40% with mesh repair, while moderate pain was present in 14% patients with darning repair and 12% with mesh repair Severe pain occurred in 2% patients in both the groups. Post-operative infection occurred in 12% patients with darning repair and 8% with mesh repair. Scrotal hematoma was seen in 6% patients with darning repair and 2% patients with mesh repair. Nerve entrapment neuralgia was seen in one patient operated by the darning method Recurrence was only seen in one [2%] patient, who belonged to the darning group.Polypropylene mesh repair is better as it is associated with lower recurrence rate and complications

Ten years experience of Mini Cholecystectomy versus ten years experience of conventional Cholecystectomy at K.V.S.S. Site Hospital, Kar.

Over a span of ten years i.e. from 1994 to 2003, 1040 Mini Cholecystectomies [MC] were performed at K.VS.S. SITE Hospital through a small [about 3.5 cms] sub costal incision placed just below the tip of ninth costal cartilage. The cases were studied for operative time, post operative hospital stay, post operative pain, resumption to daily life and work, antibiotics used, drain insertion, post operative complications and conversion to Conventional Cholecystectomy [CC]. Results of the above mentioned study were compared with the results of 950 cases of Conventional Cholecystectomy performed through Kocher's incision during the preceding ten year period i.e. from 1984 to 1993. As a result of comparison of the two procedures it is concluded that Mini Cholecystectomy is superior to Conventional Cholecystectomy