Mesh hernioplasty: surgeons' training ground?

To clinically evaluate the outcome of Inguinal Hernioplasty in terms haematoma, wound infection and recurrence, with special reference to surgery done by trainee surgeons. Case control study with prospective data collection, conducted from Sep. 2005 to August 2006. Surgical Unit two, Civil Hospital, Karacho. All male patients above 30 years of age with Inguinal hernia were included in the study. Patients presenting in emergency and those with age less than 30 years were excluded, as they did not undergo Mesh Hernioplasty. Patients with symptoms like chronic cough and constipation, and those with conditions like anaemia, diabetes and hypertension were optimized before surgery. Anaesthesia fitness was taken after necessary investigations. Patients were mostly operated under Regional [Spinal] anaesthesia. Two doses of a first generation cephalosporin or co-amoxiclav were used as a prophylactic antibiotic. Data was collected on a pre-designed proforma; record was also duplicated on the computer in the SPSS Version 10. Out patient follow-up was done for 6 months as a minimum. A total of 75 males with 78 inguinal hernias were operated during the study period; three patients had bilateral hernia. Sixty five percent of our patients had hernia on the right side and 31% on the left side, while 4% were bilateral. The ages of the patients ranged from 30 to 81 years; majority [72%] were under the age of 60 years. Sixty percent of the patients were manual workers. Sixty nine [88.5%] inguinal hernias were reducible and 9 [11.5%] irreducible; 6[7.7%] were recurrent. Trainee surgeons did 70% of the operations. Haematoma occurred in five cases, seroma in nine, urinary retention in four, wound infection in four and recurrence in one case. No mortality occurred during the study. In our set-up Mesh Hernioplasty has proven to be effective with low complication and recurrence rates. It is easily learnt by trainee surgeons. Early ambulation should be the aim. Cost of the mesh is a minor stumbling block, but the long term benefits of this hernia repair makes it the benchmark for all

Post operative wound infection: a surgeon's dilemma

Keeping in view the prevalence of wound infection in our set up, this study was designed to evaluate the frequency, clinical presentation, common risk factors and different organisms involved in cases of clean and cleancontaminated surgery. Observational descriptive study from March 2005 to February 2006. Surgical Unit III, Civil Hospital, Karachi. One hundred patients who underwent clean and clean-contaminated surgery. Biodata of the patients together with their clinical features, diagnosis, type of surgery performed and the development of any complications including wound infection was noted and the data analyzed. Out of the 100 patients [52 males and 48 females] in the study, 69 belonged to the clean surgery group and 31 to the clean-contaminated surgery group. The overall incidence of surgical site infection [SSI] in the study was 11%; 5[7.2%] cases in the clean surgical group and 6[19.4%] cases in the clean-contaminated group developed infection. Patients in the age group 51-60 years were infected more than those in the younger age groups. The incidence of wound infection was more in male patients [11.5%] as compared to female patients [10.4%]. Obesity was also a main cause of SSI as evident from the fact that patients with more than 60kg/m2 were infected more [20%] as compared to 30-40kg/m2 [7.1%]. Surgical site infection was found more in patients with extended pre-operative hospital stay. Anaemia, smoking, diabetes mellitus, prolonged surgery, operations by junior surgeons and operations late in the list were also associated with more surgical site infection. The usual time of presentation of SSI was within three weeks following surgery and most patients presented with wound abscess and cellulitis, while two patients had wound dehiscence. The common organisms involved in the SSI were Staphylococcus aureus, E. coli, Streptococcus pyogenes and Pseudomonas group. Meticulous surgical technique, proper sterilization, judicious use of antibiotics, improvement of operation theatre and ward environments, control of malnutrition and obesity, treatment of infective foci and diseases like diabetes, and avoidance of smoking helps control the morbidity of surgical wound infections

Blunt abdominal trauma; does clinical evaluation suffice?

To correlate preoperative clinical diagnosis with per-operative findings in cases of Blunt Abdominal Trauma. Observational study with prospective data collection from Jan. 2004 to Dec. 2005. Surgical Unit III of Civil Hospital, Karachi. All patients over 12 years of age who underwent surgery for admitted with Blunt Abdominal Trauma. The patients were resuscitated and prepared for surgery: starting. blood transfusion in haemodynamically unstable patients, passage of nasogastric tube, bladder catheterization and doing appropriate investigations where conditions permitted. Pulse, Blood pressure, Temperature, Respiratory rate, Oxygen saturation and Urinary output monitoring started. As soon as possible surgical exploration was carried out through a midline incision under general anaesthesia. The surgical procedures performed depended upon the laprotomy findings. The data collection was done on a standard performa. During the two-year study period 25 patients, 21 males and 4 females, aged 16-52 years [mean 27 years] were admitted with Blunt Abdominal Trauma. At the time of presentation in the Casualty Dept. most of the patients [64%] were in a state of circulatory shock. Road Traffic Accident [RTA] was the commonest cause of Blunt Abdominal Trauma in our study, accounting for 16 [64%] patients, followed by fall from height in six [25%] and assault in three [12%] cases. A clinical diagnosis of splenic injury was made in 11 [44%] cases, liver injury in eight [32%],intestinal perforation in five [20%] and bladder injury in one [4%] case. Our pre-operative clinical diagnosis correlated with the operative findings in 22 [88%] cases. However in three [12%] cases, the operative findings did not correlate with clinical diagnosis. An early examination of Blunt Abdominal Trauma patients, enables the surgeon to reach a correct working diagnosis in the majority of cases