Frequency of contralateral patent processus vaginalis in children presenting with unilateral hernias

To determine the frequency of contralateral patent processus vaginalis [PPV] in children who presented with unilateral inguinal hernias. A Descriptive Study. Department of Paediatric Surgery, Military Hospital Rawalpindi, from November 2006 to November 2007. All children under the age of 6 years and presenting with unilateral inguinal hernia were included. Those children who had a hernia on the contralateral side, or a history of swelling in the past, previous operations on the contralateral side, associated conditions like connective tissue disorders, ascites or VP shunts were also excluded. A standard Rehbein procedure was carried out for hernia repair on both sides. The results were analyzed and presented as mean [range] or mean +/- SD. There were 76 patients who underwent bilateral inguinal explorations. Males were 66 [86.8%] and 10 [10.8%] were female. Almost two thirds [n=52, 68.4%] were children younger than two years of age [mean age 1 year and 9 months]. There was a preponderance of left sided hernias [45 vs. 31, 59.2% vs. 40.8%]. The asymptomatic contralateral side exploration showed the presence of a definite PPV in 5 [6.6%] patients. The mean operating time was 35 + 10.4 minutes. The risk of contralateral hernia, in children presenting with one sided inguinal hernia is quite low. This does not justify routine exploration of the contralateral groin to prevent only a few clinical hernia developments later on

Biliary atresia: experience in a Military Hospital

The purpose of this case series is to determine the types of biliary atresias presenting to our department, options available to confirm the diagnosis with appropriate management and their results. A total of 12 patients with suspected biliary atresia presented to the Department of Paediatric Surgery at Military Hospital Rawalpindi. Out of them 11 patients underwent surgical intervention. Age of the patients ranged from 6 weeks to 16 weeks [mean age 68.80 days]. One patient was beyond the scope of biliary drainage. Out of 11 patients operated, operative cholangiography revealed patent extrahepatic biliary tree in 6 patients [55%], thus excluding biliary atresia. One patient [9%] had patency of distal biliary tree with proximal obliteration [Type B] and 4 patients [36%] had complete obliteration of extrahepatic ducts [Type A]. These 5 patients of biliary atresia [45%] underwent traditional Kasai portoenterostomy. Two patients [40%] were stable postoperatively, 2 patients [40%] had gradual deterioration after initial improvement, and 1 patient [20%] died in perioperative period

Neonatal biliary atresia

Bilrary atresia continues to emanate controversy and despair among Physicians and patients alike. With the development of liver transplant and new techniques a new insight in NBA surgical care has come forth. This condition is the most common cause of persistently direct [conjugated] hyper bilirubinemia in the first 03 month of life. Kasai portoenterostomy and liver transplantation battle to become todays leading therapy. The main focus of attention however remains that the results after portoenterostomy are decided by the promptness of the initial workup and referral to surgery. More then 80% of babies with NBA have satisfactory bile flow after hepatic portoenterostomy if the procedure is done before 8th week of life

Urinary bladder gossipyboma [retained post operative foreign body in urinary bladder]

A 57 years old gentleman was brought with history of recurrent UTI [Urinary tract infection] of 01 year duration. Following transvesical prostatectomy. UTI could not be controlled after using appropriate antibiotics. All relevant investigations were performed. His cystoscopic examination revealed retained gauze piece [12 inches] in urinary bladder, which was retrieved

Carcinoma oesophagus: comparison of various treatment modalities

To compare various modalities of treatment in management of carcinoma oesophagus with particular stress on relief of dysphagia due to ca. Descriptive, retrospective study. Surgical department CMH Rawalpindi. From 1996 to 2000 [4 years]. The study subjects included 33 patients with histopathological diagnosis of carcinoma oesophagus [including criteria], 28 patients were operated upon [curative 18, palliative 10] with 17.5% operative mortality, 4 merited solely on chemo/radiation therapy [advance stage tumor], while 01 patent opted for chemo/radiation despite being favorable candidate for surgery. Of the 33 cases, 29 were operated out of which 11 were subjected to Ivor-lewis procedure, 15 were operated upon through transhiatal approach while in the remaining cases, palliative bypass procedures were done. Surgery [transthoracic + tans hiatal approach] proved to be the only reliable mode of treatment whether supplemented by adjuvan t therapy or not, Chemo/radiation as a sole mode of treatment had drastic results