Comparative study of laparoscopic versus open cholecystectomy

To compare our results of Laparoscopic Cholecystectomy with Open Cholecystectomy regarding case selection, technical difficulties, duration of surgery, operative complications, post operative complications, post operative hospital stay, morbidity and mortality, patient's attitude after operation, operative expenses, total expenses and general impression in the society. Comparative study carried out from January 2002 to December 2005. Department of Surgery, surgical 'D' Ward, Khyber Teaching Hospital, Peshawar. This study was conducted on two hundreds patients, one hundred patients were submitted to Laparoscopic Cholecystectomy and the other hundred to traditional Open Cholecystectomy. These patients were admitted in our unit through Out-door department or in emergency as acute cholecystitis. All patients were thoroughly assessed and necessary investigations carried out. After consent all patients were operated on the next operation list. The patients were randomly assigned to either one of the procedures. There was no significant difference in the selection of patients in the two groups. No mortality was seen in both the groups, but complications were more in the open procedure than the laparoscopic one. There isles pain, less hospitalization, early mobilization and early return to work in the laparoscopic surgery. Laparoscopic Cholecystectomy is a superior procedure in comparison to Open Cholecystectomy as regards to the results. Hence it is recommended as the first choice operation

Experience of day care surgery at Peshawar

To evaluate the results of Day Care Surgery in our set-up. Retrospective study from Jan. 2003 to May 2005. Surgical 'C' Unit of Khyber Teaching Hospital, Peshawar. A total of 190 patients who underwent Day Care Surgery were included in this study. All patients were evaluated and counselled before hand, and asked to come on a given date. On the day of surgery they were shifted to the Operation Theatre, operated, kept under observation and sent home the same day with the advice to contact the concerned surgeon in case of any problem or complication. The patients were followed-up on the 3rd and 7th days, and examined for evidence of any local or distant complication. The patients were once again followed within a months time. Out of 190 patients, there were 131 male and 59 female patients, with an age range of two months to 65 years. All patients went home following surgery the same day except two, who were apprehensive and had to he kept for night. Twelve made telephone calls and were given advice. Five patients were readmitted with vomiting. two with severe pain and two with reactionary hemorrhage, and were discharged home the next day. One patient with hernia repair was readmitted after two days with scrotal oedema and treated. Day Care Surgery in uncomplicated cases is safe and cost effective. Majority of the patients were satisfied with this approach of early discharge

Surgical treatment of fractured penis

To evaluate the outcome of surgical repair of fractured penis. Case Series. This study was conducted in surgical department of Khyber Teaching Hospital, Peshawar from March 1999 to October 2003. A total of 23 cases were studied during this period. Patients with fractured penis were admitted and early surgical intervention was done in all cases under general anesthesia repairing the corpus cavernosusm. Patients were followed for a minimum period of 6 months. The outcome of the procedure in terms of early and late complications like sub optimal painful erection, late penile deformity, difficulty in coitus and pulsatile diverticulum were looked for. The average hospital stay of patients after surgery was 24-48 hours. Three[13%] patients had wound infection and collectively 5 [21.7%] patients out of 23 developed late complications. i.e. 2 patients had penile deformity, one each developed difficulty in coitus, pulastile diverticulum and painful erection. Early surgical intervention has good results with less complication rate in cases of fractured penis

Is routine histopathological examination of the gall bladder a futile exercise?

This study was conducted in Surgical "B" Unit of Khyber Teaching Hospital, Peshawar from October 1998 to November 2003 to look for the incidence of malignancy in apparently benign looking gall bladders. A total of 750 patients, 126 [16.80%] males and 624 [83.20%] females, were included in the study. Cholecystectomy was performed in all these patients for non-malignant diseases, mostly gall stones, and all the specimens sent for histopathology. The biopsy reports of these specimen showed chronic cholecystitis in 512 [68.27%] patients, acute cholecystitis / empyema in 225 [30%] and normal gall bladder in 10 [13.33%] patients; in the latter it was removed as part of other procedures. Three [0.40%] gall bladders, which did not reveal any evidence of malignancy on gross peroperative examination, had primary carcinoma at an early stage i.e. confined to mucosa only. It is, therefore, concluded that early stage carcinoma [Stage I] does occur in normal / non-neoplastic looking gall bladders at operation, but in a negligible number. However, it does not alter the management of these patients, as cholecystectomy is the only treatment for early carcinoma. Hence selective histopathology of gall bladder is safe and recommended, as it will save the un-necessary expenditure on routine biposy of every case