Outcome of open versus laproscopic appendicectomy in department of surgery, lady reading hospital, Peshawar

To compare safety and benefits of laparoscopic versus open appendicectomy in a randomized control clinical trial. Between January 2008 and October 2009 one hundred and twenty patients [86 male and 34 female] with suspected acute appendicitis were assigned either to laparoscopic [n=60] or open [n=60] appendicectomy. Surgical technique was standardized for both laparoscopic and open procedure. The patients were analyzed in terms of the following aspects and findings; operation time, postoperative pain, intra and post operative complications, hospital stay and return to normal daily activities. There was no mortality. Wound infection [8.3%] and intra-abdominal abscess [11.6%] formation rate was significantly higher in open group than in the laparoscopic group [1.6%] and [3.3%] respectively. Postoperative pain scores [assessed by a pain distress variable, indicated on visual linear scale 0 to 10 and a pain activity scale, indicated on visual linear scale 0 to 10] was significantly lower in laparoscopic group. Hospital stay was significantly shorter in laparoscopic group [p<0.0353] and mean operation time was similar in both groups. One patient [1.6%] was converted from laparoscopic to open appendicectomy due to diffuse pelvic adhesions. Though operation time was same but complications, pain and hospital stay was less in the Laparoscopic group

Rectal atresia with complete absence of posterior vaginal wall [large rectovaginal fistula] a case report

A case report of congenital anorectal malformation in 21 years old female patient is presented who had history of passing urine and stools per vaginum since birth. Examination under anesthesia revealed absence of anal orifice. Ultrasonography reported a big gas filled mass in the lower abdomen. Barium contrast study was inconclusive. The diagnosis made was high anorectal malformation with big recto vaginal fistula

Sentinel lymph node biopsy in the management of axillary involvement in breast cancer

To know the efficacy of sentinel lymph node biopsy in the management of axillary involvement in breast cancer. Material and This study was conducted in Surgical "A" unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. A total of 30 patients with operable breast cancer diagnosed on fine needle aspiration cytology [FNAC] and clinically non-palpable lymph nodes in the axilla were studied. While on the operation table for modified radical mastectomy, one ml of sterilized solution of methylene blue was injected subdermally under the areola of the diseased breast. After 5-10 minutes sentinel lymph nodes were harvested via a small incision over the axilla, marked as blue nodes or blue lymphatics leading to a node. All the patients were females with mean age 45 +/- 13.48 years. Mean tumor size was 3.7 +/- 1.60 cm. The tumor was present in upper and outer quadrant in most [63.33%] of the patients. No complications were noted related to the procedure. The sensitivity of the method was found to be 85.7% and false negative rate was 7.1%. Sentinel lymph node biopsy with methylene blue is safe and cheaper and accurately predicts the axillary lymph node status in most of the patients

Morbidity and mortality in patients with colostomies - A study on 50 cases

To discuss the morbidity and mortality associated with the fashioning of colostomy and its closure. Material and This study was conducted in the Surgical 'A' unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. A series of 50 consecutive patients with colostomy for various indications were managed in surgical 'A' unit and emergency departments of LRH. Fire arm injuries [34%] were the most common indication of colostomy, followed by blunt trauma [26%], anorectal malignancy [14%] and sigmoid volvulus [12%]. Total of 20 patients suffered from 24 stoma related problems. The hospital stay was between 5-46 days. Thirty six of these patients under went colostomy closure with an average hospital stay of 11 days. There was one death. Careful stoma formation minimizes risks of complications associated with it. In our study there was no difference between single layer and double layer closure