Comparision of excision and primary [midline] closure with karydakis technique in the surgical treatment of pilonidal sinus

Pilonidal sinus is a common anorectal problem that occurs in the cleavage between the buttocks [natal cleft] and causes discomfort and embarrassment and absence from work for the sufferers. It typically affects young men and women. Numerous surgical procedures have been described but treatment failure and disease recurrence is common leading to considerable morbidity in these otherwise healthy patients

Objective: To compare the effectiveness of excision and primary closure with Karadykis Technique of cleft closure in the surgical treatment of pilonidal sinus

Materials and Methods: Setting: Department of Surgery, Ch. Rahmat Ali Memorial Hospital, Township, Lahore. Study Duration: 3 years [Jan 2009 to Dec 2011]

Sample Size: 40 patients, 20 in each group

Inclusion Criteria: All adult males and females with clinical diagnosis of chronic pilonidal sinus

Exclusion Criteria: Recurrent pilonidal sinus disease, acute pilonidal abscess

Results: Out of 40 patients, 35 [87.5%] were males and 5 [12.5%] were females. Age range was 16 to 35 years with mean age of 25.5 years. Group A consisted of 20 patients who underwent Excision and Primary closure while group B had 20 patients who underwent Karydakis Technique of cleft closure. The postoperative complications encountered in Group A were post operative pain, wound infection, numbness at the site of surgery and recurrence while in Group B, complications included post operative pain, hematoma/seroma formation, wound infection, wound dehiscence, numbness at the site of surgery and recurrence

Conclusion: Karadykis procedure is better than excision and primary midline closure in terms of less postoperative complications, reduced hospital stay and recurrence rate

Childhood circumcision, indications and complications

Circumcision is the most commonly performed operation in males worldwide and is an integral part of several religions like Islam and Judaism. Medical indications of circumcision are a few. Circumcision is contraindicated in a number of congenital penile disorders, including hypospadias, epispadias, chordee, buried penis and micropenis. Various techniques are available for performing circumcision. Complications include haemorrhage, infection, and meatal injury resulting in stenosis, removal of incorrect amount of skin, penile injury, urethral injury and painful scarring. However many of these complications can be prevented by using precise surgical techniques, meticulous asepsis and haemostasis

Objectives: To note indications, age of children and complications developing after circumcision

Patients and Methods: The study was conducted in the Surgical Department of Ch. Rahmat Ali Memorial Hospital, Township, Lahore, from Jan 2009 to Dec 2011. A total of 1000 cases were included in the study

Results: 860 [86%] children had circumcision performed in the surgical department and 140[14%] were referred to our unit after circumcision performed by quacks, barbers and general practitioners, after developing some complications. Ritual [religious] circumcision was done in 936 [93.6%]. 64 [6.4%] had medical indications. Out of 936, 815 [87%] were Muslims and 121 [13%] were non Muslims. 64 [6.4%] children were circumcised because of medical indications, mainly phimosis and paraphimosis. 140 [14%] children were referred to our unit because of complications, mainly bleeding in 34 [24%], infection in 20 [14.2%], under circumcision in 85 [60.7%] and excessive removal of skin in 1 [0.7%] child. The only complication which occurred in children operated in the hospital was infection in 6 [0.7%]children. Ages of the children were: Less than 1 month- 208 [20.8%] 1 to 12 months- 655 [65.5%] 1to 5 years- 110 [11%] More than 5 years- 27 [2.7%]

Oral gabapentin reduces hemodynamic response to direct laryngoscopy and tracheal intubation

Laryngoscopy and tracheal intubation increase blood pressure [BP] and heart rate [HR]. We studied the effect of gabapentin 800 mg given orally one hour before surgery on hemodynamic responses to laryngoscopy and tracheal intubation. Sixty patients were randomly allocated to one of the two groups. Group I received 800 mg of gabapentin and Group II received placebo with sip of water one hour before the induction of anaesthesia. After standard induction technique, study variables, pulse and noninvasive BP [systolic, diastolic and mean] and HR were noted every minute for first five minutes then at 10 and 15 minutes. Relevant demographic data and study variables were recorded. Mean systolic BP with Gabapentin was lower compared to placebo but it was significant at 1min [136 +/- 22vs149 +/- 23], 2min [120 +/- 21vs136 +/- 24], 10min [107 +/- 12vs118 +/- 16] and 15 min [106 +/- 13vs116 +/- 13] after intubation [P<0.05]. Mean diastolic BP with gabapentin was significantly lower at 3min [69 +/- 15vs74 +/- 17] after intubation with P<0.05. Mean BP with gabapentin was significantly lower at 2min [91 +/- 18vs103 +/- 18], 10min [79 +/- 12vs88 +/- 13] and 15 min [79 +/- 14vs86 +/- 12] after intubation at P<0.05. Decrease in HR with gabapentin was significant at 10min [92 +/- 15vs101 +/- 18] and 15 min [87 +/- 14vs99 +/- 16] after intubation [p<0.05]. Oral gabapentin decreases the response to laryngoscopy and intubation on systolic BP at 2 min and 15 min; mean arterial pressure at 2, 10 and 15 min and HR at 10 and 15 min following laryngoscopy

Administration of local anaesthetics through epidural needle before catheter insertion does not improve the quality of anaesthesia or reduce catheter related complications

The objective of this study was to compare the effect of injecting local anaesthetics through epidural needle and catheter on quality of anaesthesia and catheter related complications. We randomized 60 patients into 2 equal groups; in the Needle Group [n=30], catheters were inserted after injection of a full dose of local anesthetic through the needle. In the Catheter Group [n=30], the catheters were inserted immediately after identification of the epidural space; local anesthetic was then injected via the catheter. The groups were compared for paresthesias, inability to advance the catheter, intravenouos or subarachnoid catheter placement; sensory and motor block were assessed 20 min after the injection of local anesthetic. Statistical analysis was performed by SPSS for Windows [version 10.0] Patient characteristics were analyzed using the t-test for independent groups. Block height, perioperative anesthesia quality and incidences of catheter related complications were analyzed using chi square test. Thoracic level sensory block and motor block was comparable in both the groups. Frequency of paresthesia during catheter placement was comparable; [23.3% versus 13.3% P=0.3]. Intra-vascular catheterization occurred in 23.3% versus 10% of patients in the catheter and needle groups, respectively [P=0.166]. Excellent surgical conditions were statistically similar in both the groups. Injecting local anaesthetic through the epidural needle before catheter placement does not reduce catheter-related complications or improve the qualityof epidural anesthesia