Comparison between on lay and sub lay methods of mesh repair of incisional hernia

To evaluate the repair of incisional hernia by two different methods onlay [Conventional method] and sublay[retromuscular preperitoneal] methods at two different tertiary care centres of Karachi-Pakistan. Patients diagnosed clinically and confirmed ultrasonographi-cally and subsequently operated upon with either methods were included in this study. The primary endpoint was hernia recurrence. Secondary endpoints were operative time, length of hospital stay and postoperative complications of the two methods. A total of 80 patients were allocated in two groups, group A [n=40] underwent incisional hernia repair by sublay method and the remaining in Group B, [n=40] by onlay method. The frequency of wound infection was found significantly higher in the Sublay method of mesh placement [p=0.019]. The frequency of seroma formation was significantly higher in the onlay method of mesh placement[p=0.076] The sublay technique was proven to be very effective, with minimal complications and low recurrence rate.

Testicular carcinoma misdiagnosed as hydrocele: lesson to learn

About 99% of testicular tumors are malignant though they only constitute about 1-2% of malignant tumors in male. They are more readily accessible to examining fingers than a tumour of any other organ in the body, however too often they escape detection until it has metastasised. Worst error is to plunge a trocar and cannula into the enlarge testis or operating from scrotal approach in the belief that it is a hydrocele. Proper pre-operative assessment and diagnosis has the key role in the life expectancy of patient. Hydrocele and testicular tumor both have different operative approaches. For hydrocele scrotal approach and for tumor inguinal approach is recommended. For tumor, if scrotal approach has been adapted it may result in disaster. Two cases of testicular carcinoma initially diagnosed and operated as cases of hydrocele are reported

Management of obstructive jaundice: experience in a tertiary care surgical unit

To evaluate the presentation, clinical features and treatment of Obstructive Jaundice cases. Prospective observational study from Jan. 2003 to Dec. 2004. Surgical Unit IV, Civil Hospital, Karachi. All patients who were admitted and treated for Obstructive Jaundice. The patients were evaluated clinically and by investigations. After appropriate preparations surgery was carried out; the procedure depending upon the nature of the lesion. Intra and post-operative complications, and the outcome of the patient was noted and the whole data analyzed. This study comprises of 24 cases of Obstructive Jaundice. Their ages varied from 25-65 years [mean age being 41.12 years]; 10 were males and 12 females. Amongst these 13 [54.17%] patients had jaundice due to malignancy, 9 [37.5%] had stones in the common bile duct [CBD] and the remaining 2 [8.33%] patients had amoebic liver abscesses. In the malignant group five patients had Carcinoma Head of the Pancreas [two treated by pancreatoduodenectomy and three by cholecystojejunostomy], three had Cholangiocarcinoma [treated by hepatojejunostomy], three had Carcinoma Gall bladder [one treated by hepatojejunostomy, two inoperable] and two patients with malignant nodes at the porta hepatis who refused surgery and were referred for endoprostheses. All patients with stones in the CBD were treated by cholecystectomy and choledocholithotomy, whereas those with amoebic liver abscess underwent drainage/aspiration. Early diagnosis of the cause of obstruction is very important especially in malignant cases, as resection is only possible at that stage

Post-operative complications in a general surgical ward of a teaching hospital

To find out post-operative complications during hospital stay of patients in a general surgical ward at a tertiary care teaching hospital of Karachi. Descriptive retrospective analysis. Surgical Unit IV, Civil Hospital Karachi. Six months, from January 1, 2004 to June 30, 2004. The records of all patients who underwent surgery between January 2004 to June 2004 were reviewed regarding postoperative complications developed during hospital stay. The following data were collected: age, sex, presentation at time of surgery [emergency or elective], surgery performed, complications during postoperative period and outcome. All data was analyzed with the help of SPSS-10. Surgery performed, post operative complications. A total of 501 patients were admitted during the study period. Total 411 surgeries were performed. 258 [62.8%] were elective and 153 [37.2%] were emergency procedures. Hernia repair was the most common surgery performed in 92 [22.4%] patients, followed by appendicectomy in 64 [15.6%] and cholecystectomy in 54 [13.2%] patients. Complications were documented in 122 [29.6%] patients. Most common complication observed was postoperative pyrexia in 75 [18.2%] patients, followed by postoperative nausea and vomiting [PONV] in 48 [11.6%], wound infection in 47 [11.4%], respiratory tract infection in 29 [7.0%] patients. During the study period 4 patients [0.9%] died in the postoperative period. This study revealed that the commonest postoperative complication was fever followed by PONV, wound infection and respiratory tract infection. It is important that the resident staff should be aware of these complications and how to manage them because these are better yardstick to measure the quality of care

Pattern of abscesses at civil hospital, Karachi

To study the pattern of abscesses at Civil Hospital, Karachi. Descriptive study from March 2003 to August 2004.Emergency Operation Theatre, Civil Hospital, Karachi.The data of all patients who presented with abscesses was collected and analyzed.Out of 537 patients who underwent drainage of abscesses, 327 were males and 210 females, with a male to female ratio of 1.56:1. Their ages ranged from 1 to 80 years with a mean age of 33.08 years. Diabetes mellitus was found in 75[13.96%] patients with a male to female ratio of 2.57:1. The most common site of abscess was the hand [17.31%] followed by breast [16.38%], anorectal region [13.96%] and foot [12.84%]. The common presenting complaints were pain, swelling and fever. All were treated by drainage with satisfactory outcome.Abscesses are the 2nd most common cause of emergency surgery at Civil Hospital, Karachi, the commonest cause being appendicitis

Firearm injuries: a three years experience

During the last 3 years i.e. from Jan. 1994 to Dec. 1996, 1063 cases of penetrating gun-shot injuries were brought to the Emergency Department of Civil Hospital, Karachi. Of these 15 died during resuscitation, 530 patients were given treatment in the Emergency Department and discharged while 518 patients were admitted. Amongst these 78 cases were treated in Surgical Unit II and include 66.6% with abdominal injury, 10.2% with thoracic, 8.9% with thoraco-abdominal, 6.4% with head and face, and 7.6%, with limb injuries. Laparotomy was performed in 75.6%, thoracic intubation in 19.2%, wound exploration in 14.1% and tracheostomy in 1.2% cases. Average hospital stay was 8 days. Complications occurred in 7.8% cases and the mortality was 3.8%