Surgical Techniques for haemostasis in penetrating trauma to femoral artery

To analyse the efficacy of various operative procedures and factors affecting the outcome especially the effect of limb ischemia time in penetrating trauma to the femoral artery. Prospective. Study was conducted at West Surgical Ward, Mayo Hospital Lahore. August 2001 to July 2004. All the patients >12 years of age referred from periphery as well as directly admitted with penetrating trauma to the femoral vessels alone or associated with other organ injuries having hard/soft physical signs of an arterial injury were included in the study. 39[97.5%] patients were male, age ranged from 14-53 years with the mean limb ischemia time of 7.8 hours in the series. 35[87.5%] patients sustained firearm injuries. Superficial femoral artery was injured in 23[57.5%] followed by vein in 12[30%] and major vessels were found intact in 4[10%] patients. Lateral arteriorrhaphy was performed in 4[10%] and venorrhaphy in 3[7.5%] patients with 100% succ ess rate, resection and primary anastomosis in 18[45%] patients with pseudo aneurysm formation in 1[2.5%] patient. Reverse great saphenous vein graft was interposed in 9[22.5%] patients with graft failure rate of 5% [2 patients]. Femoral vein was ligated in 12[30%] patients with development of deep vein thrombosis in 2[5%] patients. There were 3[7.5%] deaths. No synthetic graft was used in the series. Exsanguination, prolonged injury duration, associated organ injuries and extensive soft tissue and skin damage of the extremities were the major factors responsible for increased morbidity particularly limb loss and mortality. Proximity of injury to the femoral vessels was a poor predictor of an arterial injury in the study. Arteriorrhaphy and primary end-to-end anastomosis are the main stays for an arterial injury repair, next comes the use of autogenous vein graft, in our setup. Moreover ligation of femoral vein is not associated with leg amputation

Post thyroidectomy hypocalcaemia - an audit of 100 cases

Purpose of our study is to compare the incidence of hypocalcaemia after total, near total or subtotal thyroidectomy for benign multinodular goitre. One hundred consecutive thyroidectomies performed for euthyroid benign multinodular goitre at West surgical unit, Mayo hospital, Lahore Pakistan, were included in the study. Mean age of patients was 33 [range 14 to 60] years. Preoperative serum calcium level ranged from 7.7 to 10.0 with an average of 8.8mg/dl. 34 patients had total thyroidectomy, 31 had near total thyroidectomy, 28 had subtotal thyroidectomy and 7 had lobectomy and isthmusectomy. Consultants performed 46 thyroidectomies, while senior registrars and residents performed 52 and 2 thyroidectomies respectively. 28 patients developed clinical features of hypocalcaemia.8 out of 31 patients who had near total thyroidectomy developed hypocalcaemia [25.8%]. Out of 34 total thyroidectomies, 11 patients had hypocalcaemia [32.3%]. In 28 patients who had subtotal thyroidectomy, 7 developed hypocalcaemia [25%]. 2 out of 7 lobectomy and isthmusectomy patients also required treatment for hypocalcaemia [28.5%]. Hypocalcaemia developed within 48 hours of surgery in 53% of our patients. Incidence of hypocalcaemia among patients operated by consultants was 23.9% [11 out of 46], while among patients operated by senior registrars and residents 17 out of 54 developed hypocalcaemia i.e. 31.5%. Average postoperative duration of hospital stay was 5.42 days in hypocalcaemic patients [range 2-17 days] and it was 2.77 days in normocalcaemic patients [range 1-6 days]. We conclude that post thyroidectomy hypocalcaemia is a complication with significant morbidity. The incidence of this complication can be reduced by meticulous surgical technique with special emphasis on haemostasis. Identification and preservation of well vascularized parathyroid glands must be attempted in every thyroidectomy

Mini cholecystectomy: a comparison with laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the gold standard procedure for symptomatic gallstones but at a higher price. Recently a few studies comparing mini cholecystectomy to laparoscopic cholecystectomy have shown that mini cholecystectomy has comparable results to laparoscopic cholecystectomy at an affordable price. We compared these two techniques over a period of two years.224 patients were studied, 122 had laparoscopic and 102 had mini laparotomy cholecystectomies. Results showed that operation time and theatre cost were low in mini laparotomy cholecystectomies but these patients required more post operative analgesics. There was no significant difference in total hospital stay and resumption to routine activities. Total cost to hospital and patient was also similar for these two techniques. There were two common bile duct injuries in laparoscopic group and none in mini cholecystectomies and there was no mortality in either group. We conclude that results of mini laparotomy cholecystectomy are very much simi lar to laparoscopic cholecystectomy and it can be used as an alternative to laparoscopic technique

prospective analysis of 100 laparoscopic cholecystectomies at Lahore general hospital

Laparoscopic cholecystectomy is rapidly replacing the open cholecystectomy. Within 12 months period, a total of 100 patients had laparoscopic cholecystectomy in our unit. The operation was successfully completed in 92 patients and converted to open operation in 8%. There was no death. The morbidity rate was low [total 11.0%, bleeding 4.0%, minor bile duct injury 1.0%, bile leakage 3.0%, wound infection 3.0%]. Mean operating time significantly improved from 1st 33 patients to last 33 patients, indicating a rapid learning curve. Direct insertion of trocar instead of using veress needle was employed in most cases thus considerably reducing the operating time without adding any morbidity. The mean hospital stay was 2 days. Laparoscopic cholecystectomy is a safe and effective procedure that can be performed with a minimal risk by surgeons familiar with biliary anatomy. Complications of laparoscopic cholecystectomy can be minimized by early elective conversion to open operation if difficulty arises