Laparoscopic colonic surgery: early experience

The paper reports early experience with laparoscopic colonic surgery in relation to indications, tumour size, operative time, duration of analgesic requirement postopera-tively, return of bowel activity, postoperative complications and mortality. A multicentre case series study at Jinnah Postgraduate Medical Centre, Orthopedic and Medial Institute, SIUT and South City Hospital between February 2007 and February 2010. Clinical and operative records of all laparoscopic-assisted colonic procedures performed between February 2007 and February 2010 were studied. 80 laparoscopic-assisted colonic surgeries were performed during this period. There were 74 cases of carcinoma, 5 cases of tuberculosis and 1 case of polyp. Laparoscopic-assisted procedures included right hemicolectomy in 54 cases, left hemicolectomy in 15 cases, sigmoid colectomy in 6 cases, segmental resection of splenic flexure in 2 cases, transverse colostomy in 3 cases. Eight cases were converted to open surgery; six because of locally advanced disease, one because of bleeding and one because of failure to localize the tumour. Mean operative time was 150 minutes. The mean tumour size was 6cm. Mean duration for analgesic requirement was 2.5 days. Mean time to return of bowel activity was 2.7 days with a mean hospital stay of 5 days. Intraoperative traction injury to the small bowel was encountered in 1 patient. Postoperatively 2 patients had local wound infection and 2 patients developed pulmonary infection. Laparoscopic-assisted colonic procedures are associated with a smaller wound, quicker return of bowel activity, reduced consumption of analgesics, a shorter hospital stay and low rates of pulmonary infection. Laparoscopic colonic surgery is feasible and a logical progression towards acquisition of advanced laparoscopic skills with good results

Rationale for near total thyroidectomy in patients with multinodular goitre

To prove that Near total Thyroidectomy [NTT] with minimal residual tissue is the procedure of choice in patients with Multi-Nodular Goitre [MNG]. Retrospective study from February 2002 to December 2006. Surgical Ward-II, Jinnah Postgraduate Medical Centre [JPMC], Karachi. A total of 521 consecutive patients, operated for simple or toxic MNG were included in this study. Apart from detailed clinical work-up, investigations including thyroid function tests and thyroid scans were carried out in all cases. All patients underwent near total thyroidectomy with preservation of recurrent laryngeal nerves and parathyroid glands. Out of 521 cases, 73 [14%] had carcinoma on histopathological examination of the removed glands; 47 [64%] underwent completion thyroidectomy which was uneventful, while 22 had radioiodine ablation with decreased dosage for provision of minimal residual tissue and four declined further treatment. Near total thyroidectomy is a versatile surgical procedure for patients with MNG, keeping in view the risk of associated occult malignancy. Furthermore, the risk of damage to recurrent laryngeal nerve [RLN] and parathyroids is low in patients undergoing completion thyroidectomy. Hence, a more radical procedure should be adopted for surgical treatment in MNG

Completion thyroidectomy: Relation of timing with complications

To assess the association of timing with complications following completion thyroidectomy. Prospective, quasi-experimental clinical trial from June 2002 to March 2007. Surgical Unit-2, Jinnah Postgraduate Medical Centre [JPMC], Karachi. A total of 114 patients who underwent completion thyroidectomy. The patients were divided into two groups viz. Group-I [n = 76] where completion thyroidectomy was performed between 10 days and three months and Group-II [n = 38] where completion thyroidectomy was carried out beyond this time. Transient hypocalcaemia was seen in two cases of Group-I and one case of Group-IL while transient recurrent laryngeal nerve paresis was seen in two patients, one in each group. However, there was no statistically significant difference in the outcome between Group-I and IL in terms of complications. Timing does not influence the complication rate after completion thyroidectomy