Left-sided appendicitis in a 14-year girl with midgut malrotation

We present a case of 14-year girl with left-sided acute appendicitis who presented with lower abdominal pain. Midgut malrotation occurs at a rate of 1 in 500 live births. The condition is incidentally diagnosed during various radiological investigations done for other purposes. However, such patients may present with conditions like acute appendicitis, which poses a diagnostic dilemma if a high index of suspicion is not kept. The purpose of this case report is to increase awareness in the emergency physicians and young surgeons of this rare presentation; and the importance of radiological investigations in the diagnosis of left-sided appendicitis, to decrease morbidity and mortality

Laparoscopic assisted appendectomy in children. Our experience of first 50 cases at tertiary care hospital Rawalpindi

Objective: To present an experience of the first 50 cases of appendectomy performed via laparoscopy assisted open technique

Study Design: Descriptive case series

Place and Duration of Study: This study was carried out at Pediatric Surgery department, Pak Emirates Military Hospital Rawalpindi, from Jan 2016 to Apr 2018

Material and Methods: Fifty patients [<12 years old] diagnosed as cases of acute appendicitis were enrolled after ethical committee approval. The procedure was performed via three ports [4 ports if required]. Appendix was brought out through the right iliac fossa port and appendectomy was performed by extracorporeal knotting technique. Operative time, position of appendix and postoperative complications were recorded. Data was expressed as means and frequency percentages

Results: Out of 50 patients, 31 were male and 19 were females. The mean age of the patients was 7.99 +/- 3.34 years. Forty one patients had acute appendicitis while 9 patients were diagnosed as appendicular mass. The mean operative time was 24.9 +/- 7.42 minutes. There were no cases of surgical site infection. Thirty eight patients were operated via three ports while 12 patients required four ports. Three patients required conversion to open appendicectomy due to extensive adhesions or abscess. Post-operatively drain was placed in only 6 patients

Conclusion: Laparoscopic assisted open appendectomy is a safe, quick and easy to learn technique in children which combines all the advantages of minimal access surgery with open appendectomy while reducing the number of complications associated with it. The technique has the added advantage of diagnostic laparoscopy over open surgery

Comparison of Onlay versus Sublay mesh repair for ventral abdominal hernias. a randomized controlled trial

Objective: To compare onlay versus sublay mesh repair for ventral abdominal hernias in terms of mean operative team, frequency of post-operative wound infection, seroma formation and hematoma formation

Study Design: Randomized controlled trial

Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Apr 2017 to Dec 2017

Material and Methods: A total of 78 patients [39 in each group] diagnosed as a case of ventral abdominal hernia meeting the inclusion and exclusion criteria were included in the study. Patients with complicated hernias, recurrent hernias and bleeding disorders were excluded. Group-A patients underwent mesh repair by the onlay method while group-B patients underwent mesh hernioplasty via the sublay technique. All patients were followed for wound infection, seroma formation and hematoma formation. Data was analyzed by SPSS ver. 23.0

Results: The mean operation time in group A was 46.10 +/- 7.25 minutes while in group B, the mean operation time was 77.82 +/- 9.97 minutes [p<0.001]. The frequency of wound infection was 5.13 percent vs 0 percent [p=0.49] and hematoma formation was 5.13 percent vs 7.69 percent [p=0.999] between the two groups respectively which were statistically insignificant. However, seroma formation between the two groups was 23.08 percent vs 5.13 percent, which was statistically significant [p=0.023]

Conclusion: Sublay mesh repair for ventral hernias is better than onlay mesh repair for ventral abdominal wall hernias in terms of frequency of complications. However, it requires a longer operative time

Rectovaginal fistula as a result of coital injury

Rectovaginal fistula following sexual intercourse is rarely reported. It is a social stigma; and without adequate treatment and social support, the patient may end-up in isolation. A thorough knowledge of the problem and management is essential for successful outcome. We report a case of low rectovaginal fistula in a newly married female managed trans-vaginally with prior defunctioning colostomy

Comparison of laparoscopic and open appendectomy in terms of operative time, hospital stay and frequency of surgical site infection

To compare laparoscopic and conventional open appendectomy in terms of operative time, hospital stay and frequency of surgical site infection [SSI]. Quasi-experimental study. Combined Military Hospital, Quetta from 6[th] Jun 2010 to 1[st] Sep 2011 and Combined Military Hospital, Multan, Pakistan from 2[nd] Sep 2011 to 5[th] Jun 2012 over a period of 2 years. A total of 417 patients underwent appendectomy during this period. 137 patients underwent laparoscopic appendectomy [group A] while 280 patients had open appendectomy [group B]. The sample includes all patients who were operated upon, between the time-span of June 2010 to September 2011. A chi square-test was performed to compare the data for statistical significance. Mean operative time for group A was 79.21 +/- 23.42 minutes whereas in group B, the mean operative time was 41.49 +/- 20.86 minutes. Group A patients had a shorter hospital, 1 stay [3.6 +/- 1 day] but in group B, it was [5.2 +/- 3 days]. Seven patients [5.1%] developed surgical site infection [SSI] in group A and 34 patients [12.14%] developed postoperative SSI in group B [p < 0.05]. Laparoscopic appendectomy is superior to open appendectomy because of shorter hospital stay and lesser post-operative SSI, but requires longer operative time