Use of drainage after thyroid surgery: is it evidence based?

To assess whether a Surgical Drain is an absolute necessity after Thyroidectomy. Prospective, comparative study from Feb. 2000 to Feb. 2005. Hamdard University Hospital, Patel Hospital, Kitiyana Memon Hospital, Masoomeen Hospital and K.V SITE Social Security Hospital in Karachi. A total of 150 patients who presented with a Goitre and underwent surgery. Detailed data of the patients was recorded, and they were alternately assigned to two different groups viz. "Drain group" and Non-Drain group". Both groups underwent surgery. Out of 150 patients, six [4%] from the Non-drain groups developed serous collections which were aspirated, whereas nine [6%] patients from the Drain group developed complications. These included two [1.3%] cases with bilateral recurrent nerve paralysis, one [0.67%] with unilateral recurrent nerve paralysis, five [3.3%] with transient recurrent nerve palsy and one [0.67%] case with superior laryngeal nerve paralysis. Thyroid surgery should be performed by experienced thyroid surgeons. To minimize bleeding, designated steps be followed like staying in the subplatysmal plane, using coagulation diathermy, staying close to the thyroid, identification of the vessels with precise ligation. Meticulous haemostasis precludes drainage of the operative area and prevents complications

Traumatic lumbar hernia due to zanjeer [knives]

Lumbar hernias are a very rare entity. Many of the traumatic hernias in the lumbar region are related to seat belt injuries in motor car accidents. Here we describe the case of a rare traumatic lumbar hernia caused by the use of Zanjeer [Knives] during Ashura Matam. To our knowledge a traumatic Zanjeer Lumbar Hernia has not been reported so far

audit of laparoscopic cholecystectomy

To evaluate the outcome of Laparoscopic Cholecystectomy in Gall stone disease, critically analyzing the complication rate, morbidity and mortality rate. It is retrospective study from June 1997 to June 2006. Hamdard University Hospital, Saifee Hospital, Burhani Hospital and Remedial Hospital, Karachi. All patients [>12 years] with cholelithiasis were included in this study. Patients with common bile duct dilation [>8mm] or stones, or gall bladder mass or jaundice, and those declared unfit for anaesthesia were excluded. The detailed data of the cases was compiled and analyzed. Out of the total of 1345 patients operated during the study period, 1234 [91.75%] were females and 111 [8.25%] males; their ages ranges from 12 to 89 years, majority were in the age bracket of 30-50 years. Our conversion rate was 6.4%. Nine [0.67%] patients developed bleeding from the port site, 30 [2.23%] port site infection, 43 [3.20%] umbilical port hernia, two bile ducty injury and one colonic injury. There was no mortality in this series. Laparoscopic Cholecystectomy is a safe and effective treatment for Cholelithiasis

Is laparoscopic cholecystectomy treatmen1 of choice in acute cholecystitis?

To evaluate the role of early laparoscopic surgical intervention in acute cholecystitis in our setting. Descriptive study. At Hamdard University Hospital and some other private hospitals of Karachi from July 1998 till July 2005. All cases of acute cholecystitis admitted under our care at Hamdard University Hospital and some other private Hospitals of Karachi were included in this study. The data collected through review of files for presenting symptoms and signs, biochemical findings and histopathology of resected gall bladder specimen. Those cases who had known history of cholelithiasis and had a recurrent attacks we also included in this study. Those patients who had clinical jaundice, ultrasound examination suggestive of dilated common bile duct [CBD], impacted stone in CBD, empyema gall bladder on ultrasound with swinging pyrexia were excluded from the study. There were 516 cases of acute cholecystitis with the age range of 16 to 80 years. All cases were operated within 24 to 48 hours after admission. Our conversion rate was 6.4% with the mean operating time of 55 minutes. Laparoscopic cholecystectomy is a safe and effective procedure in acute cholecystitis in experienced hands

Unusual soft tissue tumours of the abdominal wall

To highlight the importance of remembering unusual tumours in the differential diagnosis of Soft Tissue Tumours of the Abdominal wall. Retrospective, decriptive study conducted between June 2000 to June 2003. Hamdard University Hospital and other private hospitals in Karachi. All patients presenting with Unusual Soft Tissue tumours of the Abdominal wall. The biodata, symptoms and signs of these patients were recorded and analyzed. They were extensively investigated; besides routine investigations Ultrasound, CT Scan and MRI were done where indicated. All the tumors were surgically excised and the diagnosis was confirmed on histopathology and immunohistochemical studies. Ten patients, six females and four males, aged 16-59 years, were seen with Unusual Soft tissue Tumours of the Abdominal Wall. Most of them [90%] presented with a swelling, while some had pain [30%] and fever [10%].Surgical excision and histopathology revealed them as desmoid tumour [n-6], rhabdomyosarcoma [n-2], urachal remnant tumour [n-1] and port-site metastatic tumour [n-1]. There was no recurrence in all the patients, except the one with urachal remanant. He died inspite of further excision, radio and chemotherapy. Abdominal wall tumours are rare. They may be innocent like the lipoma, or may show variable behavior like the desmoid tumour, or may be very aggressive like the rhabdomyosarcoma. They need proper clinical workup before embarking upon surgery, which should be wide surgical excision as they show aggressive infiltration in the surrounding tissues. They also require proper follow-up as they are famous for recurrence

Morbidity and mortality following colostomy in penetrating colonic injuries

To study the complications and mortality associated with colostomy in penetrating colonic injuries; besides gathering additional information regarding the mechanism, pattern and the type of colonic injuries. Retrospective study from Jan. 1997 to Dec. 2005. Surgical Unit III, Abbasi Shaheed Hospital, Karachi. All patients with penetrating colonic injuries who underwent colostomy as a mode of treatment. The data of the above mentioned patients was collected from records and analyzed. A total of 83 patients, majority being young [78.3% <40 years] and males [91.5%], underwent colostomy for penetrating colonic injuries. In most [89%] of the patients the mechanism of trauma was gunshot injury. The over-all morbidity was 28.9%, while the colostomy related complications were 8.4%. The mortality in this series was 2.4%. Colostomy is a safe and effective method of treating patients with penetrating colonic injuries

Stromal Tumour Of Jejunum

Gastro-intestinal Stromal Tumours are extremely rare and of unknown etiology. As a result their timely diagnosis is difficult. We are reporting a very interesting patient who presented to a general practitioner with clinical features of weakness and anaemia. Later on she also developed an abdominal lump. This unique case illustrates the need of a high index of suspicion in order to diagnose the condition

Port site metastasis after laparoscopic cholecystectomy

Laparoscopic surgeries are becoming popular day by day and have replaced open surgeries at most of the centers. With the increase in number of diagnostic and therapeutic laparoscopic sugical procedures, increase number of complications also has been reported. One of the most dreadful complication which is worrying laparoscopic surgeons, now a days is port site metastasis. We present a case of 39 years old male patient who had no evidence of intra-abdominal malignancy who presented with port site metastasis, after laparoscopic cholecystectomy for cholelithiasis. Possible mechanisms of recurrence are postulated and including haematogenous spread

Is open pneumoperitoneum safe for laparoscopic surgery

To find out complications associated with open pneumoperitoneum technique of laparoscopy. Patients And The study included patients managed at Hamdard University Hospital and Saifee Hospital Karachi from April 1997 till April 2004. The laparoscopic procedures included were laparoscopic cholecystectomy, laparoscopic appendicectomy, diagnostic laparoscopy and laparoscopic orcheidopexy. In our study of 1018 cases, we only had a single major complication. Our complications mainly were port site bleeding, infection- of umbilical port and incisional hernia. Laparoscopic procedures using blunt trocar with open method is a safe procedure with no major complications

Incisional hernias: why do they occur?

Over a period of five years 110 cases of incisional hernia were evaluated at teaching hospitals of Dow Medical College and Peoples Medical College, Nawabshah to ascertain their causes. It was found that these hernias were seen more frequently after emergency surgery [87.27%] performed by resident surgeons [89.09%]. About 70% patients had previous history of gynaecological and obstetric operations. Midline incision is more prone to herniation than paramedic and transverse incisions as evidenced by 73.64% patients in this series. Other important causative factors are wound infection [69.09%], chest infection [30.91%], abdominal distension [14.55%] and constipation

Video TURP: need of the time

One hundred transurethral resections of prostate were performed in two medical institutions of Sindh by using a continuous flow electroscope attached with a video camera. The surgeon stands or sits comfortably using a professional monitor as the source of judgment for manipulating the TURP loop. TURP performed with video monitor is more efficient, comfortable and safe as it prevents contamination of the surgeon leading to dangerous infections like HIV, hepatitis B and C. However, the most important aspect of video TURP is that it makes the teaching and training of the procedure quite easy and effective for both the under and postgraduate trainees. The results of video TURP are quite encouraging when compared with a previous study of 57 cases of conventional TURP using the same electroscope

Trans-uretheral resection of prostate experience at nawabshah

Trans Urethral Resection of Prostate is still in initial stages in our rural areas. In this paper we report our experience of 57 cases of prostatic enlargement, dealt with TURP. Forty three [82 Percent] of the patients presented with Retained Catheter and Urinary tract infection; the average post operative stay was 11.5 days and average time for removal of catheter was 6.5 days. The major post operative complications we faced was persistent urinary tract infection [73 percent] and secondary Hematuria [15.3 percent]. Tissues analysis of respected prostate incidentally revealed carcinoma prostate in six cases [11.5 percent]

Carcinoma of biliary tract: a one year experience

7 cases of carcinoma of biliary tract were admitted to Surgical Unit-VI Civil Hospital Karachi during a 12 month period [March 1989 to February 1990]. Carcinoma of the gall bladder is rare in the western world [1% of total cholecysteclomies]. In our series of 46 cholecysteclomies 7 [15.2%] had carcinoma of gall bladder. Of these 7 only 1 was male. Only 1 patient presented in stage 2, the remaining 6 being stage 5. The age ranged from 50-70 years in patients with carcinoma as against 20-60 years in patients undergoing cholecystectomy for benign disease

Acquired ectopic kidney

The case history of a patients with an acquired with an acquired ectopic kidney is discussed

Peutz Jegher's syndrome [gastro-intestinal polyposis] and its complications

A rare case of multiple jejunal polyps, presenting as an acute abdominal emergency with complications of intussusception and gangrene is discussed. The relevant features of Peutz Jegher's syndrome and the surgical management of it's complications are highlighted

Role of excretory urography in prostatectomy: is it really necessary?

Excretory urography [IVP] is done as a preoperative investigation for prostatectomy. The results of IVP before prostatectomy in 40 cases are reviewed. It was found that only 15 cases had an abnormal IVP. Out of these 15 cases, 11 had radio-opaque calculi, easily seen on KUB film. Two had space occupying lesion [cyst] and none of the IVP finding were significant enough to defer prostactic surgery. Excretory Urography is an expensive test with a low yield of useful information in patients with prostatic symptoms and its routine use is not indicated