Primary hyperparathyroidism.

OBJECTIVE: The aim of the study is to present the clinical pattern, surgical indication and management of primary hyperparathyroidism in a teaching hospital in the Kingdom of Saudi Arabia (KSA). METHODS: The records of patients who underwent surgical treatment for primary hyperparathyroidism at the King Khalid University Hospital, Riyadh, KSA from March 1992 to October 2002 were reviewed for epidemiological data, biochemical, radiological investigation, operative procedures, histopathology result, preoperative localization studies included neck ultrasonogram, neck computerized tomography and thallium-technetium subtraction scan. All patients underwent surgery under general anesthesia and procedures were bilateral, unilateral neck exploration, or minimal invasive parathyroidectomy. RESULTS: A total of 41 patients with diagnosis of primary hyperparathyroidism were reviewed. There were 30 females and 11 males with a mean age of 42 years (range 14-78 years). The musculoskeletal symptoms were the major symptoms in 30 patients (73%) followed by renal stone in 6 patients (14.6%), peptic ulcer in 2, acute pancreatitis in one, asymptomatic patients accounted for 5% (2 patients) and the thallium-technetium scan has the highest sensitivity rate (89%) among the preoperative localization studies. The histopathological results showed adenoma in 36 cases (87.8%), hyperplasia in 3 cases (7.3%) and no pathology found in 2 cases. CONCLUSION: Almost all the patients presented with late symptoms and complications of primary hyperparathyroidism, the number of asymptomatic patients, is low due to lack of routine serum calcium check up. Owing to the high sensitivity of thallium-technetium scan and the relatively low incidence of hyperplasia (7.3%), we believe that unilateral neck exploration guided by preoperative scan is a suitable procedure for primary hyperparathyroidism.

Intestinal obstruction due to mesenteric panniculitis.

This report describes a case of mesenteric panniculitis in a 40-year-old male who presented with features of intestinal obstruction. Computed tomography scan showed a mass in the mesentery of small bowel. Resection of mass with associated small bowel and anastomosis resulted in complete recovery of the patient.

Plication darn for the repair of inguinal hernia. A university hospital experience.

OBJECTIVE: Recurrence rate in inguinal hernia repair is the main concern of both the surgeon and patients. The aim of this study is to evaluate the outcome in patients undergoing open inguinal hernia repair by using muscle fascial plication and nylon darn. METHODS: This technique was performed in 2 University hospitals within the Kingdom of Saudi Arabia. King Abdul-Aziz University Hospital and King Khalid University Hospital, Riyadh, for a period of 23 years, October 1978 through to October 2001, on a total of 600 patients. RESULTS: The total number of patients was 654 these were all male. The same repair was performed in elective cases, in acute emergency and for both direct and indirect inguinal hernia. Patients suffering from chronic cough are referred to a pulmonologist for treatment before surgery. Follow-up was for a period of 10 years thereafter by phone communication. Fifty-four patients were excluded from the study as they failed to attend for follow up after the 3rd year. Six hundred patients underwent 619 repairs. Post operative pain was controlled by pethidine in the first 24-hours, thereafter by paracetamol tablets. Patients were advised to return to normal activity after 3/52. No heavy weight lifting before 3-4 months. Recurrence occurred in one case. CONCLUSION: Muscle fascial plication combined with nylon darn is a good operation for the repair of inguinal hernia.

Bowel anastomosis. A comparative study of various surgical techniques.

OBJECTIVE: Mechanical suture (stapler) has been in use for bowel anastomosis since the second half of the 20th century, however, it became popular since it was used widely by the United States of America in the late 1960. Since it is more expensive than the conventional method, a local experimental assessment was introduced to compare stapler with conventional methods. METHODS: Eighteen local dogs were used, 36 anastomosis were assessed in the animal house operating theater of King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between October 1998 and March 2000. RESULTS: The weight needed to disrupt the anastomosis was more in the stapler technique, the amount of intraperitoneal fluid, adhesion and the inflammatory response in histopathological study were less in the stapler technique. Our study has shown that the stapler technique is superior when compared with conventional bowel anastomosis. CONCLUSION: We recommend stapler use in bowel anastomosis whenever clinically feasible.

Discharging umbilicus.

OBJECTIVE: Umbilical discharge is a symptom of varied pathology. Treatment policies of this clinical problem vary among different institutions. Our experience in the management of 44 patients with umbilical discharge is presented. METHODS: This is a retrospective study of the 44 patients treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia over a period of 19 years from 1982 to 2001. RESULTS: With the exception of one patient, all patients were treated in the outpatient clinic. General anesthesia was not employed but instead local anesthesia was used in some cases. One patient required admission for surgical excision, diagnosed to have an ulcerating dermoid cyst. Most patients had hair tuft in the infected umbilicus (pilonidal sinus of umbilicus), 2 patients had concrete like material inside the infected umbilicus. CONCLUSION: We propose a conservative approach to treat this problem and preserve surgical excision only for selected cases.