Laparoscopic Splenectomy for Trauma.

BACKGROUND AND OBJECTIVES: The use of laparoscopy in the trauma setting is gaining momentum, with more therapeutic procedures being performed. We evaluated the use of laparoscopic splenectomy among trauma patients with data from the National Trauma Database. We compared outcomes for trauma patients undergoing laparoscopic (LS) versus open splenectomy (OS). METHODS: From the National Trauma Database (2007 to 2015), we identified all patients who underwent a total splenectomy. Patients who had other abdominal operations were excluded. All patients were categorized into 1 of 2 groups: LS or OS. Outcomes of in-hospital mortality, postoperative length of stay, and incidence of major complications between the 2 groups were compared. Bivariate parametric and nonparametric analyses were performed. Patients were then matched on baseline demographic and injury characteristics by using propensity score matching techniques, and we compared differences by using regression analysis. RESULTS: A total of 25,408 patients underwent OS and 113 patients underwent LS (0.44%). Patients were significantly different at baseline, with the LS group being less severely injured. Bivariate analysis revealed no difference in length of stay (9 vs 8 days, P = .62), incidence of major complications (10% vs 15%, P = .24), or mortality (6% vs 11%, P = .23). LS was performed in 29.2% of patients beyond 24 hours from presentation compared with 9.5% in the OS (P < .001). Adjusted multivariate analysis showed no overall difference in outcomes. CONCLUSION: LS for trauma is increasingly being used at many centers throughout the United States. The procedure is safe, with outcomes similar to those of OS in selected trauma patients.

Juvenile nasopharyngeal angiofibroma: experience at a tertiary care centre in Pakistan.

OBJECTIVE: To review the clinical presentations of Juvenile nasopharyngeal angiofibroma surgical approaches used and outcomes of patients at an urban tertiary care centre in Pakistan. METHOD: The retrospective study was conducted at Aga Khan University Hospital, Karachi, involving medical records of patients with histologically confirmed Juvenile nasopharyngeal angiofibroma who were treated between 2000 and 2008. RESULTS: Eighteen male patients were identified, with an average age at diagnosis of 16 5.6 (range 11-28) years. Most patients (n = 16; 88.9%) presented with epistaxis. CT scan was the most common (n = 17; 94.44%) radiological investigation for staging. Blood supply of the tumour was varied (ipsilateral or bilateral internal maxillary artery). According to Andrews staging, 4 (22.22%) patients presented with stage I disease; 5 (27.77%) with stage II; 4 (22.22%) with stage IIIa; 1 (5.55%) with stage IIIb; and 4 (22.22%) with stage IVb disease. Of the 18 patients, 17 (94.44%) underwent 19 surgical procedures, with a recurrence rate of 10.5% (n=2) and incomplete resection in 15.8% (n = 3) procedures. Lateral rhinotomy was the most frequently employed (n = 13; 68.42%) surgical approach in the 19 surgical procedures conducted at the AKUH. CONCLUSION: Surgery continues to be the mainstay treatment modality. Surgical approach is dependent on various disease factors as well as institutional resources. In situations of limited resources, the condition may still be managed effectively with traditional approaches that result in good functional outcome and low morbidity.

Adult laryngeal haemangioma; a rare entity.

Laryngeal haemangioma is commonly seen in children. Adult laryngeal haemangiomas are rare and usually involve the supraglottic region. Most common symptom includes dysphagia, dysphonia and shortness of breath. Detailed history, fiberoptic laryngoscopy and computerized scanning may suggest benign nature of the lesion but diagnosis is only confirmed by a biopsy. In comparison to infantile haemangiomas which usually respond to propronolol, the treatment of adult laryngeal haemangiomas is always surgical removal. We present a case report of a supraglottic haemangioma in an adult male, who was treated surgically without any complications.

Nasal encephaloceles presenting at later ages: experience of otorhinolaryngology department at a tertiary care center in Karachi, Pakistan.

Encephaloceles are anomalous herniations of the meninges, with or without brain matter. Globally the incidence of encephalocele is about 1 per 35,000 births, but it is more frequently reported in Southeast Asia. As the defect is more pertinent to embryological development, an encephalocele is a more common entity in an infant with a mean age of presentation ranging between 15.5 and 21 months; making an encephalocele presenting for the first time in a relatively, older individual a rare occurrence. Consequently a surgeon might not consider an encephalocele among his differentials. Here we present a series of encephaloceles that presented at a later than usual age as nasal masses to the otorhinolaryngology department of our hospital, and recommend that the differential of encephalocele be entertained for nasal masses as proceeding with routine procedures may result in potentially lethal complications.

Surgical correction of aorto-pulmonary window: a rare and lethal cause of pulmonary hypertension.

Aorto-pulmonary window is a relatively rare congenital cardiac malformation with an overall incidence of 0.1%. Pulmonary hypertension develops quickly if the lesion is left untreated hence early surgical intervention is warranted after diagnosis. The surgery for correction of APW has evolved over years, currently an open repair on cardiopulmonary bypass (CPB) with a single patch technique yields good results. Mortality is affected by association of pulmonary hypertension and other cardiac malformations. We present a case of an infant with a large type II APW with a relatively low pulmonary vascular resistance. Hospital stay was complicated because of pulmonary arterial disease making it an important reason for correction in the first few months of life.