De Garengeot hernia masquerading as a painless groin lump: a case report.

De Garengeot's hernia is a rare subtype of femoral hernia in which the appendix is located within the herniated sac. These cases are important to report as both the diagnosis and treatment are quite challenging. We present a case of a 68-year-old gentleman with few months history of a lump in the right groin that gave him mild discomfort but no other symptoms. Initial investigations with an ultrasound did not prove to be helpful and so a plan was made to surgically explore the lump. The appendiceal tip was incarcerated within the hernial sac. The appendix was removed using an open inguinal incision with repair of the defect using a light weight partially absorbable mesh. It is important to consider the possibility of a De Garangeot's Hernia as a differential diagnosis for patients presenting with a groin lump.

Pre-operative antibiotic use reduces surgical site infection.

OBJECTIVE: To assess the efficacy of World Health Organisation Surgical Safety Checklist as a simple, reliable and effective tool to ensure appropriate administration of intravenous antibiotics. METHODS: The prospective interventional study was conducted in three phases at Mayo Hospital, Lahore, from May 2011 to January 2012. The first phase comprised baseline data collection, followed by implementation of World Health Organisation Surgical Safety Checklist, and finally post-implementation data collection. The duration of each phase was 3 months. Primary end points were discharge from hospital, 30 days or death of the patient. RESULTS: Of the 613 patients in the study, 303(49.4%) were in the pre-implementation phase and 310(50.5%) in post-implementation phase. Adherence of optimal administration of antibiotic increased from 114(37.6%) to 282(91%) (p<0.001). The rate of post-operative infection fell from 99(32.7%) to 47(15.2%) (p<0.001). Mean hospital stay was reduced from 7.8±5.7 days to 6.5±5.6 days (p<0.001). CONCLUSIONS: Appropriate and timely administration of antibiotic reduced surgical site infection by more than half. Hospital stay was shortened by 1.3 days on average which results in considerable reduction in morbidity, mortality and costs.

Modified Limberg's flap versus primary closure for treatment of pilonidal sinus disease: a comparative study.

OBJECTIVES: To compare the outcome of Rhomboid excision and Modified Limberg's flap closure with excision and primary closure for the treatment of Sacrococcygeal Pilonidal sinus. METHODS: The study was conducted at the Surgical Department of Mayo Hospital, Lahore, from 2009 to 2012. A total of 60 patients of pilonidal sinus were randomly divided into two equal groups. The patients were operated under general anaesthesia in prone position by Rhomboid excision and Modified Limberg's flap closure with a closed suction drain in group 1, and excision and primary closure over a drain in group 2. Patients were followed up for 12 months for surgical complications of the treatment. SPSS 17 was used for statistical analysis. RESULTS: In group 1 there were 27(90%) males and 3(10%) females, while group 2 had 28(93.3%) males and 2(6.7%) females. The infection rates were observed to be 2(7%) in group 1 and 8(26.6%) (p<0.038) in group 2. The recurrence rate was only 1(3.3%) in group 1 compared to 4(13.3%) in group 2. Average hospital stay was 1.63±0.67 days group 1 and 2.8±1.24 days in group 2. CONCLUSION: Modified Limberg's flap closure is an effective treatment modality for pilonidal sinus disease with 1.5 times less infection rate, 4 times less recurrence rate and 40% in-hospital time.