BACKGROUND: Abdominal injury is among the major causes of trauma admissions. The aim was to determine etiology, commonly injured organs, indication and outcome of patients with abdominal injuries requiring laparotomy.METHODS: A retrospective study of all adult patients who underwent laparotomy for abdominal injury at St. Paul’s Hospital Millennium Medical College was conducted from January 2014 to December 2016. The factors associated with outcome were identified with bivariate and multivariate logistic regressions.RESULTS: Laparotomy for abdominal injury was performed for 145 patients. Of these, 129 (89%) case records were retrieved. The male to female ratio was 6.2:1. The mean age was 29 years, and most of them were unemployed. Penetrating trauma was the commonest injury, stab (46, 35.7%) and Road Traffic Accidents (RTA) (27, 20.9%) being the leading causes. Extra-abdominal injuries were seen in 33.3% (46) of the cases. Hollow organs were commonly injured than solid organs. Small intestine (35, 43.8%) and Spleen (17, 34.7%) were the leading injured organs in penetrating and blunt respectively. The main procedure performed was repair of hollow and solid organ laceration/perforation (70,54.3%). The negative laparotomy rate was 4.6% (6). Complications were seen in 23(17.8%) patients, the commonest being irreversible shock (7,30.4%). The mortality rate was 8.5 %(11), and it was significantly associated with blunt abdominal injury (AOR=7.25; 95% CI 1.09-48.37; p=0.041) and systolic blood pressure<90mmHg (AOR=8.66; 95% CI 1.1-68.41; p=0.041).CONCLUSION: Stab and RTA were the commonest indications of laparotomy. The mortality was significantly associated with blunt abdominal injury and hypotension (SBP<90mmHg).

Background: Surgical informed consent (SIC) is an established ethical and legal requirement for surgical treatment. Patient understanding of the process is essential for efficient surgical care. This study aimed to assess the knowledge and perception of operated patients towards surgical informed consent. Methods: An institution-based cross-sectional study of all adult surgical patients who signed informed consent and underwent surgery at St. Paul's Hospital Millennium Medical College (SPHHMC) from February 1st to March 30th, 2018, was performed. Data were collected postoperatively before discharge using a pretested structured questionnaire. Results: Of 420 patients identified, 385 (91.7%, M:F=2:1) agreed and interviewed. The mean age was 40.3 years (SD± 15.1), and many of the respondents (285, 74.0%) had some level of formal education. Even if most (336, 87.3%) knew the reason why they had surgery, less knowledge and awareness was reported regarding the options of alternative treatments (153, 39.7%), identifying the operating surgeon (129, 33.5%), the type of surgery (160, 41.6%), anesthesia-related risks (96, 24.9%), complications of surgery (69, 17.9%) and postoperative care (4, 1.0%). The legal requirement of surgical informed consent was reported by 267 (69.4%) subjects; however, more than half had no information on the right to change their mind after signed surgical informed consent (223, 57.9%) and whom it protects (224, 58.2%). Only 40 (10.5%) respondents had a good level of knowledge, and it was significant in those with some level of formal education (OR=4.8; 95% CI 1.45-16.01; P=0.010) and in patients who live in an urban area (OR=4.7; 95% CI 1.81-12.35; p=0.002) than their respective groups. Conclusion: Our patients had limited knowledge and perception regarding surgical informed consent. Hence, the current consent process seems inadequate and needs a revisit.

Background. Mastectomy is the most common form of treatment for a developing-nation woman diagnosed with breast cancer. This can have huge effect on a women’s quality of life. Objective. To assess mastectomy-related quality of life in female breast cancer patients. Materials and Methods. A facility-based cross-sectional descriptive study was conducted from February 1st to July 30th, 2018. A pretested structured data collection format was used to interview patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Breast Cancer-Specific (EORTC QLQ-BR23) were used to evaluate quality of life, functional capacity, and symptom scales. Data was analyzed with SPSS version 23. Results. The mean age of the 86 patients was 43.2 years (SD±11.4) and ranged from 25 to 70 years. 54.7% (47) of patient’s mastectomy was done on the right side. Based on EORTC QLQ-C30 global health status/QOL scale, the mean score was 48.3. On the evaluation of EORTC QLQ-BR23, future perspective about their health was low with a mean of 40.3 and their sexual functioning and enjoyment were significantly affected with mean scores of 85.3 and 71.2, respectively. Symptom scales were low with mean from 19.1 to 24.5. Majority (49, 57%) of respondents do not want to have breast reconstruction after mastectomy. Conclusion. Our breast cancer patients who underwent mastectomy performed poor in terms of quality of life as compared to international findings which demands attention in incorporating psychosocial aspects in the treatment plan.

BACKGROUND: Complications from abdominal surgery may necessitate a second or more surgeries, re-laparotomy. It is associated with significant morbidity and mortality. Data on relaparotomy from the developing nations is limited. This study aims to assess the indications and outcome of patients who had relaparotomyMETHODS: A retrospective review of medical records of all patients who underwent Re-laparotomy at St. Paul’s Hospital Millennium Medical College from January 2016 to December 2017 was done.RESULT: Of 2146 laparotomies, 6.9% (149) needed re-laparotomy and 129 patients were analyzed. Most (123,95.3%) had on-demand re-laparotomy. Patients operated on emergency made 70.5% (91) of the cases making the ratio of emergency to elective surgery 2.4:1. The three most common surgeries that needed re-laparotomy were, Perforated appendicitis (35,27.1%), bowel obstructions (28,21.7%) , and trauma (20,13.4%). The most common indications for relaparotomy were intra-abdominal abscess (57,44.23%), wound dehiscence (17,13.2%) and anastomotic leak (15 ,11.6%). Surgical site infection (128,100%) and malnutrition (58,45%) were the leading complications. The overall mortality rate was 12.8 % (19). There was no statically significant difference in mortality rate between on-demand and planned re-laparotomy (P=0.388), urgency of the primary surgery (P=0.891) and the number of relaparotomy (p=0.629). Re-laparotomy for anastomotic leak(p=0.001) and patients above fifty years of age (P=0.015) had significant associations with mortality.CONCLUSION: Intra-abdominal abscess collection, wound dehiscence and anastomotic leak were the most common indications of re-laparotomies. Age above fifty years and anastomotic leaks were significantly associated with mortality