Objective: To evaluate the safety and cost effectiveness of single layer interrupted intestinal anastomosis in comparison with the double layer conventional method of intestinal anastomosis. Study Design : Prospective comparative study. Period & Setting: Surgical unit 4 DHQ hospital Faisalabad operated by single team during 12 months starting from Feb. 2007 to Jan. 2008. Materials and Methods: The cases were assigned to the two techniques, each being applied on alternate patient, single layer extra mucosal interrupted anastomosis anddouble layer anastomosis. In group 1 we used black silk 3/0 and in double layer we used vicryl 3/0 for inner continuous layer and black silk 3/0 for outer continuous layer. Comparison between two techniques was done on the bases of procedure time, cost effectiveness, morbidity in terms of rate of leakage/. Results: Average time for the construction of the single layer anastomosis was 20 minutes and in double layer was 35 minutes, the difference in average time is statistically significant (p<.001) while average duration of stay was 168 hrs and 216 hrs in group 1 and 2 respectively (p<.001). Leakage rate was double (12%) in group 2 while 6% in group 1. Moreover structure material consumption was more in two layered technique and longer stay added to that lead to more hospital expenses on two layered technique. Conclusion: Anastomosis usinga single layer interrupted extra mucosal technique was faster to perform, cost effective, less likely to leak and as strong as a 2-layer anastomosis.
Objectives: To evaluate the long-term impact of ilioinguinal neurectomy on the incidence of postoperative neuralgia and paraesthesia following the tension free Lichtenstein`s hernia repair. Study design: Case Descriptive Study. Place and duration of study: DHQ Hospital, Faisalabad (January 2003 - January 2005). Patients and methods: A total of 200 patients having unilateral inguinal hernia were included in the study. After a detailed history, patients were subjected to standard Lichtenstein inguinal hernioplasty. All patients underwent elective ilioinguinal neurectomy at the time of hernioplasty. Postoperative pain and paraesthesia were recorded and categorized on a mild, moderate or severe scale. Patients were followed 1 month, 6month and 1 year postoperatively. Results: The incidence of chronic pain was 9% at 1 month & 6% at 6 months and 1 year postoperatively. None of the patients developed severe persistent pain in inguinal region. The incidence of post operative paraesthesia showed a continuous decli ne. It was 32% at 1 month, 24% at 6 month and 19% at 1 year of follow up. The paraesthesia was never severe or bothersome at the end of the follow up period. Conclusion:Routine ilioinguinal neurectomy significantly reduces the chronic post-hernioplasty inguinal pain. Moreover it is safe to perform & well tolerated by the patients.
Background: Laparoscopic surgery is associated with shorter hospital stay, less post-operative pain and excellent cosmesis. Post-operative pain is lesser in laparoscopic procedures but in some cases, it is not absolutely painless. The aim of different methods to reduce the post-operative pain is to avoid the use of opioids by using anti-inflammatory drugs and infiltration of local anesthesia either intra-peritoneal or in the wound. Theoretically peripheral blockage of pain stimuli with local anesthetic agent is more effective than treating pain. For this purpose, Bupivacaine has been recently used to be injected at port sites. Objective: To evaluate the pain and requirement of injectable anti-inflammatory drug (inj. Ketorolac 30mg) after port site infiltration of inj. bupivacaine in laparoscopic cases. Study Design: Prospective randomized study of elective laparoscopic procedures. Settings: Surgical Unit-IV, DHQ Teaching Hospital Faisalabad, Medical University Faisalabad Pakistan. Duration: November 2015 to May 2017. Methodology: Two hundred and sixty patients included in the study were divided into two groups with equal number in each group. Results: In the study group(A), 103(79.3%) patients were females of 27(20.7%) patients were males. All female patients in the study group underwent LC and among males, 26(96.3%) patients underwent TAPP and 1(3.7%) patient underwent LC. In the control group(B) 97(74.6%) patients were females, 33(25.4%) patients were male. All female patients (100%) underwent LC and among the males, 30 patients (90.9%) underwent TAPP, 3(9.1%) patients underwent LC. In the study group, the mean VAS in the study group at 2 hours, 6 hours, 12 hours after surgery was 1.
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