Objectives: To compare the tissue based Desarda repair with Lichtenstein mesh technique for inguinal hernia in terms of operation time, hospital stay, return to normal activities, cost and post-operative complications such as seroma formation, surgical site infection and recurrence. Study Design: Randomized Controlled trial. Setting: Department of General Surgery Hayatabad Medical Complex, Peshawar, Pakistan. Period: June 2017 to June 2019. Material & Methods: Total of 150 male patients were selected using Non probability consecutive sampling technique. Patients were randomized into two groups using lottery method. 75 patients in group A underwent hernia repair with Desarda no mesh technique and 75 patients in group B underwent hernia repair by performing Lichtenstein mesh technique. Patients were followed up after 2 weeks, 1 month, 3 months, 6 months and 1 year. Data was evaluated using version 22 of SPSS and expressed as a standard deviation, mean. Independent-sample T test was used to compare continuous variables. Categorical variables were compared using Fischer’s exact test. P value of less than 0.05 was considered significant. Results: The mean age of Desarda group was 44.59±10.58 years while it was 44.44±10.30 years in the Lichtenstein group (P=0.932).Mean Operative time was less for Desarda repair (42.08 ± 3.42 min) when compared to Lichtenstein repair (49.01 ± 4.77min) (p=0.000). The average hospital stay after Desarda repair was 2.08±0.27 days and after Lichtenstein repair it was 3.00±0.40 days (p=0.000). After Desarda procedure the average duration to return to work was 11.10±2.32 days while it was 13.92±2.24 days in Lichtenstein procedure (p<0.0001). The total cost of the operation was (Rs 3893±293) in Desarda group and (Rs 7844±175) in the Lichtenstein group (p=0.000). When compared for observed postoperative complications like seroma, wound infection and recurrence in both groups all the p-values were > 0.05 and were non-significant statistically. Conclusion: In comparison to Lichtenstein mesh repair, Desarda technique is cost effective, easy to learn, patients have less hospital stay, less chances of post-operative complications and early return to basic physical activities However Desarda technique is not possible in patients having thin external oblique aponeurosis with divided fibers and here Lichtenstein technique is better option. Further long term randomized control trials are required on large-scale to evaluate this technique further.
Objective: To find out the frequency of recurrence in inguinal hernia mesh repair in Surgical Unit, Khalifa GulnawazTeaching Hospital Bannu / DHQ, Bannu. Material & Methods: 60 consecutive cases of inguinal hernia (direct/ indirect) of either side, inthis study were repaired by Lichtenstein's repair. The study was conducted from January, 2010 to October, 2010 with an initial follow up ofone year. Cases above 76 yrs were excluded from the study. Conclusions: The procedure of choice for inguinal hernia repair is tensionfree mesh repair.
Background: Choledocholithiasis affects 10%-15% of individuals with gallbladder stones. Approximately 7%-15% of cholecystectomy patients develop common bile duct (CBD) stones. It occurs more frequently in older age groups. It may result in a complete or partial blockage of the bile duct and present as pancreatitis or cholangitis due to gallstones.Objective: The aim of this study was to compare the outcomes of primary closure of duct and T-tube drainage after open choledochotomy and to evaluate the effectiveness and safety of primary closure.Material and methods: From January 2018 to December 2021, this descriptive study was carried out in the surgical department of the Hayatabad Medical Complex in Peshawar. In total, 60 patients who had open choledocholithotomy after a failed endoscopic extraction were included in this study. Of these, 30 (50%) patients got primary duct closure after choledochotomy, while 30 (50%) patients had T-tube insertion.Results: Among the total of 60 patients (primary closure: 30 and T-tube drainage: 30 patients), 10 (16%) were males, while 50 (84%) were female patients. The mean age was recorded as 45.9±13.9, and the mean hospital stay in days in both groups was 4.87±1.4 (T-tube: 5.24±1.50 and primary closure: 4.50±1.3). Complications developed in group A were a biliary leak in three (10%) patients, postoperative jaundice in two (6.5%) patients, wound infection in three (10%), intra-abdominal collection in three (10%) patients, and dislodgement of a tube in two (6.5%), while 17 (57%) patients had no complications developed. Conclusion: If the duct is free of stones, as determined by preoperative choledochoscopy, primary closure of the common bile duct (CBD) is a safe, cost-effective procedure with less morbidity than regular T-tube drainage after open choledochotomy.
Background: Rectal bleeding is considered an important sign of colonic disease, particularly colorectal cancer. Rectal bleeding is considered to be an alarm feature in particular for colorectal cancer that, in tum, is the second- leading cause of cancer death globally. Colonoscopy has been reported recently as cost effective method of evaluating asymptomatic rectal bleeding 14, while rectal bleeding as a diagnostic indicator has been questioned in general practice. Objective: The objective of this study is to determine the frequency of common causes of bleeding per rectum among patients presenting to surgical OPD at tertiary care hospital. Materials and Methods: This descriptive cross sectional study was carried out at Department of General Surgery Hayatabad Medical Complex Peshawar from September 2021 to March 2022. Total of 164 patients with lower GI bleed were included in the study. All patients were enrolled in a consecutive manner and subjected to lower GI proctoscopy, other relevant investigations to detect the cause of GI bleed. Results: Total 164 patients were included. Age ranged between 15-60 years with a mean age of 37.5 years. There were 107(65.2%) male and 57(34.8%) female, with a male to female ratio of 1.9:1. Age distribution was analyzed as 63(38.4%) belongs to age group of 20-30 years, 30(18.3%) in 30-40 years, 26(15.9%) in 40-50 years and 45(27.4%) in age group 50-60 years respectively. On proctoscopy, hemorrhoids were found in 54(32.9%) patients, colitis in 15(9.1%), inflammatory bowel diseases (IBD) in 39(23.8%), ulcerative colitis in 29(17.7%), diverticular diseases in 10(6.1%) and abdominal TB in 17(10.4%). None of the patients had colorectal cancer. Conclusion: Hemorrhoids, inflammatory bowel diseases and ulcerative colitis were common causes of lower gastrointestinal bleed in our population and ulcerative colitis was significantly high in female patients.
Introduction: The development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer. Owing to that, an increased awareness and investment towards better outcomes regarding patients sexual and urinary function has been recently observed. Objective: Evaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for rectal cancer. Materials and Methods: An observational retrospective study including all male patients who underwent a surgical treatment for rectal cancer between January 2015 to December 2019. A total of 113 patients were included in the study. All patients were underwent major surgery for rectal cancer. An inquiry questionnaire presented to every patient about its sexual habits and level of function before and after surgery. Results: All patients included in the study were males. Patient age range between 40-75 years with mean age of 57 years. Surgical procedure was rectum anterior resection (RAR) in 62(54.8%) patients and an abdominoperineal resection (APR) in 51(45.1%). 71(62.8%) patients described their sexual life as important/very important. Sexual function worsening was observed in 83 (73.4%) patients with complains of erectile dysfunction and ejaculation impairment. 30 (26.5%) patients didnt resume sexual activity after surgery. Increased age (p=0.06), surgery performed (APR) (p=0.04) and the presence of a stoma (p=0.04) were predictors of erectile dysfunction after surgery. Conclusions: This study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for rectal cancer. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option.
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