Search

Acute intestinal obstruction due to tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. The aim of this study was to determine the commonly involved region of intestine and different surgical procedures tailored.Thirty patients operated upon for acute intestinal obstruction in emergency with operative and histopathological findings suggestive of tuberculosis were included in the study. Demographic profile, operative findings, details of surgical procedure, complications and post-op hospital stay were recorded. The patients were followed for 6 months.Intestinal tuberculosis is more common in young female, with male to female ratio of 1:1.5. Stricture of the small bowel was found in 50% of the cases. The next common finding was ileocaecal tuberculosis found in 40% of patients. Strictruplasty was performed in 11 (36.33%). The right hemicolectomy, limited ileocaecal resection and segmental bowel resection with end to end anastomosis were performed in four patients each. Other procedures were release of adhesions and bands in 4 patients, ileotransverse bypass in 1 patient and loop ileiostomy in 2 patients. Major complication in 10 patient and mortality rate was 10%.Because of non-specific clinical features, ignorance and malpractice intestinal tuberculosis presents late. Ileocecal tuberculosis is becoming less common as compared to small bowel strictures. Less radical surgery gives better results. Post operative complications and mortality are related to the perforation of the intestine at the time of surgery.

Intestinal Obstruction is a frequent complication after operation for Ovarian Cancer. This study was done to see the outcome of palliative surgery for Intestinal Obstruction due to recurrent ovarian Cancer.We retrospectively evaluated the records of all the patients who presented with intestinal obstruction after operations for Ovarian Cancer in all the three Surgical Units of Ayub Teaching Hospital Abbottabad from March 1998 to April, 2009. Demographic data, type of management, morbidity, mortality, hospital stay, surgical procedure, symptomatic relief, return of bowel function and outcome were analyzed.There were 56 patients with symptoms of partial or complete intestinal obstruction. Conservative treatment was successful in 22 (39%) patients. Laparotomy was done in 30 (53.5%) patients. The cause of intestinal obstruction was adhesions 8 (26.6%), local recurrence 10 (33.3%) and diffuse carcinomatosis in 12 (40%) patients. Palliative surgery was done in 20 (66.6%) patients while 8 (26.6%) had adhesionolysis only. 9 (30%) patients had resection and anastomosis, 7 (23.3%) had bypass surgery, 3 (10%) had colostomy and one (3%) had Hartmann procedure. Postoperative complications occurred in 26 (86.6%) patients. 12 (40 %) patients died after surgery. Mean hospital stay was 18 (9-42) days. Palliative surgery was successful in 8 (26.65%).Majority of patients with Intestinal obstruction after operation for Ovarian Cancer can be managed conservatively. Palliative surgery is associated with high mortality and morbidity but it should be done in patients not responding to conservative measures.

Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable.This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor.Out of 11 boys included in the study, 7 (63.63%) had failed orchidopexy. Another 3 (27.27%) were opened for 2nd stage orchidopexy and 1 (9.09%) had iatrogenic ascent of testis after herniotomy. On clinical examination 4 (36.36%) had a palpable testicle at the superficial ring, 2 (18.18%) were in inguinal canal (1 doubtful!), and no testicle could be palpated in 5 (45.45%). Ultrasonography picked up 2 testicles (18.18%) at the superficial Inguinal ring, 1 (9.09%) in Inguinal canal and 1 (9.09%) testicle in the abdominal cavity. On reexploration, 10 (90.9%) testicles were found and brought down, 7 (63.63%) being considered of reasonable consistency and size. Another 3 (27.27%) were considered soft or small in size, and in 1 (9.09%)), no testicle was found. In 5 patients (45.45%), the testicle was at superficial ring, in 3 (27.27%) in the inguinal canal, and in 2 (18.18%) in the abdominal cavity. Results were considered good in 6 (54.54%), fair in 3 (27.27%)) and poor in 2 (18.18%).Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent

Primary Vaginal Hydrocoele of Testis is a common condition which is primarily treated surgically. Many patients with Hydrocoele of testis are either not willing or are unfit for surgery. This study was done to know the safety, efficacy and out come of tetracycline induced sclerotherapy of Primary Vaginal Hydrocoele of Testis in adults.This quasi experimental study was done in Shahina Jamil Hospital, attached with Frontier Medical College and Ayub Teaching Hospital, Abbottabad from March 2006 to April, 2007. Thirty-seven patients with primary vaginal hydrocoele were included in the study. Aspiration and instillation of Tetracycline was done after spermatic cord block with 2% lignocaine. Procedure time, Peri and Post-procedure complications, number of injections for cure and patients' satisfaction with the procedure were recorded. Patients were discharged home 3 to 4 hours after the procedure and followed up after one week, one month, three months and six months. Direct admission and re-admissions were recorded.The mean age of patients was 47 years. Mean procedure time was 45 minutes. All patients were cured. Mild postoprocedure pain occurred in 12 (40%), moderate pain in 14 (46%) patients and severe pain in 4 (13.3%) patients. No patient developed haematoma or local infection. One patient (3.3%) had micturition problem. Two (6.6%) patients had minimal recurrence. One injection was sufficient for cure in all patients. 28 (93%) patients were satisfied while 2 (6.6%) patients were not satisfied with this procedure. No patient was admitted in the hospital after the procedure.Aspiration and injection of tetracycline in Primary vaginal Hydrocoele of Testis in adults is safe, effective and very economical procedure.

Laparoscopic Cholecystectomy first introduced in 1987, is becoming more and more popular and now it has become gold standard in symptomatic gallstone disease. The current descriptive study is carried out in Department of General Surgery, Ayub Teaching hospital, Abbottabad to evaluate the result of Laparoscopic Cholecystectomy in symptomatic gallstones disease in our set up with special emphasis on complication rate, morbidity and mortality.The data of all patients who underwent Laparoscopic Cholecystectomy form January to December 2007 was entered in standardized proforma and analysed on SPSS 10.Out of 60 patients, 51 (85%) were female and 9 (15%) were males; the age range from 17 to 65 years mean age being 40.30 years, majority were in age 30-40 years group. Two (3.3%) patients had bile leak, 1 (1.3%) patient developed port site wound infection 1 (1.3%) patient developed collection in pouch of Morrison and in 1 (1.3%) patient stone were recovered from the epigastric port site wound. There was no bile duct or colonic injuries. The conversion rate was 5%. There was no mortality.Laparoscopic cholecystectomy is a safe and effective treatment for gall stone disease and is up to the accepted standard in our set up as compared to national and international data.

Mesh Hernioplasty is the preferred surgical procedure for abdominal wall hernias and infection remains one of the most common complications of this technique. In some patients the mesh may need removal to overcome infection, where as others may be salvaged by conservative treatment. This study was conducted to assess the outcome of conservative management for mesh site infection in abdominal wall hernia repairs.This study was carried out in Ayub Teaching Hospital Abbottabad Pakistan from Jan 2006 to Dec 2007. Thirteen consecutive cases were included, who developed mesh site infection after abdominal wall hernia repair. Pus or purulent fluid was sent for culture and sensitivity. All patients were treated by intravenous antibiotics and local wound care. Treatment was taken as successful when there was complete resolution of infection and healing of the wound.There were 7 inguinal (53.84%), 4 para-umbilical (30.76%) and 2 incisional hernias (15.38%). Eight patients were males (61.53%) and 5 females (38.46%). Median age of the patients was 40 years (range 28 to 52 years). Staphylococcus aureus was the most commonly found organism causing infection in 8 patients, (76.9%). Mean hospital stay was 22 days (range 18-26 days). All cases were effectively treated conservatively without removing the mesh. Polypropylene mesh was used in all of these cases.Conservative management is likely to be successful in mesh site infection in abdominal wall hernia repairs.

Cancellation of operations in hospitals is a significant problem with far reaching consequences. This study was planned to evaluate reasons for cancellation of elective surgical operation on the day of surgery in Ayub Teaching Hospital, Abbottabad.From July 2006 to June 2007 the medical records of all the patients who had their operations cancelled on the day of surgery in all the three General Surgical units of Ayub Teaching Hospital, Abbottabad were audited prospectively. The number of operation cancelled and reasons for cancellations were documented.3756 patients were scheduled for surgery during the study period. 2820 (75%) patients were operated upon. 936 (25%) operations were cancelled out of which 338 (36%) were cancelled due to shortage of time, 296 (31.6%) were cancelled due to medical reasons, 152 (16.2%) were cancelled due to shortage of beds while 55 (5.8%) were cancelled due to shortage of anaesthetists. Three operation lists were lost completely. The Anaesthetist cancelled 43%, Surgeon 39% while 18% of operations were cancelled due organizational reasons.Cancellation of patients on operation lists occupy a substantial population (25%) of cases. Majority of cancellation were due to reasons other than patients medical conditions. Better management could have avoided most of these cancellations.

Gallstone disease is common in women. Many patients undergoing abdominal ultrasound for gynaecological diseases are found to have gallstones. This study was done to see the results of combined abdominal hysterectomy, mini-cholecystectomy and appendicectomy in a set up lacking facilities of laparoscopic surgery.This prospective study was conducted in Ayub Teaching Hospital, Iltaf Hospital and Shahina Jamil Trust Hospital of Abbottabad from August 1998 to July 2004. All patients undergoing combined abdominal hysterectomy and mini-cholecystectomy were exclusively studied with reference to following variables. Age, Weight, Parity, Co-morbid conditions, peri-operative and post-operative complications, blood transfusion, hospital stay and mean extra time for mini-cholecystectomy and appendicectomy after abdominal hysterectomy.There were 25 patients in the study group. The ages ranged from 35-50 years. Mean weight was 65 Kg. There were no operative complications. Mild postoperative complications occurred in 7(28%) patients. Mean extra time for cholecystectomy was 25 minutes. Mean hospital stay was 9 days.In selected women, combined abdominal hysterectomy, cholecystectomy and appendicectomy is a safe, feasible and cost effective procedure.

Day-case surgery has become an important component in the provision of surgical care in the Western countries. This study was done to introduce the concept of day-case surgery and assess the patients' satisfaction after day case general surgery in our set up with vast rural communities lacking medical facilities and no day-case surgery units in the hospitals.All those patients suitable for day-case surgery and who accepted day-case surgery for general surgical procedures in General Surgical 'A' unit of Ayub Teaching Hospital, Abbottabad were interviewed after the operation on follow up visits. Questions were asked about their satisfaction with day-case surgery. If they were not satisfied, the reasons for dissatisfaction were noted. Direct admissions and re-admissions after day-case surgery were recorded. Any complications in the postoperative period were also noted. The patient's preference for a similar procedure as day-case in future was also recorded.There were 122 patients in this study. 60(49%) were operated under general anesthesia and 62(51%) under local anesthesia. Fourty Nine (40%) patients were satisfied while 73(60%) were not satisfied with day-case surgery. Six (5%) patients were admitted directly after day-case surgery while 7(5.7%) patients were admitted after discharge. Complications occurred in 41(33.6%) patients at home. Wound complications and pain were the most common morbidity encountered by the patients. Twenty eight (23%) patients contacted a hospital or a doctor in the early postoperative period. Sixty two (51%) patients would prefer operation as in-patient while 74 (60.6 %) would prefer an overnight stay after the operation next time.Patients' satisfaction with day-case surgery in Ayub Teaching Hospital is not high. Short-stay surgery would be more appropriate in our set up.

Gallstone disease is common in Pakistan. It is primarily diagnosed by ultrasonography. which is traditionally done by radiologists. If surgeons could perform ultrasonography, it would enable early diagnosis in one-stop clinic. This study was done to evaluate the accuracy of surgeon-performed abdominal ultrasonography to detect gallstones.This study was carried out at Surgical A and Surgical C units of Ayub Teaching Hospital, Abbottabad from July, 2000 to December, 2002. One hundred fourty two patients with signs and symptoms of gallstone disease who had ultrasonography performed by a surgeon. trained in ultrasonography were exclusively studied. These patients were referred for further scanning by the radiologists who were unaware of the surgeon's interpretation. The results of surgeon and radiologist performed ultrasonography were compared.The interpretation of surgeon-performed ultrasonography was correct in 100 patients and incorrect in 42 patients. There were 100 True Positive, 41 True Negative, One False Negative and Zero False Positive scans yielding 99%, Sensitivity, 100% Specificity and 99.3%, Accuracy. Sensitivity of surgeon-performed ultrasonography in detecting gallstones compared to operative findings was 100%.Abdominal ultrasonography performed by an ultrasonography trained surgeon can detect gallstones as accurately as by a radiologist.

A retrospective study of 25 children with gastrointestinal perforation due to blunt abdominal trauma in a single region of Pakistan is presented. The age, sex, aetiology, site of perforation, abdominal and X-ray findings, associated injuries, surgical procedures and outcome were analysed. There were 20 boys and 5 girls: mean age was 10 years. The injuries were the result of road traffic accidents 12 (48%), falls 11 (44%) and ‘struck by animals’ two (8%). Associated injuries occurred in 19 (76%). On admission 20 (80%) patients had peritonitis while 18 (72%) had pneumoperitoneum. Mean time from trauma to admission was 10 hours and admission to operation was 5 hours. Ileum was the most common site of perforation. Simple closure was the most common surgical procedure. Complications occurred in nine (36%) patients — six (24%) died. Delay in presentation and operation was associated with increased morbidity and mortality. Frequent evaluation of the child and abdominal X-rays are still the important tools for early diagnosis of gastrointestinal perforation following blunt abdominal trauma.

To present the clinical picture of small bowel obstruction caused by Persimmon phytobezoars in children of Hazara (Northern Pakistan).Descriptive case series.Three general surgical units of Ayub Teaching Hospital, Abbottabad from November 1998 to March 2003.Nineteen children were managed for small bowel obstruction due to persimmon phytobezoars. The age, gender, season at the time of presentation, history of persimmon ingestion, symptoms, signs, site of obstruction, operative procedure and outcome were analyzed.There were 15 males and 4 females with ages ranging from 4-11 years (mean 7 years). All presented in winter with a positive history of persimmon ingestion. All had signs and symptoms and evidence of small bowel obstruction on plain abdominal x-rays. At laparotomy, ileum was the commonest site of obstruction. Milking of bezoars into caecum was performed in 17 patients while 2 patients required enterotomy for removal of bezoars. Complications occurred in 4 patients. There was no mortality.Small bowel obstruction in children due to persimmon phytobezoars is uncommon. However, it should be considered pre-operatively as a possible cause of intestinal obstruction in winter in children who have access to the fruit. Laparotomy should be performed for persistent obstruction or signs of strangulation.

Amoebic liver abscess is a serious problem in Pakistan. Its management includes antimicrobial drugs, needle aspiration and surgical drainage. This study was done to see the therapeutic efficacy, safety and outcome of ultrasound guided needle aspiration of amoebic liver abscess combined with antiamoebic drugs.This was a prospective study with a minimum follow up of six months comparing the results of needle aspiration plus antiamoebic drugs with drug treatment alone in Amoebic Liver Abscess. It was carried in Surgical 'B' Unit of Ayub Teaching Hospital from July 1998 to June 2001. The patients were divided into two groups. Group A with abscess300 cm3 were treated with drugs alone. Group B patients with abscess300 cm3 or smaller abscesses which failed to respond to medical treatment were treated with both needle aspiration and drugs. Main outcome measures were abdominal pain, fever, anorexia, hepatomegaly, resolution of amoebic liver abscess on ultrasound, length of hospital stay and any complications.There were 46 patients in the study group. 21 (45.5%) patients were in Group A and 25 (54.5%) in Group B. The ages ranged from 15-70 years. 38 patients were male and 8 were females. The right lobe was involved in 44 (95.5%) patients and left lobe in 2 (4.5%) patients. Mean volume of abscess in Group A was 225 cm3 and in Group B was 560 cm3. Needle aspiration was successful in 24 (96.3%) patients and failed in 1 (3.7%) patient. The mean time of clinical improvement was 7 and 3 days respectively in Groups A and B. The mean hospital stay was shorter in Group B (3.5 day) than Group A (7.5 days). The resolution of abscess seen on ultrasound was rapid in Group B. Complications occurred in only one patient in Group B. No mortality was seen in any group.Needle aspiration combined with antiamoebic drugs is more effective than drug treatment alone in the management of amoebic liver abscess.

We report on 100 patients (88 men and 12 women) who underwent ligation-excision haemorrhoidectomy for prolapsing haemorrhoids in an outpatient office setting under local anaesthesia. Operating time, complications during procedure, postoperative complications and patient satisfaction with the procedure were analysed. The mean operating time was 55 (40–90) minutes. Ninety-seven were discharged three to five hours after surgery. Three patients were directly admitted to the hospital after surgery. One patient was readmitted after discharge. Severe postoperative pain occurred in eight; three suffered urinary retention; 88% were satisfied with the surgery but 12% were not. This study shows that, in selected patients, performing ligation-excision haemorrhoidectomy under local anaesthesia in the outpatient office setting is safe and viable.