Background: Present era of endoscopic and laparoscopic approaches have revolutionized surgical ma... more Background: Present era of endoscopic and laparoscopic approaches have revolutionized surgical management of Common Bile Duct (CBD) stones. Open procedures like Choledochoduodenostomy (CDD) have become a rarity but are not completely obsolete. It may be considered a relatively safe alternative when dealing with recurrent, too large or impacted stones, a failed ERCP, and CBD stricture with stones. The aim of this study was to establish safety, efficiency, cost effectiveness and easy availability of CDD in selected patients. Methods: In this observational study, the outcome of 90 consecutive patients undergoing CDD between 1st January 1995 and 31st Dec, 2016 in surgical unit C, Ayub Medical Complex, Abbottabad was reviewed. Choledochoduodenostomy was offered to patients who refused or had a failed ERCP and when CBD size was more than 1cm. Common Bile Duct was anastomosed to Duodenum using standard technique. Results: Medical records of 90 patients (age range 34-96 years) were reviewed; 5 were excluded and 85 were included in the study. Complication rate was 31.76% (n=27) including respiratory complications in 16.47% (n=14), wound infection in 10.6% (n=9), anastomotic leak in 2.35% (n=2) and Cholangitis in 1.18% (n=1) and Mortality in 1.18% (n=1). There was no evidence of Sump Syndrome. Total cost of procedure was Rs.50 as admission fee, which included daily provision of food and there were no room charges. Conclusions: Choledochoduodenostomy is a safe procedure, with fewer complications and significantly low cost. In case of ERCP failure, CDD is recommended.
Background: Vesical calculi refer to stones in the urinary bladder. The causes of bladder stones ... more Background: Vesical calculi refer to stones in the urinary bladder. The causes of bladder stones include bladder outlet obstruction, neurogenic voiding dysfunction, infection, or foreign bodies. Very rarely, these vesical calculi may reach very large sizes and the largest dimension can sometimes reach 13 centimeters. Methods: This descriptive cross-sectional study was conducted from 1ST May 2019 to 31st October, 2019 at Institute of Kidney Diseases, Urology Department, Hayatabad Peshawar. 164 patients with vesical stone were included in study. Ultrasound-KUB was used for diagnosis of vesical stone and after informed consent, and they underwent transurethral nephroscopic lithotripsy via the pneumatic Swiss Lithoclast. Results: Frequency of stone clearance was 96.34%. No statistically significant association of stone clearance was observed with age, gender, number of stones or max dimension of largest stone in the bladder (p > 0.05). Conclusion: Transurethral nephroscopic pneumati...
Introduction: Anal fissure is an elongated ulcer in lower anal canal which presents with severe p... more Introduction: Anal fissure is an elongated ulcer in lower anal canal which presents with severe perianal pain during and after defecation with red streaks of blood. Chronic anal fissure is a fissure for more than six weeks with a skin tag (sentinel tag). Surgical options include Lord's dilatation of anus, lateral internal sphincterotomy (LIS) and posterior anal flap. Aims & Objectives: To compare LIS and Lord's operation in cases of chronic anal fissure in terms of occurrence of incontinence. Place and duration of study: Department of General Surgery, Ayub Teaching Hospital Abbottabad from September 2018 to March 2019. Material & Methods: This quasi-experimental study was carried on 92 patients with anal fissure. By convenience (non- probability) sampling patients were divided into two equal groups of 46 patients as group A for LIS and group B for Lord's dilatation. Data was collected on a structured proforma and analyzed using SPSS 20. Results: Flatus incontinence was o...
Journal of Ayub Medical College, Abbottabad : JAMC, 2019
BACKGROUND Present era of endoscopic and laparoscopic approaches have revolutionized surgical man... more BACKGROUND Present era of endoscopic and laparoscopic approaches have revolutionized surgical management of Common Bile Duct (CBD) stones. Open procedures like Choledochoduodenostomy (CDD) have become a rarity but are not completely obsolete. It may be considered a relatively safe alternative when dealing with recurrent, too large or impacted stones, a failed ERCP, and CBD stricture with stones. The aim of this study was to establish safety, efficiency, cost effectiveness and easy availability of CDD in selected patients. METHODS In this observational study, the outcome of 90 consecutive patients undergoing CDD between 1st January 1995 and 31st Dec, 2016 in surgical unit C, Ayub Medical Complex, Abbottabad was reviewed. Choledochoduodenostomy was offered to patients who refused or had a failed ERCP and when CBD size was more than 1cm. Common Bile Duct was anastomosed to Duodenum using standard technique. RESULTS Medical records of 90 patients (age range 34-96 years) were reviewed; 5...
Background: Present era of endoscopic and laparoscopic approaches have revolutionized surgical ma... more Background: Present era of endoscopic and laparoscopic approaches have revolutionized surgical management of Common Bile Duct (CBD) stones. Open procedures like Choledochoduodenostomy (CDD) have become a rarity but are not completely obsolete. It may be considered a relatively safe alternative when dealing with recurrent, too large or impacted stones, a failed ERCP, and CBD stricture with stones. The aim of this study was to establish safety, efficiency, cost effectiveness and easy availability of CDD in selected patients. Methods: In this observational study, the outcome of 90 consecutive patients undergoing CDD between 1st January 1995 and 31st Dec, 2016 in surgical unit C, Ayub Medical Complex, Abbottabad was reviewed. Choledochoduodenostomy was offered to patients who refused or had a failed ERCP and when CBD size was more than 1cm. Common Bile Duct was anastomosed to Duodenum using standard technique. Results: Medical records of 90 patients (age range 34-96 years) were reviewed; 5 were excluded and 85 were included in the study. Complication rate was 31.76% (n=27) including respiratory complications in 16.47% (n=14), wound infection in 10.6% (n=9), anastomotic leak in 2.35% (n=2) and Cholangitis in 1.18% (n=1) and Mortality in 1.18% (n=1). There was no evidence of Sump Syndrome. Total cost of procedure was Rs.50 as admission fee, which included daily provision of food and there were no room charges. Conclusions: Choledochoduodenostomy is a safe procedure, with fewer complications and significantly low cost. In case of ERCP failure, CDD is recommended.
Background: Vesical calculi refer to stones in the urinary bladder. The causes of bladder stones ... more Background: Vesical calculi refer to stones in the urinary bladder. The causes of bladder stones include bladder outlet obstruction, neurogenic voiding dysfunction, infection, or foreign bodies. Very rarely, these vesical calculi may reach very large sizes and the largest dimension can sometimes reach 13 centimeters. Methods: This descriptive cross-sectional study was conducted from 1ST May 2019 to 31st October, 2019 at Institute of Kidney Diseases, Urology Department, Hayatabad Peshawar. 164 patients with vesical stone were included in study. Ultrasound-KUB was used for diagnosis of vesical stone and after informed consent, and they underwent transurethral nephroscopic lithotripsy via the pneumatic Swiss Lithoclast. Results: Frequency of stone clearance was 96.34%. No statistically significant association of stone clearance was observed with age, gender, number of stones or max dimension of largest stone in the bladder (p > 0.05). Conclusion: Transurethral nephroscopic pneumati...
Introduction: Anal fissure is an elongated ulcer in lower anal canal which presents with severe p... more Introduction: Anal fissure is an elongated ulcer in lower anal canal which presents with severe perianal pain during and after defecation with red streaks of blood. Chronic anal fissure is a fissure for more than six weeks with a skin tag (sentinel tag). Surgical options include Lord's dilatation of anus, lateral internal sphincterotomy (LIS) and posterior anal flap. Aims & Objectives: To compare LIS and Lord's operation in cases of chronic anal fissure in terms of occurrence of incontinence. Place and duration of study: Department of General Surgery, Ayub Teaching Hospital Abbottabad from September 2018 to March 2019. Material & Methods: This quasi-experimental study was carried on 92 patients with anal fissure. By convenience (non- probability) sampling patients were divided into two equal groups of 46 patients as group A for LIS and group B for Lord's dilatation. Data was collected on a structured proforma and analyzed using SPSS 20. Results: Flatus incontinence was o...
Journal of Ayub Medical College, Abbottabad : JAMC, 2019
BACKGROUND Present era of endoscopic and laparoscopic approaches have revolutionized surgical man... more BACKGROUND Present era of endoscopic and laparoscopic approaches have revolutionized surgical management of Common Bile Duct (CBD) stones. Open procedures like Choledochoduodenostomy (CDD) have become a rarity but are not completely obsolete. It may be considered a relatively safe alternative when dealing with recurrent, too large or impacted stones, a failed ERCP, and CBD stricture with stones. The aim of this study was to establish safety, efficiency, cost effectiveness and easy availability of CDD in selected patients. METHODS In this observational study, the outcome of 90 consecutive patients undergoing CDD between 1st January 1995 and 31st Dec, 2016 in surgical unit C, Ayub Medical Complex, Abbottabad was reviewed. Choledochoduodenostomy was offered to patients who refused or had a failed ERCP and when CBD size was more than 1cm. Common Bile Duct was anastomosed to Duodenum using standard technique. RESULTS Medical records of 90 patients (age range 34-96 years) were reviewed; 5...
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