Polypropylene suture versus skin staples for securing mesh in lichtenstein inguinal hernioplasty.

OBJECTIVE: To compare polypropylene suture and skin staples for securing mesh in Lichtenstein inguinal hernioplasty in terms of mean operating time and postoperative pain. STUDY DESIGN: Randomized clinical trial. PLACE AND DURATION OF STUDY: Surgical Ward, Combined Military Hospital, Kharian, from August 2011 to February 2012. METHODOLOGY: All individuals fulfilling inclusion criteria underwent elective Lichtenstein inguinal hernioplasty as admitted patients, under spinal anaesthesia and with aseptic measures. In group 1, during the operation, mesh fixation was done with 2/0 polypropylene suture and skin was closed with subcuticular 2/0 polypropylene suture whereas in group 2, the anchorage of mesh was done with skin staples and skin was closed with staples from the same stapler. Mean operative time and postoperative pain, assessed on a visual analog score, were compared between the groups. RESULTS: The overall postoperative pain was lower (p = 0.026) when staples were used to anchor mesh. Moreover, operative time was also lower (37.42 ± 2.69 minutes) in staple group versus (42.44 ± 2.55 minutes in polypropylene group). CONCLUSION: Mean operating time and postoperative pain is less in securing mesh with skin staples as compared to polypropylene suture in Lichtenstein inguinal hernioplasty.

Tracheal schwannoma: a rare tracheal tumour.

Primary tracheal tumours are histologically similar but 100 times less common than main stem tumours. We report a case of primary tracheal schwannoma in a middle aged man. He had chronic cough for 2 years, and developed hemoptysis and stridor in the days preceding to presentation. He was treated by resection of the tumour and primary anatomosis of the trachea. The patient recovered well after surgery and had a near normal PEFR after one and a half year of follow-up and bronchoscopic examination excluded any recurrence.

Gastropleural fistula: an unusual sequel of blunt chest trauma.

In the October 2005 Earthquake in mountainous Azad Kashmir and adjacent areas in Pakistan, a young female sustained crush injury chest and upper abdomen. She remained hospitalized with lower chest pain. All initial investigations were normal and she was discharged symptom-free on conservative management. Six months later, she developed acute left sided chest pain and dyspnoea. Provisional diagnosis of empyema was made on X-ray, and tube thoracostomy was done. Diagnostic VATS revealed gastropleural fistula secondary to necrosis of herniated stomach. Resection of necrosed stomach, repair of diaphragm and decortication and transthoracic repair with lower thoracoplasty two months later was performed but both were unsuccessful. After another 02 months, a Roux-en-Y gastrojejunostomy at fistula site was fashioned which proved curative.

Pilomatrixoma breast mimicking carcinoma.

A 50-year-old male with a painless progressively increasing lump of right breast, misdiagnosed on fine needle aspiration cytology as carcinoma breast, operated for modified radical mastectomy, is presented here. Histopathology of the resected specimen revealed pilomatrixoma.

Threaded-alive on a wooden picket.

A case of 4-year-old girl is presented, brought threaded-alive on wooden picket due to head-on fall from roof with wooden picket entering through left subcostal region and exiting from right buttock. Midline laparotomy was performed. Wooden picket was removed after enlarging the entry and exit wounds.

Fournier's gangrene--a rare complication of hydrocele aspiration.

A case of Fournier's gangrene of scrotum with systemic inflammatory response syndrome resulting from hydrocele aspiration in young male patient is presented. He was treated with antibiotics, wide local debridement of scrotal skin with evacuation of pus and gas; followed by serial debridements and dressings. Secondary suturing of scrotal defect was done after 02 weeks.