Effect of size on the surgical management of pulmonary hydatid cyst.

BACKGROUND: Hydatid cyst disease is a parasitic disease caused Echinococcus granulosus. Hydatid cysts of 10 cm or greater in diameter are called "giant" cysts and traditionally have been considered to be more difficult to treat surgically often requiring pulmonary resection. In this study we reviewed our experience with pulmonary hydatid cysts. METHODS: This study was carried out in Thoracic surgery unit Lady Reading Hospital Peshawar, from 1st June 2007 to 31st May 2012. Patients admitted with intra-thoracic hydatid cysts were evaluated. Patients were divided into 2 groups, i.e., patients who had cysts < 10 cm (group A) and those who had large cysts which were 10 cm (group-B). Data regarding age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes were collected and analysed. RESULTS: Total of 224 patients underwent hydatid cystectomy. Group A comprised 190 patients (85%), Group-B comprised 34 patients (15%). Large cysts were more common in younger patients. The most frequent complaints were cough, chest pain, and dyspnea. Patients with large cysts were more often symptomatic at presentation. In both groups, lower-lobe locations predominated. Parenchyma-saving operations were almost uniformly performed for each group; however, a higher percentage of patients in group B required anatomic resection (5.8% vs. 1%). Cystic rupture occurred more frequently in group-B than in group-A (26% vs. 12%). There were no deaths in either group, and the morbidity was 23 (12%) in (group-A) and 6 (17.6%) in (group- B). CONCLUSION: Large hydatid cysts of the lung occurred more often in younger patients and were more often symptomatic at presentation. Regardless of size, the cysts could usually be surgically treated without lung resection, and size did not appear to influence short-term post-perative outcomes.

Gastroesophageal anastomosis: single-layer versus double-layer technique--an experience on 50 cases.

BACKGROUND: Considerable controversy exists regarding the optimum technique for gastroesophageal anastomosis. Double layer technique has long been considered important for safe healing but there is evidence that single layer technique is also safe and can be performed in much shorter time. The purpose of this study was to compare the outcome of single layer and double layer techniques for gastroesophageal anastomosis. METHOD: A prospective randomized study was conducted in cardiothoracic unit, Lady Reading Hospital from Jan 2006 to Jan 2008. Fifty patients with oesophageal carcinoma undergoing subtotal oesophagectomy were randomized to have the anastomosis by single layer continuous or double layer continuous technique (group A (n=24) and B (n=26) respectively). The demographic data, operative and anastomosis time, postoperative complications and hospital mortality were recorded on a proforma and analyzed on SPSS 10. RESULTS: There was no significant difference between group A and B in terms of age, gender, postoperative complications and duration of hospital stay. Anastomotic leak occurred in 4.2% patients in group A and 7.7% in group B (p=NS). Mean anastomosis time was 10.04 minutes in group A and 19.2 minutes in group B (p = 0.0001). Mean operative time was 163.83 minutes and 170.96 minutes in group A and B respectively. Overall hospital mortality was 2%; no deaths occurred due to anastomotic leak. CONCLUSION: Single layer continuous technique is equally safe and can be performed in shorter time and at a lower cost than the double layer technique.

A three-year audit of rigid oesophagoscopy at Lady Reading Hospital Peshawar.

BACKGROUND: The number of oesophagoscopies performed annually provides an indication of the extent of oesophageal disorders in any particular setting. The present study aimed to provide such data for rigid oesophagoscopy at the only referral centre for this procedure in Peshawar. METHODOLOGY: An audit of all available records of patients undergoing rigid oesophagoscopies from January 2002 to December 2004, at the Lady Reading Hospital Peshawar was performed. RESULTS: A total of 200 cases of rigid oesophagoscopies were performed during this three-year period of study. The ages of patients ranged from I to 90 years, with a two fold male preponderance. The main indication was dysphagia. with major causes being oesophageal carcinoma (115, 57.5%), reflux oesophagitis (56, 28%), strictures of various aetiologies (19, 9.5%) and foreign bodies (10, 5%). Successful dilatation was possible in 70% of cases: the morbidity rate was 4.5% due to perforation observed in 9 cases. The mortality rate was 1.5% due to septicemia in 3 cases. CONCLUSION: A high rate of rigid oesophagoscopies was observed indicating an increased frequency of oesophageal disorders in this setting. The morbidity and mortality rates observed are within acceptable ranges for this procedure.

Presentation and management of empyema thoracis at Lady Reading Hospital Peshawar.

BACKGROUND: Empyema thoracis remains a common thoracic problem with challenging management strategies. We undertook the present study to outline key aspects of the presentation and management of this condition at our tertiary care hospital. METHODS: We analyzed 105 consecutive patients treated for empyema thoracis over a one-year period at Thoracic Surgical unit, Lady Reading Hospital Peshawar Pakistan. The study included patients aged 10-60 years of either sex. Patients were subjected to detailed diagnostic and management protocols with a view to define successful diagnostic and management strategies. RESULTS: The majority of patients (68%) were male, with a mean age of 28.5 +/- 14.2 years, a majority (42%) being in the 10-20 years age group. Common presentation was with fever (73%), cough (65%) and chest pain (60%). The mean duration of symptoms was 6.1 weeks. Common aetiologies of empyema were pneumonia (46.7%), iatrogenic (21.9%), traumatic (16.2%) and malignancies (11.4%). Forty patients (38%) underwent an unsuccessful therapeutic procedure prior to admission to the Thoracic unit. In the unit, 58 patients received closed intercostal drainage (31 of which required further intervention), five patients were treated with repeated thoracentesis and 8 patients were subjected to fibrinolytic therapy. The majority of patients underwent a surgical procedure like rib resection (7), decortication (23), thoracoplasty (3) and other procedures in the first instance with only 4 patients requiring further surgery. Majority of patients (97/105, 92.4%) were cured of their disease. The hospital mortality was 7.6%. CONCLUSION: Multiple therapeutic options exist for the treatment of thoracic empyema. Optimal therapy requires selection of the most appropriate first procedure for each patient with post procedure imaging to avoid inordinate delays between interventions. Early referral of all empyema patients to thoracic units for definitive therapy is recommended.

Pictorial review: Imaging features of unusual patterns and complications of hydatid disease.

Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. We demonstrate rare locations and unusual complications of this entity during past 6 years. Rare locations during our observation included lumbar spine, sacral spine, spleen, ovary, abdominal wall, diaphragm, pelvis and right kidney. Unusual complications included formation of bronchopulmonary fistula, complete collapse of left lung secondary to hilar location of Hydatid cyst and hydatiduria.