Duplication of the Vas Deferens: A Rare Anomaly.

Background: Duplication of the vas deferens, a rare congenital anomaly of the pelvic anatomy, is often an incidental finding during surgeries involving the spermatic cord, such as inguinal hernia repair, varicocelectomy, orchidopexy, and vasectomy. Case Report: A 25-year-old male presented to our surgical outpatient clinic with bilateral swelling in the inguinal region. A diagnosis of bilateral inguinal hernia was established. While performing spermatic cord dissection during hernioplasty, a duplicated vas deferens was revealed within the left spermatic cord. Doppler ultrasonography confirmed the absence of waveforms in both vasa deferentia, differentiating them from adjacent vessels. The hernia repair was performed without complications. Conclusion: Our case highlights the importance of radiologists' and surgeons' ability to recognize a duplicated vas deferens to avoid possible iatrogenic injury.

Predicament Of Doctors; Discerning Burnout Level Amongst Surgical Residents Of Karachi, Pakistan.

BACKGROUND: Stress and burnout have been soaring among doctors. It does not only have deleterious effects during working hours but also impact personal lives of the doctors. The primary focus of this study is to gauge level of burnout among surgical residents working in two major tertiary care hospital of Karachi, Pakistan. METHODS: This was a cross sectional study comprising of 118 candidates who completed the questionnaire based on demographics variables, professional details and Maslach Burnout Inventory (MBI), which scores the burnout level on the basis of three components namely emotional exhaustion, depersonalization and personal accomplishment. The duration of study was one month starting from 1st January to 31st January 2019. Residents working in Department of General Surgery were part of inclusion criteria. Consultants and medical students met the exclusion criteria. Data was analysed by SPSS-23. RESULTS: Mean MBI score was 57.15 with mean scores of Emotional Fatigue, Personal Fulfilment and Depersonalization were 22.42, 19.89 and 14.81 respectively. In terms of emotional fatigue, female residents (49.2%) were more likely to suffer than their male counterpart (50.8%) (p=0.018). Married residents (37.3%) tend to have higher mean personal fulfilment scores (p=0.02). Residents who were living alone (31%) have higher mean depersonalization score (p=0.02). With respect to personal factors, higher MBI scores were observed among doctors who were married, worked about 75-90 hours and remain sleep-deprived and those who were not able to sustain their families financially. CONCLUSIONS: On the basis of higher MBI scores in married, sleep deprived residents who were working for extensive hours and felt financial constraints, there is an extensive need of comprehensive support groups, humane number of working hours, improved salary packages, de-stressing activities like sports etc. to ameliorate the mental health of resident physicians and enhance their productivity.

Is fistulotomy with marsipulization more effective than fistulectomy alone for low fistula in ano?

Background: Fistula in ano is a very common perianal condition seen in outpatient departments. Fistulotomy and fistulectomy are two conventional options of surgery. The present study is designed to observe wound healing time and mean postoperative pain score in the comparison of outcome of the fistulectomy to fistulotomy with marsupialization. Methods: This prospective randomized trial was conducted in the surgical department of the Civil Hospital Karachi for a period of 12 months, in which 60 patients with low anal fistula were divided into 2 groups. Thirty patients in group A were treated with fistulectomy, and 30 in group B were treated with fistulotomy with marsupialization. The postoperative pain severity was assessed after 24 hrs through a visual analogue scale and on weekly and fortnightly follow-ups for 6 weeks. Wound healing was assessed by clinical examination on weekly and fortnightly follow-ups for 6 weeks to estimate the mean healing time. Results: The mean pain score was significantly lower in group B in comparison to group A (3.6±1.99 versus 2.40±1.52; p=0.01). The mean wound healing time was shorter in group B in comparison to group A (4.23±0.77 versus 5.80±0.41 weeks; p=0.0005). Conclusion: Fistulotomy with marsupialization is a simple, easy, and more effective method than fistulectomy for the treatment of simple perianal fistula. (AU)