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Publications (26)

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    [Show abstract] [Hide abstract] ABSTRACT: Background and Objective: Acute gallstone pancreatitis is quite common throughout the globe. Conventionally definitive cholecystectomy has been delayed in index hospital admission. Since the last decade timing of cholecystectomy is gradually shifting towards the earlier phase of disease and currently gallstone pancreatitis is being evaluated as a further indication for laparoscopic cholecystectomy. There is also great concern regarding compliance of patients for definitive surgery due to poverty, ignorance and illiteracy in developing countries. The aim of this study was to assess the feasibility and safety of laparoscopic cholecystectomy as a definitive treatment in patients with mild and resolving gall stone pancreatitis. Methods: This was a prospective study from July 2009 to June 2012. Patients were diagnosed by clinical examination, biochemical tests, ultrasonography and contrast enhanced CT. Patients with mild form of the disease (Ranson Score ≤3) and who showed clinical improvement were offered laparoscopic cholecystectomy in index hospital admission. Those who were unfit for surgery were referred for endoscopic sphincterotomy. Common bile duct stones were excluded preoperatively. Results: A total of 38 patients were admitted with acute gallstone pancreatitis in the study period. The mean age of patients was 46.3 years with male to female ratio of 11/27. 22 (57.8%) patients were selected for laparoscopic cholecystectomy and procedure was completed successfully. Ten (26.3%) patients were referred for ERCP and endoscopic sphincterotomy and 11 (28.9%) were managed by conservative treatment and went without any definitive treatment. Mean duration of time from onset of symptoms and laparoscopic cholecystectomy was 7 days (range 4-10). Mean duration of operative time was 45 minutes and hospital stay was 7 days. There was no operative mortality. No major intra-operative or post-operative complication was recorded. two patients (9%) had minor complications. Conclusion: Laparoscopic cholecystectomy can be safely performed in selected cases of mild gallstone pancreatitis in order to prevent further attacks of acute pancreatitis and other consequences of delayed treatment. Furthermore it resolves the problem of noncompliance of patients in third world countries where many patients are lost for definitive treatment.
    Full-text Article · May 2014 · Pakistan Journal of Medical Sciences Online
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    Arshad M. Malik · Azzam Alkadi · K Altaf Hussain Talpur · Jawaid Naeem Qureshi
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To study the incidence, pattern of injuries, presentation and management of stray bullet injuries. Methods: All patients presented and admitted with stray bullet injuries during a period of 4 years from January 2006 to December 2010 were included in this prospective study which was conducted at Liaquat University of Medical and Health Sciences Hospital Hyderabad/Jamshoro. All of the study subjects were admitted through casualty and were initially thoroughly examined and resuscitated. The pattern of injuries was noted and requisite investigations performed. Patients who sustained injuries demanding surgery were prepared accordingly and were submitted for laparotomy or other procedures depending upon the severity of injuries. The data collected on individual basis and variables studied including demographics, pattern of injuries, time since injury occurred and management. Results: A total number of 165 patients with a mean age of 17.1 years, SD 13.807 and range of 74(2-76) presented with stray bullet injuries during study period. The study population comprised 117(70.90%) males and 48(29.09%) females. Majority of the patients were brought late because of delay in diagnosis or delay in transportation. The commonest victims were young children in their teens and comprised 78% of the study population. Haemothorax/ pneumothorax or peritonitis was the common presentations occurring in 11% and 61.81% of the study population respectively. Of the total number, 92 (55.75%) patients underwent laparotomy while remaining patients either had chest intubation or some other procedures done accordingly. Nine (5.45%) patients developed permanent disabilities while 13(7.87%) patients died either immediately after arrival or later on in the hospital during or after the operative treatment. Mortality was related to the time of arrival in hospital since the injury and thus was highest among those brought 4 or more hours after the shot (P<0.001). Patients who did not sustain major injuries were kept under observation and were subsequently discharged. Conclusion: Stray bullet injuries are an ever increasing challenge in our society. Unlawful and jubilant use of weapons in celebrations, weddings and similar occasions are causing a lot of morbidity and mortality in the society.
    Full-text Article · Sep 2013 · Pakistan Journal of Medical Sciences Online
  • K. Altaf Hussain Talpur · Arshad Mahmood Malik · Amir Iqbal Memon · [...] · Abdul Aziz Laghari
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: This study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years. Methods: This is a prospective observational study conducted over a period of 10 years (January 2001-december 2010). A total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct (CBD) stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, CBD strictures and cases who developed iatrogenic biliary injuries during cholecystectomy (both open & laproscopic) during this period of time. The patients who required biliary bypass surgery were further analysed for indications and outcome. Results: Out of 1500 patients 83(5.53%) required biliary bypass surgical procedures. The CBD stones were observed as the most common indication (25.3%), followed by CBD injuries after open(10.84%) or laproscopic-cholecystectomy (14.46%), carcinoma head of pancreas (12.05%) and CBD obstruction(14.46%) either due to CBD strictures or unknown distal obstruction. Roux-en-Y-hepatico-jejunostomy (26.51%) was the most frequently performed procedure, followed by choledochoduodenostomy and Roux-en-Y choledocho-jejunostomy (i.e. 25.3% and 12.05% respectively). Roux-en-Y biliary bypass procedure was observed to be associated with better outcome in terms of rate of complications as well duration of hospital stay. Conclusion: Biliary bypass surgical procedures are the better options to restore the continuity of biliary system in patients with iatrogenic biliary tree injuries and un-operable pancreatico-biliary malignancy. Roux-en-Y biliary bypass procedure is safe and problem solving method in these cases.
    Article · May 2013 · Pakistan Journal of Medical Sciences Online
  • Ahmed Khan Sangrasi · Abdul Aziz Laghari · K. Altaf Hussain Talpur · [...] · Naushad. A. Shaikh
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To evaluate the feasibility and safety of laparoscopy in the management of hydatid cysts. Methodology: All consecutive patients diagnosed with liver hydatid disease were offered laparoscopic management. We performed select conservative procedures using standard laparoscopic instruments after sterilization of the cysts with 20% hypertonic saline. Deroofing, evacuation and partial cystectomy were performed. Omentoplasty was performed, and a drain was placed in the cyst cavity. Results: A total of 63 patients (M:F=48:15) with 75 cysts were managed successfully by laparoscopy. The mean age +/- SD of the patients was 38.59 +/- 11.46 years old. The mean operative time +/- SD was 88.24 +/- 23.52 minutes (range: 52-145 minutes). The mean size of the cysts was 9.2 cm (range: 5.8-16.5cm). The mean hospital stay +/- SD was 3.49 +/- 1.16 days (range: 1-7 days). There was no disease or procedure related mortality. Recurrence of a cyst was observed in 3 (4.76%) cases. Open surgery had to be performed on four patients. There were no major complications; minor biliary leaks were observed in 7 cases and cavity infections in 5 cases. The mean follow-up +/- SD in 51 patients was recorded as 28.9 +/- 31 months. Conclusion: Laparoscopic treatment of hydatid cysts of the liver is safe and effective, with low morbidity and a low recurrence rate in uncomplicated cysts. Despite some of its limitations, the procedure is a good alternative to open surgery in select cases.
    Article · Oct 2012 · Pakistan Journal of Medical Sciences Online
  • K. Altaf Hussain Talpur · Arshad Mehmood Malik · Ahmed Khan Sangrasi · [...] · Champa Susheel
    [Show abstract] [Hide abstract] ABSTRACT: Objective: This study was conducted to analyse the different causes and factors for exploration and their management after laparoscopic cholecystectomy in 1000 cases of cholelithiasis. Methodology: This is a prospective study conducted in the department of surgery Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, from January 2003 to December 2010. Thousand cases of cholelithiasis were operated for laparoscopic cholecystectomy in eight years and were observed for their recovery and complications postoperatively. Those patients who developed major problems were assessed clinically and by different investigations like LFT, Ultrasound, CT scan and HIDA scan to find out the cause. They were operated once absolute indication of exploration was made. All patients were included in study after getting informed consent for first operation as well as for Re-do surgery if any one required exploration. Results: Out of 1000 cases, 58 patients (5.8%) developed unidentified complications during laparoscopic cholecystectomy who required surgery for one or other reason. The problems which required exploration were bleeding in 2.2%, biliary leak in 1.9% and obstructive jaundice in 1.0% of cases as main reasons. The cases were managed by various open surgical procedures depending upon the pathology found on exploration. Conclusion: Laparoscopic cholecystectomy though proved as gold standard for cholelithiasis but still is not free of complications and can land up into major problems for patients who had either difficult cholecystectomy or over looked congenital anomalies of biliary tree.
    Article · Apr 2012 · Pakistan Journal of Medical Sciences Online
  • Khamiso Alias Altaf Hussain Talpur · Arshad Mahmood Malik · Amir Iqbal Memon · [...] · Ahmed Khan Sangrasi
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To identify various factors which prolong post-operative hospital stay after laparoscopic cholecystectomy. Methodology: This is an observational prospective study conducted at a teaching hospital over a period of five years (Jan 2005-Dec 2010) and includes 580 patients of symptomatic cholelithiasis, admitted and treated by laparoscopic surgery. All patients were observed from 1st postoperative day to date of discharge and different operative, postoperative and patient related variables were recorded on a proforma which were found responsible for an unduly prolonged post-operative stay in the hospital. The duration decided for short stay was 48 hours and duration more than that was considered as prolonged stay. Results: Out of 580 patients, 187 (32.24%) had prolonged stay extending from 3-28 days. Majority of patients presented in 4th & 5th decade (60.52%) with pain in right hypochondrium (58.79%) and pain in right hypochondrium combined with pain in epigastrium (27.6%) as main clinical features. Twenty eight variables were identified comprising of 10 patients related (15.86%), 12 surgery related (16.55%) and 6 post-surgery related (16.38%) which contributed to prolong the hospital stay. Patients having co morbid conditions, difficult operative procedure and major postoperative complications were main factors for prolonged stay. Conclusion: The prolonged post-operative hospital stay can be reduced by careful pre-operative assessment, meticulous surgery and proper post-operative management.
    Article · Oct 2011 · Pakistan Journal of Medical Sciences Online
  • Arshad M Malik · Khamiso Altaf Hussain Talpur · Abdul Ghani Soomro · Jawaid Naeem Qureshi
    [Show abstract] [Hide abstract] ABSTRACT: Abdominal tuberculosis is extremely common in developing countries such as Pakistan and India. The presentation is varied and nonspecific, making the diagnosis extremely difficult at times. This study was performed to find out the efficacy of diagnostic laparoscopy in establishing the histopathological diagnosis of abdominal tuberculosis. An analytical descriptive study of 109 patients with abdominal tuberculosis diagnosed by laparoscopy was conducted over a period of 5 years (between January 2004 and December 2009) in a teaching hospital and in various private hospitals. All patients with vague abdominal symptoms and suspicion of abdominal tuberculosis were admitted and examined thoroughly. Data were collected and statistically analyzed using SPSS version 16. A total of 133 patients with vague abdominal symptoms and an unsettled diagnosis were included in this series, of which 109 (82%) patients were diagnosed with abdominal tuberculosis on laparoscopy. The common symptoms were pain in abdomen, changing bowel habits, loss of weight, and generalized weakness. Clinical examination was not significant, except for anemia in the majority and generalized abdominal tenderness in a few patients. Various tuberculous lesions were detected on laparoscopy. Biopsy of the specimens proved abdominal tuberculosis in 109 patients. Patients were saved from unnecessary laparotomies and were managed on antituberculosis drug therapy. Diagnostic laparoscopy is an efficient and reliable diagnostic tool for patients suspected with abdominal tuberculosis.
    Article · Jun 2011 · Surgical laparoscopy, endoscopy & percutaneous techniques
  • K. Altaf Hussain Talpur · Arshad Mahmood Malik · Ahmed Khan Sangrasi · [...] · Jawed Naeem Qureshi
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To compare the results of conventional open with laparoscopic cholecystectomy regarding their operative time and postoperative parameters. Methodology: This is a comparative study of 400 patients of cholelithiasis operated for either open or Laparoscopic cholecystectomy during five years from January 2004 to December 2008. The cases were compared for operative time and various postoperative parameters in order to assess the advantages and disadvantages of each procedure. The patients were divided into two groups, group OC for open and group LC for laparoscopic cholecystectomy, each comprising of 200 cases. Results: The operative time was longer in OC than LC patients with mean operative time of 54.16± 11.94 minutes in OC and 46.89±14.83 minutes in LC group (P<0.001). The overall frequency of postoperative complications was relatively high in OC group 50.5% as compared to LC (37%) including all minor and major problems with combined morbidity of 43.75% (P<0.001). The mean hospital stay was shorter in LC group as compared to OC group i.e. 3.02±1.75 (range 1-5) days versus 5.56±9.8 (range 4-10) days respectively. Return to normal work was also significantly shorter in LC group i.e. 18.06±5.16 days (range 1-4 weeks) as compared to 31.61±7.6 days (range 3-6 weeks) in OC group with p value <0.001. Conclusions: The laparoscopic cholecystectomy is superior to open cholecystectomy due to short operative time, early mobilization and fast recovery, less postoperative pain and complications, short hospital stay and early return to work.
    Article · Jan 2011 · Pakistan Journal of Medical Sciences Online
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    Arshad Mehmood Malik · Rafique Pathan · Noshad Ahmed Shaikh · [...] · Khamiso Altaf Hussain Talpur
    [Show abstract] [Hide abstract] ABSTRACT: To investigate the pattern of presentation, severity, factors responsible for delayed presentation and outcome of breast cancer in patients presenting to a teaching hospital of Jamshoro. It's a prospective descriptive study of 103 malignant breast lumps treated at a tertiary care teaching hospital over a period of 8 years. All patients were admitted through Outpatients department and were thoroughly examined and investigated. Treatment offered was based on triple assessment and ranged from lumpectomy to toilet mastectomy depending upon the stage of disease. The variables studied were recorded on a proforma and analyzed on SPSS version 12 for measuring frequencies and using Chi square test where applicable. The mean age of the study population was 39.17 +/- 6.019 years and a range of 22 to 54 years. The frequency of advanced malignancy was alarmingly high in younger patients. Intra- ductal carcinoma was the commonest tumour in 93 (90%) patients, while the remaining included lobular (07) and Paget's disease (03). The high figures of advanced disease at presentation is attributed to lack of knowledge and education, poverty and local customs of women not exposing themselves even to the physicians. In addition, there is a substantial delay in the referral of patients from under privileged, remote areas where patients continue to receive symptomatic treatment till such time that disease becomes incurable. Advanced breast disease is common in younger patients belonging to underprivileged and remote rural areas. Great efforts are required to educate people so as to make early diagnosis possible
    Full-text Article · Sep 2010 · Journal of the Pakistan Medical Association
  • [Show abstract] [Hide abstract] ABSTRACT: To compare the postsurgical outcome of laparoscopic and open inguinal varicocelectomy. Quasi-experimental study. Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2003 to June 2007. One hundred seven patients underwent either open inguinal or laparoscopic varicocelectomy. Diagnosis was made by clinical examination and color Doppler scan in doubtful cases. Pre-operative semen analysis was done in all patients. Operative time, postoperative analgesic requirement in number of tablets, hospital stay in days, improvement in semen parameters in subfertile subjects, pain on visual analog score. and postoperative complications were recorded and compared between the two groups. There were 50 patients in each group, with age ranging from 12-50 years (26.9+/-7.67 in open inguinal and 26.2+/-7.08 in laparoscopic group). Average operative time was 34.8+/-7.89 minutes for open inguinal and 43.8+/-8.95 minutes for laparoscopic group. The analgesic requirement was 16.3+/-1.58 tablets in the open inguinal and 11.3+/-2.23 in the laparoscopic group. Postoperative pain was significantly less in the laparoscopic group. There was statistically significant (p < 0.001) improvement in sperm count as well as motility in both groups irrespective of procedure. The open inguinal (Ivanissevich) procedure and laparoscopic varicocelectomy had almost equivalent postoperative outcomes regarding improvement in semen parameters and postoperative complications. Open inguinal procedure had a shorter operating time while laparoscopic varicocelectomy had the advantage of less analgesic requirement and short hospital stay. On the whole, open inguinal (loupe magnified) varicocelectomy is an effective procedure where availability and costs of laparoscopic instruments are barriers.
    Article · Feb 2010 · Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
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    Khamiso Altaf Hussain Talpur · Abdul Aziz Laghari · Sikandar Azam Yousfani · [...] · Sangrasi Ahmed Khan
    [Show abstract] [Hide abstract] ABSTRACT: To assess the frequency of anatomical variations of extrahepatic biliary system in patients undergoing laparoscopic cholecystectomy. This is an observational study performed in the Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro for a period of four years from January 2004 to December 2007. All diagnosed patients of cholelithiasis undergoing routine laparoscopic cholecystectomy were assessed for anatomical/congenital extra hepatic biliary and vascular anomalies. Structures mainly assessed for anomalies were gall bladder, cystic duct, supraduodenal part of Common Bile Duct (CBD), cystic artery and hepatic artery which are routinely handled during laparoscopy. However, assessment of variations and anomalies, of hepatic ducts, portal vein, retroduodenal and pancreatic parts of CBD were not done due to possibility of iatrogenic injuries. Three hundred cases of cholelithiasis comprising 255 (85%) females and 45 (15%) males with mean age of 39.85 +/- 18.82 years were included in the study. Patients mainly presented with upper abdominal pain including pain in right hypochondrium (71.67%), pain in right hypochondrium and epigastrium (19%) and pain in epigastrium alone (9.33%) as main symptoms. Operative findings revealed variations in 61 (20.33%) patients mainly involving cystic artery (10.67%), cystic duct (4.33%), right hepatic artery (2.67%) and gallbladder (2%). Postoperatively 3.67% revealed bleeding and 1.67% biliary leak from drain as main complications related to anatomical variations giving rise to 1% morbidity, however, no mortality was seen in this series. Congenital anomalies and normal variants of biliary tree, are not common but may be of significance during laparoscopic surgery as failure to recognize them leads to iatrogenic injuries and can increase morbidity and mortality.
    Full-text Article · Feb 2010 · Journal of the Pakistan Medical Association
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    Arshad Mehmood Malik · Asad Khan · Khamiso Altaf Hussain Talpur · Abdul Aziz Laghari
    [Show abstract] [Hide abstract] ABSTRACT: To study various factors influencing outcome of open hernia repair in elderly population. This is a retrospective descriptive study from January 2004 to December 2008 including all patients (n = 212) of 60 years and above operated for inguinal hernias either electively or in emergency during this period. One of the co-authors was assigned the duty to collect the record files of all patients over 60 years age operated for inguinal hernia in the department of surgery LUMHS as well as in private hospitals in Hyderabad. The records of all patients were reviewed and data retrieved on a proforma mentioning variables to investigate the common co-morbidities and their influence on the overall results of surgical intervention in geriatric patients. SPSS version 12 was used for statistical analysis of the data. The mean age of the patients in this series was 69.82 +/- 7.8 years of whom 208 (98%) were males and 4 (2%) females. In 190 (89.61%) patients the hernias were unilateral while 12 (5.7%) cases had bilateral inguinal hernias and 10 (4.7%) patients presented with recurrent hernias. In 159 (75%) patients the hernia was simple while 53 (25%) patients presented with one or the other complication such as obstruction or strangulation. Elective surgery was performed in 161 (75.9%) patients while 51 (24.1%) patients were operated in emergency. Co-morbidities were present in 79 (37.26%) patients. Out of the total study population, 7 (3.30%) patients died of which 6 were operated in emergency and had co-morbidities. All of them had gangrene of bowel for which resection and anastomosis was done. One patient died of acute MI on 5th post-operative day. Emergency hernia surgery carries a high mortality in elderly patients. Co-existing medical problems make surgery still challenging in the geriatric population. An early elective hernia repair is highly recommended.
    Full-text Article · Jan 2010 · Journal of the Pakistan Medical Association
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    Arshad M Malik · Asad Khan · Atif Jawaid · [...] · K Altaf Hussain Talpur
    [Show abstract] [Hide abstract] ABSTRACT: The groin hernia repair is one of the common operations in general surgery. The optimum repair method is under debate and the best mode of repair is yet to be decided. This study is conducted to compare the results of open non-mesh (Modified Bassini's) and Lichtenstein's mesh repair of primary inguinal hernia in terms of recurrence, postoperative complications and quality of life in the long-term. This retrospective comparative analytical study includes 840 patients of which 40 patients were excluded from the study due to various reasons. The remaining 800 patients with unilateral primary inguinal hernia, above 16 years of age, operated during January 2000 to December 2007 in a teaching hospital are included in the study. Of the total number, 392 patients (49%) underwent Lichtenstein mesh repair, while remaining 408 patients (51%) were operated by modified Bassini's suture technique. Follow up was conducted 1, 5, 8 and 15 days; 1, 2, 6, 24 and 36 months. The recurrence rate and postoperative pain were significantly low in Lichtenstein mesh repair compared to open non-mesh repair by modified Bassini's technique (p < 0.001). Recurrence occurred in 8 (2.0%) out of 392 patients those with Lichtenstein mesh repair. On the other hand 29 (7.1%) patients with Bassini's repair reported recurrence within 3 years time. Mesh repair of inguinal hernia is much superior to non-mesh repair in terms of recurrence and postoperative chronic pain.
    Full-text Article · Jan 2009 · Journal of Ayub Medical College, Abbottabad: JAMC
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    A M Malik · A Khan · U Sheikh · [...] · K A Talpur
    [Show abstract] [Hide abstract] ABSTRACT: An overall increase in the incidence of paediatric cholelithiasis forms the basis of this study, which aims to investigate the overall changing clinical pattern of cholelithiasis. Methods: This is a retrospective observational descriptive study including twenty three (23) patients with gallstones admitted and operated during June 2006-June 2008 in surgical department of a teaching hospital. All the patients with sonological evidence of gallstones, less than 10 years of age with history of acute or chronic abdominal symptoms are included in the study population. After admission all the subjects were investigated and finally operated by open approach (21 patients) during the same admission. The details of all the patients were recorded on a proforma and statistical analysis done on SPSS version 12. Of the total study population, there were 19 (82.6%) males and 4 (17.39%) females with a mean age of 7 years and a range of 4-10 years. Ultrasound revealed gallstones in all the patients with a varying proportion of the walls of gallbladder. The commonest presentation was abdominal pain in the right upper quadrant, which was vague, and of mild to moderate intensity. In 21 (91.30%) patients, no specific underlying cause was found while two patients (8.6%) had haematological disorder as underlying cause for the gallstones. This study indicates an alarming increase in the incidence of idiopathic gallstones in children less than 10 years of age with a distinct male predominance.
    Full-text Article · Oct 2008 · Journal of Ayub Medical College, Abbottabad: JAMC
  • Arshad M Malik · Abdul Aziz Laghari · Qasim Mallah · [...] · K Altaf Hussain Talpur
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To deteremine the incidence, nature and management of extra-biliary complications of laparoscopic cholecystectomy. Materials and Methods: This study presents a retrospective analysis of extra-biliary complications occuring during 1046 laparoscopic cholecystectomies performed from August 2003 to December 2006. The study population included all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was performed. The extra-biliary complications were divided into two distinct categories: (i) Procedure related and (ii) Access related. Results: The incidence of access-related complications was 3.77% and that of procedure-related complications was 6.02%. Port-site bleeding was troublesome at times and demanded a re-do laparoscopy or conversion. Small bowel laceration occurred in two patients where access was achieved by closed technique. Five cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot's triangle. In 21 (2%) patients the procedure was converted to open surgery due to different complications. Biliary complications occurred in 2.6% patients in the current series. Conclusion: Major extra-biliary complications are as frequent as the biliary complications and can be life-threatening. An early diagnosis is critical to their management.
    Article · Feb 2008 · Journal of Minimal Access Surgery
  • A.A. Laghari · K.A.H. Talpur · A.M. Malik · [...] · A.I. Memon
    [Show abstract] [Hide abstract] ABSTRACT: OBJECTIVE: To assess the role of laparoscopic cholecystectomy (LC) in gallstone disease with its complicated problems. DESIGN: Prospective observational study. SETTING: Surgical Department of Liaquat University of Medical & Health Sciences, Jamshoro and Private Hospitals of Hyderabad, Sindh-Pakistan; from May 2001 to April 2005. METHODS: The patients were categorized as cases of complicated gallstone disease on the basis of clinical assessment, investigations especially ultrasound abdomen and operative findings noted during laparoscopic cholecystectomy. All patients were explained for advantages and disadvantages of early LC with their difficult disease problem and willing taken for study. Sampling strategy was convenient. The patients with uncomplicated gallstones, obstructive jaundice, acute pancreatitis and carcinoma of gall bladder were excluded from this series. RESULTS: 120 out of 400 patients presented with one of the known complication of cholelithiasis such as chronic cholecystitis 50%, acute cholecystitis 12.5%, empyma 18.33%, mucocele 10% and fibrosed gall bladder in 9.17% of cases as assessed on clinical examination, ultrasound and laparoscopic findings. Majority (75%) of cases were having adhesions around gall bladder and 25% without adhesions. Problems encountered during LC were difficult separation of tight adhesions around gallbladder (50.0%), grasping and holding of thick walled and distended gallbladder (41.67%), dissection and identification of structures in Calot's triangle (29.17%), haemorrhage from main cystic artery and gall bladder bed 20.83% and delivery of large and thick wall gallbladder in 25% of cases. Intra operative complications seen during procedure were haemorrhage in 20.83% cases, perforation of gallbladder by instrumentation in 12.5% and avulsion of cyctic duct in 1.67% of cases. Two patients (1.67%) were converted to open cholecystectomy due to bleeding. Postoperatively 12.5% of patients developed biliary leak, out of which 3 cases (2.5%) were due to actual common bile duct injury, 2.5% of cases developed port-site sepsis as main postoperative complications. Cases with bile duct injury were re-explored and managed accordingly. Hospital stay varied from 2-7 days but majority of patients were discharged (70.83%), within 2-3 days, no mortality was seen in this series. CONCLUSION: Laparoscopic cholecystectomy like uncomplicated biliary stone disease is equally effective procedure for complicated cholelithiasis. Its applicability is almost 95% in experienced hands.
    Article · Jan 2008 · Journal of the Liaquat University of Medical and Health Sciences
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    Malik Arshad · Laghari A Aziz · Mallah Qasim · K Altaf Hussain Talpur
    [Show abstract] [Hide abstract] ABSTRACT: Appendicular mass is a well-known complication of acute appendicitis. It is conventionally treated conservatively followed by interval appendectomy. This study aimed to determine the feasibility and safety of an early appendectomy in these cases. Descriptive and comparative. Department of Surgery Liaquat University Hospital, Jamshoro/Hyderabad from March 2003 to December 2007. One hundred and seventy six (176) patients with appendicular mass were included in this study. Patients were conveniently divided into two groups, A and B with equal distribution of cases (88 Patients each), regardless of age and sex. Immediate appendicectomy was performed in group A patients after preliminary investigations, where as patients in group B were initially treated conservatively followed by interval appendicectomy. A total 114 (64.8%) males and 62 (35.2%) females with a mean age of 25.09 years (Range 8-44 years) are included in the study population. Post-operative wound sepsis occurred in 17 (19.31%) patients in group A. Treatment failure, patient compliance, re-admission and overall expenses are main limitations in group B population. Early appendicectomy is a safe and superior option in patients with appendicular mass compared to conventional treatment.
    Full-text Article · Jan 2008 · Journal of Ayub Medical College, Abbottabad: JAMC
  • Arshad M Malik · A A Laghari · K A Talpur · [...] · J M Memon
    Article · Oct 2007 · Journal of Minimal Access Surgery
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    Arshad M Malik · Abdul Aziz Laghari · K Altaf Hussain Talpur · [...] · Jan Mohammad Memon
    [Show abstract] [Hide abstract] ABSTRACT: Advancing age with its associated co-morbidities increases the likelihood of postoperative complications as well as conversion rate during laparoscopic cholecystectomy. Recent studies have also questioned efficacy of this procedure in geriatric patients. The present study assesses the safety and applicability of laparoscopic cholecystectomy in geriatric patients. The objective of the present study was to asses safety and applicability of laparoscopic cholecystectomy in the elderly patients of 65 years and above. This is a prospective analysis of 173 patients, over 65 years of age, who underwent laparoscopic cholecystectomy from December 2002 to November 2006 at Liaquat University Hospital, Jamshoro. Patients presenting with complicated and uncomplicated gallstone disease were included in the study population and all of them were operated laparoscopically. The data included demographic details, co-morbidities, underlying biliary pathology, indications for surgery, operative and postoperative complications, morbidity and mortality, and hospital stay. The statistical analysis of the data performed on SPSS version 10. Laparoscopic cholecystectomy undertaken in 173 elderly patients with a mean age of 69.72 years, out of whom 52 (30.05%) were males and 121 (69.94%) were females. Co-morbid conditions were identified in 53.17% (n = 92) patients and included hypertension in 38 patients (21.96%), Diabetes Mellitus in 23 patients (13.29%), COPD in 19 (10.98%) patients, Coronary artery disease in 9 (5.20%) and cardiac arrhythmias in 3 (1.73%) patients. Indications for surgery included simple biliary colic in majority of patients (69.94%) and complicated stone disease in 52 (30.05%) subjects. There were 37 (21.38%) emergency laparoscopic cholecystectomies and 136 (78.61%) patients were operated electively. Mean operative time was 100 minutes with a SD 29.03. Fourteen (8.09%) patients required conversion to OC (Open Cholecystectomy) due to various reasons. Mean hospital stay was 6.28 days. Overall 23 (13.29%) patients developed postoperative complications. One patient died of acute MI on 2nd postoperative day. There is no undue risk in laparoscopic cholecystectomy in the elderly population and the procedure can be regarded as safe as in patients below 65 years of age.
    Full-text Article · Oct 2007 · Journal of Ayub Medical College, Abbottabad: JAMC
  • K.A.H. Talpur · A.A. Laghari · A.M. Malik · S.A. Khan
    [Show abstract] [Hide abstract] ABSTRACT: OBJECTIVE: To determine the diagnostic accuracy of FNAC versus histopathology in various body lumps. DESIGN: Quasi-experimental study. SETTING: Surgical department of Liaquat University Hospital Jamshoro/ Hyderabad, Sindh-Pakistan, from January 2003 to December 2005. PATIENTS AND METHODS: One hundred and sixty five patients with lumps at various body sites were studied. Patients were evaluated by history, examination and investigations. Then they underwent for FNAC followed by open biopsy. Reports of FNAC and histopathology were compared and accuracy of FNAC assessed. RESULTS: Out of 165 cases, 92 (55.76%) had neck lumps (with thyroid and extra-thyroid swellings, 46-cases each), 35 (21.21%) breast lumps, 10 (6.06%) parotid swellings and 11 (6.66%) cases had axillary lump as main sites for FNAC, along with various other parts of body. FNAC revealed benign neoplastic conditions in 13.94% of cases, malignancy in 18.18%, tuberculous lymphadenopathy in 14.54%, goitre in 18.79%, and inflammatory lesions in 11.52% of cases as main lesions with false negative results of 18.78% and false positive result of 0.60%, whereas histopathology revealed malignancy in 24.85%, benign neoplastic lesions in 20.0%, goitres in 19.39%, tuberculous lymphadenopathy in 23.03% as main disease problems. CONCLUSION: FNAC has high sensitivity and specificity in diagnosis of various body lumps. Findings of this study are almost comparable to histopathology however, FNAC shows high false negative results which may be due faulty sampling technique or lack of expertise.
    Article · Sep 2007 · Journal of the Liaquat University of Medical and Health Sciences