HAL plus RAR is safe, good for patients satisfaction and long term results are also satisfactory-Dr.Wasif Majid

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 Proceedings of Int. Medical Conference at SMDC-III

HAL plus RAR is safe, good for patients
satisfaction and long term results are
also satisfactory-Dr.Wasif Majid

Radiologists need to collaborate with Clinicians and in future
Value Based Medicine will replace Evidence
Based Medicine-Dr.Ahmad Murtaza

LAHORE: Dr. Wasif Majid Chaudhry was the first speaker during one of the scientific sessions devoted to Surgery and Radiology at the First International Medical Conference organized by Shalamar Medical & Dental College from February 3-5, 2017.The topic of his presentation as Hemorrhoidal Artery Ligation Operation which was based on his three years’ experience.  The prevalence of hemorrhoids, he said is about 4% in general population and it is classified as Stage 1-4. Different surgical procedures are performed for different degree of prolapse. In Stage-1 one should add fiber to the diet, use laxatives and liquids. In Stage-2, injection sclerotherapy, haemorrhoidectomy and rubber band ligation are used. Improvement of symptoms of hemorrhoids improves the quality of life of the patient.

Bleeding leading to anaemia, ulceration, soiling were mentioned as some of the indications for surgery. Closed haemorrhoidectomy may be performed in some patients. Stapled haemorrhoidectomy has lot of complications that is why it has been abandoned in United States. He further stated that full thickness excision of rectal wall can damage sphincter. Lasers is not being used in Pakistan. Open and close haemorrhoidectomy both have lot of pain but it does reduce recurrence and prolapse.  He then talked about HAL (Hemorrhoidal Artery Ligation) and RAR recto anal repair. Hemorrhoidal Artery Ligation is simple to learn, reduces blood flow to internal Hemorrhoidal plexus. It is good and is recommended for Grade two, three and four. It has low pain and low prolapse rate and offers high patient satisfaction. It is safe and effective.

During the three years period 2014-2016 they managed 95 patients. Some of them had failure with band ligation. The patients were followed up after one, three, six months and one year. About 60% were male and 40% were female. The procedure, he said, takes about thirty five to forty five minutes. Average hospital stay of the patients was nineteen hours and it ranged from 14-48 hours. About 84% of patients had mild pain which was relieved with NSAIDs. Three patients experienced excessive pain and 12% had moderate pain. Early complications noticed included retention of urine and patient’s satisfaction was 83%. No recurrence was recorded and there was no anal stenosis.  His conclusions was that HAL plus RAR is safe and good for patient’s satisfaction and long term results are also satisfactory.

Prof. Safdar Malik was the next speaker who talked about varicose Vein radiofrequency ablation, how to elicit reflux and potential complications.  He also demonstrated this procedure. They managed 124 patients and saw skin burnt in just one patient. His conclusions were that it is quick, safe and effective procedure well tolerated by the patients.

Dr.Ahmad Murtaza talked about Radiology in the Next Decade. He pointed out that in radiology we have come a long way. He then discussed the Picture Archiving and Communication System (PACS) which offers facilities to view, store and transport medical images.  Digital X-ray is just like Smart Phone. He then spoke about Ultrasound in the next decade, discussed value imaging, innovations in MRI, Brain MRI imaging, Neuro MR Application.  The software is very expensive and as costly as the scan itself. Now we have portable MRI scanners. He emphasized the importance of collaboration between radiologists and clinicians. In future Value Based Medicine will replace Evidence Based Medicine, he added.


Prof.Khalid Durrani made a presentation on Bile Duct Injuries and the Lessons Learnt. He pointed out that there is an unending story of bile duct injuries. Laparoscopic surgery has increased the importance and with some surgeons the risk of injury was three times as compared to open laparoscopic cholecystectomy. Age of the patient and in males it is a bit difficult to detect. He also discussed the blood supply to bile duct and pointed out that touch of hands was very important for the surgeons who have twelve eyes and not just two. He then showed some ERCP slides. MRCP, he said, was expensive and not available everywhere. He also discussed in detail fluids and electrolytes balance, sepsis control, anaemia, clotting abnormalities, definite treatment, end to end repair and Roux-en-y hepaticojejunostomy besides putting tube drainage. He was of the view that one should avoid early interventional surgery, concentrate on sepsis control.  Delayed repair can be undertaken after two three months. Endoscopic/radiological interventions are good, is associated with little mortality but greater morbidity. He then described the management of forty nine patients which mean age of forty two years. Stents, he stated, are put in very selected cases as they take infection from outside. Bile duct injuries are more due to laparoscopic cholecystectomy, four of their patients were re-do surgeries. He also discussed timing and type of repair and opined that primary repair by experienced surgeon’s gives best results.

Prof. Kh. Azeem was the next speaker who talked about Thyroid surgery what he had learnt in the last thirty seven years. He first mentioned about the diagnostic challenges in our set up, issues with reliability and limitations of FNAC. False positive was a challenge. He was of the view that we have very few cyto pathologists and mostly it was the histopathologists are doing the reporting.  Lobectomy is more reliable. He further opined that the quality of dissection should be superb in Head and Neck surgery. Preservation of recurrent laryngeal nerve is very important.  External laryngeal nerve also needs to be preserved. Radical neck dissection was the pinnacle of Head and Neck surgery. Continuing Prof.Kh. Azeem said that it was the disease burden which determines surgery. Total thyroidectomy is a very difficult operation. Ultrasound and CT scan should be done before the surgical procedure which will help in planning surgery. Block dissection is determined by disease burden. He concluded his presentation by stating that let the patient die respectfully and with dignity. There is no role for radiotherapy and chemotherapy in these patients.