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Purpose of our study is to compare the incidence of hypocalcaemia after total, near total or subtotal thyroidectomy for benign multinodular goitre. One hundred consecutive thyroidectomies performed for euthyroid benign multinodular goitre at West surgical unit, Mayo hospital, Lahore Pakistan, were included in the study. Mean age of patients was 33 (range 14 to 60) years. Preoperative serum calcium level ranged from 7.7 to 10.0 with an average of 8.8mg/dl. 34 patients had total thyroidectomy, 31 had near total thyroidectomy, 28 had subtotal thyroidectomy and 7 had lobectomy & isthmusectomy. Consultants performed 46 thyroidectomies, while senior registrars and residents performed 52 and 2 thyroidectomies respectively. 28 patients developed clinical features of hypocalcaemia.8 out of 31 patients who had near total thyroidectomy developed hypocalcaemia (25.8%). Out of 34 total thyroidectomies, 11 patients had hypocalcaemia (32.3%). In 28 patients who had subtotal thyroidectomy, 7 developed hypocalcaemia (25%) . 2 out of 7 lobectomy & isthmusectomy patients also required treatment for hypocalcaemia (28.5%). Hypocalcaemia developed within 48 hours of surgery in 53% of our patients. Incidence of hypocalcaemia among patients operated by consultants was 23.9 % (11 out of 46), while among patients operated by senior registrars and residents 17 out of 54 developed hypocalcaemia i.e. 31.5%. Average postoperative duration of hospital stay was 5.42 days in hypocalcaemic patients (range 2-17 days) and it was 2.77 days in normocalcaemic patients (range 1-6 days). We conclude that post thyroidectomy hypocalcaemia is a complication with significant morbidity. The incidence of this complication can be reduced by meticulous surgical technique with special emphasis on haemostasis. Identification and preservation of well vascularized parathyroid glands must be attempted in every thyroidectomy.

A 70 year old gentleman presented with features of gastric outlet obstruction. He had recently been investigated for upper GI symptoms and a barium meal had revealed a large paraoesophageal hernia. He had positive gastric splash. Endoscopy confirmed the presence of a hiatus hernia with associated gastric volvulus. He underwent exploratory laparotomy and was found to have a large paraoesophageal hernial sac containing most of the stomach, part of the omentum and the spleen. There was organoaxial volvulus of the stomach and a large subcapsular splenic haematoma. Splenectomy with repair of the hernia and gastropexy was performed after reducing the contents and excising the sac. He recovered well and was discharged on the eleventh postoperative day

Laparoscopic cholecystectomy is the gold standard procedure for symptomatic gallstones but at a higher price. Recently a few studies comparing mini cholecystectomy to laparoscopic cholecystectomy have shown that mini cholecystectomy has comparable results to laparoscopic cholecystectomy at an affordable price. We compared these two techniques over a period of two years.224 patients were studied, 122 had laparoscopic and 102 had mini laparotomy cholecystectomies. Results showed that operation time and theatre cost were low in mini laparotomy cholecystectomies but these patients required more post operative analgesics. There was no significant difference in total hospital stay and resumption to routine activities. Total cost to hospital and patient was also similar for these two techniques. There were two common bile duct injuries in laparoscopic group and none in mini cholecystectomies and there was no mortality in either group. We conclude that results of mini laparotomy cholecystectomy are very much simi lar to laparoscopic cholecystectomy and it can be used as an alternative to laparoscopic technique.

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