Gallbladder carcinoma; frequency in patients under going cholecystectomy for chronic cholecystitis

Chronic Cholecystitis is one of the commonest diseases presenting in surgical department and is subjected to cholecystectomy each time. Asuspicious gall bladder on ultrasound initiates further investigations to rule out carcinoma of gall bladder yet some times a benign looking gall bladder on ultrasound turns out to be carcinoma of gall bladder on histopathology. Descriptive study. District Head Quarters Hospital, Sargodha, from September 2007 to March 2009. 200 patients who underwent both open and Laparoscopic cholecystectomy for cholelithiasis were subjected to this study. All relevant data was documented on a standardized data form. Patients were between the ages of 28-74. Patients already diagnosed as Gallbladder Carcinoma, empyema gall bladder, mucocele and gall bladder polyp were excluded from the study. Gall bladders removed after each surgery ware sent to laboratory for histopathological evaluation. A total of 200 cases were studied [161 females, 39 males; M: F ratio 1:4]. The mean age was 45 years [range 28-74 years]. The most common presenting complaint was pain right hypochondrium with nausea and vomiting [85%].The average operating time was 50 minutes in case of open cholecystectomy and 1 hour in laparoscopic cholecystectomy. Complications included biliary leak in 2 patients [1%], Wound Infection in 3 patients [1.5%] and death in one case [0.5%]. The overall rate of complications was 3%. There were a total of 5 patients of laparoscopic cholecystectomy who required extension of the incision, for Carcinoma Gallbladder. Carcinoma of gall bladder is a very aggressive malignancy and usually presents at a very advance stage as its symptoms mostly are marked by symptoms of cholecystitis. Detection of gall bladder carcinoma is very difficult in early stages on ultrasound. Any findings in ultrasound suggesting malignancy should be confirmed on further investigations like CT scan .Carcinoma of Gall bladder is not very common in cases of cholecystectomy for chronic Cholecystitis but once found should be dealt with extreme precision following established operating protocols

Wound infection; frequency in clean surgical operations

The aim of the study was to evaluate the frequency of infection in clean surgical cases [General and Orthopaedic]. A descriptive study. This descriptive study was conducted at department of surgery and orthopaedic DHQ Teaching Hospital Sargodha from July 2007 to Dec, 2008. In this study 1500 clean surgical cases were included. Wounds were examined on third post operative day and then regularly after removal of stitches. Surgical wounds were examined finally on fifteenth post operative days. Description of wound condition and detailed data of patients were collected on preformed performas. Patients with wound infection developed pain at operation site and fever on third post operative day. Wounds were examined for swelling, redness, discharge; stitch abscess. Routine investigations were done as per protocol ie complete blood examination, complete urine examination, blood sugar, C-reactive proteins etc. Wounds swab was taken for microscopy and culture sensitivity. This study was carried out on fifteen hundred clean surgical cases [General and Orthopaedic]. There were 1064 males and 436 females. Male to Female ratio was 2.4:1. Infection was detected in 110 patients [7.3%] while no infection was found in 1390. Infection was maximum in patients more than 60 yrs of age [10.9%]. Wound infection was minimum in young patients [3.5%].commonest micro organism isolated from the infected wound was staphylococcus areus. Other organism isolated was streptococcus pyogenes, proteus and pseudomonas. No MRSA was detected. In our case study clean cases were found generally free of infection especially young patients. Whereas increased incidence of infection was noted in old patients. Wound infection is associated with significant morbidity in the form of delayed wound heeling, prolonged hospital stay and increased economical pressure on the patient