Laparoscopic cholecystectomy: a recent experience

A long the period from October 1992 to July 1993, 162 consecutive patients with gall stones were considered for laparoscopic cholecystectomy in the Gastroenterology Center of Mansoura. 106 females and 56 males, their ages ranged from 23 to 65 years. All the patients underwent ultrasonic abdominal examination, complete laboratory, chest and cardiac assessment. E.R.C.P., papillotomy and stone extraction when needed was done in cases with history [or] of jaundice before the procedure. Cardiac and hypertensive patients were excluded from the study. Laparoscopic cholecystectomy was successful in 135 out of the 262 cases [83.3%]. 27 cases failed to be completed by laparoscopy [16.7%], 5 cases were due to uncontrollable bleeding, 3 from injured cystic artery and 2 from cirrhotic liver. The other failures were due to marked dense adhesions with acutely inflammed gall bladder in 9 cases, injury of common bile duct in 2 cases, injury of gall bladder with escape of multiple small stones intra-abdominally in 2 cases, 5 cases gall bladder masses, failure to grasp or manipulate thick walled gall bladders that were packed with multiple small stones in 2 cases, presence of cholecysto-duodenal fistula in one case and injury of the right common iliac vessels by the trochar in one case. There were no deathes, but post-operative major complications occured in 4 cases that needed laparotomy, 2 cases of internal haemorrhage and 2 cases of biliary peritonitis. There were 6 minor complications, 3 surgical emphysema, and 3 small collections in gall bladder bed, that all passed conservatively. The shortest time of the procedure was 20 minutes and the longest was 3 hours. The median post-operative stay was 2 days and all the patients could start oral diet in the morning of the second day. In Conclusion, from this recent experience and results. We could suggest what are the possible difficulties and complications that could be met with laparoscopic cholecystectomy and we suggest that it should tried in most of patients who require elective or urgent cholecystectomy specially if radiological and endoscopic support are available

Parietal cell vagotomy [P.C.V.] 15 years experience

Along 15 years, 106 patients had elective parietal cell vagotomy for duodenal ulceration. Ninty nine patients have complete follow up from 12 months to 15 years. Of those, 42 patients had surgery over 10 years ago and 35 patients survived for more than 10 years. There was no hospital mortality. Gastric stasis recorded early in 3 cases [3%] and 2 of them required reoperation in 2 patients splenectomy was required as a result of operative trauma. Mild dumping occured in 2 cases [2%] and mild diarrhea in other 2 cases, 40 cases suffered from early mild and transient [40.4%] dysphagia. From 2-10 years after surgery, thirty patients [30%] have had recurrent ulceration. In seven [7%] of these cases the recurrence was asymptomatic. The overall clinical results by using modified Vi-sick's were excellent and very good in 66.4% of cases and unsatisfaction in 33.6%