Intra-operative predictors of difficult cholecystectomy and conversion to open cholecystectomy - a new scoring system

Objective: To evaluate the intra-operative scoring system to predict difficult cholecystectomy and conversion to open surgery

Methods: This descriptive study was conducted from March 2016 to August, 2016 in the Department of Surgery, Shalimar Hospital. The study recruited 120 patients of either gender, age greater than 18 years and indicated for laparoscopic cholecystectomy [LC]. Intra-operatively all patients were evaluated using the new scoring system. The scoring system included five aspects; appearance and adhesion of Gall Bladder [GB], distension or contracture degree of GB, ease in access, local or septic complications, and time required for cystic artery and duct identification. The scoring system ranges from 0 to 10, classified as score of <2 being considered easy, 2 to 4 moderate, 5-7 very difficult, and 8 to 10, extreme. Patient demographic data [i.e. age, gender], co-morbidities, intra-operative scores using the scoring system and conversion to open were recorded. The data was analysed using statistical analysis software SPSS [IBM]

Results: Among one hundred and twenty participants, sixty seven percent were females and the mean age [years] was 43.05 +/- 14.16. Co-morbidities were present in twenty percent patients with eleven diagnosed with diabetes, six with hypertension and five with both hypertension and diabetes. The conversion rate to open surgery was 6.7%. The overall mean intra-operative scores were 3.52 +/- 2.23; however significant difference was seen in mean operative score of converted to open and those not converted to open [8.00 +/- 0.92 Vs. 3.20 V 1.92; p-value = 0.001]. Among eight cases converted to open, three [37.5%] were in very difficult category while five [62.5%] were in extreme category. Moreover, age greater than 40 years and being diabetic were also the risk factors for conversion to open surgery

Conclusion: The new intra-operative scoring system is a valuable assessment tool to predict difficult laparoscopic cholecystectomy and conversion parameters to open surgery and its utility could improve patient's clinical outcome indicated for laparoscopic cholecystectomy

Colorectal carcinoma

Prognosis is excellent in colonic carcinoma in case of well differentiated growth. All efforts must be done to diagnose the malignancy at an earlier stage for a better outcome specially if it is well differentiated growth. To compare the different modes of presentation of carcinoma of large bowel in a tertiary care hospital and their association with pathological findings. It is a cross sectional retrospective study. Patients with histological proof of carcinoma were included in the study. Data over the period of two year was collected and analyzed. This study included one hundred patients. Mean age was 49.56 years and 56% of the patients were males. 40% of the patients present between the ages of 40 to 60 years. Mean time of start of symptoms and the time of presentation in the hospital was 6.5 months ranges from 1 to 24 months. 76% of the patients had history of altered bowel habits and 60% had anorexia and weight loss. 41.66% of patients had well differentiated growth while 37.55% of patients had moderately differentiated adenocarcinoma. Majority of the patients with colonic carcinoma had well or moderately differentiated growth. If they are diagnosed and properly treated at an early stage, outcome is good

Presentation of colorectal carcinoma, a local experience

Introduction: Colorectal carcinoma is the third commonest malignancy all over the world. In countries like Pakistan, mostly patients present first time in emergency department with fecal peritonitis or acute intestinal obstruction. These patients got worst prognosis and stormy post-operative time with high percentage of complications. Otherwise prognosis is excellent if diagnosed at stage I or II and treated properly

Objectives: To compare the common post-operative complications in large bowel malignancy in elective and emergency presentation

Material and Methods: It is a cross sectional retrospective study. Patients with histological proof of carcinoma were included in the study. Data over the period of two year was collected and analyzed

Results: This study included one hundred patients. Mean age was 49.56 years and 56% of the patients were males. 40% of the patients present between the ages of 40 to 60 years. Mean time of start of symptoms and the time of presentation in the hospital was 6.5 months ranges from 1 to 24 months. 76%of the patients had history of altered bowel habits and 60% had anorexia and weight loss. 44 out 100 patients presented in the emergency. Rate of post-operative complications was much higher in those patients who admitted through emergency including leak from anastomotic site and wound dehiscence

Conclusions: All the patients of 50 years or more should be seen by surgeon for exclusion of large bowel carcinoma if they had symptoms of altered bowel habits associated with weight loss and anorexia. If the colonic carcinoma is diagnosed at an early stage, chances of life threatening post-operative complications are far less as compare to those who presented with advance stage