Laparoscopic cholecystectomy; common bile duct injury after learning curve

To determine the frequency of common bile duct [CBD] injury in laparoscopic cholecystectomy in our settings, in my last 500 cases, after going through the learning curve associated CBD injuries. Descriptive study. Surgical Unit-I, Rawalpindi General Hospital and the author's Surgical Clinics from January 2003 to December 2008. Five hundred patients undergoing laparoscopic cholecystectomy by the same surgeon were included. The important variables included demographic data, intra operative time and findings, frequency of CBD injury and post operative hospital stay. There were 419 [83.8%] females and 81 [16.2%] males with mean age 45.04 +/- 11.03 years. 294 [58.8%] patients had chronic cholecystitis with cholelithiasis and were admitted through Out Patient Department whereas 206 [41.2%] were admitted through Accident and Emergency Department with acute cholecystitis. Abdominal ultrasound showed multiple calculi in 351 [70.2%] patients and 149 [29.8%] patients had single calculus preoperatively. Empyema was found in 97 [19.4%] cases whereas adhesions were present in 182 [36.4%] patients. In our study frequency of CBD injury was 1%. Mean operating time was 35 minutes. 96.8% of the patients were discharged within 48 hrs of operation. Laparoscopic Cholecystectomy in our set up proved to be a safe procedure, having frequency of CBD injury of only 1% and a short hospital stay 493 [96.8%] being discharged in less than 2 days

Effect of single oral dose of sodium rabeprazole on the intragastric pH & volume in patients undergoing elective surgery.

BACKGROUND & OBJECTIVE: While evaluating the effectiveness of drugs used for the prophylaxis of acid aspiration of gastric contents, the impact of duodeno-gastric reflux on gastric contents has not been studied earlier. This study was carried out to evaluate the effect of preanaesthetic oral administration of sodium rabeprazole on pH and volume of gastric contents in adult patients undergoing elective surgery by excluding cases contaminated with duodeno-gastric refluxate. METHODS: The patients in group C (control) in the triple blind placebo controlled trial received placebo while group S sodium rabeprazole 20 mg orally at 2100 h, a night before elective surgery. Next day, gastric contents were aspirated with a large bore, multi-orifices gastric tube passed through an endotracheal tube placed blindly in oesophagus after tracheal intubation and analyzed for the presence of bile salts, pH and volume. The pH and volume of gastric contents were the primary and duodeno-gastric reflux secondary outcome measures of the study. RESULTS: The pH and volume of group S-2 were 3.97+/-1.78 and 9.48+/-8.39 ml respectively compared with 1.90+/-0.47 and 19.60+/-18.56 ml of group C-2. Sodium rabeprazole, after excluding contaminated cases with duodeno-gastric refluxate, significantly increased the pH (P<0.001), decreased the volume of gastric contents (P<0.005) and the proportion of the patients (30.76 vs 2.63%) considered at risk compared with placebo (P<0.001) according to the criteria defined (pH < 2.5 and volume > 25 ml). Thirty nine samples (33.33%) out of 117 were contaminated with duodenal contents. Duodenogastric reflux significantly (P<0.001) affected pH and volume of gastric in both groups C-1 vs C-2 and S-1 vs S-2. INTERPRETATION & CONCLUSION: Sodium rabeprazole 20 mg given orally a night before surgery provided adequate prophylaxis for acid aspiration syndrome at the time of induction of anaesthesia and duodeno-gastric reflux significantly affected both the pH and volume of gastric contents.