place of laparoscopy in acute abdomen

Laparoscopy offers a simple safe and rapid mean of evaluation and diagnosis of intrabdominal diseases when the indications for laparotomy are equivocal. In this study laparoscopy was employed in 60 patients with acute abdomen. Three categories of patients were included, those with queery acute appendicitis [40 patients], those with blunt abdominal trauma [10 patients] and those with a provisional diagnosis of acute cholecystitis [10 patients]. Laparoscopy was done for every case for diagnosis and proceed accordingly.It was concluded that, laparoscopy is a very useful procedure in managing the patient who complained of acute abdominal pain and indication for laparotomy is equivocal. So the main value of laparoscopy in such cases were either avoiding unnecessary laparotomy or proceeding laparoscopically or ending into laparotomy

Laparoscopic cholecystectomy in elderly patients

Laparoscopic cholecystectomy was done for twenty patients. The results showed that it was a safe technique as the success rate was 95% with no mortality and a complication rate of 15.7%. The complications were: operative bleeding in two cases and bile leakage in one case, all of them were controlled during the procedure. The mean operative time was 82 minutes and the mean length of hospital stay was 2.2 days. Only one patient required conversion of the laparoscopic procedure to laparotomy because he was found to have a carcinoma of the gallbladder during the procedure. The above results are encouraging, however, laparoscopic cholecystectomy should be applied in elderly patients on a wide scale, for better evaluation. Age alone should not be a contraindication to this procedure, as elderly patients should share its benefits of less postoperative pain, hence shorter postoperative bedridden time and lower incidence of respiratory complications, also, less incidence of wound infection and shorter hospital stay

Duodenogastric reflux before and after simple cholecystectomy in patients with gallstone disease

20 gallstone patients were investigated for the occurrence of duodenogastric reflux [DGR] before and after cholecystectomy and compared their results with 20 control subjects. DGR was found in 35% of the control group compared to 70% of the gallstone patients, and the mean bile acid [BA] concentration in the gastric juice of the control group was 1.86 mu mol/hour compared to 7.93 mu mol/hour for gallstone patients before operation and 26.49 mu mol/hour after cholecystectomy. None of the gallstone patients without DGR developed reflux after cholecystectomy. However, in those with DGR, the reflux increased significantly after cholecystectomy. This may be due to the presence of great amount of BA in the duodenum after cholecystectomy which leads to greater reflux through the previously incompetent pyloric sphincter