ABSTRACT
Background: gallstone disease is defined as the presence of gallstones accompanied by symptoms attributable to their presence [Biliary colic] or complications such as cholecystitis, cholangitis and biliary pancreatitis. In addition, the disease is thought to be a risk factor for developing pancreaticobiliary cancer
Objective: this study aimed to determine the rate of biliary disease in King Faisal Medical Complex as a reflection of the prevalence of the disease in Taif region
Methods: this a cross sectional retrospective analysis included 565 patients with gallstone disease, in King Fisal Medical Complex during 1 year [from 1 July 2015 to 30 Jun 2016]. Data of the patients were collected from patient's files which included 4 departments. 1-Emrgency Room 2-Surgical Outpatient Department 3-Operating Room and 4-Histopathological Department
Result: this study included 565 patients with gallstone disease, [10 years and above]. 398 [70%] females, 167[30%] males. Mean age for females was 44.89 years [SD+15.93], Mean age for males was 48.45 years [SD+19.67]. The overall ratio of gall bladder disease to all general surgery operation was 24%. The Majority of them diagnosed with chronic cholecystitis present to OPD [57%], while acute cholecystitis presented to ER was 43%. Most of them were females [77%] while, males were 23%. 85% of patients underwent to lap cholecystectomy with 1% rate of conversion. 14% of patients underwent ERCP and 1% open cholecystectomy. There was significant gender differences in type of operation [P value=.013]. 38% of male patients with gallstone disease came to the emergency department compared to 62 % of females. Variety of GBD diagnosis was observed, chronic calculous cholcystitis [50%] acute calculous cholecystitis and empyema [30%], obstructive jaundice [14%], Biliary colic [5%], GB mass [1%]
Conclusions: the number of patients presented with gall stones disease and it's complications to King Faisal Medical Complex, Taif alone showed significant high number, mostly due to hypoxia as our region is one of the highest altitude region in the Middle East. Prevalence of disease was more in female population and it showed the target population which should be educated regarding prevention of disease
ABSTRACT
Background: It has been shown that bleeding from injured liver cancease spontaneously, in the majority of blunt hepatic trauma. The aim ofthe study was to evaluate the criteria of non-operative management forpatients with blunt hepatic injury
Study design:Thirty five patients with blunt hepatic trauma were selected for non-operative management from January 2003 to October2005. All patients were hemodynamically stable and admitted to the Intensive Care Unit [ICU] for the first 24-72 hours. They were subjected toresuscitation, close observation, serial laboratory investigations and scanning assessment
Results: Thirty five patients with liver injuries were classified according to CT findings into grade I in 2 patients [6%], grade II in 11 patients[31%], grade III in 12 patients [34%] and grade IV in 10 patients [29%]. CTscan revealed minor hemoperitoneum in 8 patients [22.8%], moderate he-moperitoneum in 10 patients [28.6%] and major hemoperitoneum in 10 patients [28.6%]. Liver enzymes ALT and AST levels at admission weresignificantly correlated to the grade of the hepatic injury. Non-operativemanagement succeeded in 28 patients [80%] of patients with blunt hepatic trauma while 3 patients [8.6%] required laparotomy after initial successof non-operative management. Percutaneous guided drainage was required for 4 patients [11.4%] with localized collection. The mortality ratewas 2.8%
Conclusion: Minimal intervention is the policy of treating blunt hepaticinjuries in hemodynamically stable patients. It requires strict clinical,hemdynamic, and scanning monitoring, in a centre with intensive care facilities and immediate access to the operating room
ABSTRACT
This study was designed to evaluate the outcome of combined laparoscopic cholecystectomy and fundoplication during one single laparoscopic procedure. The study included only patients assigned to undergo cholecystectomy for calcular cholecystitis and had symptomatic gastroesophageal reflux disease [GERD], 22 patients [7 males and 15 females] were enrolled in the study. All patients underwent clinical history taking including duration of symptoms, physical examination and upper gastrointestinal endoscopy. Esophageal manometry was performed preoperatively and 2 and 6 months after surgery. Laparoscopic procedures were performed through 5-port access. Operative time and the frequency of conversion to open surgery, time till initiation of oral intake, postoperative hospital stay and complications and time to recover full activity were recorded. Through a monthly visit for 6 months after surgery, patients were monitored for the extent of resolution of GERD-related symptoms. There was a significant increase [p<0.001] of postoperative lower esophageal sphincter [LES] pressure compared to preoperative pressure with a non-significant difference between pressures estimated at 2 and 6 months. No intraoperative complications were encountered and there was no need for conversion to open surgery in any case. The mean operative time was 78.3+/-9.7; range: 60-90 minutes. All patients tolerated oral ingestions after the first 48 hours. The mean duration of postoperative hospital stay was 4+/-0.8; range: 3-5 days and 9 patients [40.9%] were discharged on the 3[rd] postoperative day. The mean duration till resumption of full daily activities was 11.6+1.4 [10-14] days. Clinically, a marked resolution of symptoms due to reflux was observed, only one patient developed dysphagia for solid food and a sensation of trapped air occurred in two patients causing discomfort, however, these three patients were asymptomatic at 6 months after the surgery. It could be concluded that combined laparoscopic surgery for cholelithiasis and GERD is an appropriate procedure, when indicated, giving excellent short-term outcome results and could be managed during one single laparoscopic procedure
ABSTRACT
The aim of this study was to evaluate the immediate and short-terme follow-up results of one-stage subtotal or total colectomy and anastomosis for patients with malignant left colon obstruction. The study comprised 21 patients [10 males and 11 females] with age range of 36-81 years; presented by acute large bowel obstruction with clinical and radiological evidence of obstruction. The choice of the extent of resection was determined by the extent of fecal load, the presence of colonic perforation, serosal tears of the cecum and/or massive colonic distension with concomitant ischemia: the presence of these features in a hemodynamically stable patient favored subtotal or total colectomy and ileo-colic or ileo-rectal anastomosis. The site of obstruction was at the sigmoid colon in 9 patients [42.9%], rectosigmoid in 8 patients [38.1%], splenic flexure in 3 patients [14.3%] and descending colon in one patient [4.7%]. Ileosigmoid anastomoses were done in 13 patients [61.9%] and 8 patients [38.1%] had ileorectal anastomoses. The mean operative time was 201+/-33.2; range: 150-270 minutes, the mean operative blood loss was 633.3+/-408.2; range: 250-1800 cc; 11 patients [45.8%] required blood transfusion with a mean number of blood bags used was 2.8+/-1.2; 1-5 bags. Oral feeding was resumed after a mean period of 4.9+/-0.9; range: 4-7 days and the mean postoperative hospital stay was 10+/-2.2; range: 8-18 days. Overall, after 12-months follow-up only one patient had anastomotic line recurrence with a recurrence rate of 4.75%, one patients died of acute liver failure secondary to hepatic metastasis with mortality rate of 4.75% and 19 patients had follow-up free of morbidity with no-local recurrence or metastasis and a follow-up free rate of 90.5%. Thus, it could be concluded that one-stage subtotal or total colectomy and ileo-colic or ileo-rectal anastomosis are safe procedure with satisfactory outcome for management of obstructing malignant lesions of the left colon