Evaluation of laparoscopy in the management of abdominal emergencies

Laparoscopy has rapidly emerged as the preferred surgical approach for the management of abdominal emergencies. It allows for a correct diagnosis and proper treatment. The main aim of this study was to evaluate the role of laparoscopy as a major diagnostic and therapeutic tool for the management of patients with abdominal emergencies and to find a less invasive diagnostic approach. Eighty patients with acute abdominal pain presented to the Department of surgery of Al-Azhar University [Bab El Shearia and Al Husein] hospitals during October 2009 to September 2011 were included in the study. They were divided into two groups: traumatic [40 patients] and nontraumatic [40 patients]. Their ages ranged between 14 and 65 years [mean= 39.5 years]; 49 patients were males and 31 patients were females. Complete clinical data were obtained. All patients underwent a routine preoperative workup. Laparoscopy was performed for all patients within 24 h of admission. The procedure was carried out under general anesthesia. Both open and closed pneumoperitoneum techniques were practiced. Diagnostic laparoscopy was beneficial in 79 patients [98.5%]. Of them, 42 [52.5%] patients underwent successful therapeutic procedures with laparoscopy: 28 male patients [17 nontraumatic and 11 traumatic] and 14 female patients [12 nontraumatic and two traumatic]. Conversion to therapeutic laparotomy was done for 12 patients [15%]. In this study, the mean postoperative hospital stay after laparoscopy was 2.1 days and 4.55 days after laparotomy. Wound infections occurred in 2.5% of patients. Early laparoscopic intervention for abdominal emergencies is as safe and effective as conventional surgery. It results in minor trauma, helps avoid extensive preoperative studies or delays in operative intervention, has a rapid postoperative recovery, and reduces morbidity. Such features make laparoscopy an attractive alternative to open surgery in the management of abdominal emergencies

Non-traumatic surgical abdominal emergency in the elderly

The most frequent surgical problem in the elderly patients is the abdominal surgical emergency, which is potentially serious, considerable challenge and a life threatening condition in this populations. The higher incidence of serious pathology in this age group, increasing demand for surgical emergency care to save life and increase its expectancy. The aim of this study was to evaluate the causes and the outcome of non-traumatic surgical abdominal emergencies in elderly patients. A total of 150 patients aged 60 years and above, with a mean age of 68.3 [range 60-84] years who had undergone emergency surgical interventions studied, as regards, the demographic features the indications for emergency surgery the post-operative clinical course and the outcome of surgery. Sixty percent [90/l 50] of patients were males. Causes of surgical emergency were acute cholecystitis 39/150 [26%], strangulated hernia 30/l50 [20%], hollow viscus perforation 27/150 [18%], bowel obstruction 18/150 [12%], acute mesenteric ischaemia l4/150 [9.3%], acute appendicitis 12/150 [8%] and upper gastrointestinal bleeding 10/l50 [6.6%]. Gallstones had been previously detected by ultrasound in 16 [4 1%] of 39 patients with acute calculous cholecystitis. Twenty eight [93.3%] of 30 patients were aware of their external hernias prior to incarceration. Twenty one patients 21/150 [14%] died in the early postoperative period. A higher mortality rate was noted in acute mesenteric ischaemia 11/14 [78.5%], gastrointestinal bleeding 3/10 [30%] and in perforation 4/27 [14.8%] cases, being 35.3% [18/51] in patients with these three severe conditions, and 3.03% [3/99] in the remaining patients. So, we conclude that the acute calcular cholecystitis and external strangulated hernias, which are generally preventable, were the most common surgical emergencies. Surgical treatment of acute mesenteric ischaemia, gastrointestinal bleeding and peritonitis secondary to free perforation had a worse prognosis in older patients

Evaluation of laser therapy in management of chronic venous leg ulcer

The aim of this study was to evaluate the efficacy of laser therapy in the treatment of chronic leg venous ulcer, which is resistant to surgical or conservative treatment. Thirty patients with chronic leg venous ulcers were chosen from surgery and vascular surgery clinics at El-haram health insurance and El-sahel teaching hospital and subjected to laser therapy at Faculty of physical therapy, Cairo university. They were 22 males and 8 females, their ages ranged from 30 to 50 years [25 patients had post-phlebitic syndrome and 5 patients had recurrent V.V with incompetent ankle perforators and cocket's ligation was done for them]. Divided into two groups: The 1[st] is the study group [15 patients:10 males and 5 females] and the 2[nd] is the control group [15 patients: 12 males and 3 females], during a period of 15 month Nov.2005-Jan. 2007]. Both groups were good evaluated. The ulcer measures [size and volume] were taken, and both groups received the same conservative measures. But the 1[st] [study] group received the low level laser therapy [2 setting weekly for 2 months] in addition to conservative measures, and the ulcer measures [size and volume] were evaluated before, one month after and at the end of the study. Both groups were comparable for, demographic, clinical and diagnostic data which were statically analyzed, and were shown statistical significant decrease in ulcer surface area and ulcer volume after one month and after two months of laser therapy in the 1[st] group, but there were no statistical significant difference in ulcer surface area and ulcer volume after one month and after two months of medical treatment in the 2[nd]. group. From this study, we conclude that low intensity level laser therapy is an effective modality in the treatment of chronic leg venous ulcers, which are resistant to surgical and/or conservative treatment