Laparoscopic cholecystectomy; outcome in patients with co-morbidity

To determine the frequency of bleeding, surgical site infection and common bile duct injury after laparoscopic Cholecystectomy in patients with co-morbidity. Descriptive Study. [Case series]. Department of Allied and D.H.Q hospital Faisalabad. July 2006 to December 2007. It comprised of 30 consecutive patients of cholelithiasis with co-morbidity presenting in surgical department. Patients having uncontrolled hypertension, chronic obstructive airway disease and malignancy were excluded. Detailed history and physical examination was carried out as per protocol. It was followed up by relevant investigations. All the cases underwent laparoscopic cholecstectomy. The age of the patients ranged from 23-68 y, with mean age of 40-56 y. Among these 14 cases were having D.M [46.66%], 06 patients were cirrhotic [20%], 06 patients had acute cholecystitis [20%], 02 patients were having H.T.N [6.6%] and 02 patients were > 70 years [6.6%]. All the patients were females. Out of diabetic patients undergoing laparoscopic cholecystectomy, SSI was noted in 02 [6.66%] patients. While mild postoperative bleeding was noted in 01 [16.6%] of cirrhotic patients after laparoscopic cholecystectomy.No untoward event was noted in patients with H.T.N ac, Cholecystitis and advanced age. In high risk patients undergoing laparoscopic cholecystectomy, very few complications were noted. Postoperatively, Morbidity following above procedure was quite low as compared to conventional one. Laparoscopic cholecystectomy should be the preferred option in high risk patients for better outcome

Determinants of outcome of primary repair of colonic trauma

To search of parameters for the selection of the group cases of colonic injuries getting maximum benefit of primary repair. A prospective non-randomized study. Surgical Unit IV, DHQ Hospital, Faisalabad. Patients with colonic trauma due to penetrating and non-penetrating injuries. The main outcome determinants found significant were age, proper prompt treatment, severity of injury, haemodynamic status at the time of operation and gross faecal contamination. Thirty patients colonic trauma who the basis of history, clinical examination and investigations. Patients were closely observed for sign and symptoms of anastomotic leak, and intra- record of these patients was maintained on preformed proforma. All risk factors were made measurable on abdominal sepsis, wound infection. Out of 30 patients, presented to Emergency Ward during one year, underwent exploratory laparotomy. The complete 24 patients were managed by primary repair and six patients were managed by staged procedure. All the 24 patients developed no infective complications. One out of six patients of staged procedure group died on 3[rd] post-operative day due to sudden myocardial infarction and three out of six patients developed infective complications. Age, proper prompt treatment, severity of injury, haemodynamic status at the time of operation and gross faecal contamination are determinants of outcome of primary repair of colonic trauma

Blunt liver trauma: selective conservative approach

To highlight the scope of conservatism in the selective blunt liver injuries in patients who are hemodynamically stable. Prospective non-interventional descriptive study. The study was conducted in Surgical Unit-I and IV of Allied and DHQ Hospitals, PMC, Faisalabad, during three years from August 2004 to august 2007. Out of 45 patients received during this period, 28 were hemodynamically unstable and were immediately explored, the remaining 17 were enrolled in the study who were managed conservatively. After resuscitation all the patients underwent Ultrasound and then followed up with serial Hb% estimation and repeat ultrasound scanning in the High Dependency Unit of the wards. The patients were discharged on 7[th] day, if the hematology and check Ultrasound scan was normal with the advice to restrict physical activity and the regular follow-up in the OPD. Out of the 17 patients treated conservatively, 14 were male and only 3 were females.the SGPT levels were elevated in 84%. More than one liter of hemoperitoneum was detected in two cases who were given 4 units of blood and 11 of the 17 patients needed blood transfusion. There was no missed intraabdominal injury in our series. The mean length of hospital stay was 10.2 days. The two patients [11.76%] developed perihepatic abscess and were treated by subcutaneous drainage. Selective non-operative approach is a valid policy for patients with blunt liver trauma who are hemodynamically stable

Tuberculosis of the liver

A fifty years old lady underwent elective extended right hemicolectomy for a mass of ascending and transverse colon along with incision and drainage of abscess in the right lobe of liver. Histopathology turned out to be tuberculous liver abscess and tuberculous colitis. Although tuberculosis is very common in our country, but tuberculosis of liver is rare this case is one of that, showing the decreased immunity of the patient and local spread of disease. The tuberculous liver abscess is rare [1], when present is associated with focus of infection in the lungs or the GIT