ABSTRACT
Objective: To assess the rate and causes of conversion of laparoscopic to open cholecystectomy [OC] in 450 patients who underwent laparoscopic cholecystectomy [LC] by the same surgeon in tertiary care teaching hospitals
Study Design: Descriptive study
Place and Duration of Study: The study was conducted initially at Pakistan Navalship [PNS] Shifa, Karachi and later at Combined Military Hospital, Lahore from November 2009 to June 2013
Material and Methods: All the patients of both genders and of any age group, undergoing LC for gall bladder pathology whether acute or chronic, acalculous or calculous were included in this study by convenient sampling. The exclusion criteria were choledocholithiasis, malignancy, and patients who willingly opted for open cholecystectomy. All the patients were operated by the same experienced laparoscopic surgeon. The number and sizes of the ports varied from patient to patient and was on the choice of the operating surgeon. A detailed proforma was filled which included the demographic data of the patients, indications for cholecystectomy, histories of previous abdominal surgery, their comorbidities [if any], operating time, intraoperative findings, complications, post-operative hospital stay and rate and reasons for conversion to open cholecystectomy [if required]
Results: Out of 450 consecutive patients for whom LC was attempted by a single surgeon, 7 patients [1.6%] were converted to OC. There were 380 female and 70 male patients [F: M ratio 5.4:1]. Their mean age was 44.6 +/- 13.5 years, ranging from 9-82 years. All patients who required conversion to OC were females. The mean operating time was 38.9 +/- 16.2 minutes [range 15-120 minutes]. The reasons for conversion included cystic artery bleeding2, liver bed bleeding1, common hepatic duct injury1, cholecystoduodenal fistula1, severe adhesions caused by tissue inflammation and fibrosis of Calot's triangle1 and cystic duct avulsion1
Conclusion: The overall rate of conversion to OC was 1.6%. Laparoscopic cholecystectomy is a safe procedure with very little chances of conversion to open even in acute cases, when performed by an experienced surgeon
ABSTRACT
To compare open cholecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters. Randomized controlled trial. Department of Surgery, CMH Rawalpindi from May 2010 to Nov 2010. Patients with symptomatic cholelithiasis subjected to elective cholecystectomy were studied. The patients were divided into two groups. Open Cholecystectomy was performed on patients in group I, and laparoscopic cholecystectomy was performed in patients in group 11. Respiratory function tests were performed preoperatively and on the morning of the 1st post-operative day. Preoperative pulmonary function tests were normal and did not differ significantly between the two groups. After operation a significant reduction in the FEVl [Forced Expiratory Volume in first second], FEV6 [Forced expiratory volume in first six seconds] and their ratio FEVl/FEV6 occurred after both open and laparoscopic cholecystectomy. However, mean reductions in FEV1, FEV6 and FEVl/FEV6 in the laparoscopic cholecystectomy group were significantly [p <0.05] less as compared with those after open cholecystectomy. Laparoscopic cholecystectomy causes less impairment of lung function than cholecystectomy performed through a subcostal incision
Subject(s)
Humans , Male , Female , Cholecystectomy, Laparoscopic , Respiratory Function TestsABSTRACT
To compare the frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion. Randomized controlled trial. General surgical department, Combined Military Hospital, Rawalpindi, Pakistan, from Jan 2010 to Dec 2010. Sixty patients of clinically diagnosed wrist ganglia were randomized into groups A and 'B' with 30 patients in each group. After approval by the hospital ethical committee, patients in group 'A' were subjected to aspiration and injection of methyl-prednisolone acetate 40 mg/ml and those in group 'B' underwent surgical excision of the ganglion. Patients were explained the procedure they were subjected to and they were also counselled about the risk of recurrence after a particular procedure and after that informed written consent was obtained from them. Patients were followed up at intervals of 2 weeks, 6 weeks, 3 months and 6 months after the procedure to look for recurrence in both groups. On follow up at 6 months, 12 [40%] patients in group A while only 2 [6.66%] patients in group B had recurrence of the ganglion. No complications were noted. This difference was found to be statistically significant [p = 0.0023]. Recurrence of wrist ganglion is considerably less in patients treated with surgical excision and should be preferred over aspiration and steroid injection
ABSTRACT
A 24 years old lady presented with classical history of acute intestinal obstruction. There was a background history of chronic abdomen for 9 years. There was asymmetrical abdominal distension. On laparotomy, the entire small intestine was cocooned and enclosed in a yellowish white thick fibrotic membrane resulting in obstruction of the small intestine. When the membrane was carefully peeled off the small intestine, the underlying small gut was found to be absolutely healthy. The histopathology report was consistent with non-specific dense fibrosis. Based on these findings, a diagnosis of abdominal cocoon or sclerosing encapsulating peritonitis was made which is an extremely rare cause of small bowel obstruction
ABSTRACT
The objective of this study was to compare Polydioxanone [PDS] and Prolene suture material for abdominal fascial closure regarding morbidity in terms of post-operative wound complications. Cohort comparative ramdomized study. Dept of surgery Combined Military Hospital Rawalpindi from January 2002 to December 2003. A series of 100 patients presenting in the General Surgical OPD and requiring midline laparotomy were studied. In group "A" all the midline abdominal wounds were closed with Prolene 1 and in group "B" PDS 1 was used. In both the groups the data was collected, based on post-operative wound complications including post-operative wound pain, wound infection, wound dehiscence, suture sinus formation, stitch granuloma and incisional hernia. All the post-operative wound complications were then compared between the two groups. Our results show that the post-operative wound infection, wound dehiscence, suture sinus formation, stitch granuloma and chronic wound pain were significantly lower with PDS 1 as compared to Prolene 1, without any significant increase in incisional hernia formation. Slowly absorbable suture material [PDS] appears to be superior than non-absorbable suture material [Prolene] in midline abdominal fascial closure
ABSTRACT
Gallstones are the most common cause of hospitalization and most common elective procedure being carried out in hospitals. Although laparoscopic cholecystectomy is not as popular in Pakistan as in the west, because people have misconception of its complications. Therefore the present study was conducted to assess the early complications of laparoscopic cholecystectomy for calculus cholecystitis. This study was conducted at CMH Rawalpindi from January 2003 to July 2003. A total 100 patients with calculus disease were admitted. This comprised of 88 [88%] females, 12 [12%] males, age ranges from 21 to 60 yrs with mean age of 45 yrs. Patients were assessed per-operatively and post-operatively followed at 01 week, 01 month and 03 months for complications. The overall incidence of complications was 12% with major complication seen in only 4% cases. There was no mortality in our series. It is concluded that Laparoscopic cholecystectomy is safe with less post-operative morbidity and mortality