ABSTRACT
To evaluate management and outcome of Iatrogenic Common Bile Duct injury after cholecystectomy. Descriptive study. Isra University Hospital Hyderabad during the period of April 2013 to April 2014. All patients presented with CBD injury after cholecystectomy included while CBD tumor and CBD stone and trauma were excluded from study. Total of sixteen patients with CBD injury were admitted from outside the hospital in surgical ward in Isra University hospital either through OPD or Emergency Room or Endoscopy Suite depending on the mode of presentation and failure of ERCP if performed according to the need and clinical presentation. All patients were resuscitated and investigated thoroughly and the procedure whether ERCP, or reconstructive surgery or conservative treatment performed based on patient's clinical presentation and mode of injury and is recorded in the preset approved Performa from relative hospital's ethical review committee and the data compiled in SPSS version 10. All 16 patients; 4[25%] male and 12[75%] females admitted from outside the hospital in two year period. Presented in variable time interval12 [75%] patients admitted in 1 month, 3[18.8%] in 6 monthsand 1[6.3%] in 12 months. Jaundice was the main presenting symptom. Patients were resuscitated and optimized for invasive procedure i.e. ERCP and reconstructive surgery. Six patients were treated with ERCP successfully and 9 underwent reconstructive surgery and 1with some biliary drainage responded to simple conservative treatment. Operative success rate was 75% with 25% mortality which was related to the presence of peritonitis, development of multiorgan failure and late repair of bile duct injury. Although CBD injury is one of the most devastating complication but its early diagnosis and prompt treatment can prevent patient's life with subsequent few or no complication even after its reconstructive surgery. Training must be emphasized to find the all possible ways of recognizing biliary tract anatomy during surgery and possess skills to overwhelm the primary and leading cause of bile duct injury i.e. the visual misperception
ABSTRACT
To compare the out come of laparoscopic and open appendicectomies in terms of operative time, analgesic requirement, postoperative complications, hospital stay, return to normal activity and condition of scar. This prospective study was carried out in Department of Surgery, Liaquat University Hospital Hyderabad/ Jamshoro from September 1997 to August 2000. One hundred consecutive patients of age ranging from 15-45 years with features suggestive of acute appendicitis were equally divided into laparoscopic appendectomy [LA] and open appendectomy [OA] groups, after taking informed consent. LA was done with the help of three trocar/cannulae creating pneumoperitoneum with CO2 whereas OA was performed by Lanz incision. The data were analyzed by Student t-test and Chi square tests using SPSS version 10. The operating times in OA and LA were 20-70 minutes [mean 30] and 25-95 minutes [mean 55] respectively. Increased doses of analgesics, antibiotics and antiemetics were required in OA, as compared to LA. The mean postoperative hospital stay in LA group was 1.4 days [range 1-3 days] whereas it was in OA group, it was 3.5 days [range 2-6 days]. 2 LA is safe and has major benefits like less postoperative pain, decreased wound infection, early hospital discharged, early return to work and a better cosmetic scar than OA