Laparoscopic cholecystectomy at Dr-Soliman Fakeeh hospital: the first year experience

A retrospective study of the first year experience with laparoscopic cholecystectomy at Dr. Sulayman Fakeeh Hospital, Jaddah, Saudi Arabia, between November 1, 1991 and October 31, 1992 was presented. Laparoscopic cholecystectomy was attempted in 98.4% of patients [n = 250] presented with primary gallbladder disease and was completed in 94.8%. Conversion to open cholecystectomy was necessary in 13 patients [5.3%] either because of technical difficulty [n = 9], the onset of complications [n = 2], or unclear anatomy [n = 2]. There were no deaths and the total postoperative complication rate was 14 out of 237 [5.9%], with 2 [0.8%] being serious complication requiring laparotomy. The total incidence of bile duct injury was 3 out of 246 [1.1%]. The mean operating time for all cases was 89.4 +/- 39.4 minutes and it improved significantly from the first 10 cases to the last 10 cases [125.5 +/- 24.5 minutes versus 33.5 +/- 7.8 minutes respectively]. Electrocautery was used in all cases. Postoperative narcotic requirements were limited to oral or no-medications in about 78.9%. 80% of patients were discharged within 24 hours of surgery and 78% were able to tolerate regular diet by the morning following the procedure. About 48% of patients required the insertion of a suction drainage which were nearly removed by the second postoperative day. The mean time for return to full activity was 11.5 +/- 5.9 days after operation. Analysis of hospital costs revealed a saving of about 600 dollars for laparoscopic cholecystectomy when compared to an open, uncomplicated cholecystectomy. Follow-up for 3 months of the patients revealed that they were satisfied with the procedure and were doing well

Herniography: a useful diagnostic tool for occult groin hernia in adult patients with obscure groin pain

20 adult patients [mean age of 39.8 years] with established groin pain of duration of 8.9 months and normal physical examination underwent herniography. All patients had a history of medical evaluation on several occasions by other physicians. The pain was described as an ache in most patients and was unilateral in 17. Apart from 2 cases of brief syncope, no serious herniographic complications were recorded in the present series. In the presence of bilateral hernial sacs, the larger sac was found at the painful side. 18 patients [90%] were found to have 26 occult groin hernias. 4 were direct and 6 were bilateral. Exploration of the painful side confirmed the herniographic findings in all patients. Three months follow-up after operation revealed resolution of the patients' symptoms. The technique of herniography and the normal herniogram were described

tension free repair on inguinal hernia

The technique of Lictenstein was used 50 male patients with 57 total primary inguinal hernia repairs. There were 41 indirect and 16 direct hernias. The indirect sac was always ligated high up versus to the original technique in which the sac was simply inverted into the abdomen without excision, suture or ligature. The distance between the arching line of conjoined muscles and pubic ramus was 1-2 cm in 35 cases, 2-3 cm in 14 cases and 3-5 cm in 8 cases. There were 3 wound hematomas with no post-operative wound infections. All patients were discharged within few hours of their procedure and they resumed their daily activities within 2 to 7 days [mean = 3.5 days]. Admittedly, the follow-up period was short [ranged from 1 to 2 years with a mean of 1.5 years] with no recorded recurrences. With the use of polypropylene mesh and local anesthesia, there was no suture line tension, and the technique was simple, rapid, less painful effective and allowing early return to daily activities particularly in old and high risk patients

role of calcium metabolism in the pathogenesis of renal lithiasis

Thirty adult patients with renal stones and 10 normal adult persons as a control were studied. They were 19 males and 11 females. Their ages ranged between 16 and 70 years. Hormonal studies revealed a significant rise of serum PTH, with a significant importance in the process of renal lithiasis, whereas other measures showed no significant role. Stone analysis revealed that calcium phosphate stone represented the most common type of stones [46.67%], with calcium content comprising 83.3% of stone matter. The recurrent stones were found in 23.33% of cases and showed a good correlation with an increase in the total serum calcium [P = 0.01]; a decrease of urinary pH [P = 0.04]; and Ca phosphate type of stone [P = 0.04]. Multiple stones were found in 23.33% of cases and showed a good correlation with a low serum calcitonin [P- 0.02] and a low urinary 24 hours proteins [P = 0.05]

Plasma amino acid patterns in different stages of Egyptian splenomegaly and following the commonly used surgical procedures

Plasma fasting amino acid profiles were studied among ninety patients selected and classified into 4 main groups. Group A [control group] included 20 normal subjects, with a mean age of 28.95 +/- 1.86 years. Group B included 10 patients with noncomplicated portal hypertension and a mean age of 30.6 +/- 2.4 years. Group C included 30 patients with complicated portal hypertension and classified into 3 subgroups. Subgroup I, 10 patients with ascites and a mean age of 41 +/- 3.49 years. Subgroup II, 10 patients with encephalopathy and a mean age of 48.6 +/- 3.26 years. Subgroup III, 10 patients with bleeding esophageal varices and a mean age of 34.8 +/- 1.87 years. Group D included 30 patients following 3 commonly used surgical operation used for treatment or portal hypertension. Their aminogram was assessed 3 months after operation to nulify the effect of postoperative complications. Subgroup I, 10 patients with a mean age of 26.3 +/- 2.05, for whom splenectomy was done. Subgroup II, 10 patients with a mean age of 29.6 +/- 3.07 years, for whom Hassab's operation was done. Subgroup III, 10 patients with a mean age of 26.3 +/- 1.76 years, for whom Warren's shunt was done. When compared to control group, noncomplicated cirrhotic group B showed a significant increase of aspartic acid and threonine. Group C [I] showed a significant increase of histidine, glutamic acid and threonine. Group C [II] showed a significant increase of glutamic acid, tyrosine, threonine phenylalanine and aspartic acid, and a significant decrease of leucine and isoleucine. Group C [III] showed a significant increase of threonine. Group D [I] showed a significant increase in aspartic acid and group D [II] a significant increase in threonine. Group D [III] showed a significant increase of aspartic acid, glutamic acid, phenylanine, lysine and threonine. Disturbed amino acid patterns were found among the different groups studied with a characteristic pattern among patients with hepatic encephalopathy. Among surgical approaches used for treatment of portal hypertension, shunt operation was associated with increased levels of amino acids of known deletrious effects on cerebral functions and is therefore better avoided group