ABSTRACT
Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter total hospital stay and reduction in days away from work at the cost of longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.
ABSTRACT
Aim of Study:Laparoscopiccolorectal surgery has gained popularity around the Globe. Laparoscopiccolectomy significantly improves the short term and long term outcomes of patients. The bowel anastomosis after laparoscopic resection of the tumour can be done in two ways -extracorporeal anastomosis and Intracorporeal anastomosis. Our study observed and evaluated the data of the patients who underwent these two techniques.Materials and Methods:A prospective observational study was conducted in the department of General Surgery, SMHS hospital of Government Medical College, Srinagar. A total of 32 patients were studied out of which 20 patients had undergone intracorporeal anastomosis and 12 patients had undergone extracorporeal anastomosis. The aims of the study were to assess the operative time, post-operative ileus, length of hospital stay, anastomoticleak and other anastomotic complications,wound infections and extraction site hernias.Results:The patients in our study were in the range of 30-85 years with a mean age of 59.18 ± 14.92. and 59.4% of patients were males and the rest 40.6% were females, with male/female ratio of 1.46:1. There was no significant difference in mean operative time between the intracorporeal group and extracorporeal group (188±9.78 minutes’ vs.180.3±13.8 minutes). The patients in the intracorporeal group had earlier return of bowel function than extracorporeal group as reflected by earlier appreciation of flatus and tolerance to orals. This had led to the shorter hospital stay of the intracorporeal group than the extracorporeal group of patients (median of 5 days vs. 6.5 days) The wound infection rate was 6.3 percent in our study, 5.0% in the intracorporeal group and 8.3% in the extracorporeal group. Only 1 out of the total 32 patients developed mesenteric twist to the extracorporeal group (1 out of 12 patients). We observedno leak or incisional hernia in either groups.Conclusion:Intracorporeal anastomosis in laparoscopic colorectal surgeries leads to earlier return of bowel function, earlier resumption of orals and shorter hospital stay than the extracorporeal anastomosis. There does not exist a significant difference between the two modes of anastomosis in terms of anastomotic and wound related complications
ABSTRACT
Background:The hypotensive effect of propofolis attributable to a decrease in sympathetic activity,direct vasodilatation and myocardial depression. The aim of the study wasto assessthe effect of propofol when injected at different speeds for induction of general anesthesia on the following parameters:blood pressure,time of induction of anesthesia,dose of propofol used.Methods:The present study was conducted in post Graduate Department of Anesthesia and Surgery, Govt. Medical College,Srinagar for a period of two years and included 90 patients from July 2014 to June16,the study was prospective one.Results:In our study patients divided into three groups with 30 patients in each group.The mean age in group P400,P600,P800 wasstatistically insignificant p>0.843.The mean weight in group P400, P600, P800 was statistically insignificant p>0.885.The mean height in group P400,P600,P800 was statistically insignificant p>0.748.The mean induction time in P400 and in P600 was statistically significant.The mean systolic blood pressure, pre and post induction in P400,in P600 and in group P800 was statistically significant. The mean diastolic blood pressure, in pre and post induction in P400,P600,P800 was statistically insignificant with a p>0.05.The mean arterial pressure in pre and post induction in P400,P600,P800 was statistically significant (p<0.05).The mean heart rate in pre and post induction was statistically insignificant. The mean oxygen saturation (%) pre and post induction was statistically insignificant. Conclusions: We concluded that induction dose required for loss of consciousness increased with a faster rate of infusion while time for induction was shorter in P800 compared to P400 and P600, and the decrease in mean blood pressure was less after induction in P400.Propofol injection should be slow enough to prevent any hemodynamic deterioration in anesthesia induction