Biliary leakage following cholecystectomy and its outcome

To find out the causes and outcome of management in cases of bile leakage following cholecystectomy. Prospective descriptive study from April 2005 to December 2006. Surgical Unit five of Civil Hospital, Karachi. A total of 140 patients who were operated for symptomatic gall stones. Detailed information regarding the patients was collected. Initially due to non-availability of ERCP as well as high cost in the private sector, all patients with biliary leakage underwent open surgery. Later on all patients underwent ERCP due to its availability in the unit; operative intervention was only undertaken when the ERCP was not therapeutic or failed. Ultrasound studies were done in patients who were suspected to have bile collections but no discharge from the drains or the operative wounds. Out of 140 patients, two patients were noticed to have biliary leakage during surgery and 10 post-operatively. The former cases underwent repair on the spot, while in the latter group five underwent re-exploration and four ERCP; one patient expired without intervention and another from the re-exploration group. In three patients ERCP was successful and sphincterotomy with stenting was done while in one patient there was failure of cannulation, resulting in open exploration

Aspiration combined with seton insertion for treatment of wrist ganglions

To evaluate the results of Aspiration combined with Seton insertion in the treatment of wrist Ganglions. Prospective, quasi experimental study from Jan. 2004 to Dec. 2006. Surgical Unit V, Civil Hospital, Karachi. Fifty five patients who presented with wrist Ganglia. All patients were assessed in detail clinically, and treated by aspiration with 14 gauge IV cannula and 10cc syringe followed b Seton [Silk No. 1 on straight needle] insertion through the cavity. Seton was removed on the 12th day. The average follow-up time was one year. Out of 55 patients, 51 [92.7%] had a Dorsal Carpal Ganglion and 4 [7.3%] a Volar Ganglion. Twenty nine [52.7%] cases were males and 26 [47.3%] females, with an age range from 17-35 years. All patients complained of a localized swelling, while 12 [21%] had pain during activity. Fifty two [95%] cases had a smooth recovery, while two had residual swellings requiring re-aspiration and on developed signs of inflammation which subsided on conservative management. No recurrence of the ganglion occurred in any case. Aspiration combined with seton insertion for treating Ganglions of wrist is a simple, economic, cosmetic, uncomplicated procedure which can be done in the out-patient department. It is a reliable and safe alternative to open resection for successful eradication of the wrist Ganglion