ABSTRACT
Laparoscopic Cholecystectomy [LC] is yet to be fully established in developing countries due to lack of economic resources and training facilities. These limitations dictate that an approach be used whereby laparoscopic technique can be established without the need of attending costly training sessions. This study was aimed to describe the strategy that we used to introduce LC in our hospital and to present the outcome of the initial 250 cases. Prospective Study, Place and Duration of Study: Sindh Government Qatar Hospital [SGQH], Karachi, Pakistan from January 2009 to July 2011. The strategy used involved initial detailed literature review regarding LC, practice with instruments using a costless endotrainer, initial careful case selection and hands-on supervision of the first 25 cases by an experienced laparoscopic surgeon. Initially selected patients included those with duration of symptoms less than 6 months, thin patients and patients with gallbladder wall thickness of up to 4 cm on ultrasound. Outcome in terms of conversion rate, postoperative recovery, complications including CBD injury and mortality is described. The mean operative time for the first 25 cases was 89 minutes and overall was 46 minutes. Four [1.6%] patients were converted to open procedure. 153 [61.2%] were discharged by the 3rd postoperative day. 35 postoperative complications were detected in 22 [8.8%] patients with rate of CBD injury being 1.2%. Major complications occurred in 8 [3.2%] patients. The mortality rate was 1 .2%. Our results indicate that the strategy we used to introduce LC in our setup was successful in establishing the procedure with an initial slightly higher but comparable complication rate
ABSTRACT
To find out the presence of Helicobacter pylori in dyspeptic patients with endoscopically normal stomach. In this observational study all patients above the age of 15 years with dyspepsia of more than one month duration were included in the study. Patients taking antibiotics or proton pump inhibitors were excluded. Upper Gastro intestinal [GI] endoscopy was done in all patients and specimens from the antrum of stomach were taken for rapid urease test and histology. Patients were divided into group A [who had no abnormal finding of stomach on endoscopy] and group B [patients who had abnormal finding of stomach on endoscopy]. There were 100 patients in the study, 50 in group A and 50 in group B. Mean age in group A was [30.2 years] with 21 [42%] males and 29 [58%] females, while in group B it was 36.4 years with 32 [64%] males and 18 [36%] females. Most common complaint of epigastric pain was present in 40 [80%] patients in group A and 42 [84%] in group B followed by heart burn 6[12%] in group A and 22[44%] in group B. On endoscopy oesophagits was seen in 7[14%] patients in group A and 18 [36%] patients in group B. All patients in group A had normal stomach on endoscopy while in group B 15[30%] patients showed antral erythema and 35[70%] showed pangastic erythema.Duodenum was normal in all Group-A patients while four patients in Group-B had duodenal erosions. Histologically 34[68%] patients were positive for H. pylori in Group-A, compared to 39[78%] in Group-B. H. pylori is present in a significant number of dyspeptic patients with endoscopically normal stomach. Normal looking gastric mucosa in these patients could be either due to milder infection or endoscopy done early during the course of infection. H.Pylori eradication has the potential to reduce the risk of gastric cancer development whose incidence varies geographically