Laparoscopic cholecystectomy in Songklanagarind Hospital

Objective: To contribute our five years of experience of laparoscopic cholecystectomy in Songklanagarind Hospital and find out the risk factors of prolonged length of hospital stay.Design: A retrospective study.Materials and methods: A review of the hospital database of all the patients who underwent laparoscopic cholecystectomy between January 2001 and December 2005.Results: A total of 539 laparoscopic cholecystectomies were performed; the conversion rate was 23.19%. In the cases of successful laparoscopic surgery; patients the mean time for hospital stay was 5.23 days. Surgical site infection occurred in 9.67% of the cases and prophylactic antibiotics were used for 85.27% of the patients. Significantly, surgical wound infection was associated with the type of drain used and also obesity (p = 0.03, p \< 0.001). Local injections of marcaine did not reduce the volume/quantity of narcotic used (p=0.236), and was found to very slightly increase the incidence of wound infection (p = 0.215). Prophylactic postoperative nausea and vomiting (PONV) did not reduce the incidence of severe PONV and medication used (p = 0.109). One patient had a common bile duct injury (0.28%).Conclusions: Laparoscopic cholecystectomy is a safe and feasible procedure. We have tried to improve the patient outcome through moving to a day care laparoscopic cholecystectomy surgical option.

Ganglion cell in vermiform appendix

Background/purpose: Presence of ganglion cells in the appendix excludes total colonic aganglionosis. However, it remains unclear whether or not absence of ganglion cells in this organ should be a criterion to rule in the disease. The aim of this study was to examine for presence and number of myenteric ganglion cells in vermiform appendix taken from various surgical conditions and controls.Methods: One hundred and thirty two appendectomy specimens were available for the study; group I, total colonic aganglionosis (TCA); group II, other type of Hirschsprung's disease (HSD); group III (control), incidental appendectomy in cases without aganglionosis; group IV, acute appendicitis. Amount of ganglion cells was evaluated semiquantitatively in blinded fashion.Result: The number of ganglion cells in any given high power field (HPF) was very variable in all groups; group I no ganglion cells found, group II 1.03 (0-2.9), group III 0.67 (0-2.4), group IV 0.46 (0-1.8) cells/HPF. There was significant difference between the HSD group and groups with TCA or appendicitis. Absence of ganglion cells in the appendix could be detected in 100%, 16.7%, 13.1% and 27.3% in groups I, II, III and IV, respectively.Conclusions: Aganglionosis of the vermiform appendix could not provide a diagnostic clue to total colonic aganglionosis because the condition could be found in other conditions.

Bowel preparation for pull-through operation in Hirschsprung's disease

Background/Purpose: Mechanical cleaning of the bowel is an essential component of preoperative bowel preparation. The aim of this study was to compare the adequacy of bowel preparation and patient outcomes.Methods: Medical records were retrospectively reviewed of 43 consecutive patients from 2001 to 2004 with Hirschsprung's disease who underwent a modified Duhamel's pull-through operation. Comparisons were made regarding adequacy of the bowel preparation at the time of the pull-through procedure, operating time, operative morbidity and length of hospital stay.Results: Thirteen patients had a preoperative colostomy and 30 patients had no colostomy. At the time of the pull-through procedure, the adequacy of the bowel preparation was recorded as fair (83.7%) or poor (16.3%). The wound complication rates of the fair and poor bowel preparation cases were 13.9% and 14.3%, respectively. The creation of a preoperative colostomy had no statistically significant effect on bowel preparation quality or postoperative complications.Conclusions: Mechanical bowel preparation showed no statistically significant effect in relation to bowel preparation quality or patient outcome. Thus good bowel preparation may not be necessary for elective colonic surgery in Hirschsprung's patients.

Detection of PAX/FKHR fusion by reverse transcription polymerase chain reaction (RTPCR): an adjunctive molecular diagnosis in pediatric alveolar rhabdomyo-sarcoma

Background: Rhabdomyosarcoma (RMS), an uncommon soft tissue sarcoma, is subdivided according to its histopathology into 2 major subtypes; embryonal rhabdomyosarcoma (ERMS) and alveolar rhabdomyosarcoma (ARMS). In certain circumstances, distinguishing between the two subtypes is difficult. Recently, molecular pathology has discovered a potentially new adjunctive diagnostic tool for ARMS; the detection of fusion transcripts PAX/FKHR.Objective: To study PAX3/FKHR and PAX7/FKHR fusion in RMS, and secondarily to look for any correlation between the fusion gene detection and the histopathological findings.Methods: The sample set consisted of 6 ERMS and 5 ARMS. Detection of the fusion gene used reverse transcription polymerase chain reaction (RT-PCR). Positive results were confirmed by nucleotide sequencing.Results: PAX3/FKHR fusion was detected in 3 of 5 ARMS frozen tissue samples. RT-PCR gave a negative result when formalin-fixed paraffin-embedded tissue was used as a template. None of the ERMS gave positive results. Two ARMS that were fusion-gene negative stained negative for desmin, contained no anaplastic histology, presented no rhabdomyoblast differentiation, but both cases had clear evidence of cystic component and electron microscopic evidence suggesting ARMS. The fusion-negative patients seemed to have a better clinical outcome. All ARMS and ERMS showed negative results of PAX7/FKHR.Conclusion: Laboratory detection of PAX3/FKHR fusion gene in ARMS was successfully performed. The test should be useful in differentiating ARMS from ERMS, especially in cases without typical alveolar cystic portion.