Reasons for conversion from laparoscopic to open cholecystectomy

To determine the frequency and reasons of conversion of laparoscopic cholecystectomy [LC] to open cholecystectomy [OC]. This prospective study was carried out in the Surgical unit III, Peoples Medical College Hospital from April 2006 to October 2009 male and female] were included in the study, all were evaluated fully preoperatively in respect to disease and general fitness of the patient for surgery and counseled regarding possibility of conversion from LC to OC. 6 patients [8.8%] were converted to open procedure. Obscure anatomy of Calot's triangle, bleeding and bile duct injury were common reasons of conversion. Even in difficult cases LC is a safe procedure with low incidence of conversion and complications in hands of experienced laparoscopic surgeon, where as junior surgeons being in learning curve are less confident and skillful, so are prone to more complications. Therefore they are advised to convert to open procedure earlier according to the criteria laid down, before complication occurs

Outcome analysis of lateral sphincterotomy in the management of chronic anal fissure

To evaluate the post operative outcome, following lateral sphincterotomy for chronic anal fissure [CAF], in our set up. This prospective study was conducted in the Department of Surgery, Peoples Medical College Nawabshah from July 2005 to September 2009. A total of 80 patients with symptoms of CAF requiring surgery were included in the study having 48 males and 32 females, age ranged between 20-60 years. The diagnosis was made on clinical presentation and confirmed on pen anal examination; lateral sphincterotomy was performed under local or general aesthesia. Patients were followed on weekly bases to see any complication. All the cases of acute and complicated anal fissure were excluded from the study. Anal pain and bleeding. were the leading presentation found in 72 [91%] and 63 [78%] patients respectively, commonest site of fissure was posterior midline in 73 [92%] of cases. Post operative pain was observed in 5 [6%] cases, flatus incontinence in 15 [20%] patients, fecal incontinence in 3 [4%] cases, bleeding in only in 1 [1.2%] patients and infection was observed in 3 [4%] cases. Lateral sphincterotomy is the procedure of choice for the treatment of CAF. It has low rate of incontinence to stool and flatus, low recurrence and healing rate is faster. We advocate this procedure as an ideal treatment for CAF

Common bile duct pathologies at Nawabshah

To determine the causes, prentation, management and outcome of Common Bile Duct [CBD] pathologies. Descriptive analytical study from January 1995 to December 2006. Surgical Unit-I, Nawabshah Medical College and Hospital, Nawabsheh. All patients who presented with CBD pathologies. Data of all the patients with CBD pathologies was collected and entered on a proforma, including their complaints, positive examination findings, investigation, diagnosis, procedure performed and its outcome. During the study period 45 patients presented with CBD pathology. Amongst them 14 were males and the rest females [31], with a mean age of 36.7 years. Around 67% patients had choledocholithiasis as the commonest cause. Exploration of the CBD with T-tube insertion was the commonest procedure, performed in 69% patients. About 4% patients had retained stones and 20% developed wound infection. Mean hospital stay was 13 days. Most common pathology involving the CBD was secondary stones; 95% patients had associated gall stones also