Management of malignant dysphagia with self expanding metallic stents

The use of self -expanding metal stents [SEMS] for palliation of malignant dysphagia is increasing. Early experience in 26 patients was included with respect to the value of stenting and management of complications encountered. SEMS were inserted in 26 patients [18 men and 8 women] of mean age 64.6 years with malignant esophageal obstruction. Data regarding stent insertion and score of dysphagia were gathered prospectively. The insertion of covered SEMS was successful in all 26 patients. Improvement in dysphagia grade by at least one grade was achieved in 96.2 percent of our patients. There were no mortality related to the procedure. Recurrent dysphagia was recorded in four cases [15.3 percent]. Two were due to stent migration and treated by another stenting. One was due to tumor overgrowth while the last was due to epithilial hyperplasia and treated by balloon dilation. Self -expanding metallic stents offer an excellent way of palliating dysphagia due to esophageal carcinoma with shorter hospital stay. It is usually successful, safe [minimal morbidity and mortality] and effective [ability to eat a near -normal diet]. Problems such as migration of the stent may be overcome by future improvements in stent design

Laparoscopic appendectomy does not change the incidence of postoperative infectious complications

It is not clear whether the laparoscopic approach does decrease the incidence of postoperative infectious complications after appendectomy. One hundred twenty nine patients were randomized, 67 with laparoscopic [LA] and 62 with open appendectomy [OA]. Patients in the OA group had a Mc Burney incision, LA was performed in the Lithotomy position. Acute appendicitis was confirmed in 85 percent of patients. The appendix was perforated in 5 patients of the LA versus 2 of the OA group. No conversion to the open procedure was necessary. The median operating time was 35 minutes in the LA group and 31 minutes in the open group [P=0.58]. The median postoperative hospital stay was shorter after Laparoscopic than after open surgery [2 days versus 5 days P= 0.026], where as the time required for return to work was not significantly different [14 versus 15 days]. There were 5 [7.4 percent] patients with superficial wound infection following LA and 6 [9.6 percent] after OA [P=0.67]. Intra-abdominal fluid collections were found in 2 [2.9 percent] patients following LA and 3 [4.8 percent] patients following OA [P =0.60]. In the LA group, 3 patients presented with intra abdominal hemorrhage and another 3 developed a paralytic ileus that was treated conservatively. Laparoscopic appendectomy is as safe as and as effective as the open procedure, however it does not decrease the rate of postoperative infectious complications

Unusual abscess pattern following dropped gallstones during laparoscopic cholecystectomy

Laparoscopic Cholecystectomy has become the standard treatment for symptomatic cholelithiasis. Numerous clinical trials have deemed it a safe procedure, regardless of the known increased risk of bile duct injury. However, the consequences and incidence of less well-known complications are still being addressed. Between 1995 and 1998, 200 laparoscopic cholecystectomy were performed at El-Minia Surgical Department, 3 patients [1.5 percent] subsequently developed abscesses as a consequence of dropped stones during the Laparoscopic Cholecystectomy, while 2 [1 percent] other patients developed trocar site "tumor" masses that were secondary to inflammatory tissue around gallstone fragments. All patients were successfully treated by surgical drainage, stone removal, and antibiotics. Trocar site inflammatory masses required excision only. This experience closely resembles that of the other centers and points out the existence of late postoperative complications following laparoscopic cholecystectomy that was rarely encountered with open cholecystectomy. Strategies from avoiding this problem are discussed. Whether dropped stones are an indication for conversion to open cholecystectomy remains unclear. Thorough irrigation at time of surgery with or without placement of a drain in the subhepatic space does not prevent this complication