Timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography

To evaluate the effect of timing of laparoscopic cholecystectomy [LC] on the conversion rate and the postoperative complications in patients of calcular obstructive jaundice after endoscopic retrograde cholangiopancreatography [ERCP]. The study included all patients considered for elective LC after ERCP for calcular obstructive jaundice at The Department of General Surgery, Minia university hospital from January 2005 to January 2007. LC was planned and performed within 1 week [early group, 17 patients] or after 4 weeks [delayed group, 16 patients]. The conversion rate was 5.8% in the early group versus 56.2% in the delayed group [Chi-square test, P=0.006]. The mean operative time in the early group was 70 +/- 33 versus 117 +/- 45 min in the delayed group [Unpaired student's t-test, P=0.0015]. The mean length of hospital stay in the early group was 3 +/- 2.1 versus 7 +/- 3.5 days in the delayed group [Unpaired student's t-test, P=0.0003]. The postoperative complication rate was 11.7% in the early group versus 62.5% in the delayed group [Chi-square tests, P=0.002]. The mean follow-up period was 12 +/- 3.7 months. The early LC after ERCP is preferred than delayed cholecystectomy because it has low conversion rate, short operative time, short hospital stay and low rate of postoperative complications

Endoscopic management of postcholecystectomy bile leak

This prospective study was done to evaluate the results of endoscopic management of patients with postcholecystectomy biliary leak. Between July 1999 and July 2005, 31 patients [18 men and 13 women, aged from 16 to 67 with mean age 49 + 12.1 years] underwent endoscopic management for postcholecystectomy bile leak in the Endoscopy Unit of Minia University Hospital. In 29 of 31 patients [93.5%], endoscopic management was effective, safe, without mortality and the reported complications were treated by endoscopic management. The mean hospital stay for treatment of the leak was 6.1 + 4.3 days. During follow up, 60% of patients of major bile duct leaks developed biliary stricture formation and endoscopic management was repeated, which was successful in 50% of patients. Two patients of complete transection of common bile duct [CBD] underwent primary surgical therapy. Endoscopic management is safe and effective in the diagnosis and treatment of post-cholecystectomy bile leaks. Long-term results show that its efficacy and success is less in cases of major bile duct leaks due to subsequent biliary stricture formation. Surgical treatment is indicated in cases of complete transection of CBD and in cases of subsequent stricture formation

Evaluation of the role of laparoscopy in management of the nonpalpable testis

To evaluate the safety, efficacy of the laparoscopic treatment of nonpalpable testes [NPT] and follow up the results for 12 months after orchiopexy. Between June 2004 and June 2007, 40 nonpalpable testes in 35 patients were evaluated by laparoscopy. Patients age ranged from 2 years to 22 years [mean age 8 +/- 4 y]. The laparoscopy was used in all cases under general anesthesia. Laparoscopic diagnosis was successful in 32 of 35 cases [91.4%] and 36 of 40 NPT [90%]. Laparoscopic orchiopexy was successful in treatment of 12 testes [30%] and laparoscopic orchiectomy was successfully done in 9 testes [22.5%]. The reasons for orchiectomy included dysgenesis in 2 cases, atrophic remnants in 4 cases and ischemia after Fowler-Stephens in 3 cases. While the standard orchiopexy was done in 13 testes [32.5%] and standard orchidectomy was done in 2 testes [5%] due to canalicular vanishing testes. The mean laparoscopic operative time was 62 +/- 14.3 minutes. The mean hospital stay was 1.8 +/- 0.6 days. The mean length of follow up was 12 + 4.3 months. The testes were located in the scrotum in all orchiopexies. laparoscopy is the diagnostic modality of choice for evaluating the nonpalpable testis because it is reliable and safe in locating the testis or in proving its absence. Laparoscopic orchiopexy is feasible

Stapled versus hand-sewn anastomosis of the large bowel due to abdominal trauma: a prospective comparative study

To compare stapled with hand-sewn anastomosis in cases of large bowel injuries after abdominal trauma. This prospective study was done in The Department of General Surgery, Minia University Hospital in a period between March 2004 and March 2007. All patients with colonic injuries requiring urgent resection due to abdominal trauma were included. There were 39 patients enrolled in this study, comprising 18 patients [46.2%] with stapled anastomosis and 21 patients [53.82%] with hand-sewn anastomosis. They were 30 males [76.9%] and 9 females [23.1%], with a mean age of 46.7 +/- 11.3 years. There were 3 patients [16.6%] of anastomotic leak in the stapled group versus 8 patients [38%] in the handsewn group [P<0.05]. The operative time was 112 +/- 30.2 min in the stapled group versus 160 +/- 27.4 min in the hand-sewn group[P<0.05]. The mean +/- SD of hospital stay was 9.2 +/- 8.3 days in the stapled group versus18.9 +/- 14.5 days in the hand-sewn group[<0.05]. Stapled large bowel anastomosis is safe and effective in setting of abdominal trauma. It is associated with fewer anastomotic leaks, lesser operative time and shorter hospital stay than hand-sewn anastomosis