Laparoscopic cholecystectomy for empyema gall bladder

Objective: To describe the experience of treating empyema gall bladder with laparoscopic cholecystectomy. Study Design: Descriptive observational study

Place and Duration of Study: The study was carried out at Combined Military Hospital [CMH] Peshawar, from Feb 2012 till May 2014 for a period of twenty eight months

Material and Methods: Twenty eight patients were enrolled in the study who fulfilled the criteria for empyema and were willing for laparoscopic cholecystectomy, chances of conversion to open cholecystectomy and risk of complications involved. We defined the operative difficulty levels according to the intra-operative findings. Level 1-adherent ornentum, level 2-oedematous gall bladder wall, level 3-necrotic gall bladder wall, level 4-adherent gut and level 5 - adherent Hartmann's pouch and oedematous Calot's triangle having no defined planes. The results were noted in terms of time taken for the operation and complications of the operative procedure. Results: Twenty eight patients of empyema gall bladder underwent laparoscopic cholecystectomy. Mean age was 46.2 +/- 7.1 years. Average duration of symptoms was 4.1 +/-2.3 days. Two patients had level-I operative difficulty, 6 patients had level-II difficulty, 9 patients had level-3 difficulty, 2 patients had level-IV difficulty and 9 patients had level-V difficulty. In 21[75%] patients total cholecystectomy was performed, anterior partial cholecystectomy was done in 2 patients [7.1%] and 5 patients [17.9%] were converted to open cholecystectomy. One patient [3.5%] had Stresburgh Bismuth type D injury and was managed by open exploration and T-tube placement. No mortality was encountered in the study group

Conclusion: The technique of laparoscopic cholecystectomy can be used effectively for treating empyema gall bladder specifically in American Society of Anaesthesiologists [ASA] I and II patients. Further randomized controlled trials can elaborate its efficacy. This will not only prove to be cost effective but it will also add to the comfort of the patient

Video assisted thoracoscopic surgery [VATS] lung biopsy for non-responsive patients of interstitial lung disease [ILD]

To study the results of VATS [Video Assisted Thoracoscopic Surgery] Lung Biopsy in Interstitial Lung Disease [ILD] case series. Department of Thoracic Surgery, CMH Rawalpindi from Jan 2009 to Mar 2010. All those patients of ILD [Interstitial Lung Disease] were included who failed to improve after a period of observation including those on empiric therapy, all patients in which BAL [Bronchoalveolar Lavage] and TBLB [Transbronchial Lung biopsy] was inconclusive and all those patients fit to undergo thoracoscopic surgery. Patients excluded were elderly patients, those with systemic disorders frequently associated with ILD and those with known neoplasm likely to have lymphangitic dissemination. We used three thoracoscopic ports, all biopsies were sent for histopathology examination, single chest tube was placed in all cases and it was removed once the airleak ceased. All complications encountered were noted. Fourteen patients were registered during study period. Biopsy showed that 9 had ILD, and 5 did not have ILD. Only complication was a prolonged airleak for 2 days in 2 patients. No mortality was encountered. Thoracoscopic surgical biopsy can be accomplished safely in most cases where there is a diagnostic dilema for interstitial lung disease