New variants of laparoscopic subtotal cholecystectomy in management of acute cholecystitis.

Background: Laparoscopic Subtotal Cholecystectomy has successfully brought down the conversion rate to a very low in difficult patients where the only option was conversion to open. Aims & Objective: To determine a new classification of Laparoscopic Subtotal cholecystectomy and their various types/variants like Type-I, Type-II and Type III and determine the use of port positions in LSC. Materials and Methods: The patients were recruited from specialized hospitalized which is recognized training centre for Laparoscopic Surgery. The 661 subjects were enrolled in the study. Both males and females were included in the study. All 14485 patients were subjected to Laparoscopic Cholecystectomy during the past 2 years and 5 months from February 2009 to June 2012. All surgical procedures were performed at a single tertiary level hospital. Among them, 661 patients (4.46%) with various types of cholecystitis were treated by Laparoscopic Subtotal Cholecystectomy and were included in the study. Results: The 48 patients belonging to Laparoscopic subtotal cholecystectomy-Type-I, only 4 ports were used in all 48 (100%) patients. No extra port was required. 591 patients belonging to laparoscopic subtotal cholecystectomy-type-II, 4 ports were used in 546 (92.39%) patients, 5 ports in 42 (7.10%) patients and 3 ports in 3 (0.50%) patients. Of 22 patients belonging to laparoscopic subtotal cholecystectomy-Type-III, only 4 ports were used in all 22 (100%) patients. No extra port was required. In all, in 616 (93.19%) procedures, 4 ports were used. In 42 (6.35%) procedures 5 ports were used (all Laparoscopic Subtotal cholecystectomy -Type-II), and in 3 (0.45%) procedures only 3 ports were used (all Laparoscopic Subtotal cholecystectomy -Type-II). Conclusion: In this study. Laparoscopic subtotal cholecystectomy has been further classified into Type-I, Type–II, Type–III. Laparoscopic subtotal cholecystectomy Type-I is used for difficult gall bladder bed. Laparoscopic subtotal cholecystectomy Type-II in difficult hilum, and laparoscopic subtotal cholecystectomy Type-III for difficult hilum with difficult gall bladder bed. In this study, laparoscopic subtotal cholecystectomy Type-III has been newly classified and this has helped us to bring down the conversion rate and other complications like bleeding and injury to biliary tree.

Laparoscopic management of duodenal ulcer perforation: is it advantageous?

BACKGROUND: Surgery is the mainstay of treatment of patients with peptic duodenal perforation. With the advent of minimal access techniques, laparoscopy is being used for the treatment of this condition. METHODS: Retrospective analysis of 120 consecutive patients (mean age 44.5 years; 111 men) with duodenal ulcer perforation who had undergone laparoscopic surgery. RESULTS: 87 patients had history of tobacco consumption, 12 were chronic NSAID users, 72 had Helicobacter pylori infection and 36 had a co-morbid condition. The mean time to surgery from onset of symptoms was 28.4 hours. The median operating time was 46 minutes. All patients underwent laparoscopic closure of the perforation with Graham's patch omentopexy; 12 patients underwent additional definitive ulcer surgery. The morbidity rate was 7.5%; no patient needed conversion to open surgery or died. The mean postoperative hospital stay was 5.8 days. CONCLUSION: Results of laparoscopic management of perforated peptic ulcer are encouraging, with no conversion to open surgery, low morbidity and no mortality.

Late rejection after transabdominal pre-peritoneal inguinal repair: laparoscopic extraction of mesh.

We report a 29-year-old man who developed mesh rejection 3 years after laparoscopic transabdominal pre-peritoneal inguinal repair. The mesh, which was lying in a fluid cavity adherent to the urinary bladder and right iliac vessel, was removed laparoscopically.

Composition of gallstones in Coimbatore District of Tamil Nadu State.

BACKGROUND: Gallstones in northern India are predominantly of the cholesterol type; such information on gallstones in southern India is scant. AIM: To analyze the composition of gallstones from patients residing in Coimbatore District in Tamil Nadu State. METHODS: The stones were classified using the Bernhoft criteria and was correlated with the morphological characteristics. RESULTS: Of the 105 gallstones analyzed, 67 (63.8%) were of the pigment variety and 36 (34.8%) of the intermediate/mixed type. There were only two cholesterol stones. The mean proportions of cholesterol, bilirubin and calcium in the pigment and intermediate stones were 7.1%, 26.1% and 7.8% and 30.2%, 18.4% and 6.3%, respectively. The mean proportion of bilirubin in the pigment stones was higher than in the intermediate type. Morphologically, pigment stones were black in 55% and amorphous in 63%; the intermediate stones were hard in 50% and of variegated color ranging from yellow to ivory white in 61%; both cholesterol stones were multiple, hard and brown. CONCLUSIONS: There is a predominance of pigment and intermediate gallstones (98%) in this district. These stones have reduced cholesterol and an increase in bilirubin and calcium proportions.