Laparoscopic cholecystectomy without the use of drain in selected cases

Objective: To observe the effects of omitting the routine drainage after laparoscopic cholecystectomy, with respect to hospital stay, morbidity, and mortality

Methodology:This comparative observational study was carried out in the Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, from January 2009 to December 2009. During study period 100 consecutive cases of cholelithiasis, underwent laparoscopic cholecystectomy. The patients were divided in two groups; group A without drain and group B with drain. The effects of omitting the drain, regarding hospital stay, morbidity, and mortality were observed

Results: This study consists of 100 patients [male 22 and females78] with male female ratio of 1:3.54 and mean age of 37.86 years. Post operative hospital stay in patients without drain was 2.1 days as compared to 3.58 days for those with drain [p-value 0.000]. Moreover the use of drain has also been found to be associated with significant drain site pain / discomfort. There was no mortality in any group

Conclusion: We have observed that routine placement of drain after laparoscopic cholecystectomy, not only prolongs the post-operative hospital stay; it also leads to drain site pain / discomfort

Gastric perforation in newborns: analysis of 14 cases

Objective: Neonatal gastric perforation is a rare entity with poor prognosis. Etiology of this anomaly is unknown but prematurity, low birth weight and hypoxia is considered as contributing factors. The purpose of this study is to share our experience regarding the etiology, clinical features and surgical outcome of neonatal gastric perforation

Methodology:We reviewed the data of all newborn with gastric perforation in Liaquat University Hospital as well as in private practice, from July 2003 to June 2010 with respect to age , sex, weight, parity, mode of delivery, clinical presentations, investigations, associated anomalies and surgical outcome

Results: There were 14 patients, 9 males and 5 females. Birth weight ranged from 1.6 kg to 3 kg with mean of 2.3 kg. Out of 14 babies 11[87.57%] were full term and 3[21.42%] preterm. Clinical features observed were abdominal distension, respiratory distress, vomiting and hematemesis. Associated anomalies were found in three patients, which were Down's syndrome, talipes equinovarus and bilateral inguinal herniae with hypospadias. Most of the patients had spontaneous gastric perforation and few might had ischemic cause. Nine had perforation on posterior wall of body of stomach and three on posterior wall of greater curvature of stomach while two had on anterior wall of body of stomach and anterior wall of greater curvature of stomach respectively. All the patients had primary closure of perforation along withintraperitoneal placement of drain. Complications observed in 4 [28.57%] cases, three term low birth weight and one preterm baby; wound dehiscence in two patients, who were re-operated, wound infection in one and pneumonia in one which were treated conservatively. Three patients 21.4% [two term low birth weight and one preterm] expired in this series due to septicemia

Conclusion: Prominent features in this study were low birth weight and perforation on the posterior surface of stomach. There is need to evaluate the correlation of these findings

Childhood intussusception: delayed presentation and surgical outcome

Objective: to compare the clinical presentation and surgical outcome in early versus delayed presentation of childhood intussusceptions

Method and material: this comparative study was conducted in the Department of Pediatric Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from January 2005 to July 2007.All the diagnosed patients of intussusception were categorized into early and delayed group [patient presented later than 24 hours from the onset of first symptom]. Data regarding age, sex, clinical presentation, duration of presentation [early or late], surgical findings, treatment and complications were recorded on proforma. All patients of intussusceptions were subjected to laparotomy due to non-availability of image intensifier. Parameters including clinical presentations, surgical findings, treatment options and compliations were analyzed with SPSS version 16

Results: this study was comprised of 80 patients; males 57[71.3%] and females 23[28.7%] with male: female ratio 2.5:1.Early presenting patients were 10 and delayed presenting were 70. Major clinical symptoms were pain in abdomen, vomiting and bleeding per rectum. Significant difference found in early and delayed presenting group was in bleeding per rectum [P<0.001], mass per rectum [P=0.001], mass per abdomen [P=0.029], fever [P=0.006] and abdominal distension [P=0.001]. Gangrene of bowel, complications and mortality were more common in delayed presenting group

Conclusion: pain in abdomen, disarrhea and vomiting were almost same in both groups, while distension of abdomen, palpable mass per rectum, bleeding per rectum, mass per abdomen, and fever had significant variability in both groups. There was also high morbidity in delayed presenting group. Early diagnosis and early treatment are main keys to curtail the morbidity and mortality in childhood intussusceptions

Intestinal obstruction due to lymphangioma of mesentery: a case report

A case of intestinal obstruction due to lymphangioma of mesentery in a two months old child is presented. Patient presented with signs and symptoms of intestinal obstruction. X-ray showed multiple air fluid levels, while ultrasound was insignificant. Exploration revealed a milky white cyst of mesentery causing complete occlusion at mid ileum. Cyst along with segment of ileum was resected and end-to-end anastomosis made. Post-operative recovery was un-eventful. Histopathological findings were consistent with lymphangioma of mesentery

Sinus histiocytosis with massive lymphadenopathy [rosai dorfman's disease]: a rare cause of lymphadenopathy in children

Sinus histiocytosis with massive lymphadenopathy also called as Rosai-Dorfman's disease is a benign self limiting rare histiocytic disorder with very few case reports in Pakistani literature. This case report describes a young boy of nine years age who presented with progressive, asymptomatic bilateral cervical lymphadenopathy for eight months. Open cervical lymph node biopsy confirmed the diagnosis on classical histopathological features. As the patient was asymptomatic, we kept him on observation, with follow-up. He shown remarkable reduction in cervical lymphadenopathy