Early cholecystectomy; in acute cholecystitis: our experience

This study was conducted to evaluate results of early cholecystectomy in acute cholecystitis in terms of procedural safety. In this study 50 consecutive cases of acute cholecystitis who underwent early laparoscopic cholecystectomy [within 03 days of attack] were included. Patients with symptoms of more than 03 days duration or those with associated diseases were excluded. Evaluation of results was done by analyzing the data in SPSS V-17. Out of 50 patients operated 46 [92%] were female and 4 [8%] were male. Most of the patients were received within 24 hours after the onset of symptoms. The age of patients ranged from 30-70 years with the median age of 45 years. Ultrasound revealed oedematous gall bladder with pericholecystic fluid in 38 [76%] patients. In 8 [16%] patients, gall bladder was small, shrunken and thick walled, there was empyema in 2 [4%] patients and mucocele with stone impacted at hartmann's pouch in 2 [4%] patients. Average operation time was 40 minutes. All patients were operated within 72 hours of onset of symptoms. Per operatively severe inflammation was noted in 32 [64%] patients, adhesions with colon/stomach/omentum in 10 [20%] patients, adhesions with CBD in 3 [6%] patients, distorted anatomy at Calot's triangle in 5 [10%] patients. 6 [12%] patients had bleeding from liver bed, but controlled with diathermy. In 46 [92%] patients laparoscopic cholecystectomy was completed successfully. In 4 [8%] patients, laparoscopic procedure was converted to open cholecystectomy. Reasons of conversion were acute cholecystitis with severe adhesions which caused bleeding in 2 [4%] patients, obscure anatomy of Calot's triangle in 2 [4%] patients. Post operatively, there was bile leak in 1 [2%] patient which was due to minor injury of CBD, which required re-exploration and suturing of defect. No patient developed post operative jaundice. There was no major bleed post operatively. 3 [6%] patients developed wound infection. Laparoscopic cholecystectomy is an effective and safe technique of treating symptomatic gallstones even in cases of acute cholecystitis because of accelerated recovery couple with less postoperative pain and short hospital stay

Veress needle related complications in laparoscopic surgery: our experience

A retrospective analytical, multicenteric study conducted to evaluate closed technique for creating pneumoperitoneum in terms of procedural safety. 5244-patients undergoing laparoscopic surgery from January 2001 to December 2009 for different indications in which pneumoperitoneum was created using closed technique by veress needle. Evaluation of results was done by analyzining the data in SPSS V-17. Only 31 [0.6%] patients developed complications like small bowel injury [0.04%], liver injury [0.02%],omental vascular injury [0.13%], omental emphysema [0.19%] and extra peritoneal emphysema [0.2%] while using the closed method for primary access. Only one patient required major intervention while all the rest were managed by simple measure laparoscopically. Closed technique using veress needle for creating pneumoperitoneum is as safe as Hasson's technique and no method has advantage over the other

Thyroid malignancy; management update

[1]. Audit of our one year experience of management of thyroid carcinoma in accordance with latest approved guidelines. [2] To point-out high risks of malignancy in population with thyroid diseases. Prospective study. Surgical Unit-IV of DHQ Hospital Faisalabad with cooperation of Department of Pathology, Punjab Medical Collage, Faisalabad. From 2000-2001. All patients irrespective of age and sex with suspicious of thyroid malignancy were included in this study Out of total 56 patients of thyroid diseases 13 cases were proved thyroid carcinoma on histopathology. Carcinoma of thyroid was found more common in females. Papillary carcinoma was found in early age group. Follicular carcinoma was found in younger age group. All patients with anaplastic carcinoma were above, the age of 50 years. Total thyroidectomy was found the treatment of choice for the management of carcinoma thyroid. Modified neck dissection was done in selected cases. We offered lobectomy for one patient with young age with 1.5cm lesion in one lobe. Most patients were placed on TSH suppression thyroxine therapy. Postoperative follow-up was done for one year. The most important prognostic factor was age of patient, size, type and extent of tumor. Another important factor was the treatment of the disease offered to the patient. Screening programme at least in goitrous areas should be done to detect malignancy at early stage and then early management should be offered in hope of good survival and least morbidity