Gall bladder stones: surgical treatment.

Background: There is higher incidence of gall stones in Karnataka and more commonly seen in women aged between 25 to 55 years. In this study men are also encountered with gall stone. As all the gall stones cannot be removed by laparoscopic procedure, the complicated and adherent gall bladder with stones and where laparoscopic procedure is not available are removed by conventional open method of cholecystectomy and in this study open cholecystectomy procedure is dealt in detail. Methods: Open cholecystectomy through Right Kocher’s incision. Results: In this study of 10 cases with complications of gall stones dealt surgically by doing open cholecystectomy gave satisfactory postoperative results without much postoperative complications. Conclusions: Among 10 cases of open cholecystectomy 6 cases were done through duct first method and 4 cases were done through fundus 1st method, which gave good results and less postoperative complications.

Prospective study of comparison between the ultrasonography with the plain radiography in the diagnosis of pneumoperitoneum of hollow viscus perforation.

Background: This study was conducted to compare the plain radiography with the abdominal ultrasonography in the detection of pneumoperitoneum in suspected cases of hollow viscus perforation. Methods: A total number of 60 patients with suspected hollow viscus perforation were studied. All the patients had undergone plain radiography (Erect x-ray abdomen and left lateral decubitus views), ultrasonography and exploratory laparotomy. The investigational findings were compared with that of laparotomy findings. They were compared in terms of their sensitivity, specificity, predictive value of a positive and negative results and their percentage of false positive and false negative results. Results: Of the 60 patients, who underwent laparotomy, 57 had hollow viscus perforation. Out of 3 non-hollow viscus perforated cases 2 had appendicular perforation and 1 had mesenteric lymphadenitis. In the diagnosis, ultrasonography vs. radiography, their respective parameters were sensitivity (73.7% vs. 80.7%), specificity (66.7% each), predictive value of a positive test (97.7% vs. 97.9%), predictive value of a negative test (11.8% vs. 15.4%), percentage of false negative (26.3% vs. 19.3%) and percentage of false positive (33.3% each). Conclusion: In detection of pneumoperitoneum plain radiography appears to be more sensitive than ultrasonography with comparable specificity. Ultrasonographic finding of pneumoperitoneum is considered as an added finding.