ABSTRACT
This study was done to assess the association between quality of laparoscopic instruments and the incidence of conversation from laparoscopic to open cholecystectomy. Observaional and descriptive study from October 2004 to September 2006. This study was conducted at Baqai Medical University Hospital and two other private hospitals in Karachi. All patients who underwent laparoscopic cholecystectomy, including those that had to be converted. The records of all attempted laparoscopic cholecystectomies were studied retrospectively. Apart from demographic data, the clinical diagnosis, histopathology, conversion rate and quality of the instrument i.e. old or new was studied. SPSS Version 11 was used for statistical analysis. The frequencies were drawn and association between conversion rate and quality conversion rate and quality of instruments was noted using odds ratio. Laparoscopic cholecystectomy was attempted in 93 patients during the study period. Amongst them 79 were females and 14 males, with an age range 16 to 72 years [mean 46 years]. Seven [7.53%] patients had to be converted from laparoscopic to open cholecystectomy. The causes of this conversion were instrument failure in five cases, CBD stone in one and unclear anatomy at Calot's triangle in one case. The laparoscopic instrument that failed during surgery included insufflators in two cases while monitor, camera, and clip applicator, each in one case. Fifty six surgeries were performed with old instruments and 37 with new instruments. Correlating the two variables i.e. conversion rate and quality of laparoscopic instruments revealed that only one case was converted with new instrument, while six conversions were with old instrument. All the instrument failures were with old instruments and the odds ratio was 4.32. The chances of conversion from laparoscopic to open cholecystectomy are 4.32 times more if old instruments are used compared to the new ones. The difference in conversion rate due to instrument failure is stasitically significant
Subject(s)
Humans , Male , Female , Cholecystectomy , Equipment Failure , GallstonesABSTRACT
The objective of the study was to explore the prognostic factors by comparing survivor from non-survivor group with the diagnosis of acute mesenteric ischemia. This study was conducted at the Aga Khan University Hospital, Karachi over six and half years. Eighteen patients were hospitalized with the diagnosis of acute mesenteric ischemia [AMI]. Survivor and non-survivor groups had 8 and 10 patients respectively, giving the overall mortality rate of 56%. The surviving patients had significantly shorter length of bowel necrosis, i.e. 176 cm [mean] compared to 525cm [mean] in non-survivor group [P-value 0.0003]. The surviving patients also had less number of "re-look" laparotomies as compared to non-survival group; mean 1.1 and 2 respectively [P-value 0.0002]. The higher number of "re-look" laparotomies were attributed to incorrect visual determination of bowel viability at the time of first laparotomy. The duration of symptoms and interval between arrival to hospital and operation were not different between the two groups [P values 0.98 and 0.65 respectively]. Length of bowel necrosis and number of surgical procedures are the prognostic factors in acute mesenteric ischemia. Comparing the two groups also showed that difference in age, sex and symptoms were insignificant