How early is early laparoscopic cholecystectomy in acute cholecystitis?

The efficacy and timing of early laparoscopic cholecystectomy for acute cholecystitis has been a subject of debate for years. Prospective comparative study, done at Ghulam Muhammad Mahar Medical College and Hira Medical Center, Sukkur, from July 2007 to June 2010. All patients undergoing Laparoscopic cholecystectomy for acute cholecystitis were included in the study. They were admitted through emergency with acute cholecystitis. Patients were divided into two groups according to the timing of surgery from the onset of symptoms. Group I included 205 patients who presented with acute cholecystitis within 48-72 hours of onset of symptoms and their surgery was done within 48-72 hours of presentation. Group II included 95 patients who presented after 72 hours of onset of symptoms and their surgery was done after 72 hours to one week of presentation. Clinical data was recorded and routine investigations along with ultrasound abdomen were carried out. The procedure performed, and its complications and success rate noted and compared between the two groups. The study included 300 patients with acute cholecystitis who underwent early laparoscopic cholecystectomy within 48 to 72 hours of onset of symptoms in Group I and after 72 hours to 1 week in Group II. Among 300 patients there were 90[30%] males and 210[70%] females. The age of patients ranged from 20 to 70 years with a mean of 45 years. There were no open conversion in group I while 4.2% had to be opened in group II, the median operative time was 65 minutes in group I and 90 minutes in group II, postoperative hospitalization was 1 day in group I and 3.5 days in group II and total hospital stay was 2 days in group I and 4.5 days in group II. Intra-operative and postoperative complications were less in group I as compared to group II. Early laparoscopic cholecystectomy within 48-72 hours of onset of symptoms results in lower conversion rate, shorter operative time and reduced hospitalization. All patients with acute cholecystitis should be operated within 48-72 hours of the symptoms

Outcome analysis of transvesical prostatectomy in our setting

To evaluate the outcome of suprapubic transvesical prostatectomy in our setting. Prospective and descriptive audit from July 2002 to July 2005. Department of Surgery, Peoples Medical College Hospital, Nawabshah. A total of 120 patients with lower urinary tract obstruction due to benign prostatic hyperplasia [BPH]. The details of all the above mentioned patients were recorded and the data analyzed for age, presentation, accompanying problems, blood transfusion, hospital stay, complications and mortality. The age range of the patients was from 50-90 years, mean age being 64.73 years. The indications for surgery were retention of urine in 64 [53.33%] cases, prostatism in 53 [44.17%] and haematuria in three [2.5%] cases. Associated problems were seen in 73 [60.83%] patients, including bladder stones in 19 [15.83%], inguinal hernia in 15 [12 .5%], haemorrhoids and renal stones in four [3.33%] each, and medical problems in 30 [25%] patients. The average operation time was 67.5 minutes and 51 patients needed blood transfusion [1-3 units]. Complications were seen in 49 [40.83%] cases including haemorrhage and urinary tract infection in eight [6.67%], clot retention in six [5%], wound sepsis in seven [5.83%], and transient incontinence and suprapubic urinary leakage in five [4.17%] cases each. The post-operative mortality was in 1.67% [two cases]. Transvesical prostatectomy [TVP] performed under spinal anesthesia is a safe and effective way of managing BPH. Its success has a durable effect and is a satisfactory modality in situations where facilities for transurethral resection of prostate [TURP] are not available