Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia

Problems during laparoscopic cholecystectomy include bile duct injury, conversion to open operation, and other postoperative complications. We retrospectively evaluated the causes for conversion and the rate of conversion from laparoscopic to open cholecystectomy and assessed the postoperative complications. Of 340 patients who presented with symptomatic gall bladder disease over a 2-year period, 290 [85%] patients were evaluated on an elective basis and scheduled for surgery, while the remaining 50 [14.7%] patients were admitted emergently with a diagnosis of acute cholecystitis. The mean age of the patients was 41.9 [12.6] years. Conversion to laparotomy occurred in 17 patients [5%]. The incidence of complications was 3.2%. The most common complication was postoperative transient pyrexia, which was seen in four patients [1.2%] followed by postoperative wound infection in three patients [0.9%], postoperative fluid collection and bile duct injury in two patients each [0.6%].Laparoscopic cholecystectomy remains the 'gold standard' by which all other treatment modalities are judged. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertise

Limited excision and primary closure for pilonidal sinus

Pilonidal disease is a common disorder of the sacrococcygeal region. Various techniques have been used but no method provides the ideal treatment. This study was done to establish to what degree pilonidal sinus could be treated with limited excision and primary closure. 39 patients with chronic pilonidal sinus were treated by limited excision and primary closure between July 2005 and January 2008 by the authors at general surgery department Mansoura University Hospital. They were followed up in the early postoperative period and thereafter for 12 to 30 months. One patient had mild seroma, another one developed irregular scar with accepted healing outcome. All patients were discharged from hospital in the 2nd postoperative day. Operative wounds healed in a period ranged from 12-22 days. The postoperative follow-up now ranges from 12 to 30 months, and no recurrences have been recorded so far. Limited excision of Pilonidal Sinus represents a good therapeutic option for treatment of pilonidal sinus This method has the advantages of having a low morbidity, short hospital stay, early return to work, no recurrence and good long-term results

Paraumbilical hernia repair during caesarean section; maternal and neonatal outcome

A prospective study to evaluate the outcome of combined cesarean section and paraumblical hernia repair in tertiary referral university hospital. Patients and methods: 48 patients undergoing Cesarean section combined with paraumbilical hernia repair versus 100 patients undergoing cesarean section alone. Main Outcome Measures: Operation time, Apgar Score, blood loss, uterine atony, breast feeding initiation, pain sensation, periparturn complications, prolonged lochia [more than 42 days], deep venous thrombosis, hospital stay, hernia recurrence, and patient choice. The combined procedure consumed significantly longer time than cesarean section alone in the mesh hernioplasty subgroup. There were no major complications. Apgar Score, uterine atony, initiation of breastfeeding, prolonged tochia, wound infection and hospital stay did not differ significantly from those of controls. Pain at hernia site repair in two patients, one hernia recurred in the primary repair subgroup during follow up period which reach up to 3 years. All hernia group patients reported that they prefere the combined operation. Combined cesarean section and paraumbilical hernia repair had the advantage of single incision, single anesthesia, and single hospital stay. The combination approach proved to be safe, effective, and well accepted