Management of polypoid lesions of the gall bladder

To analyze the demographic and clinical characteristics of patients diagnosed with polypoidal lesions of gall bladder and to correlate the radiological and histopathological diagnosis. Descriptive study. At Hamdard University Hospital Karachi over a period of 9 years [July 1999- June 2008]. The study included all those patients who were operated for gall bladder polyps. Patients of both sexes above14 years of age diagnosed on the basis of ultrasound and underwent cholecystectomy were included in the study. Twenty eight patients were included in this study with male to female ratio of approximately 1:8. Mean age of patients was 47.5 years. Twenty five patients were having symptomatic gall bladder disease. On the basis of ultrasound 19 patients had solitary polyp while 9 had multiple lesions. All these patients were operated laparoscopically; only one patient had a conversion to open cholecystectomy. Out of total 28 patients 19 were histopathologically proven benign polyps, one patient had severely dysplastic polypoidal lesion while eight patients had chronic cholecystitis with prominent folds with or without gall stones. Of 19 patients with benign disease 15 had cholesterol polyps and remaining 4 had adenomas. Gall bladder polyps are important cause of symptomatic gall bladder disease with peak incidence in 4th to 5th decade. Most of the gall bladder polyps are benign with cholesterol polyps and adenomas being the commonest lesions found on histopathology. Ultrasonography is good diagnostic tool with reasonable accuracy

Laparoscopic surgery in children

To assess the efficacy and safety of various laparoscopic procedures in paediatric population. An analytical case series. Various public and private sectors hospitals of Karachi, from January 2001 to December 2006. Case records of all paediatric patients who underwent laparoscopy for diagnostic or therapeutic purposes were reviewed. Age, sex, investigations, preoperative diagnosis, per operative diagnosis, procedure, duration of operation, hospital stay and intra-operative and post-operative complications where recorded. Patients with impalpable testes were excluded from the study as they are reported in another study. During the study period, 19 paediatric patients underwent laparoscopy for different surgical conditions. Age ranged from 5 to 12 years. Eight patients were males and 11 females. Six patients underwent cholecystectomy for cholelithiasis. Investigations did not reveal any cause for cholelithiasis. Appendicectomy was performed in 7 cases. Two of them had interval appendicectomy, while five were operated for acute appendicitis. Out of 5, three had acute appendicitis while two had mesenteric lymphadenitis. Adhesiolysis was performed in five patients. Adhesions in four of them were due to tuberculosis, band, recurrent appendicitis and post-operative adhesions, while in fifth patient no cause could be ascertained. One patient underwent left varicocelecotmy. None of the patients required conversion to open surgery. There was no intra-operative complication while post-operative complications were minimal. We conclude that laparoscopic surgery is feasible, effective and safe in the management of a wide range of surgical conditions in children

Repair of vesico-vaginal fistula by using omental flap

Fourteen patients of vesico-vaginal fistula of more then 2 cm, of high type, were treated by transperitoneal trans-vesical approach with extensive dissection and omental flaps over a period of 4 years. Their age ranged from 20 to 76 years. 78.5 percent patients belonged to younger age group [20-40 years] with history of long duration and neglected labour. Three cases were already operated for repair of vesico-vaginal fistulae once or twice trans-vaginally and failure was reported within three months after repair. The success rate of this series is 93%. Out of fourteen repairs only one failure was recorded in one of the recurrent cases, who was diabetic, had renal stone and persistent urinary tract infection