ABSTRACT
Introduction: Laparoscopic cholecystectomy today hasbeen rapidly embraced worldwide as the procedure of choicefor cholecystectomy. Conventionally, titanium clips areused to ligate the cystic duct. Recently, various methods ofsuture ligation of the cystic duct both intra corporeal andextra corporeal have been described during laparoscopiccholecystectomy. Only limited number of studies have beencarried out prospectively to compare the various methods. Thepresent study was thus designed to compare clip occlusionversus extra corporeal suture ligation (Roeder knot) of thecystic duct in laparoscopic cholecystectomy.Material and methods: This study was a single blindedrandomized controlled trial conducted on 150 adult patientsundergoing laparoscopic cholecystectomy. They wererandomized into two groups of 75 each to compare theprocedures of clip occlusion versus extracorporeal sutureligation (Roeder knot) of the cystic duct with respect to theoperative time, complications, associated morbidity, operativecost and hospital stay.Results: There was no significant (p>0.05) differencein duration of surgery between the groups (Clipligation=40.44±4.63 minutes, suture ligation=43.32±4.44minutes). Bile leakage due to slippage of ligature was presentin 2 (2.7%) patients with clip ligation as compared to 0% insuture ligation. This difference was found to be statisticallysignificant (p=0.03). Obstructive jaundice due to accidentalligation of CBD was present in 2 (2.7%) patients with clipligation as compared to 0% in suture ligation. This differencewas also found to be statistically significant. (p=0.03). Thecost of Clip ligation (Rs.369.07±8.08) was higher than sutureligation (Rs.300.00±0.00).Conclusion: The results of this study indicate thatextracorporeal (Roeder’s knot) is a safe, cost effectivealternative with a low complication rate as compared totitanium clip ligation of the cystic duct in laparoscopiccholecystectomy
ABSTRACT
Objective To explore and discuss the safety and treatment effect in intraoperative and postoperative intracerebral an-eurysm clip occlusion .Methods Retrospective analysis of 285 cases from April 2010 to April 2012 which underwent aneurysm clip occlusion was conducted .All patients received lumbar drainage surgery after anaesthesia .All patient′s complications were statisti-cally analyzed .Results In 285 patients ,no aneurysm rupture happened after drainage ;brain retraction syndrome′s incidence rate was 3 .00% ;cerebral vasospasm′s incidence rate was 11 .60% ;hydrocephalus′s incidence rate was 2 .10% ;intracranial infection′s incidence rate was 9 .10% .The mortality rate was 1 .05% .Conclusion Lumbar drainage is a safe ,effective ,simple treatment .It can effectively reduce the risk of aneurysm clip occlusion ,prevention and treatment of postoperative complications ,and ultimately im-prove the prognosis .
ABSTRACT
The authors have experienced seven cases of spontaneous intracranial dissecting aneurysm. Headache on the suboccipital region was the most common presenting symptom. Four patients had subarachnoid hemorrhage(SAH). Most of the patients were males:six men, one woman. The locations of the aneurysm were vertebral artery in six and basilar artery in one. An irregularly narrowed arterial segment with proximal and/or distal dilatation was the most significant angiographic findings. The introduction of MRI and DSA made the diagnosis of dissecting aneurysm easier in the suspicious cases with a traditional cerebral 4-vessel angiography. Five patients were treated surgically:Proximal clip occlusion of affected artery in three cases, trapping in one, wrapping combined with proximal clip occlusion in another. The surgical results were excellent in all the cases. There was no further dissection of affected artery on postoperative follow-up angiography.