Laparoscopic cholecystectomy; early vs delayed acute cholecystitis

The role of laparoscopic cholecystectomy in treatment of acute cholecystitis is still controversial. The objective of this prospective randomized controlled trial was to evaluate the outcomes of early laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy. Sheikh Zayed Hospital, Lahore. 1[st] Feb, 2012 to 31[st] July 2012. 60 diagnosed patients of acute cholecystitis were randomly allocated to two groups, Group 1 underwent early laparoscopic cholecystectomy [Group 1, n = 30] and Group 2 to initial conservative treatment followed by delayed laparoscopic cholecystectomy, 6 to 12 weeks later [Group 2, n = 30]. The overall complication rate was 3.3% [01] in early group and 16.7% [05] in the delayed group. There was no common bile duct injury in both groups. The complications included wound infection and intraperitoneal collection. According to the results our study we concluded that early laparoscopic cholecystectomy can safely be carried out for acute cholecystitis as the complications for early laparoscopic cholecystectomy are less as compared to delayed laparoscopic cholecystectomy. Early laparoscopic cholecystectomy has also an edge over delayed because of single hospital stay

Colorectal carcinoma; frequency in adult patients presenting with large bowel obstruction

Introduction: Large bowel obstruction due to colorectal carcinoma occurs in up to 20% of the patients and usually accompanied by morbidity and mortality[2-4]. Almost 25 % deaths occur post-operatively following surgery for colorectal cancers occur in those who initially present with obstruction[1]. Usually elderly patients with associated co-morbidities presents with bowel obstruction

Objective: Find out the frequency of colorectal cancers in patients presenting with large bowel obstruction

Design: Prospective cross sectional study

Setting: Shaikh Zayed Hospital Lahore

Period: from 31st December 2010 to 31st December 2012

Materials and Methods: A total 20 patients were presented with large bowel obstruction with the age ranges between 40 to 70 years. All the 20 patients underwent routine haematological and biochemical tests. In these patients an abdominal x-ray in a supine or standing position was taken and dilated loops of bowel, air-fluid interfaces, or both was observed then Contrast radiography [Barium/gastrograffin] was done to define the site and extent of the obstruction. An abdominal computed tomography scan was done to evaluate the extent of the disease. Colonoscopy was also carried out in the patients with colorectal cancers to find out the size and location of the tumor and biopsy taken by colonoscope

Results: 12 patients out of 20 presented with large bowel obstruction were diagnosed to have a colorectal cancers and the age ranges from 60 to 70 years. The 8 patients were diagnosed to have a sigmoid colonic tumour and 4 patients were suffering from a tumour of recto sigmoid junction. Whereas in rest of the 8 patients the large bowel obstruction was due to other benign causes like volvulus and intussusception and age range was 50 - 60 years. 6 patients were suffering from sigmoid volvulus and remaining 2 had colo-colic intussusception

Conclusions: It is concluded that the major cause of the large bowel obstruction is the left sided colorectal cancers the tumours of recto sigmoid junction