Cholecysto cholangiography versus cystic duct cholangiography in laparoscopic cholecystectomy: a prospective controlled randomized trial

This study evaluated the safety and effectiveness of cholecysto-cholangiography [CCC], an extremely rapid and easy way of imaging the biliary tree during laparoscopic cholecystectomy and a viable alternative to cystic duct cholangiography in the era of minimal invasive surgery. Sixty patients with symptomatic gallbladder stones were studied in this series, 30 were evaluated for cholecysto-cholangiography and other 30 for transcystic-cholangiography. The success rate in cholecysto-cholangiography approached 80% with excellent quality films obtained. Delineation of anatomy approached 85%; 75% for cholecysto-cholangiography and transcystic cholangiography respectively. Exposure time to radiation compares favourably with cystic duct cannulation with a mean time 2.4 min. Cholecysto-cholangiography added less than 11 mins to the procedure; mean 10.4 mins, while transcystic cholangiography added an extra 30 mins; mean 31 mins. There were no cholangiogram related complications or false positive findings with a smooth for two months follow up

Assessement of peritoneal adhesions due to starch granules of surgical glove powder an experimental study

Introduction of foreign material into abdominal cavity during surgery causes irritation of peritoneum leading to postoperative [P0] adhesions. To assess and prevent P0 adhesions, an experimental study was done to assess the caused by starch granules of the surgical glove powder and to avoid complications using the effect of normal saline and low molecular weight heparin [LMWH]. Thirty Wister Albino male rats were subjected to laparotomy and ileocaecal abrasions were done mechanically to induce postoperative peritoneal adhesions. Rats were divided into 3 groups, 10 animals each. The sterile starch powdered gloves were used in the laparotomy procedure. The basic procedure performed in the three groups was serosal abrasions at the ileocaecal region and using the 2-layer technique in the closure of the abdominal cavity. In GI no further management was performed than the basic procedure. In GIl and G III before closure normal saline and [LMWH] was spilled into the peritoneal cavity respectively. The results showed that in GI, there were severe firm intraperitoneal adhesions especially at the site of the ileocaecal abrasions. This was proved macroscopically and histologically. The reactions detected in biopsies of GIl and GIll were lesser in intensity compared to GI. Morphometric assessment of collagen deposition in the intra-peritoneal adhesions revealed a significant decrease in GIl and GIll compared to GI

Conservative versus radical surgery for treatment of uncomplicated hepatic hydatid cysts

This work evaluated both radical and conservative surgical approaches in the management of hepatic hydatid cyst. A total of 32 cases with uncomplicated hepatic hydatid cysts were divided into 2 groups according to the type of surgery. Patients in the first group [n=18] were subjected to conservative surgery in the form of endocystectomy, omentoplasty with or without drainage. Cases in the second group [n= 14] underwent radical surgery that included closed pericystectomy, open pericystectomy, wedge hepatic resection or segmentectomy. The results showed that the use of rib cage retractor could avoid the need for thoracotomy incision with its morbidity to manage cysts at the dome of the liver. The mean operating time in GI [140.15 +/- 38.30 mm] was significantly shorter than in GII [190.4 +/- 50.2 mm], with P<0.05. The need of blood transfusion in GI [16.7%] was lesser than in GII [35.7%], but the difference was statistically not significant. The postoperative pain, evaluated by the number of IM analgesic injection was significantly lower in GI [7.2 +/- 3.3] than in GII [9.9 +/- 3.9] with P<0.05. Wound complications were more observed in GII. There was only one reported recurrence in G I in a case with multiorgan cysts that did not receive perioperative anthelmintic chemotherapy. So, conservative surgical management of uncomplicated hepatic hydatid cysts with perioperative anthelmintic chemotherapy supposed to be a simple, safe and effective approach. Its efficacy is comparable to radical surgical procedures with much less morbidity