Minilaparoscopic versus laparoscopic cholecystectomy: a randomised controlled trial.

Since its introduction in 1987, the technique of cholecystectomy has continued to undergo evolution. Surgeons have reduced the port size and number or both to achieve improvement in postoperative pain control, rapid return to activity and better cosmetic results. Therefore, this study was done to compare the standard 4 port laparoscopic cholecystectomy (LC) with the 3 port laparoscopic cholecystectomy using a 5 mm telescope instead of 10 mm telescope (mini laparoscopic cholecystectomy - MLC). Forty patients were randomised to each group. Mean operating time, intraoperative and postoperative complications, mean period to resume walking, eating and return to normal activities and mean hospital stay were similar in the two groups. The level of postoperative pain was significantly lower in the MLC group. Patients who underwent MLC required a significantly lower dose of analgesics. In conclusion mini laparoscopic cholecystectomy is a feasible and safe procedure with less postoperative pain and better cosmesis and without increased complications.

Evaluation of the Alvarado score in the diagnosis of acute appendicitis.

Acute appendicitis may simulate many other acute abdominal illnesses and the exact diagnosis is important for the proper management. The present study was undertaken to evaluate the role of the Alvarado score in the diagnosis of a patient with suspected appendicitis. The study was carried out on 100 patients operated with a presumptive diagnosis of acute appendicitis on the basis of clinical grounds. Alvarado scoring was done in all these patients preoperatively by different personnel. Discriminant analysis of the Alvarado score of all the patients was done to determine the cut-off value in an Indian set-up. The positive and negative predictive values of the Alvarado score were 77.6% and 52.4%, respectively. It is more effective in men and children, with a predictive value of 84% and 92.8%, respectively. Discriminant analysis revealed a cut-off value of > or = 6 rather than the original value of > or = 7. The sensitivity of the Alvarado score increased from 69.2% to 92% with the new cut-off value of > or =6. The Alvarado scoring system can be used in surgical emergency departments to diagnose acute appendicitis. In women, additional investigations may be required to confirm the diagnosis. The original cut-off value given by Alvarado may be changed in the Indian set-up to increase sensitivity.