Day care laparoscopic cholecystectomy: a study of feasibility and safety in Qatar

Laparoscopic cholecystectomy [LC] is the treatment of choice for symptomatic gall bladder disease amid is one of the most frequently performed operations in Qatar. Day-care laparoscopic cholecystectomy [DCLC] was started in 2003 offering many advantages over conventional laparoscopy including reduced demand for hospital beds. DCLC has been shown to be safe in many centers worldwide but in Qatar its feasibility and safety had not been studied. During the 24 months July 2003-July 2005 fifty-six cases of DCLC were studied. Inclusion criteria were aged less than 60 years, Grade 1 and 2 anesthesia risk according to American Society of Anesthesiology [ASA], living within an hour's drive of the hospital, had telephone access, living with a responsible adult, capable of reaching the hospital with or without depending on emergency medical services [EMS], able to understand discharge instructions, agreeing to participate by informed consent and the presence of symptomatic gall bladder disease. Complicated cases were excluded. The success rate of DCLC [same day discharge] was 48/56[86%], most patients being observed in the Daycare Unit [DCU] for 6-8 hours. Pain, post-operative nausea and vomiting [PONV] were the most common causes of failure. There were no re-admissions within 30 days of surgery. Complications were minor and most patients were highly satisfied with same day discharge from the hospital. We conclude that DCLC is safe, feasible and has potential benefits for the health care system in Qatar .Surgeons performing laparoscopic cholecystectomy should recognize the advantages of DCLC and offer this approach to their patients in uncomplicated cases

An unusual common bile duct foreign body

A 35-year-old man developed obstructive jaundice ten months after laparoscopic cholecystectomy. Endoscopic retrograde cholangiography extracted a foreign body from the common bile duct. Histopathological examination revealed that the extracted foreign body was the remnant of vicryl endoloop with calcification around. Since laparoscopic surgery has become a very common procedure, endoclips and endoloops are used more frequently. It is emphasized that careful surveillance and strict follow-up are necessary to avoid similar complications

Effect of duodenal ulcer surgery on Helicobacter pylori

The association of Helicobacter pylori [Hp] with gastritis and chronic peptic ulceration has been shown. Although there are data on the effects of medical therapy for peptic ulcer on Hp, the fate of this organism after peptic ulcer surgery has not been established. The effects of surgery for chronic duodenal ulcers on Hp was explored. A series of 30 patients with chronic duodenal ulcer [Du] were selected for this study and classified into 3 groups: Group A underwent highly selective vagotomy [18 patients + 60%], group B underwent truncal vagotomy and drainage [9 patients = 30%] and group C underwent a resective procedure [3 patients = 10%]. Endoscopic biopsies were examined preoperatively as well as one month and 6-12 months postoperatively for the presence of Hp and gastritis. Seventeen patients of group A were Hp positive preoperatively [94.4%] and remained positive postoperatively. All ulcers of this group have healed. All 12 patients of groups B and C were Hp positively and became negative postoperatively [100%], while 2 cases of ulcer recurrence were detected in group B. The study suggested that Hp cannot survive in the enterogastric reflux following operations that disrupt or bypass the pyloric sphincter and that Hp infection is not a main cause in ulcer recurrence after surgery while successful control of acid secretion is the corner stone in treatment of Du