Day case laparoscopic cholecystectomy

Day case laparoscopic cholecystectomy [DC-LC] is being practised in the USA and at sporadic centres in the UK including our department. The aim was to evaluate the initial experience of DC-LC at the unit. Prospectively collected data was analysed retrospectively. The case notes of all patients were retrieved from the medical records and reviewed individually. Standard laparoscopic cholecystectomy was performed. All patients had anti-DVT prophylaxis [pneumatic compression and enoxaparin], per-operative antibiotic, oro-gastric tube, paracetamol suppository and local anaesthetic to all wounds. They were discharged the same day. The end point was 6-week follow-up [86% overall]. Over a 32-month period, 164 consecutive patients with symptomatic cholelithiasis and ASA score of III or less were included. M:F was 1:5 and median age 43y. There were two conversions. The direct admission rate [DAR] was 26/164 [14%]. The indication for direct admission included observation alone [7/26], wound pain [6/26], nausea [3/26], suction drain [2/26] and operation in the afternoon [2/26]. Six [3.6%] required re-admission. One had a cystic artery pseudo-aneurysm presenting with colonic bleeding and anot her with an injury to CBD. One had post-op mild pancreatitis and three had wound pain and bruising. DC-LC is safe and feasible in non-acute patients with symptomatic cholelithiasis

Adult intussusception - asurgical dilemma

Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospital admissions, 1/1300 of all abdominal operations, 1/30'1/100 of all cases operated for intestinal obstruction and one case of adult intussusception for every 20 childhood ones. The authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years. Small bowel obstruction was documented in all. They were investigated by radiographs, ultrasound exam, barium studies, endoscopy and CT scan. All however were diagnosed at operation although some pre-operative suspicion was raised in one case. All had a laparotomy. Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and three sub-acute. One intussusception had a malignancy [lymphoma] as a lead point. Two had a submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel anastomosis [2-3 weeks prior] was forming the lead point of the intussusception! The 2 ileo-ileal intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal cases. 'Target lesion' and leumen-within-leumen were the CT hallmarks on review. Retrospective barium enema review failed to show the intussusception. This may suggest the intussusception may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient was referred for chemotherapy for intestinal lymphoma. Adult intussusception remains a rare cause of abdominal pain. The treatment almost always is surgical