Laparoscopic cholecystectomy in a patient with situs inversus: Advantage of 30 scope

Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world today. Symptomatic gallstones needs surgery also patients with situs inversus. We discuss our case and problems encountered during surgery and how to solve them. A 50-year-old male presented with recurrent epigastric and left hypochondriac pain for the last year. A diagnosis of gallstones in a patient with situs inversus totalis was made following clinical examination and radiological investigation. Laparoscopic cholecystectomy was subsequently performed and the patient made an uneventful recovery. Situs inversus presenting with symptomatic gallstones is very rare. Laparoscopic cholecystectomy and other abdominal surgical operations are more difficult in patients with situs inversus hence they are rarely practiced

use of fibrin glue in surgical treatment of pilonidal sinus disease: a prospective study in the limberg flap procedure

Different surgical techniques for pilonidal disease have been described in the literature. Limberg flap has low morbidity and recurrence rates. Fibrin sealant, a two-component tissue adhesive composed of fibrinogen and thrombin, has been used in a number of surgical procedures to achieve hemostasis and to seal tissues. The purpose of this study was to investigate the effect of fibrin sealant on the Limberg flap procedure. 132 male patients with pilonidal sinus who underwent Limberg flap operation were evaluated prospectively. The patients were assigned randomly into two groups [group 1; with suction drain, group 2; fibrin glue]. Seroma was encountered in 5 of 132 patients [3.78%]; Flap oedema occurred 4[6.06%] patients in group 1. Wound infection occurred in one patient [1.5%] in group 1. Most patients in group 2 were mobilized on the first postoperative day, and the median time to first mobilization was earlier in group 2 than in group 1 [1 [1-1] versus 2 [1-2] days respectively; P<0001]. The median duration of incapacity for work was 17 [15-20] days in group 1 and 8 [6-12] days in group 2 [P< 0.001]. Total wound dehiscence and flap necrosis did not occur in any patient. There has been no recurrence in any of the patients during the follow-up period. The mean time for complete healing of wound after rhomboid excision and Limberg flap plus fibrin sealant was 8.13 +/- 7.88 days [range 6-28 days]. This was markedly increased in group 1 patients [mean 22.08 +/- 8.59 days, and range 15-60][p < 0.001]. We recommend the use of fibrin sealant with Limberg flap technique. Our results suggest that drains may be avoided with fibrin sealant