Early versus delayed laparoscopic cholecystectomy for the treatment of acute cholecystitis

Patients with a preoperative diagnosis of acute cholecystitis were prospectively allocated to treatment with early laparoscopic cholecystectomy within 24 hs of randomization or initial conservative treatment followed by delayed laparoscopic cholecystectomy 6-8 weeks later. There were 31 patients in the early group and 27 in the delayed group. There were no significant difference in conversion rate[early 19.4 percent versus delayed 22 percent], postoperative analgesic requirement [2 versus 1 dose]. Intra and postoperative complications. However, the early group has significantly longer operating time [112.5 versus 96.4 min, P=0.03] and shorter total hospital stay [3.7 versus 2.2 days, P<0.001]. The incidence of bacterial complications being markedly low, especially in the early group.These results indicate early laparoscopic cholecystectomy is safe and feasible for acute cholecystitis with the additional benefit of shorter total hospital stay and avoid the problems of failed conservative treatment and delayed surgery

Wedge resection alone or combined segmental phenolization for surgical correction of ingrowing toe nails

A retrospective analysis was undertaken of 194 patients treated surgically for ingrowing toenails. Each patient was randomly allocated to one of two treatment groups. There were 82 wedge resections and 112 wedge resection/segmental phenolization combination treatments. All patients were followed up for 6 months. The duration and intensity of postoperative pain was assessed and the recurrence rate monitored. Postoperative pain was less in wedge resection/segmental phenolization group [8.4 +/- 12.4 h] than in wedge resection group [31 +/- 36.7 h. P < 0.001]. There were 9 recurrences in the wedge resection group [11%] and none in the wedge resection/segmental phenolization group. The results in the wedge resection/segmental phenolization group were statistically significant when compared with the wedge resection group [P < 0.01]. It is concluded that the combination procedure gives better long-term results than wedge resection alone and allows excellent results to be achieved by all grades of surgeon

Submucous versus traditional haemorrhoidectomy [ligation and excision]

This study included 60 patients of both sexes complaining of symptomatic haemorrhoids [second, third degree and prolapsed piles]. These patients were divided into two groups: Group 1: included 30 patients were treated by submucosal ligation. Group 2: included 30 patients were treated by ligation-excision. Submucosal ligation was a time consuming operation [50 min.], compared with the time of ligation excision operation [20 min.], also the incidence of per-operative bleeding during submucosal ligation was high [23%] compared with that of ligation and excision [8%]. Post-operative pain was much reduced in submucosal ligation. Time required for healing in patients who underwent submucosal ligation was about 2 week, while that required for healing of wounds after ligation excision was about 5 weeks. Anal stenosis and stricture formation were less common in submucosal ligation [3%], their incidence in ligation and excision were [10%]. Sphincteric disturbance was relatively high in submucosal ligation [47%], as the study included a great number of females with a history of perineal tears. In conclusion, submucosal ligation is better in patients with 2nd and 3rd degrees of haemorrhoids

role of ultrasonography in the management of acute abdomen

The study comprised of 164 consecutive patients presenting with acute abdominal pain were assessed clinically and ultrasonographic examinations of 76 patients were performed. Of these, 54 [33%] patients would normally have had an immediate ultrasonographic scan requested; routine [within 24 h. of admission] ultrasonographic scan would have been requested in a further 22 [13%] patients. In 88 [54%] patients who were diagnosed as acute appendicitis, and ultrasonographic examination would not have been requested and appendicectomy was done for them. Ultrasonography altered the diagnosis in three patients. In the 1st patient, the diagnosis is altered from probable acute appendicitis to acute cholecystitis. In the 2nd patient, the diagnosis is altered from simple fractured rib [in car accident] to ruptured spleen with the fractured rib. In the 3rd patient, the diagnosis was changed from fracture femur and shock to multiple liver tears and retroperitoneal haematoma with the fracture femur. The study shows that immediate ultrasonographic examination of acute abdomen is helpful especially for patients with a history of trauma, for management and decision for urgent laparotomy and to exclude serious surgical pathology which required immediate intervention