Control of cystic artery in laparoscopic cholecystectomy: to clip or to use monopolar electrocautery

The purpose of this study was to compare monopolar electrocautery with clip application for securing hemostasis of cystic artery in patients undergoing laparoscopic cholecystectomy. A comparative study was performed on data collected during a 6-years period [2005-2011] from 600 patients who underwent laparoscopic cholecystectomy. In 306 cases assigned to group 1, the cystic artery was clipped while in 294 cases assigned to group 2, the cystic artery was coagulated with monopolar electrocautery. In group 1, the cystic artery was single in 91%, branched in 6% and absent in 3% cases while in group 2, the cystic artery was single in all cases. The cystic artery was of normal size in 82%, short in 7%, long in 8% and absent in 3% cases in group 1 while in group 2, it was normal in size in 88%, short in 3% and long in 9% cases. The cystic artery was originating from the right hepatic artery in 97% cases and from the superior mesenteric artery in 3% cases in group 1. In group 2, the cystic artery was originating from the right hepatic artery in 97% cases and not visualized in 3% cases. In group 1, only 3 patients had an intra-operative hemorrhage while in group 2, 3 of the patients had bleeding. The post operative recovery was also similar in both groups with 83% and 81% patients going home on the next day. There was no difference in the outcome of patients whether clips or monopolar electrocautery was used for hemostasis of cystic artery in laparoscopic cholecystectomy

Acute abdomen cases presenting at Fauji Foundation Hospital, Rawalpindi

To study the common causes of acute abdomen at Fauji Foundation Hospital, Rawalpindi, Study Design: Descriptive study. This Study was conducted at the Department of Surgery, Fauji Foundation Hospital, Rawalpindi from December 13, 2009 to February 22, 2011. A total of 840 patients who presented with acute abdominal pain and were admitted from the emergency department of Fauji Foundation Hospital, Rawalpindi from December, 2009 to February, 2011 were included in the study. The data of the 840 male and female patients was collected on the Patient Performa and then transferred to the data sheet IV of SPSS 10. The results were analyzed by calculating the frequencies of acute abdomen causes. The most frequent cause was non specific abdominal pain [38.7%] followed by acute cholecystitis [7.7%] and acute appendicitis [6.8%]. Total exploratory laparotomies done were 204 [24.3%] while 498 [59.3%] patients were managed conservatively with ultrasound abdomen and pain medication. Non specific pain was found to be the most common cause of acute abdomen followed by acute cholecystitis and acute appendicitis. The diagnostic accuracy can be enhanced especially in females of child bearing age by the use of ultrasonography and selective diagnostic laparoscopy

Ductal variations in the Calot's triangle seen on laparoscopic cholecystectomy

To describe the frequency and pattern of ductal variations seen in the Calot's triangle on laparoscopic cholecystectomy. Descriptive study. This study was conducted in the Surgical Unit 1, Fauji Foundation Hospital, Rawalpindi from December 13, 20008 to February 22, 2011. 200 patients with a diagnosis of biliary colic, cholelithiasis, acute cholecystitis, empyema gall bladder and mucocele gall bladder were included in this study. Patients with age less than 15 years were excluded. Careful dissection of the Calot's triangle was carried out. The anatomical variations of the cystic duct and other anomalous variations in the region were noted and data analyzed on SPSS 10. The age range was 19 to 88 years with a mean of 48 years. The majority [88%] of the patients presented with a clinical diagnosis of biliary colic. The cystic duct was of normal size in 88%, short in 7%, and long in 5% of the cases. The cystic duct terminated laterally into the common hepatic duct in 94% of the cases, anteriorly into the common hepatic duct in 5% and posteriorly into the common hepatic duct in 1% of the cases. Each Calot's triangle differs from the other. Ductal variations are the hallmark of this region and their knowledge is mandatory for a safe laparoscopic cholecystectomy

comparison between open and closed hemorrhoidectomy

Haemorrhoidectomy is associated with complications including pain, bleeding and wound infection which can result prolonged hospital stay. Haemorrhoidectomy is considered to provide a better outcome in terms of postoperative pain and wound healing. Aims were to compare postoperative pain, bleeding, operating time and wound healing in patients undergoing open and closed haemorrhoidectomy. This comparative study was conducted in the surgical department at Fauji Foundation Hospital, Rawalpindi from December 13, 2006 to December 31, 2011. Consecutive patients, both male and female, presenting with 3[rd] and 4[th] degree haemorrhoids in the surgical Outpatient Department were included in this study. Half of the patients were assigned to the open haemorrhoidectomy group while the other half was put in the closed haemorrhoidectomy group. Each patient was evaluated by detailed history and examination. Both digital rectal examination [DRE] and proctoscopy were done to confirm the diagnosis. A total of 260 patients were assessed, 130 in each group. In the open group, 52 patients experienced mild pain and 78 moderate while in the closed group, 30 patients experienced mild pain, 87 moderate and 13 patients severe pain. All 130 patients in the closed group showed complete wound healing after 2 weeks as compared to only 66 patients in the open group with a p<0.001. Early and late postoperative bleeding was similar in both groups. The closed technique provides a better outcome in terms of less postoperative bleeding and complete wound healing, but it is associated with more pain

Vascular variations in the calot's traingle seen on laparoscopic cholecystectomy

To describe the frequency and pattern of vascular variations seen in the Calot's triangle on laparoscopic cholecystectomy. Descriptive study. From December, 2008 to February, 2011. Surgical Unit 1, Fauji Foundation Hospital, Rawalpindi. Two hundred patients with a diagnosis of biliary colic, cholelithiasis, acute cholecystitis, empyema gall bladder and mucocele gall bladder were included. Patients with age less than 15 years were excluded. Careful dissection of the Calot's triangle was carried out. The anatomical variations of the cystic artery and other anomalous variations in the region were noted and data analyzed on SPSS 10. The age range was 19 to 88 years with a mean of 48 years. The majority [88%] of the patients presented with a clinical diagnosis of biliary colic. The cystic artery was single in 91%, branched in 6% and absent in 3% cases. The cystic artery was supero-medial to the cystic duct in 88%, anterior in 6%, and posterior in 3% of the cases. Other arterial variations included Calot's arteries [2%], Moynihan's Hump [3%] and gall bladder arterial supply from liver bed [3%]. Each Calot's triangle differs from the other. Vascular variations are the hallmark of this region and their knowledge is mandatory for a safe laparoscopic cholecystectomy