Laparoscopic cholecystectomy fate of spilled bile with gallstones during laproscopic cholecystectomy

There is a continued debate on fate of spilled bile with gallstones during laparoscopic cholecystectomy, so we felt that the outcome needs further evaluation in detail. Although laparoscopic cholecystectomy become increasingly popular, but it is associated with a slightly higher chances of injury to biliary tree and perforation of gallbladder with spillage of bile only or with gallstones. [1] To evaluate fate of spilled bile with gallstones during laparoscopic cholecystectomy. [2] To assess various possible outcomes. [3] Suggestions to prevent these and their management. Prospective study. Surgical unit of Muhammad Medical College Hospital, Mirpurkhas. February 2008 to April 2011. Data source: Total 100 patients who underwent elective laparoscopic cholecystectomy were included. Age, sex, duration of operation, operative findings, duration of hospital stay and post-op complications were recorded in proforma and analyzed on SSP version 10. The patients who underwent cholecystectomy, and had intra-operative spillage were shortlisted, included in this study and followed up. Short-term follow-up was based on OPD visits for 2 to 3 weeks postoperatively, and long-term follow-up was achieved by regular OPD visits or telephone conversation in patients at a mean of 1.4 years [range 2 to 39 months].all minor or major complications were recorded in preformed proforma. A total of 100 patients underwent laparoscopic cholecystectomy. Among the patients who underwent elective laparoscopic cholecystectomy the incidence of Iatrogenic perforation of the gallbladder is around 40%, of whom about 22% had spillage of only bile and 18% in whom spillage of both bile and gallstones. It is concluded that laparoscopic cholecystectomy with gall bladder perforation along and spillage of bile and stones took longer operative time than intact gall bladder. We suggest that attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure. In our study, we revealed that no harm is caused by retained gallstones during laparoscopic cholecystectomy after long term followup by evaluation

Liver diseases: admissions and mortality in a medical ICU at a rural centre in Pakistan

To study the frequency of admissions, complications and death rates in patients with chronic liver disease [CLD] in a rural medical Intensive Care Unit [ICU]. Retrospective analysis of 174 consecutive admissions. Out of 174 consecutive admissions, 69 patients [40%] had background liver disease. However, 55 patients out of this total [32%] were admitted directly in ICU because of the features of complications of their liver disease. Twenty six out of fifty five [47%] died. Thirteen out of twenty six had signs of encephalopathy. Seven out of fifty five had more than one complications of liver disease-only one of them survived. Hepatitis C was the cause of liver-related deaths in 18/26 [69%]. CLD is the commonest cause of admissions [32%] in medical ICU-Hepatitis C being responsible for 69%. Liver disease and its complications were also the commonest cause of all deaths in medical ICU, of which Hepatitis C contributed 69%. Encephalopathy was the most common manifested complication of cirrhosis, causing highest mortality

Pattern of gallbladder diseases in Pakistan: an audit of 163 consecutive patients operated at a teaching hospital

To find out the presentation and histological diagnosis of patients with gallstones. A retrospective review of 163 consecutive patients who underwent cholecystectomy in a teaching hospital between 01-01-93 to 31-12-96. Baqai University Hospital, Nazimabad, Karachi. One hundred sixty three patients who underwent cholecystectomy. Histopathological reports of gallbladder. One hundred sixty three patients were operated between 1993 to 1996 at a teaching hospital of Karachi. 96 patients were started as laparoscopic cholecystectomy. Of these, 12 were converted to open procedure. Rest were planned and done as open cholecystectomy. 11 patients had exploration of common bile ducts. The histological reports of all these patients were assessed. The commonest finding was chronic cholecystitis. We however, found that 9 female and 1 male patients had carcinoma of gallbladder. Our management of gallstone disease stems from conclusions based on figures from the West. This study shows that the risk of gallbladder carcinoma may be higher in this part of the world. We have seen that out of 163.patients, 10 patients had carcinoma of gallbladder [over 6%]. This is in sharp contrast to the West where the rate of incidental carcinoma is only 1-2% of routine cholecystectomy. It is about time that a large, multicentral, prospective study is designed in line of that done by Ranshoff et al. to find if the natural history of gallstones is any different in our country