Résumé
Gastrointestinal stromal tumors (GIST) represent only 0.1 to 3% of all gastrointestinal malignances. They are neoplasms with varying malignant potential ranging from virtually indolent tumors to rapidly progressing tumors. GISTs harbor an activating mutation in either kit or platelet derived growth Factor A (PDGTKA). Confirmation of diagnosis was mainly made by immunohistochemistry. We encountered 3 cases of GISTs with varying presentation. First one was a case of chronic abdominal pain for which the patient was evaluated and found to have mesenteric GIST and was operated electively after thorough work up. Second one presented as a case of acute abdomen. There was a small bowel gist causing intraluminal obstruction. The third one was a case of epigastric pain with recent episode of hemetemesis and malena for which she was evaluated with upper Gastro intestinal scopy and found to have gastric gist with low malignant potential. Patient underwent elective wide local excision of tumor with follow-up.
Résumé
Background: Vermiform appendix, though a vestigial organ in a human without much purpose forms. The most common cause of acute abdomen and also the most common surgical intervention by a general surgeon. Open appendicectomy has been practiced for more than 130 years all over the world with a good outcome. But laparoscopic appendicectomy grabbed the attention of not only surgeons but also the patients after the pioneering efforts of Kurt Semm in 1982. Although our hospital has been practicing open appendicectomy for many decades laparoscopic appendicectomy was introduced in recent past. The aim of the study: Aim was to compare the laparoscopic against open appendicectomy based on the following parameters: Post-surgical pain, Return of bowel sounds, Return to eating, Post-operative complications, Post-operative antibiotics duration. Materials and methods: Patients who come to the outpatient and emergency clinic of the Department of General Surgery, KAPV Government Medical College between January 2016 and June 2017. Among the patients who had come to General Surgery OP clinic and emergency clinic, after thorough examination patients with features of appendicitis were included as subjects for study. Patients were allotted as subjects in each group by simple random sampling. Blood investigation, Chest X-ray, X-ray abdomen, USG abdomen, CT abdomen were done and assessment obtained for Yeganathan Rajappan, Anandan Kanthan, Mahalakshmi Ashok Kumar, Manimaran Thangavelu. A comparative study between laparoscopic and open appendicectomy in KAPV Government Medical College, Trichy. IAIM, 2019; 6(3): 259- 265. Page 260 those patients after sufficient resuscitation with iv fluids, antibiotics, and analgesics. Patients who were diagnosed with appendicitis were explained about the diagnosis, need for surgery, surgical procedure planned and its complications and then informed written consent obtained. Results: In our study, mean operation duration for LA was 61.54 min and 51.62 min for open appendicectomy. The p-value was 0.022 which was significant statistically. Operation duration was short in laparoscopic appendicectomy. Our study also shows less pain for lap group which was calculated using a pain rating scale, with mean in OA as 3.16 and 2.32 in LA group and the p-value was p-0.000 which was statistically significant. Diet was started earlier in lap appendicectomy group in our study. Postoperative complication and postoperative antibiotics duration were less in LA group as like in earlier studies. Conclusion: Laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.