Management of bleedine oesophagogastric varices by stapled oesophageal transection and splenectomy vasoligation

This study included thirty patients presented with recurrent bleeding from oesophago-gastric varices, they were resuscitated, diagnosed by fibre-optic endoscopy and subjected to full clinical and laboratory investigations and were classified according to Child-Paugh classification as 18 patients class [A] [60%] arid 12 patients as class [B], [40%] they underwent splenectomy vasoligation, direct gastric variceal ligation and oesophageal transection using EEA stapler, patients were followed up I year for further bleeding and endoscopically to show the fate of varices. Complete eradication of varices was noted in 13 patients [46.4%] and the grade of varices greatly diminished in the others. The mortality rate was 2 patients 6.6%, complications were minors and mostly transitory. included transient dysphagia in 4 patients [13.3%] and persistant dysphagia in one patient [3.3%], pulmonary complications in 4 patients, [13.3%], gastric stasis in one patient [3.3%] and heart burn in 6 patients. [21.4%]. Late complications [in suruived 28 patients] included ascites in 5 [17.8%] patients, Encephalopathy in one [3.57%] and incisional hernia in two patients [7.14%]. It is concluded that oesophageal transection and splenectomy vasoligation with direct ligation of fundic varices in treatment of recurrent bleeing oesophagogaatric varices, is simple, effective method for variceal eradication arid control of bleeding

Laparoscpy in diagnosis of acute lower abdominal pain

Thirty patients with acute lower abdominal pain of uncertain diagnosis were the material of this study. After a short time of observation without a definitive diagnosis. laparoscopic exploration was performed to help in establishing a correct diagnosis and management and avoid unnecessary laparotorny. At laparoscopy the diagnosis of acute appendicitis was made in ten patients. Gynaecologjcal pathology was diagnosed in thirteen patients, one patient had Mekel's diverticuiltis, while in six patients no definitive pathology was found. One patient among the last six had acute appendicitis as the appendix was not visualized completely, laparoscopy reduced the number of un necessary laparotomy. The procedures and the results were reviewed with the conclusion that laparoscopy is safe and useful as a diagnostic and therapeutic tool in management of patients with uncertain diagnosis of acute lower abdominal pain