Role of laparoscopic cholecystectomy in the management of acute cholecystitis

To evaluate the safe technique of surgery in patients with acute cholecystitis and to highlight the better method in which patient can be prevented from complications. A descriptive study. This study was conducted at Larkana, Sindh from February 2002 to August 2004. A total of 504 patients underwent laparoscopic cholecystectomy. Out of these, 398 patients were treated by elective laparoscopic cholecystectomy and 106 patients underwent emergency laparoscopic cholecystectomy for acute cholecystectitis. Among 106 patients, females were double [73.1%] than males and most of these patients were received within 24 hours of the onset of symptoms. In 56 [52.83%] patients, ultrasound revealed odematous gall bladder, mucocele, empyma, contracted, perforated and gangrenous gall bladder. Per-operative complication was encountered in 71 [66.98%] patients including bleeding, minor injury to common bile duct [CBD] and liver, adhesions of gall bladder with omentum, stomach, colon, CBD, and distorted anatomy of Calot's triangle. The minimum time taken during the procedure was 50 minutes. In 5 [4.72%] patients, the laparoscopic procedure was converted to open and reasons for conversion were bleeding, tight, dense adhesions and perforated gallbladder leading to biliary peritonitis. Emergency cholecystectomy is reliable and safe modality in the management of acute cholecystitis. Certain factors are responsible for the conversion, which include delayed arrival of patient, patients with perforated gall bladder, bleeding and adhesions. Hence, emergency laparoscopic cholecystectomy seems to be safe, cost effective, and timely surgery with modern conception. This timely surgery prevents the complications associated with acute cholecystitis

Comparison of fnac [fine needle aspiration cytology] vs open biopsy in thyroid nodules

This study was carried out at Surgical Unit-I, Chandka Medical College Hospital, Larkana to evaluate the diagnostic importance of fine needle aspiration cytology in thyroid nodules and to compare the results with open biopsy. Of the 122 cases seen, 101 were diagnosed as benign on FNAC, open biopsy report was similar except in six cases. Five cases were reported as malignant and three suspicious on FNAC, all were proved malignant on open biopsy. Four cases of thyroid cysts disappeared on aspiration and did not recur while four with thyroiditis completely responded to conservative measures. The accuracy of FNAC in our study was 94.16% with a false negative ratio of 5.94%