Review of laparoscopic cholecystectomy in Nepal Medical College Teaching Hospital.

Laparoscopic cholecystectomy (LC) is a commonly performed procedure in general surgical practice. The present study aims to highlight the results of LC in our institute. All LC carried out at our institution was prospectively audited. Data were collected regarding indications for surgery, rate of conversion to open operation, co morbid medical conditions and complication rate. One hundred and forty patients underwent LC from March 2005 to December 2006. There were 104 (74.2%) females and 36 (25.7%) males; age range was 18-75 years with a mean of 41 years. Indications for surgery were repeated attacks of biliary colic in 87 (62.0%), symptomatic dyspepsia in 48 (34.0%) and asymptomatic gall stone in 5 (4.0%) patients. Operating time was 25-120 minutes with a mean of 71.9 minutes. Conversion was performed in 13 (9.2%) patients because of unclear anatomy due to the dense inflammatory adhesions and chronic cholecystitis. Our results of LC are favorable and comparable with those of published series. We conclude that LC has been successfully introduced in our institution.

Helicobacter pylori associated gastroduodenal problem among the Nepalese.

Present study was undertaken during a period of eighteen months (April 2001 to October 2002) to see an association of Helicobacter pylori with the gastric problems among the Nepalese. This study comprised of 203 subjects (Males: 154 and Females: 49) aged 21 to 71 years with gastric problems. The biopsy samples taken from the stomach and duodenum using endoscope were tested for the presence of H. pylori by in-house rapid urease test (RUT) and culture. Representative samples were also tested by PCR. Of the total 203, 60 (29.5%) were RUT positive. Marginally high RUT positive rate was observed in males compared with females (P>0.95). Same was true with ethnic group with a marginally higher positive rate among Tibeto-Burmans compared with Indo-Aryans (P>0.05). Age-wise, higher incidence (34.4%) was observed in the age group of 36 to approximately 50 years followed by over 50 years (29.0%), and 21 to approximately 35 years (24.4%) (P>0.05). Both RUT and culture positive rate increased with the severity of the problem. RUT results were confirmed also by PCR. All RUT positive patients were given a full course of new triple therapy (combination of two antibiotics: Clarythromycin and Amoxycillin and a proton-pump inhibitor: Omeprazole) for two weeks followed by extended monotherapy with Omeprazole for up to six weeks. Of the total, 168 (82.7%) patients were available for follow-up and all of them showed an improved condition with negative RUT.