Value of prophylactic drainage after cholecystectomy: a retrospective study

Detection of the value of prophylactic drainage after cholecystectomy. A retrospective study which was carried on 98 patients to whom cholecystectomies were done in NHTMRI between January 2008 and October 2010. The patients were divided into two groups concerning the surgical technique whether open or laparoscopic; further subdivision into two groups where prophylactic drain was fixed or not was done. During the period of the study, 98 cholecystectomies were done, 56 cases were done laparoscopically [prophylactic drains were fixed in 12 cases and the remaining 44 without drains]. The other 42 cases were done by open surgical technique [40 cases with drains and 2 without]. Post-operative follow up revealed faster return to normal gastrointestinal activity and earlier hospital discharge in the no drain group. Prophylactic drain placement cannot be advocated following simple cholecystectomy either laparoscopic or open

Laparoscopic cholecystectomy as a day surgery procedure: is it safe?-an Egyptian experience

Major surgery performed as a day surgery procedure is not uncommon. The aim of this study is to evaluate the feasibility of day surgery procedures in laparoscopic cholecystectomy [LC]. A total of 210 patients scheduled for elective LC between 2006 and 2008 were included in our study. The mean age was 40.63 years [range, 25 - 70 years]. The indication for surgery was symptomatic cholelithiasis confirmed by ultrasonography without clinical or radiological evidence of acute cholecystitis. All patients were informed about the same-day discharge policy and received the postoperative instruction form on discharge. Preoperative work-up included history taking and physical examination in addition to standard laboratory and radiological tests. Patients above 35 years of age had an ECG done. All patients were examined in the outpatient clinic by a consultant anesthesiologist the night before surgery. Operative time, hospital stay, and complications were recorded. Telephonic feedback, on the morning after surgery was routinely done as an early follow-up. Out of the total number of patients, 140 patients were ASA [I] and 70 were ASA [II] [40 patients were controlled hypertensives and 30 were controlled diabetics]. Conversion rate was 1.4%. The mean hospital stay was 6.7 hours [range, 6-8 hours]. The mean operative time was 31.2 minutes [range, 20 - 60 minutes]. None of the patients required an abdominal drain. No morbidities or mortalities were reported in this series. LC may be done as a day surgery procedure with optimal patient satisfaction and without complications

Appraisal of the modified Alvarado Score for acute appendicits in adults

Decision making in cases of acute appendicitis may be difficult specially for junior surgeons. Radiological investigations do not appear to be helpful. In some studies, the Modified Alvarado Scoring System [MASS] was helpful in minimizing unnecessary appendicectomies. The aim this study was to evaluate the sensitivity of MASS in the diagnosis of acute appendicitis in adults. All adult patients aged 16-years and above who were admitted with a provisional diagnosis of acute appendicitis between January 2001 and January 2002, into the Armed Forces Hospitals, Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia were prospectively entered into this study. The study included 125 patients between the ages of 16 and 76-years. They were prospectively evaluated on admission using the Modified Alvarado Score [MAS] to determine whether or not they had acute appendicitis. The MASS was correlated with the operative and histopathological findings. One hundred and 10 patients [88%] had appendicectomies of which 30 patients [27.3%] had normal appendices on histopathology examination. Overall the MAS system showed a sensitivity of 53.8% and a specificity of 80%. For males, the sensitivity was 56.4% and the specificity was 100%. For females, the sensitivity and specificity were 48% and 62.5%. From the results, the MASS is not sufficiently sensitive adopted as a method of diagnosing of acute appendicitis in adults in our environment. Further, requirements may be needed to improve its sensitivity and specificity

Saphenofemoral ligation as a safe and effective alternative for the treatment of chronic venous leg ulcer

To evaluate the effectiveness and safety of isolated saphenofemoral junction ligation for the treatment of chronic venous leg ulcer in comparison to traditional stripping procedure. Thirty six patients [28 men and 8 women] with mean age of 42.3 +/- 8.7, presented with a venous leg ulcer. After taking a full history, they underwent examination for presence of edema, cellulitis or local ulcer infection. The site and size of ulceration were recorded and ankle-brachial pressure index [ABPI] was measured. Venous color Doppler ultrasonography was performed and venous valvular incompetence was assessed using Valsalva test and calf compression. Patients were divided into 2 groups. Group I, [n=10] assigned for long saphenous stripping, while group II, [n=26] assigned for saphenofemoral ligation and divided combined with ligation of major tributaries under local infiltration anesthesia. Mean operative time, postoperative complications and hospital stay were recorded. The study was carried out in Benha University Hospital, Egypt and Armed Forces Hospital, Khamis Mushayt, Southern Region, Kingdom of Saudi Arabia, between January 2000 and December 2001. The mean operative time and the hospital stay were significantly [p<0.05] reduced in group II compared to group I. The postoperative complications were significantly [x2=7.5, p<0.05] reduced in group II. Ulcer healing started after 3 months in group II and 6 months in group I, but, by 12 months, group II had a significant [x2=6.7, p<0.05] number of healed ulcers [n=22, 84.6%], compared to group I [n=7, 70%]. The isolated ligation of saphenofemoral junction is a minimally invasive, safe and effective modality for treatment of chronic leg ulcer, and being easily performed under local anesthesia and considered to be a satisfactory procedure for treatment of leg ulcer in patients who are unfit for general anesthesia

Efficacy of local anaesthesia and simplicity of mesh plug technique in open inguinal hernia repair in patients above 60 years of age

Local anesthesia offers several advantages over other types of anesthesia because it is limited to a small body area. This study evaluates the efficacy of local anesthesia arid the simplicity of the Mesh Plug technique in open inguinal hernia repair, particularly in patients over the age of 60 years. A prospective study was conducted on 150 patients above the age of 60 who were admitted to a specialized hernia clinic in the Armed Forces Hospital, Southern Region, Saudi Arabia. They underwent inguinal hernia repair using the Mesh Plug technique under local anesthesia as a day surgery procedure. The mean age was 69 years. Concomitant diseases were present in 60 [40%] patients. Local anesthesia was used in 144 [96%] patients. Operative time, hospital stay and the postoperative analgesic requirement were recorded. The postoperative pain was evaluated for the first eight hours using the Wong/Baker face scale. The mean hospital stay was 0.6 day [range 8 hours - 7 days], 138 patients were discharged after eight hours from the day surgery unit, while 12 patients stayed between 1-7 days. The mean operative time starting from local anesthesia infiltration was 36 minutes [range 30-50 minutes]. Local complications were reported in 39 men, 18 [12%] had bruising, 18 [12%] had a seroma and three [2%] had neuralgia. Neither infection nor recurrence was recorded during the period under review. Local anesthesia and the Mesh Plug technique in inguinal hernia repair is a safe and effective procedure in elderly patients. Age and concomitant diseases should not be a contraindication to elective hernia repair