Fundus first laparoscopic cholecystectomy

Five cases of "fundus first" laparoscopic cholecystectomy were studied. There is controversy about using fundus first technique in dissecting the gallbladder in both open and laparoscopic surgery. The indication for using this technique was due to the inability to start dissection in Calot's Triangle safely, because of its obscure anatomy, inability to retract the liver up in cases of cirrhotic liver, big empyema of the gallbladder and reduced peritoneal cavity in obese patients. The average operative time was 110 minutes. No mortality or morbidity were recorded apart from one case of postoperative obstructive jaundice released by ERCP sphincterotomy. It was concluded that with appropriate experience "fundus first" laparoscopic cholecystectomy can be done safely in difficult laparoscopic cholecystectomy when indicated. But no structure should not be divided before the clear dissection of the cystic duct and artery

Laparoscopic cholecystectomy in a safe and effective method in treating acute cholecystitis

In a series of 230 cases, laparoscopic cholecystectomy was attempted in 18 patients having the clinical picture of acute cholecystitis, 4 cases were non-calcular by preoperative sonar which revealed thick edematous wall of the gallbladder in 13 patients. All patients were scheduled for operation 72 hours or less from the attack. There was a significant discrepancy between the clinical picture and the laparoscopic finding of the gallbladder. The average operative time was 105 minutes. Dissection of the gallbladder was done by "fundus first" method in 3 cases. The hospital stay ranged from 18 to 48 hours. Two cases were converted to open surgery because of severe inflammation obscuring the anatomy. No mortality or significant morbidity were reported. It was concluded that laparoscopic cholecystectomy is safe and effective method in treating patients with acute cholecystitis and these patients should not be denied the benefits of laparoscopic cholecystectomy in centers with appropriate experience

Comparative study of the hospital stay of some uncomplicated surgical patients in Kasr El Eini hospital and a private hospital

The hospital stay of 115 uncomplicated surgical patients in Kasr El- Aini Hospital and a private hospital was studied in 1992 to get the undue losses of money and medical care in the first group. The differences between the average lengths of hospital stay for cases with simple nodular goiter, oblique hernia and perianal fistula were 10.55, 13.62 and 13.25 days, correspondingly. Knowing that the average daily running costs of a bed in Kasr El-Aini Hospital is about LE 45, the undue lost costs will be 474.75-612.9 and 596.25, correspondingly/each case. The causes of such undue losses may be improper operation schedule, investigations are done on inpatient basis, no proper discharge plan