Laparoscopic versus open appendectomy; which method to choose? a prospective randomized comparison

Appendicitis is the most common surgical emergency with the incidence rate of 6-10%. Although several studies have compared the two approaches of open [OA] and laparoscopic appendectomy [LA] the technique of choice is still a matter of controversy. Considering this background we designed a study to compare OA and LA outcomes in our center. One hundred patients were included in this study performed from April 2008 to April 2009 at Shahid Sadoughi hospital, Yazd, Iran. Patients who gave informed consent were randomized to either OA or LA groups and were operated by McBurney's or laparoscopic technique, respectively. Patients received our center's routine diet, antibiotics and analgesic regimens. The patients' pain was measured by visual analogue scale [VAS] at their entrance to the recovery room and in 6-hour intervals up to 24 hours. Post-operation follow up visits were in weeks 1, 2 and 4. The data of operation time, hospital stay, intra-operation complications, time to resume normal activity, short term complications and neuralgia were collected and analysed. The average operation time was 34.4 +/- 8.42 min in LA and 41.7 +/- 8.84 in OA hand [P=0001]. No intra-operative complication and no LA to OA conversion were encountered in operations. Post-operative complication rate was higher in OA group [n=10] compared to LA [n=3]. The post-operative pain showed less pain in OA only at 6 and 12 hours post-operative times. Patients' mean hospital stay was 52.32 +/- 19.2 and 42.96 +/- 13.8 hours in LA and OA groups, respectively [P=0.003]. Time to resume normal activity didn't show a significant difference between two groups [P=0.53]. Only one case of neuralgia in the OA group was confronted in the follow up visits. LA has less complications and cosmetic scar with the cost of more pain. Decision between OA and LA for each patient should be made individually

Role of liver function enzymes in diagnosis of choledocholithiasis in biliary colic patients

Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography [ERCP] was performed for patients with suspicious to biliary colic and common bile duct [CBD] stones. Ultrasonography, Aspartate Aminotransferases [AST], Alanine Aminotransferases [ALT], Alkaline Phosphatase [ALP] and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter [OR:20; P=0.00] and elevated serum level of ALT [OR:2; P=0.04] were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP