Over view of laparoscopic cholecystectomy at [SMBBMU] University Hospital Larkana 1920 cases

To evaluate the safe technique in patient with cholelithiasis either simple or with acute cholecystitis and to highlight the better method in which patient can be prevented from future complication. Experimental Study. This study was conducted at University Hospital of Shaheed Mohtrama Benazir Bhutto Medical University, Larkana with effects from Jan 2005 to Jan 2011. Total number patient 1920 underwent lap chole, while 184 were admitted in acute state from casualty and Out Patient Department of university hospital. The mean age was 11-75 years, male and female ratio 1:3 with regard the 184 in acute cholecystitis among those patients reach to hospital within 24hours were 85, from 24-48hours were 65 patients while from 48-72 hours were 34 patients. While remaining patient were managed as elective cases. The operative time taken in elective cases were 30 minutes but in acute cases it was 90 minutes so average time was 60 minutes. The overall conversion rate is 2.86% but in acute case the conversion rate 8.15%. Post operative average hospital, stay remain's 1 day in elective cases but in acute Cholecystitis where conversion to open were performed the hospitalization minimum 6 maximum 7 days. The wound infection seen in 49 cases [2.8%]. Lap chole is a reliable and safe in management of cholecystitis either with or without cholelithiasis having simple or acute cholecystitis, while certain factors are responsible for conversion include delayed arrival more than 72 hours, empyema and bleeding while contradictory to international literature our study suggest that conversion rate is high in acute rather than elective Cholecystitis. So it is concluded that emergency lap chole is a safe and cost effective due to on time surgery and patient can be prevented from future complication. Therefore early lap chole is safe and can be performed in simple and complicated Cholecystitis while literature have proved that lap chole also safe in pregnant lady with certain limitation of like height of fundus

Comparison of laparoscopic appendicectomy [LA] versus open appendicectomy [OA] [a prospective randomizing audit of 1000 cases]

In this study comparison between Laproscopic and Open Appendisetomy with regard the length of operation, complication, conversion rate, postoperative hospital stay and time of return of normal activity has been made in order to assess the benefits and feasibility of the procedures. Prospective Randomizing study. This study is carried out at Shaheed Mohtrama Benazir Bhutto Medical University [SMBBMU] Hospital and At Sachal Medical Centre Larkana with effect from Jan: 2001 to Jan: 2011. All patients with diagnosis of acute appendicitis were enlisted and randomized to either laparoscopic appendisectomy [LA] or Open appendisectomy [OA]. All patients received pre-operative contibiotic. The operative time was calculated beginning with incision or insetion of Trocar till the wound was fully closed. Patients those were converted from LA to OA were considered separately. Assessment regarding the return to normal activity and work determined by questioning during the postoperative follow-up. This randomized study of 1000 cases in which 450 cases underwent OA and 550 patients scheduled for the LA procedure but successfully performed 505 and remaining 55 underwent Lap-Converted open appendisectomy. From this study reveals that the common presentation of appendicitis is simple appendicitis next is perforated appendicitis, while the reasons for lap converted open cases were of appendicular mass, perforated appendicitis, gangrenous appendicitis but 2 cases were noted of having normal appendix with pelvic inflammatory disease [PID]. The conversion rate remains higher in our study. Operative time in OA/LA remain 81/40 minutes. Wound infection rate in OA/LA remain 5.4%/3.0% Hospital stay in OA/LA 5-6/1-2 days. Patient return to normal activity in OA/LA group 14days/7 days. However early return to job found in LA than OA group of patients. After the long assessment of this study also compared with world literature that the LA is superior because of less pain; minimum wound infection, less operative time. Having the, cosmetically acceptable small scar, less hospital stay and early return to normal activity and job. Therefore this is mature time to say that LA is superior procedure in our setup while can replace open appendisectomy [OA]

Frequency of gallstones in type II diabetes mellitus

To determine the frequency and factors predisposing patients with type-Il diabetes mellitus to gallstones disease. Case-control study. Medical and surgical OPD, Chandka Medical College Hospital Larkana from January 2007 to December 2007. Total no: of 200 patients with one hundred diabetes mellitus type-2 with gallstones and one hundred age gender matched controls were taken. All the patients were examined for body mass index, waist hip ratio and investigated for blood sugar levels and lipid profile and pan abdomen ultrasound. Fifteen percent of diabetic patients had ultrasound evidence of gallstones as compared to 7% in non diabetic controls. There was significant increase in frequency of gallstones in diabetic patient's increasing age with peak incidence in seventh decade i.e. 60-69 years, and decline in 8th decade i.e. 70-79 years. The average age of diabetic patients with gallstones disease, was significantly higher than without gallstones disease. [p=-00 1]. The mean duration of disease in diabetic patients with gallstones disease was 5.0+ 4.8 years compared with 4.5+ 3.5 years in diabetic patients without gallstones disease [P=0.722]. The mean serum cholesterol and triglycerides levels 4.3.3 mmol/L and 1.5+ 0.8 mmol/L respectively in the diabetic patients with gallstones disease was higher than those without gallstones disease was higher than those without gallstones disease 3.4:f 0.5 mmol/L [P=0.0941] and 1.4 +/- 0.7 mmol/L [p=0-712] respectively, the mean body mass index with diabetic patients with gallstones disease was 26.2+ 5.5 kg/m2 compared with 25.7 +/- 6.7 kg/m2 in those without gallstones disease The frequency of gallstones disease in diabetes mellitus type II increasing with age female gender, obese hyperlipidemia and longer duration of disease