Laparoscopic cholecystectomy in patients with acute cholecystitis

A total of 230 patients with symptomatic gall-stones were treated over a 2-year period. Thirty seven [16.1%] of these patients presented with manifestations of acute cholecystitis. They were 25 females and 12 males with a mean age of 49.2 +/- 16.9 years [range 19-72 years]. Two of these patients underwent preoperative successful endoscopic removal of common bile duct stones. Laparoscopic cholecystectomy was attempted in all patients and was successful in 35 of 37 patients [94.6%]. Two laparoscopic procedures [5.4%] were converted to open cholecystectomy because of extensive difficult adhesions [one patient] and a frankly gangrenous gallbladder [one patient] precluding safe laparoscopic cholecystectomy. The mean operating time was 55 +/- 16.2 minutes [range 30-120 minutes] for the laparoscopic group in comparison to 125 and 140 minutes for the two patients required conversion to open cholecystectomy. The mean duration of hospital stay was 4.1 +/- 1.3 days [range 3 - 7 days] for the laparoscopic group and 7 days for the two patients required conversion to open cholecystectomy. There was no mortality and no bile duct or major vascular injuries in either groups with two cases [5.4%] of wound infection in the laparoscopic group

Pain and pulmonary dysfunction after cholecystectomy: open versus laparoscopic

Pain and pulmonary dysfunction were studied in 15 patients after laparoscopic cholecystectomy [LC] and compared with those in 15 patients after traditional open cholecystectomy [OC]. Studies performed pre-surgery and 24 hours after surgery included forced vital capacity [FVC], forced expiratory volume in 1 S [FEVI], and forced expiratory flow [FEF 25% - 75%] via a standard spirometry and arterial blood gases. Postoperative pain scores and analgesic requirements were also recorded. FVC, FEV1 and FEF 25% - 75% values after LC significantly exceeded those after OC. This study showed that LC is associated with less postoperative pain and pulmonary dysfunction than OC

Laparoscopic preperitoneal tension-free prosthetic repair of inguinal hernia: a preliminary experience

This study demonstrates the importance of laparoscopy in identifying the anatomic type of the hernia and the defect. It offers anatomical and tension-free repair with high rates of success, safety, less postoperative pain, low morbidity and easy repair of recurrent hernias and hernias associated with sliding sigmoid and adherent omentum to the sac. Bilateral hernia can be repaired with no additional morbidity. Results are encouraging, and longer follow up determines the long-term efficacy of this procedure from local to general anesthesia and an inexpensive procedure into a more expensive one

Endoscopic cholangiography, sphincterotomy and stone removal prior to laparoscopic cholecystectomy

Twenty four patients with common bile duct [CBD] stones were studied. They were diagnosed among 250 patients with cholelithiasis presented to the hospital for laparoscopic cholecystectomy over year [9.6%]. Liver profile revealed 3 or more elevated parameters in 15 patients [62.5%], whereas ultrasound was successful to reveal the presence of CBD stones in all of them [100%]. Endoscopic cholangiography was successful in 22 cases [91.67%] and proved the presence of stones in their common bile ducts. Stones were removed in 20 patients [83.33% of total and 90.91% of the successful cases]. The other 4 cases had open cholecystectomy with exploration of CBD and stone removal. The limited period of hospitalization and subsequent disability related to this approach render it as a good alternative to the management of choledocholithiasis combined with cholelithiasis