Early outcome of donors in living-donor liver transplantation at King Hussein Medical Center

To evaluate the safety and early outcome of donors who underwent partial hepatectomy for Living donor- related Liver Transplantation at King Hussein Medical Center [Amman- Jordan]. We retrospectively reviewed 28 living donors who underwent liver resections [21 right lobes, 5 left lobes, 2 left lateral lobes] for living donor liver transplantation at King Hussein Medical Center. The procedures were performed over a period of four years from June 2004 till August 2008. Donor characteristics, operative times, blood loss, hospital stay, and complications as graded by Clavien's classification were recorded. Donors were followed- up for a mean period of 8.5 +/- 1.91 months [range 6-12 months]. Simple descriptive statistical methods [frequency, mean and percentage] were used to describe the study variables A total of 54 potential candidates for living-donor liver transplantations were evaluated. Of these, 28 underwent successful hepatectomy for donation. Male to female ratio was 21:7. The mean age was 28.89 +/- 1.30[range 19- 49] years. A total of 26 potential donors [48%] were excluded at different points of the work-up. The mean operative times were 6.07 +/- 1.12 [rang = 4-8 hours]. The mean intraoperative blood loss were 428.5 +/- 296.9 [range: 50 to 1500ml], [intraoperative blood transfusion was required for one donor]. Donor hepatectomy in living-donor liver transplantation is a safe procedure. Meticulous and comprehensive selection protocols are a prerequisite for a good outcome

Hernia repair under local anesthesia

To describe hernia repair under local anesthesia with regard to the technique, morbidity and hospital admissions after the procedure. Two-hundred hernia repairs were performed under local anesthesia for 178 patients at King Hussein Medical Center and at Prince Hashem Hospital between January 2005 and January 2007. All patients were assessed preoperatively by a senior surgeon and written consent was obtained. The anesthesia protocol used included 0.5% lignocaine and 0.25% bupivacaine as local anesthesia supplemented with intravenous sedation by the anesthesiologist as necessary. Patients were monitored intraoperatively for heart rate, blood pressure and pulse oximetry. The procedure was successfully performed for 197 hernias under local anesthesia. Only three patients required general anesthesia. The first 50 patients were admitted overnight for observation, the rest were all planned as day case surgeries and were followed up over a three month period. Four patients developed wound hematoma, two patients developed wound infection, one patient developed post operative urine retention, and two patients showed evidence of recurrence when reviewed after one year. Our study confirmed the safety and convenience of using local anesthesia for hernia repair. Less post operative discomfort and low morbidity rate was obtained. Hernia repair under local anesthesia can be learnt easily and quickly, therefore it is the recommended procedure to be used in our practice for the repair of inguinal hernia

Pain relief after laparoscopic cholecystectomy. comparative study

The aim of this study was to determine whether subcutaneous injection of a long-acting local anesthetic at the site of ports of entry or installation of the same drug in the right subdiaphragmatic region would reduce post operative pain or not. The study was conducted on 60 patients who underwent laparoscopic cholecystectomy at King Hussein Medical Center [KHMC] between July 1995 and February 1996.Two scores of pain [visual pain scale and verbal rating scale] were used and assessment was done at two-hour intervals. Those patients were randomly allocated into three groups, group I received 20ml of 0.25% bupivacaine, intraperitoneally in the right subdiaphragmatic area, with the patient in the supine position. Group II received a total of 20 ml of 0.25% bupivacaine injected subcutaneously around the four port sites. Group III received saline with no local anesthetic. There was no significant reduction in the median visual scale or the verbal pain score among the three groups post-operatively. Subcutaneous infiltration with bupivacaine after laparoscopic cholecystectomy or its intraperitoneal instillation has no significant effect in relieving post-operative pain