Conversion of laparoscopic to open cholecystectomy: identification of preoperative risk factors

Introduction: Laparoscopic cholecystectomy has become the standard operative prodedure for cholelithiasis; however, approximately 5% to 15% of patients require conversation to open surgery for various reasons. The issue of this conversion remains unsettled. Conversion exerts adverse effects on operating time, postoperative morbidity, and hospital costs. We aimed in this current study to identify the risk factors that may predict conversion of laparoscopic cholecystectomy to open surgery

Patients and methods: A retrospective analysis of medical records of 143 patients who underwent laparoscopic cholecytectomy, including demographic, ultrasonographic, and operative and postoperative data. Preoperative risk factors affecting conversion to open surgery were identified with statistical analysis

Results: Increased risk of conversion with statistical significance was found in advanced age[OR=12.16], male gender [OR=6.86], obesity [OR=5.22], diabetes [OR=31.5], previous abdominal surgery [OR=8.20], emergency laparoscopic cholecystectomy for acute cholecystitis [OR=9.75] and thickened gallbladder wall on ultrasonographic scanning [OR=7.27]. No significant relation was found between the likelihood of conversion and any of the following: concomitant diseases [cardiovascular diseases or cirrhosis], preoperative ERCP, and preoperative abnormal liver function test results

Conclusion: knowledge of these factors will help the surgeon to counsel and select the patient, arrange the operating schedule, and plane of the duration of convalescence but they were not contraindication for the operating schedule, and plane of the duration of convalescence but they were not contraindication for laparoscopic cholecystectomy

Study of the role of C reactive protein measurement in reducing the rate of negative explorations for acute appendicitis

Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remains high [15-30%] despite several techniques and investigations used to improue our diagnostic accuracy. Many studies investigated the role of raised C-reactive protein in improving the diagnosis of acute appendicitis with con-jlicting results. This study emphasizes the impact of a normal [rather than raised] serum C-reactive protein in reducing the rate of negative explorations. In a double blind study, blood for the measurement of serum C-reactive protein [CRP] was collected pre-operatively from 156 patients just before going to the operating room for appendicectomy. The histopathology of the 156 appendices were grouped into positive [acute appendicitis] and negative [normal appendix]. White blood count [WBC], CRP and the histopathology findings were correlated. In patients with histopathologically proven acute appendicitis both the WBC count and serum CRP level were significantly raised [P=0.025 and P<0.0001 respectively]. Serum CRP level was normal in 26 out of 30 negative explorations [normal appendix on histopathology]. The specificity and sensitivity of serum CRP was 86.6% and 93.6% respectively. A normal preoperative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal appendix Deferring surgery in this group of patients would probably reduce the rate of unnecessary appendicectomies

Study of the deleterious effect of varicocele on both testicular volume and consistency matched with spermiogram and FSH

Male subfertility is a very common health problem facing urologist, dermatologist and general surgeons every now and then. In addition to its importance as a health problem, it presents also a big social problem hence the great deal for early detection and treatment. Varicocele is a common treatable cause of male subfertility. It is more frequent and larger in taller men and usually first appear at the time of puberty [1]. Testes associated with large varicoceles are smaller and may be soft with more severe disturbances of spermatogenesis [2]. Men with varicoceles have poorer semen quality than those without varicoceles indicating adverse effects of varicocele on testis [3]. In this study we investigate 32 infertile patients with different grades of varicocele for evaluation of the effect of varicocele on testicular volume, consistency and seminogram the results showed epsilateral reduction of testicular volume and consistency plus poor seminogram parameters. Another 10 normal fertile volunteers were subjected to the same investigation and showed significant difference between both groups as regards to testicular volume, consistency and seminogram variables