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Introduction: This study proposes to compare the use of thelow pressure pneumoperitoneum/LPLC (< 9 mm Hg) with theuse of standard pressure pneumoperitoneum/SPLC (14 mmHg) in patients undergoing laparoscopic cholecystectomy ina prospective randomized manner in an attempt to lower theimpact of pneumoperitoneum on human physiology.Method and Materials: The study was carried out with asample size of 50 patients randomised into two groups, onewith 25 patients - SPLC while the other group with 25 patientsLPLC. To compare post-operative pain incidence of shouldertip pain, average operation duration, need of additionalanalgesia post-operatively, duration of hospital stay, change inPulse rate, SBP & DBP in both groups.Result: Incidence and intensity of post-operative pain, postoperative pain referred to the tip of the right shoulder weresignificantly lower in LPLC group compare with SPLC group.The average change in SBP in patients who underwent LPLCwas an increase of 0.83 ± 8.66 mm Hg and in SPLC groupwas an increase of 0.91 ± 14.67 mm Hg. Average change inDBP in patients who underwent LPLC was increase of 1.75± 8.33 mm Hg and in SPLC group was an increase of 2.64 ±8.34 mm Hg and in LPLC group was a decrease of 0.8 ± 12.01beats per minute and in SPLC group was an increase of 1.8± 5.33 beats per minute. The average change in SBP, DBP &heart rate in patients who underwent LPLC & SPLC was notstatistically significant. Average hospital stay for LPLC groupare 1.92 days and for SPLC group its 2.48 days.Conclusion: An uncomplicated gall stone disease can betreated by low pressure laparoscopic cholecystectomy withreasonable safety by an experienced surgeon. It is significantlyadvantageous in terms of post-operative pain, use ofanalgesics, less shoulder tip pain and hospital stay.
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Background: Intestinal obstruction is a common clinical occurrence and can be either dynamic or adynamic. The old saying “Never let the sun set or rise on an obstructed bowel” taught to minimize missing strangulation. Helical CT with its multiplanar reformatted imaging can accurately characterize the level, degree, cause and associated complications of obstruction. Aim of the study was to depict the spectrum of MDCT findings in cases of small and large bowel obstruction and correlation of CT scan with intraoperative findings and the cause of intestinal obstruction.Methods: Contrast enhanced MDCT examination of 50 patients were prospectively included in the study who had evidence of clinical as well as MDCT evidence of bowel obstruction and in whom surgical/clinical follow-up for final diagnosis was available. CT scan was done in all the patients with MDCT (Brightspeed GE 16 slice system). The axial sections were reconstructed in coronal and saggital planes to determine site and cause of bowel obstruction.Results: The commonest cause of intestinal obstruction in adults in this study series was adhesions/bands in 38% cases. Out of 47 operated patients for intestinal obstruction, CT findings matched with intraoperative findings in 43 patients (91%) whereas cause of intestinal obstruction matched with CT findings in 37 patients (74%).Conclusions: Management decisions in intestinal obstruction remain notoriously difficult, relying on a combination of clinical, laboratory, and imaging factors to help stratify patients into conservative or surgical treatment. CT in these patients can help surgeon to go for surgery early and prevent complications.
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Background: Intestinal anastomosis is an operative procedure that is of central importance in the practice of surgery. Intestinal anastomosis after resection of bowel may be of various types and techniques. This prospective comparative study is performed to evaluate the safety in term of anastomotic leak of single layer interrupted extramucosal technique as compared to conventional double layer technique. Methods: The patients selected for this study are those who were admitted with various clinical conditions requiring resection and anastomosis of small or large bowel presented to P.D.U. Medical College & Hospital, Rajkot between a period of August 2012 to December 2014. A total of 50 patients were included in the study. All the patients above the age of 18 years and less than 60 years, requiring intestinal anastomosis on emergency or electively, were included in the study and those requiring anastomosis to esophageal, gastric and duodenal anastomosis were excluded and randomly allotted single layer and double layer groups and results such as anastomotic leak rate, duration for anastomosis, number of suture material required noted. Results: Mean duration required for single layer anastomosis was 19.6 minutes and for double layer anastomosis was 29.5 minutes and double number of suture material used in double layer anastomosis with equal anastomotic leak rate (6%) in each group. Conclusions: Single layer interrupted extramucosal technique required significantly less duration for anastomosis, is cost effective with no significant difference in anastomotic leak rate and as safe as conventional double layer technique.