Comparison of early and delayed laparoscopic cholecystectomy for acute cholecystitis: experience from a single center.

BACKGROUND: Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis. AIMS: To evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy. MATERIALS AND METHODS: This was a prospective and randomized study. For patients assigned to early group, laparoscopic cholecystectomy was performed as soon as possible within 72 hours of admission. Patients in the delayed group were treated conservatively and discharged as soon as the acute attack subsided. They were subsequently readmitted for elective laparoscopic cholecystectomy 6-12 weeks later. RESULTS: There was no significant difference in the conversion rates, postoperative analgesia requirements, or postoperative complications. However, the early group had significantly more blood loss, more operating time, and shorter hospital stay. CONCLUSION: Early laparoscopic cholecystectomy within 72 hours of onset of symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Laparoscopic trans-mesocolic pyeloplasty in children: initial experience from a center in India.

The aim of the present study is to report our experience with laparoscopic pyeloplasty via trans-mesocolic approach in children with left pelvi-ureteric junction (PUJ) obstruction. Between May 2007 and May 2008, 12 children aged between five and 16 years, with documented PUJ obstruction on the left side, underwent laparoscopic pyeloplasty via trans-mesocolic approach. The outcome was assessed by post-operative isotope renal scan. The mean age of the study patients was eight years, ranging between five and 16 years. There were five males and seven females in the study. All children underwent Anderson Hynes Pyeloplasty by a single surgeon. All cases were stented with a JJ stent for a period of six weeks post-operatively. The procedures were completed successfully in all patients without need for conversion to open pyeloplasty in any patient. The mean operative time was 95 min, with a range of 80-140 min. The average blood loss was 57 mL. The mean hospital stay was 3.5 days with a range of 2.5 to six days. All children returned back to school within nine days following surgery. The mean follow-up period was 12 months (range, nine to 14 months). Eleven of the patients were completely asymptomatic, while one reported mild flank pain. All children underwent renal scans and renal ultrasound three months after stent removal. Ten had improved function on the scan while in one patient, the function remained the same and, in another, it showed obstructed response to diuretic, although the symptoms had improved. In all the cases, renal ultrasound showed a decrease in the severity of hydronephrosis by at least one degree. These results confirm that laparoscopic pyeloplasty by trans-mesocolic approach in children for left-sided PUJ obstruction is safe and feasible.

Total renal replacement lipomatosis.

Renal replacement lipomatosis can be defined as the proliferation of fibrofatty tissue which subsequently replaces the renal parenchyma. It is usually unilateral and occurs as a result of severe atrophy or destruction of the renal parenchyma, mostly due to a calculus with secondary proliferation of renal sinus, renal hilus, and perirenal fatty tissue to a variable extent. There may be moderate replacement of renal tissue by fat as in renal sinus lipomatosis or in severe cases the whole of the renal parenchyma may be replaced by fat and is referred to as renal replacement lipomatosis. Herein we report a case of total renal replacement lipomatosis. The possible pathogenic mechanisms and the treatment are also discussed.

Triple assessment in the diagnosis of breast cancer in Kashmir.

BACKGROUND: Although the diagnosis of breast cancer is suggested on clinical examination, the degree of suspicion is variable. Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonography) and pathology called as triple assessment test is used to accurately diagnose all palpable breast lumps. Together they give sensitivity of 99%. The triple assessment is taken as positive if any of the three components is positive and negative only if all of its components are negative for malignancy. MATERIALS AND METHODS: This study was conducted in the Department of Surgery, Government Medical College, Srinagar, Kashmir over a period of 3 years from June 2005 to May 2008. A total of 200 patients with a breast lump were selected irrespective of age. A detailed history, focused clinical examination, radiological imaging and fine-needle aspiration cytology (FNAC) were used as diagnostic tools for screening of the patients. The aim of this study was to evaluate accuracy of triple assessment in the preoperative diagnosis of patients with breast carcinoma. RESULTS: The sensitivity and specificity of all the modalities used in triple assessment when combined together was 100% and 99.3%, respectively. The concordance for the triple assessment was 99.3%, positive predictive value was 93.3%, negative predictive value was 100%, sensitivity was 100% and specificity was 99.3%. p value was significant (0.000). CONCLUSION: We conclude that triple assessment is a very useful diagnostic tool to evaluate patients with breast lumps and to detect patients with breast cancers with an overall accuracy of 99.3%.