External tube drainage or omentoplasty in the management of residual hepatic hydatid cyst cavity: a prospective randomized controlled study.

BACKGROUND: Surgical procedures advocated for management of residual hepatic hydatid cyst cavity have been a subject of controversy. The aim of this study was to compare omentoplasty (OP) and external tube drainage (ETD). MATERIAL AND METHODS: This was a prospective randomized controlled study conducted on radiologically documented cases of hepatic hydatidosis (n=50) in a tertiary care hospital of Kashmir. Patients were divided into two groups; in one group ETD was performed and in another OP was done. RESULTS: Twenty-eight patients were offered ETD and 22 OP. There was no statistically significant difference in mean operative time. The overall complication rate was higher in ETD (42.86%) as compared to OP (22.73%). In ETD group two patients had bile leak and infection of residual cavity each; whereas no such complication was seen in OP. The mean pain scores were elevated in ETD (p<0.0016).The mean hospital stay was more in ETD as compared to OP (p<0.0031). Also time for resumption of activities of daily life was more in ETD (p<0.0026). The recurrence of disease was seen in three patients in ETD as compared to none in OP. CONCLUSION: Omentoplasty offers a number of advantages over external tube drainage and should remain the preferred option whenever possible.

Laparoscopic interval appendectomy versus open interval appendectomy: a prospective randomized controlled trial.

This was a prospective randomized controlled study designed to compare laparoscopic and open interval appendectomy and involved 100 patients of appendicular phlegmon. After initial conservative management, patients were divided into 2 groups of 50 each and interval appendectomy was performed by laparoscopy in one of the groups and by open method in the other. Mean operative time in open surgery was 33.9 minutes and that in laparoscopic surgery was 57.64 minutes (P < 0.05). Concomitant pathology was observed in 16% and 2% of patients in the laparoscopic and open groups, respectively. Mean pain scores on the first postoperative day were 5.14 in the laparoscopic group and 6.01 in the open group (P < 0.05). Patients in the laparoscopic group had a shorter duration of ileus, postoperative stay, and returned to work earlier (P < 0.05). We conclude that laparoscopy offers a number of advantages over open interval appendectomy.