Laparoscopic Cholecystectomy in Cases of Acute Cholecystitis

Objective: To evaluate the laparoscopic cholecystectomy procedure in cases of acute cholecystitis. Study Design: Cohort study Place and Duration of Study: Department of Surgery, Surgical Unit-1, SIMS/Services Hospital Lahore from 1st January 2021 to 30th June 2022. Methodology: One hundred and ninety eight cases which suffered from acute cholecystitis were enrolled. The age of the cases was within 35-60 years. The cases were divided into 3 groups; group A, group B and group C. The group selection was dependent on the interval period (between the onset of acute attack and the time of presentation for treatment). Group A was the one where interval period was &lt;3 days, Group B has 3 to 7 days while it was &gt;7 days in group C. The laparoscopic cholecystectomy was performed and operative outcomes were evaluated. Results: The mean age of the patients was 40.66±1.5 years with more females in each group than males. The cases of gall bladder empyema/mucocele were presented at the highest 68.8%. This was followed by the cases having Gall Bladder phlegmon identified in 24.74% of the cases. The rate of complication was highest in Group B while operation time and post-operative hospital stay was highest in Group A. The conversion rate from Laparoscopic to open cholecystectomy was measured as 3.03%. Conclusion: Laparoscopic cholecystectomy is a procedure which can be successfully achieved in acute cholecystitis cases with reduced conversion rate and complication attained through surgical expertise. Keywords: Laparoscopic cholecystectomy, Acute cholecystitis, Conversion rate</jats:p

Comparison of Clipped Laparoscopic Cholecystectomy and Clipless Laparoscopic Cholecystectomy in Context of Biliary Leakage

Objective: To compare the outcome of clipped laparoscopic cholecystectomy and clipless laparoscopic cholecystectomy in context of biliary leakage. Study Design: Cross-sectional analytical study Place and Duration of Study: Department of Surgery Unit-II, Benazir Bhutto Hospital Rawalpindi from 1st September 2021 to 31st August 2022. Methodology: One hundred and twenty patients were included in the study and divided into two major groups. The biochemical analysis and ultrasonography was performed post 8 hours fasting. Group one had those cases which underwent clipped laparoscopic cholecystectomy while group 2 had those cases which underwent clipless laparoscopic cholecystectomy. The age of the patients was selected between 40 to 60 years and the prevalence for this sampling was considered as 20% in Pakistan. The demographic details, clinical history, signs and symptoms, clinical diagnosis based on USG, lipid profiling, and variables as post-operative time, hospital stay and ease in procedure were documented. Results: The mean age of the cases underwent clipped laparoscopic cholecystectomy was 42.3±12.11year with 40 females and 20 males who underwent those procedures. The mean age of the cases underwent clipless laparoscopic cholecystectomy was 40±11.05 years with 45 females and 15 males. The present study results evidently highlighted the fact that there were high percentage cases of biliary leakage seen in clipped cases than in the clipless cases. There were22 cases with 36.6% in clipped groups while 9 cases with biliary leakage such as 15% in clipless group. Conclusion: Clipless laparoscopic cholecystectomy is a better optional procedure with efficient usefulness in context to biliary leakage, operation time and hospital stays. Keywords: Outcome, Clipped laparoscopy cholecystectomy, Clipless laparoscopic cholecystectomy, Biliary leakage</jats:p

Association of Risk Factors for the Mortality and Morbidity of Stoma Closure

Background: Anastomal leakage is a main surgical difficulty and requires stoma closure. Objective: To find associated risks for mortality and morbidity of stoma closure. Study Design: Retrospective cohort study Place and Duration of Study: Department of Surgery Ward 2, Jinnah Sindh Medical University/Jinnah Postgraduate Medical Centre Karachi from 1st July 2020 to 30th June 2021. Methodology: One hundred and twenty patients undergone rectal carcinoma surgeries were enrolled. The complications were graded by Clavien-Dindo classification system. The stoma closure was done by two different methods; the anterior wall technique or resection with anastomosis. Time duration of surgery, scoring by American Society of Anaesthesiologists was done and clinical and demographic information documented. Results: There were 62.5% males while 37.5% females and mean age was 65.5±8.5 years range between 31 to 72 years. Vascular blood supply affected leaking anastomaly. No significant effect of stoma type or closing technique was seen. However the time of stoma (p=0.044) and ASA score closure was a main risk for causing complications and increasing morbidity or mortality chances. Conclusion: Time of closure, American Society of Anaesthesiologists score as well as vascular supply are risk factors for morbidity or mortality in stoma closure. Keywords: Surgical stoma closure, Risk factors, Morbidity, Mortality</jats:p

Factors Increasing Risk of Septicemia in Acute Cholycystectomy Patients

Background: Septicemia is defined as systematic inflammatory response syndrome which is formed as a result of an infection. Objective: To identify the factors increasing risk of septicemia in acute cholecystectomy patients. Study Design: Retrospective study Place and Duration of Study: Department of Surgery, Sahara Medical College, Narowal from 1st August 2020 to 31st May 2021. Methodology: One hundred and seventy acute cholecystectomy patients were enrolled. The patient’s demographic, clinical history, comorbidities and post-operative complications were listed. All procedures were done through laparoscopic method. Results: There were 54.1% females and 45.9% males. The mean age of patients was 52.17±14.33 years. There were 11.7% cases who developed septicemia. The immune deficient patients were 0.9% and 1.8% had perforated gall bladder. There were 2.7% cases having obesity, cirrhosis or complicated diabetes with 3.6% having chronic kidney disease. Conclusion: The factors of complicated diabetes, cirrhosis, obesity and chronic kidney disease are associated with risk of septicemia in acute cholecystectomy. Key words: Cholecystectomy, Septicemia, Risk factors, Obesity, Chronic kidney disease</jats:p

Comparison of Clinical Outcome of Laparoscopic with Open Repair Surgery for Duodenal Ulcer Perforation

Objective: To determine the clinical outcome of laparoscopic versus open repair of perforated peptic ulcer. Study Design: Comparative analytical study Place and Duration of Study: Department of Surgery Ward-2, Jinnah Postgraduate Medical Centre Karachi from 1st March 2021 to 28th February 2022. Methodology: Fifty patients with duodenal ulcer perforation were divided into two equal groups and open surgery or laparoscopic was performed after clinical examination. Boeys score, Mannheim Peritonitis Index preoperatively and VAS scoring as post-operative was done. Results: There were more males than females within both groups with a mean age of 51.3±16.5 years in group I and 55.7±14.9 years in group II. The perforation size of group I was greater as 16.3±6.4 mm than group II patients which were 15.9±5.7 mm. The post-operative complications showed a high frequency of respiratory cardiovascular and surgical site complications with greater mortality rate in Group II A major decrease in pain score was recorded in laparoscopic group such as group I in comparison with open repair such as group II. Conclusion: Shorter hospitalization and less post-operative pain was observed in laparoscopic repair for perforated peptic ulcer as compared to open-repair surgery. Keywords: Peptic ulcer, Laparoscopy, Advantages, Disease management</jats:p

Comparison of Laparoscopic and Open Appendectomy in Terms of Surgical Site Infection

Objective: To compare the laparoscopic and open appendectomy in terms of surgical site infection. Study Design: Retrospective study Place and Duration of Study: Department of Surgery Unit-2, Ghulam Muhammad Mahar Medical College Hospital Sukkur from 1st January 2019 to 31st December 2020. Methodology: One hundred patients who were further divided in two groups with 50 patients each were enrolled after clinical confirmation of appendicitis. Group A was operated through open surgery method while Group B was operated laparoscopically. The data regarding hospital stay, duration of surgery and surgical site infection through both techniques was compared and data analyzed. Results: The mean age of patients was 26.5±5.5 years males with a percentage of 76% where as only 24% of the study cases were females. Patients undergoing laparoscopy were having reduced prevalence of surgical site infection as 10% than who underwent open surgery. Among the 26.54% of reported co-morbidity cases as well, there were 65% those who has surgical site infection with open surgery protocol. Conclusion: Laparoscopic surgery technique is highly efficient in reducing surgical site infection in comparison to open surgery method. Keywords: Appendectomy, Open surgery, Laparoscopic, Surgical site infection</jats:p

Risk of Gastrointestinal Complications in Post Laparoscopic Cholecystectomy

Background: Post-cholecystectomy is related with a significant risk of developing gastrointestinal symptoms which affect the quality of life of patients. Objective: To assess the gastrointestinal complications risks in post-cholecystectomy patients (laparoscopic). Study Design: Retrospective study Place and Duration of Study: Department of Surgery, Services Hospital, Lahore from 1st April 2020 to 31st March 2021. Methodology: One hundred and fifty patients were enrolled. All patients under went laparoscopy for their acute or chronic cholelithiasis treatment. Patients demographic, body mass index, clinical assessment was documented. Patients were followed up for a period of six months and their gastrointestinal complains were recorded. Results: There were 86 females and 64 males with a mean age 49.8±6.3 years and mean body mass index were 24.8±3.6 kg/m2. Diarrhoea and fat intolerance were main complains within 56% and 57.3% patients within three months respectively. Flatulence, fat intolerance and right upper quadrant pain was also main complains of patients. Conclusion: Risk of diarrhoea, right upper quadrant pain, flatulence, and fat intolerance are noticeable as gastrointestinal complication in laparoscopic post-cholecystectomy patients. Keywords: Post-cholecystectomy, Gastrointestinal complications, Diarrhoea</jats:p

Thyroid Gland Examination for Thyroid Nodule through Free Hand Fine Needle Aspiration Cytology (FNAC) Versus Ultrasound Guided Core Sampling

Objective: To compare the free hand fine needle aspiration cytology versus ultrasound guided core sampling for thyroid nodule examination in thyroid gland. Study Design: Retrospective study Place and Duration of Study: Department of Surgery Unit-2, Ghulam Muhammad Mahar Medical College Hospital Sukkur from 1st January 2016 to 31st December 2021. Methodology: One hundred patients were divided in two groups. Group A had 50 patients who undergo ultrasonography through Doppler scanning while Group B had equal number of 50 patients which underwent free hand fine needle aspiration cytology. The clinical details were noted and graded as un-satisfactory or lacking follicular cells or else having &lt;6 groups epithelial cells or having sufficient number of follicular cells. Results: The mean age was 31.5±11.8 years and majority of the patients were females 54% in comparison with 46% males. Insufficient cytopathologic cells were noticed in 18% US guided thyroidal nodule examination while similar insufficiency was seen in 44% fine needle aspiration cytology examination. The adequate cytopathological cells were noticed in 82% Ultrasounds while same was only seen in 56% fine needle aspiration cytology. Conclusion: Ultrasound guided core sampling has presented higher adequate cytology cases in comparison to free hand fine needle aspiration cytology cases. Key words: Fine needle aspiration cytology, Ultrasonography, Thyroid nodule</jats:p

Post-Operative Pain in Transabdominal Preperitoneal (TAPP) Hernia Repair: Mesh Fixation with Tacks Versus Non-Fixation

Objective: To find the post-operative pain in transabdominal preperitoneal (TAPP) hernia repair: Mesh fixation with tacks versus non fixation. Study Design: Comparative study Place and Duration of Study: Department of Surgery Unit B, Mardan Medical Complex, Mardan from 1st October 2019 to 30th September 2021. Methodology: One hundred participants who were admitted for inguinal hernia repair through laparoscopic surgical procedure were enrolled as study participants and divided into two groups. General anesthesia was administered to all patients and a carbon dioxide pressure of 14mmHg was used for keeping pneumo-peritoneum during the surgical procedure. An incision in peritoneum was made post identification of herniasac. Pain index was measured by Visual Analogue Scale at day 1, day 3, day 7 and day 14 followed by one and six months post-surgery. Results: The mean age of group A and group B patients in the present study were 51.2±9.5 and 52.1±9.7 years respectively with majority being males in both groups. Majority of patients in both group had unilateral herni. Group B had shorter surgery duration with lessen hospital stay however chances of recurrence as 12% and wound infection as 6% was higher in it respectively. The post operative pain was 65±9.3 and 66±9.1 in group A and B. Conclusion: Mesh fixation is a longer duration process requiring longer hospital stay, however it provides less chances of complications as wound infection and recurrence. There was no difference in post operative pain in both groups. Keywords: Hernia Repair, Fixation, Mesh, Surgical Method</jats:p

Frequency of Port Site Wound Infection in Laparoscopic Surgery

Objective: To find the frequency of port site wound infection in laparoscopic surgery. Study Design: Retrospective study Place and Duration of Study: Department of Surgery, Rahbar Medical &amp; Dental College, Lahore from 1st October 2020 to 30th September 2021. Methodology: One hundred cases of laparoscopic cholecystectomy were investigated. A standard protocol of National-Nosocomial Infections-Surveillance system as provided by CDC; was applied for identifying port site infection. Weeks assessment was initially done post 7 days of surgery in majority of patients and then after every 7 days for 4 weeks in those having port site infection formation. The demographic information was also documented using a well-designed questionnaire. Results: The age of the patients was between 25-63 years with a mean age of 35.4±2.5 years. There were 52% females and 48% males. Out of the total cases of port site infection 83% cases had epigastric port site infection. Conclusion: Laparoscopic surgery is associated with low risk of port site infection. Keywords: Laparoscopic surgery, Infection, Cholecystectomy, Frequency</jats:p