A two year retrospective review of Laparoscopic versus open Appendicectomy in perforated appendix in Hospital Ipoh (June 2006-May 2008)

Appendicectomy is one of the most common general surgical procedures performed all over the world in the surgical department. Since its description by McBurney in 1894 the open approach has become the standard surgical intervention for appendicitis, remaining virtually unchanged for 100 years owing to its proven efficacy and safety. Laparoscopic appendicectomy on the other hand was first performed by Semm in 1983 (Litynski, G.S. 1999).But its popularity increased steadily throughout the 1990s. However, unlike cholecystectomy, the benefits of the laparoscopic approach have not been as apparent for appendicectomy, even more so in perforated appendicitis. Many early randomized trials failed to show any overall benefit for laparoscopy and others at best parity between the 2 procedures. Current studies however indicate a shift in favour of laparoscopy, probably due to the increase in laparoscopic exposure at all levels of surgical training. The aim of this study is to compare certain parameters between Laparoscopic appendicectomy with open appendicectomy. xii RESULTS: Two hundred and five patients with perforated appendicitis were reviewed. Fifty-six patients had laparoscopic appendicectomy and one hundred and forty nine patients had open appendicectomy. The median age in the laparoscopic group was 28 and the open group was 30. The difference in the median age groups was not statistically significant .The p value is 0.310. The mean (s.d) operating time for laparoscopic appendicectomy was 69 minutes (29 minutes).The mean operating time for the open group was 63 minutes (28 minutes). This study showed that there was no significant difference in the mean length of operating time between the two methods. The p value is 0.669. The mean (s.d.) length of hospital stay for the patients in the laparoscopic group was 3.5days (1.6 days). In the open group the mean length of hospital stay was 3.1 days (1.9 days). This was statistically not significant (p=0.382).There was also no statistical significance in the duration the patients took to tolerate orally and for the temperature to settle in both the groups. There were a total of six patients with the surgical site infection and seven who had readmission. Although all 6 patients with surgical site infection were from the open group and none in the laparoscopic group this was not statiscally significant. p = 1.000. Five patients in the laparoscopic group and two in the open group were readmitted within a week of their respective surgeries for ileus. This difference was also not statistically significant with a p value of 1.000.The mean (s.d.) amount of analgesia used in laparoscopic appendicectomy was 387.5mg (259.4mg) . The mean (s.d.) for the use of analgesia in the open group was 274.5mg (204.3mg) for the open group. This was statistically significant where p = 0.006. CONCLUSION: There is no clinically significant difference between laparoscopic appendicectomy and open appendicectomy for perforated appendicitis

Laparoscopic cholecystectomy at the Aga Khan Hospital, Nairobi

Objective: To evaluate our experience of laparoscopic cholecystectomies at the Aga Khan Hospital, Nairobi over a three-year period from the inception of the technique, and to assess its value and advantages to the patients. Design: A prospective case series study. Setting: The Aga Khan Hospital, Nairobi. Patients: One hundred and thirty five cases operated from February 1996 to April 1999. All patients were subjected to the American method of laparoscopic cholecystectomy, which is described in detail in this paper. Main outcome measures: Clinical presentation, age and sex demographics, average hospital stay, intraoperative and postoperative complications and outcome. Results: There was a female preponderance with a female to male ratio of 5:1. Mean age was forty nine years. Majority of patients suffered from chronic cholecystitis. The conversion rate to an open procedure was five per cent. There were two cases of significant bile leakage which required laparotomy. No mortality was reported in this series. Conclusion: This technique was found to have distinct advantages such as shorter hospital stay, lesser postoperative pain and very good cosmesis. It is a safe procedure if performed by a well trained surgeon

Providing adhesion for a miniture mobile intra-abdominal device based on biomimetic principles

This paper investigates the surface adhesion characteristics required for a miniature mobile device to move around the abdominal cavity. Such a device must be capable of adhering to the tissue lining and move freely across the upper surface of the insufflated abdomen. Accordingly, the potential of utilising bioinspired solutions to facilitate wet adhesion is assessed

Лапаростомия и этапные санации брюшной полости в лечении тяжелых форм распространенного перитонита

БРЮШНАЯ ПОЛОСТЬ /ХИРЛАПАРОТОМИЯПЕРИТОНИТ /ХИРСАНАЦИ

Colecistectomia laparoscopica in situs viscerum inversus totalis: nota di tecnica

The Authors report the case of a patient admitted in Emergency Room for biliary colic. She knew her dextrocardia. ECG and chest X-ray confirmed the dextrocardia. Ultrasonography and CT scan discovered a situs viscerum inversus totalis and cholecystolithiasis responsible of the abdominal colic. Laparoscopic cholecystectomy was performed. The Authors discuss the clinical case and the particular technique used

Colicestectomia laparoscópica. Revisión de los primeros 500 pacientes

Inclou referències bibliogràfique

بررسی فراوانی عوارض ایجاد شده در کله‌سیستکتومی‌های انجام شده به روش لاپاراسکوپیک در بیمارستان‌های همدان (1376 تا 1384)

زمینه و هدف: کوله‌سیستکتومی لاپاراسکوپیک، یکی از شایعترین جراحی‌های الکتیو می‌باشد و به عنوان درمان اولیه بیماری‌های علامت‌دار کیسة صفرا شناخته شده است. این شیوة جراحی نیز همانند روش‌های دیگر با وجود منافع موجود می‌تواند عوارضی را ایجاد کند که در صورت عدم توجه زندگی بیمار را به مخاطره اندازد. این مطالعه با هدف بررسی فراوانی عوارض ایجاد شده در کله‌سیستکتومی‌های انجام شده به روش لاپاراسکوپیک در بیمارستان‌های همدان (1376 تا 1384) انجام شد. مواد و روش‌ها: در این مطالعة گذشته‌نگر, 426 بیمار با تشخیص قطعی کله‌سیستیت که در بین سال‌های 1376 تا 1384در یکی از بیمارستان‌های همدان تحت عمل جراحی کله‌سیستکتومی لاپاراسکوپیک قرار گرفته بودند، مورد بررسی قرار گرفتند. یافته‌ها: از 426 بیمار مورد بررسی، 53 نفر (44/12%) مرد و 373 نفر (56/87%) زن بودند. شایعترین عارضه ایجاد شده شامل باقی ماندن سنگ در مجاری صفراوی با 7 مورد (64/1%) بود و آسیب مجاری صفراوی و نشت صفرا هر کدام با 6 مورد (4/1%) و خونریزی از شریان سیستیک با 5 مورد (17/1%) در رتبه‌های بعدی قرار داشتند. نتیجه‌گیـری: با وجود اینکه کله‌سیستکتومی لاپاراسکوپیک به عنوان درمان اصلی بیماری‌های کیسة صفرا شناخته شده است، ولی آسیب مجاری صفراوی همچنان در حد بالایی قرار دارد و باید مورد توجه ویژه قرار گیرد