Role of Intraperitoneal Normal Saline Instillation in Relieving Post-operative Pain Following Laparoscopic Cholecystectomy: A Quasi Experimental Study.

Laparoscopic cholecystectomy has rapidly become the procedure of choice for the treatment of calculus cholecystitis for having clear advantage over open method in reducing surgical morbidity, postoperative pain and complication. But still patients undergoing laparoscopic cholecystectomy complain of considerable pain especially on first post-operative day necessitating use of better methods for postoperative analgesia. This quasi experimental study was done in Surgery Unit III, Mymensingh Medical College Hospital from July 2016 to June 2017 to assess the role of intraperitoneal normal saline instillation following laparoscopic cholecystectomy in relieving postoperative pain. In this study total 200 patients of calculus cholecystitis were enrolled according to inclusion and exclusion criteria and assigned equally into two groups by non-equivalent control group design. Both the control group and experimental group were managed according to the standard protocol and operated in routine operation theater. The experimental group (n=100) was additionally instilled with 25-30ml/kg body weight of normal saline at 37°C at the gallbladder bed and subdiaphragmatic space at the end of surgery and all the data were recorded in individual case record form. Among the sample most of the patients were between 25-60 years of ages with the peak age being between 43-51 years. Eighty one percent (81%) of the total patients were female with male female ratio being 1:5.25 in Control group and 1:3.54 in Experimental group. The VAS scores for visceral pain in experimental group were significantly less than that of control group at 6 hours (p<0.001), 12 hours (p<0.001), 24 hours (p<0.001) and 48 hours (p=0.026). The VAS scores for shoulder tip pain in experimental group were also significantly less than that of control group at 6 hours (p<0.001), 12 hours (p<0.018) and 24 hours (p=0.004). The administration of analgesics was also significantly less in the experimental group than in control group at 6 hours (p<0.001), 12 hours (p<0.001), 24 hours (p=0.313) and 48 hours (p=0.297) with no significant differences at 72 hours. The mean hospital stay in this study was 2.2±0.7 days in the control group and 2.1±0.8 days in the experimental group showing no significant difference (p>0.05). Intraperitoneal normal saline instillation following laparoscopic cholecystectomy may be an eminent choice for reducing postoperative pain improving patient's experience.

A Young Girl with a Complex Female Genital Tract Malformation.

Complex malformations of the female genital tract are not as uncommon as they are thought to be. But because of their heterogeneous presentation they often pose a diagnostic dilemma and thus their management plan is crucial. Here we express a case report of a 12 year old girl with a rare and complex female genital tract malformation of uterine didelphys with obstructed hemi uterus due to unilateral cervical agenesis with ipsilateral renal agenesis and contralateral cervical dysgenesis. The girl presented to us with severe lower abdominal pain and progressive pelvic lump. In order to preserve menstrual function and fertility, a cervical fistula was made and the patient has been kept under follow up since then.