Experience of laparoscopic cholecystectomy during a steep learning curve at a university hospital.

BACKGROUND: Cholelithiasis is the most common disease of alimentary tract affecting the adult population globally and our country in particular is no exception to it as a cause of hospitalization. Surgical removal of gall bladder is the main stay of symptomatic cholelithiasis ensuring a permanent cure. The minimally invasive technique of laparoscopic cholecystectomy has gained wide acceptance as a Gold Standard treatment ever since its introduction. The purpose of this prospective observational study was to document our experience of laparoscopic Cholecystectomy during a learning curve in a single unit of a university hospital and compare it with other available data in the literature. METHODS: Total 94 patients underwent laparoscopic cholecystectomy during the learning curve from Jan 2009 to Dec 2010 in the Department of Surgery Liaquat University Hospital Jamshoro. RESULTS: Mean age was 42 years with females (88.29%) preponderance. Majority of the cases were operated by consultants (85.10%) within 25-60 minutes. Postoperative hospital stay was 3 days with return to work in 7 days. Only 6 (6.38%) cases were converted to open technique. Intra-peritoneal drains and Foley's catheter were kept in selected cases only. Eleven patients (11.70%) had intra-operative complications including complete transaction of CBD in only one (1.06%) male patient. Five patients (5.31%) had postoperative complications with two patients having iatrogenic duodenal injury which was not identified during surgery and pseudo cyst pancreas. Four patients (4.25%) died due to multiple organ failure. CONCLUSION: We conclude that Laparoscopic Cholecystectomy is a gold standard procedure and should be learned on virtual simulated models before starting this procedure on human patients.

Outcome of the rubber band ligation with Milligan Morgan haemorrhoidectomy.

BACKGROUND: Haemorrhoids is a common anorectal disease seen in our society. Conservative management is usually adopted for 1st and 2nd degree haemorrhoids. Patients who do not respond to above management are the candidates for other modalities of treatment which includes sclerotherapy, rubber band ligation, cryosurgery and stapler gun or open haemorrhoidectomy. The purpose of study was to compare the outcome of the Rubber band ligation with Milligan Morgan haemorrhoidectomy in patients with 2nd and 3rd degree haemorrhoids. METHODS: Hundred diagnosed admitted patients of uncomplicated 2nd and 3rd degree piles were treated either with rubber band ligation (RBL) or open method of Milligan Morgan (OH) for the period from January 2007 to December 2007 were included in the study. Both procedures were evaluated regarding effectiveness, safety, complications after procedures, hospital stay and return to work on a written Performa. Patients with 1st and 4th degree haemorrhoids, below the age of 12 years, bleeding diathesis, associated local anorectal conditions requiring surgery, complicated haemorrhoids, recurrent and secondary haemorrhoids were excluded from the study. Follow up of all these patients was done in OPD to assess any complication and recurrence. Data was analysed through SPSS-16.0. RESULTS: One hundred indoor patients with 2nd and 3rd degree haemorrhoids were treated either with rubber band ligation or open technique. Most (> 90%) of the patients were males. Majority of the patients were in 30-33 years age group. Fresh bleeding (90%) and constipation (45%) were the commonest symptoms followed by prolapsed, discharge and irritation. Second degree was more common than 3rd degree haemorrhoids. Intensive pain was the commonest complain after both the procedures, however faecal incontinence was not reported in either group. Hospital stay was longer in open technique (70%) compare to few hours to one day in rubber band ligation group. Return to work was earlier in patients treated with rubber band ligation. CONCLUSION: Rubber band ligation is safe and effective method compare to open technique in 2nd and 3rd degree symptomatic haemorrhoids.