ABSTRACT
There is a continued debate on fate of spilled bile with gallstones during laparoscopic cholecystectomy, so we felt that the outcome needs further evaluation in detail. Although laparoscopic cholecystectomy become increasingly popular, but it is associated with a slightly higher chances of injury to biliary tree and perforation of gallbladder with spillage of bile only or with gallstones. [1] To evaluate fate of spilled bile with gallstones during laparoscopic cholecystectomy. [2] To assess various possible outcomes. [3] Suggestions to prevent these and their management. Prospective study. Surgical unit of Muhammad Medical College Hospital, Mirpurkhas. February 2008 to April 2011. Data source: Total 100 patients who underwent elective laparoscopic cholecystectomy were included. Age, sex, duration of operation, operative findings, duration of hospital stay and post-op complications were recorded in proforma and analyzed on SSP version 10. The patients who underwent cholecystectomy, and had intra-operative spillage were shortlisted, included in this study and followed up. Short-term follow-up was based on OPD visits for 2 to 3 weeks postoperatively, and long-term follow-up was achieved by regular OPD visits or telephone conversation in patients at a mean of 1.4 years [range 2 to 39 months].all minor or major complications were recorded in preformed proforma. A total of 100 patients underwent laparoscopic cholecystectomy. Among the patients who underwent elective laparoscopic cholecystectomy the incidence of Iatrogenic perforation of the gallbladder is around 40%, of whom about 22% had spillage of only bile and 18% in whom spillage of both bile and gallstones. It is concluded that laparoscopic cholecystectomy with gall bladder perforation along and spillage of bile and stones took longer operative time than intact gall bladder. We suggest that attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure. In our study, we revealed that no harm is caused by retained gallstones during laparoscopic cholecystectomy after long term followup by evaluation
ABSTRACT
Free perforation of peptic ulcer into the general peritoneal cavity is a catastrophic event. Although laparoscopic approach has been successfully used for its management, primary closure of the perforation using an omental patch [Grahm's patch] is the immediate alterative. This study was planned to analyse risk factors, which could predict releak following Grahm's patch closure. This study was carried out for five years from April 2003 to March 2008, at department of surgery Muhammad Medical College Mirpurkhas. All patients undergoing surgery for perforated duodenal ulcer were included in the study. 53 patients underwent Grahm's Patch Closure. 6 patients developed releakage post operatively. Therefore two groups were made. Patients with releak were kept in case group [n=6] and the patients with no leak [n=47] were included in control group. In this study all patients were assessed for age, pulse rate, systolic blood pressure, hemoglobin and serum Protein / albumin, total leukocyte count [TLC] on arrival, delay in arrival since sign and symptom [probable] of perforation and size of perforation on operation were also documented. Age greater than 50 years [p=0.05], pulse greater than 110/min [p=0.22], systolic blood pressure less then 90mmHg [p=0.02l], hemoglobin less than 10gm% [p=0.25], serum albumin less than 2.5gm% [p=0.018], delay in arrival for more then 36 hour [p=0.00017], and size of proportion greater then 5mm in it maximum dimension were identified as risk factor for releak. Delay in arrival was the single most significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer