Index Admission Laparoscopic Cholecystectomy for Gall Stone Pancreatitis.

Background: Timing of Laparoscopic Cholecystectomy (LC) after gallstone pancreatitis varies considerably between surgeons.We examined outcomes at JN Medical College and hospital where most patients underwent LC following initial management of gallstone pancreatitis. Methods: This prospective study is carried out between June2009 to June 2013 in J.N.M.C.H. Patients with signs and symptoms of acute pancreatitis were admitted and evaluated. All patients admitted were provided the standard care. After exclusion of some patients, remaining underwent laparoscopic cholecystectomy irrespective of severity of disease in index admission, although patients with severe biliary pancreatitis were operated after stabilization of general condition. Results: A total of 134 patients with gallstone pancreatitis were identified of whom 90 underwent laparoscopic cholecystectomy (LC) in the index admission.77 patients were of mild pancreatitis while 13 were of severe pancreatitis. Out of 77 patients with mild pancreatitis 8 patients and 6 out of 13 patients with severe pancreatitis had a difficult dissection (p value<0.05).In terms of hospital stay mean duration of stay was 8.7 days in mild pancreatitis group, whereas it is 19.8 days in severe pancreatitis group (p value <0.05). Of these 90 patients79 (88%) underwent LC successfully while 11 (12%) required conversion to open cholecystectomy where 8 were of mild and 3 were of severe pancreatitis. 14 (15%) had a difficult dissection, where 8 were of mild and 6 were of severe pancreatitis There were 6 (6.7%) postoperative complications in form of wound infection and bile leak overall. The difference in terms of variables like conversion rate to open surgery, need of drain placement, bile leak and wound infection was statistically not significant.Conclusion: LC should be used for GSP during the same hospital admission with favorable outcome with complications and conversion rate compared to elective LC. All patients of mild pancreatitis and patients of severe pancreatitis with no local and systemic complications could undergo laparoscopic cholecystectomy in index admission.

Gossypiboma: To Err is Human – A Case Report

Gossypiboma (retained surgical sponge) is one of the identities that can be a disaster not only to the carrier of operating surgeon but also for the hospital as far as the financial burden and the reputation is concerned. The patient may have severe morbidity and in worst of the event can have mortality. The aim of this article is to highlight the fact that the incidence is not as rare as has been reported in different literatures and to discuss its various –clinico-radiological features, predisposing factors, measures to avoid it and how to manage when such a calamity has occurred. This article increases the awareness about the problem thus avoiding unnecessary morbidity/mortality to the patient as well as save the surgeon from malpractice law suits, great psychological trauma and negative publicity.