Ten years of laparoscopic cholecystectomy: a comparison between a developed and a less developed country.

OBJECTIVE: To compare the specific features and outcomes of laparoscopic cholecystectomy in two university hospitals, one in a developing country, Bosnia-Herzegovina, and the other in a well developed country, Italy. METHODS: Between January 1996 and December 2005, a total of 2018 patients underwent laparoscopic cholecystectomy in Mostar Clinical Hospital, Bosnia-Herzegovina (1066) and in Chieti University Hospital, Chieti, Italy (952). Differences in patients' presentations, diagnostic protocols, medication, surgical treatment, complications and outcomes were analyzed. RESULTS: The number of patients with life-threatening conditions was lower in Italy (15 or 1.5% vs. 53 or 4.9%; P<0.001), as was the use of analgesia and antibiotics (131 or 13.96% vs. 873 or 81.97%; P<0.001). Open-access biliary surgery was rare in Italy, where the vast majority of patients were operated laparoscopically; only 44 (4.41%) patients had open-access surgery, including 35 (3.61%) conversion patients. In comparison, 1669 (61%) patients in Bosnia-Herzegovina underwent open-access operations. There was a significant difference, in favor of the Italian hospital, in the number of surgical complications (8 or 0.84% vs. 40 or 3.75%; P<0.002) and also in the number of postoperative infections following surgical incision (0 or 0.0% vs. 6 or 0.56%; P<0.033). CONCLUSIONS: It is encouraging for surgeons in Bosnia-Herzegovina to find that satisfactory results can be achieved in a developing country. However, the number of complications encountered in the Mostar hospital emphasizes the need for further improvement of surgical technique through better structured training combined with strict supervision of junior staff. The finding of postoperative infections in the Bosnia-Herzegovina hospital, despite that their occurrence was relatively rare, highlights the necessity for further improvement of hospital infection control.

Learning through the Community Service.

AIM: To present a model of teaching general practice to medical students as a part of care for refugees in Mostar, Bosnia and Herzegovina. METHOD: With an international support, 33 medical students (from the third study year on) participated in a total of 51 field visits to 4 refugee camps near Mostar, Bosnia and Herzegovina, over a period of two years. Some students made more than 30 visits. Together with residents in family medicine at the Mostar University Hospital, the students performed physical examinations and small interventions, and distributed packs of different pharmaceutical agents to refugees. At the end of the project, participants were surveyed to assess the benefits of the program. RESULTS: Thirty out of 33 participating students responded to the survey. Fourteen students said that "the opportunity to do something, however small, for the people" was the main benefit from the project, whereas 5 thought that meeting "a real patient" early in their medical studies was very beneficial. The students assisted in 1,302 physical examinations, an average of 25-/+8 examinations per visit. The most requested physical examination was blood pressure measurement (52%), followed by chest auscultation (24%) and psychological counseling (16%). They also helped with a total of 320 minor procedures, an average of 6-/+2 per visit. Among the procedures, wound care and dressing were most common (63.4%), followed by nursing care procedures (20%) and minor surgical procedures (suture removal, abscess drainage, and bed sores debridement) in 6.9% of the cases. The students helped distribute 1,917 packs of pharmaceuticals: analgesics (52.5%), antihypertensive drugs (16.1%), antidiabetics (11.2%), cardiovascular drugs (10.9%), vitamins (5.6%), and dermatological remedies (3.6%). CONCLUSION: During the first two years of the project, we achieved three objectives. Residents in family medicine had a chance to practice and gain experience as group leaders, health promoters, and teachers. Medical students were exposed to a demanding outpatient environment early in their medical training. Refugees in three camps received health care and attention they needed so much.