Search

Introduction: Although laparoscopic cholecystectomy has replaced the open surgery for management of gall bladder stones, however, bile duct stones or choledocholithiasis remains to be a challenging task. Bile duct stones are seen in almost every 7th to 10th patient having gall bladder stonesi. There is controversy regarding the ideal approach for management of common bile duct (CBD) gallstones, more so, in view of availability of multiple options. Until the laparoscopic and endoscopic modalities came into picture, open cholecyststectomy was the only procedure for CBD exploration. Materials and methods: Prospective Study was done in all patients with a diagnosis of choledocholithiasis in OPD in surgery department at Era's Lucknow Medical College and hospital posted for elective surgery. All the patients above 18 years of age presenting with uncomplicated choledocholithiasis undergoing elective CBD exploration were included. Patients with cholangitis, gall stone pancreatitis, abnormal liver enzymes (greater than thrice the upper limit of normal), immunocompromised patient were excluded. All patients with a diagnosis of choledocholithiasis in surgery OPD at ELMCH were chosen by SNOSE technique for open and laparoscopic CBD exploration. Demographic information was obtained. Blood specimen were obtained for hematological and biochemical assessment. Pre-operative sonographic assessment was also done and stone size was assessed. All patients received preoperative parental broad spectrum antibiotics. All procedures were operated by the same experienced surgical team, under general anesthesia. Results: Out of a total of 88 patients enrolled in the study, a total of 44 (50%) underwent CBD exploration using laparoscopic procedure and comprised the Group 1 of study whereas remaining 44 (50%) patients underwent CBD exploration using open procedure and comprised the Group 2 of study. Majority of patients in both the groups were female. Proportion of males was 36.4% and 34.1% respectively in Groups 1 and 2. Overall, there were 31 (35.2%) males and 57 (64.8%) females. On comparing the data statistically, no significant difference was observed between the two groups with respect to sex of the patients (p=0.823). Mean neutrophil, lymphocyte eosinophil and monocyte count was 68.45±7.19, 26.45±7.51, 4.23±1.79 and 0.82±1.02% respectively in Group 1 as compared to 68.30±7.61, 27.32±7.69, 3.95±1.82 and 0.61±1.10% respectively in Group 2. For none of these variables, the difference between two groups was significant (p>0.05). Mean prothrombin time and INR were 12.12±1.62 seconds and 0.70±0.14 respectively in Group 1 as compared to 12.20±1.47 seconds and 0.68±0.11 respectively in Group 2. Statistically, there was no significant difference between two groups for both these parameters (p>0.05). Conclusion: The findings of the study show that except for a slightly longer duration of procedure, laparoscopic procedure was associated with fewer complications (intraoperative blood loss, post-operative infection, wound dehiscence, residual stones and Incisional hernia), shorter duration of post-operative hospital stay and cheaper overall cost. Thus laparoscopic exploration of CBD offered a better clinical outcome with fewer outcomes and could be recommended as the preferred modality for exploration of CBD. [ABSTRACT FROM AUTHOR]

Introduction: Dehiscence occurs when wound margins that were previously closed come apart either partially or completely, which is often caused by inadequate wound healing. The same factors that can contribute to poor wound healing, including ischemia, infection, elevated abdominal pressure, diabetes, malnutrition, smoking, and obesity, can also increase the risk of dehiscence. Aim: To assess the significance of predictors associated with post laparotomy abdominal wound dehiscence. Material and Methods: A total of 40 patients who were hospitalized for wound dehiscence after laparotomy were screened for inclusion and exclusion criteria eligible patients were enrolled in the study after obtaining informed signed written consent to participate in the same. Demographic profiling was done for the patients. Intra-operative assessment was done for Duration of surgery, types of sutures used, types of surgery. Post Operative findings were accessed at Day 1, Day 3, Day 5, Day 7, Day 14, Day 21 and Day 30 post-operatively. Results: The Five Most Common Causes of Wound Dehiscence as estimated by Bayes Formula showed that the most common cause was found to be dirty wound (28.30% chances) followed by contaminated wound (22.93% chances), distension (8.93% chances), raised urea/creatinine (7.50% chances) and S.Aureus organism (6.40% chances). Conclusion: Dirty wound and contaminated wound are found to be two most important predictors of wound dehiscence followed by abdominal distension, raised urea/creatinine and S. Aureus organism contaminating the wound. [ABSTRACT FROM AUTHOR]

The article presents a case study of one-year-old child who was admitted with complaints of enlarging head circumference with tense fontanelles. It mentions that the child had a normal cry with good sucking reflex and his computed tomography (CT) scan showed mixed density predominantly cystic lesion with no calcific foci A in the right occipitoparietal lobes. It adds that he was diagnosed and treated for infantile desmoplastic astrocytoma.