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Objective: To compare postoperative pain between conventional CO2 releasing method and additional suction after laparoscopic cholecystectomy (LC) considering PCA Morphine consumption which makes pain measurement more accurate than pain score. Methods: Eligible patients with indication for LC were randomly assigned preoperatively either to have the conventional CO2 releasing method, or an additional 60 seconds of suction after LC. We collected demographic data, postoperative pain at 6, 12 and 24 hours, residual intraperitoneal pressure, operative time, intraoperative Morphine amount and Morphine PCA amount in 24 hours. Pain evaluation by PCA amount was designed to get more accurate primary outcomes. Results: The patients were similarly distributed. Residual intraperitoneal pressure was statistically significantly different. Morphine PCA amount in both groups were not significantly different. Postoperative pain level at 6, 12 and 24 hours as secondary outcomes showed that suction group seemed to have slightly higher pain score at 6 and 12 hours but at 24 hours post LC, pain in suction group tended to be a bit lower than in non-suction group. Conclusion: Additional CO2 suction from this study does not reduce postoperative pain. However, with a larger study population, it might help us to consider results in the intervention group better.

Background: Post-operative surgical site infection is a common complication especially in a colorectal surgery of which wound is in a high-risk group. Prophylactic antibiotic is a well-established standard for this type of surgery. Laparoscopic surgery is a method which results in small incision, faster recovery and less chance of infection in the surgical wound. However, there is still an infection rate of 8-23%. According to Guidelines on the Management of Intra-Abdominal Infection by The Surgical Infection Society, it is recommended to use cefuroxime/ceftriaxone in conjunction with metronidazole. However, today there is a cefminox which is a new 3rd generation cephalosporin that covers anaerobe bacteria. Objectives: The aims of the study are to compare the effectiveness of the usage of cefminox and ceftriaxone in conjunction with metronidazole in order to prevent surgical site infections after laparoscopic colorectal surgery. Materials and Methods: 64 patients who schedule laparoscopic colorectal surgery are randomly separated into two groups. Group A receives prophylactic antibiotics with ceftriaxone 2 g and metronidazole 500 mg before surgery, and Group B receives cefminox 2 g. Patient characteristics, intraoperative factors and postoperative surgical site infection and complication in 30 days were recorded and compared between two groups. Results: The study includes 64 patients (37 males and 27 females). There is no significant difference of patient characteristics and intraoperative factors between the two groups. The rate of surgical site infection in group A is 18.8% (wound infection 12.5% and intraabdominal infection 8.8%) and group B's is 21.9% (wound infection 18.8% and intra-abdominal infection 3.1%). Conclusion: Cefminox is one of the choices in prophylactic antibiotic laparoscopic colorectal surgery. It can be used in single antibiotics with a reducing risk of side effect or drug allergy. Nevertheless, there is no significant difference in terms of effectiveness when comparing with traditional prophylactic antibiotics. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy (LC) is the gold standard in gallbladder removal surgery. Despite the drastic improvement LC has to offer, there is still much debate regarding the most effective method in ligating cystic duct and cystic artery during LC. Non-absorbable polymer clips (Hem-o-lok) are easy to use and do not cause artifacts during CT/MRI scans but the cost is very high. This study has suggested to use non-absorbable suture materials (silk sutures) for ligation as surgical knots are easy to apply, secure and the cost is significantly lower. Objective: To evaluate the efficacy of silk sutures in ligating the cystic duct comparison post-operative bile leakage with non-absorbable polymer clips. Furthermore, operative times, post-operative complications and the cost were into consideration. Materials & Methods: A prospective randomized controlled trial study of 90 patients who had indications for LC between September 2017 and November 2018 were carried out. Silk sutures (size 2-0) were used in Group A, while Group B received non-absorbable polymer clips. Demographic and intra-operative data were recorded. Post-operative complications such as bile leakage, surgical site infection or pancreatitis were noted if present. Liver function tests were repeated 2 weeks and 3 months after surgery. If patients experienced post-operative abdominal pain, constipation, fever or jaundice; ultrasound was recommended. Results: No statistically significant difference were observed in post-operative complications, hospital stays, operating times and intra-operative blood loss between silk sutures and non-absorbable polymer clips. None of LC procedures were converted into open cholecystectomy and none of post-operative complications had bile leakage. Only 1 case was re-admitted during follow up 2 weeks after surgery that was diagnosed dyspepsia. Conclusion: Ligating cystic duct and artery with silk sutures during LC proved to be as successful and effective as that of non-absorbable polymer clips, in terms of safety, operative times, post-operative complications and costs. [ABSTRACT FROM AUTHOR]