Classifieds for every web site!

SURGICAL WEBSITES             KIDNEY SURGERY         POSTGRADUATE SURGERY LINKS 

BREAST DISEASE     Breast cancer Breast lump Breast awareness Breast calcifications  Breast cysts Breast pain Duct ectasia Fat necrosis Fibroadenoma Hyperplasia Intraductal papilloma Phyllodes tumour Sclerosing adenosis                                                                                                                                                 

LIVER ABSCESS      Anatomy of liver Physiology of liver Method of examination of liver Haematology of liver disease. Amoebic liver abscess .Pyogenic liver abscess. Percutaneous needle aspiration of liver abscess. Case study.  Result Result continued  Discussion                                                                 

CHOLECYSTECTOMY    Introduction   Historical Review  Anatomy of Gallbladder Physiology of Gallbladder Physiologic effects of pneumoperitoneum Pathology  of Gallbladder Investigations Pre- operative preparation of laparoscopic cholecystectomy Contraindications  Treatment modalities for gallstones.  Anaesthesia                                                                                                                       

INGUINAL HERNIA    HOW SURGICAL OPERATION IS DONE     THYROID EXAMINATION MANAGEMENT OF SEVERELY INJURED PATIENT      SEPSIS AND MULTIPLE ORGAN FAILURE CHEST TRAUMA     BRONCHOGENIC CARCINOMA     TETANUS AND ANAEROBIC INFECTIONS 

INTRODUCTION

            The prevalence of the gall bladder disease as well as the prolonged hospitalisation, extended recovery time and pain associated with a major abdominal operation has prompted many investigators to explore alternative methods of treatment. Within two decades non-operative approaches to eliminate gallstones, such as dissolution therapy and lithotripsy, have been introduced. Although these procedures appeared to have a lowered morbidity because the need for cholecystectomy was eliminated, the recurrence of the symptomatic gallstones was in excess of 50%. Consequently the expense associated with repetitive procedures and the need for prolonged administration of agents to prevent recurrent stone formation made this approach less attractive. In this setting laparoscopic cholecystectomy was introduced as an endoscopic procedure for removal of the gall bladder without the postoperative pain, sequelae of open cholecystectomy.

            If conducted safely, endoscopic surgery offers saving in total health care as a result of shorter hospital stay and more rapid return to work, factors those are appealing to both commercial and governmental health care providers. The self-employed returned significantly earlier than employees did. Public awareness that endoscopic surgery is associated with diminished pain and cosmetic disfigurement as well as quicker resumption of normal activities has accelerated its acceptance by surgeons.

            We like other observers were interested in impact of laparoscopic cholecystectomy as it became the standard of care in Pakistan and through out the world. The theme of this study is to see and analyse the complications and its causes so we can define our protocols and also we can statistically explain and clarify all the questions and ambiguities in the mind of the patient and his/her curious relatives.

In initial days of laparoscopic cholecystectomy patients whom the following criteria were selected

(i)-     Symptoms consistent with biliary colic.            

(ii)-    Documented stones on ultrasonography or contrast radiography.

(iii)-   No evidence of common bile duct disease.

(iv)-   The absence of acute cholecystitis.

(v)-    Stones < 3.0 cm in diameter.

(vii)-  No previous upper abdominal surgery.

 

            Keeping aside the patients having absolute contraindications, I considered those patients in my study who had either no contraindications or relative contraindications for laparoscopic cholecystectomy and in whom intra-operative conversion of laparoscopy into open cholecystectomy (laparotomy) due to various reasons which will be discussed under different heads, for example obesity, inability to define anatomy, bleeding from cystic artery, common bile duct etc. The reasons for conversion were analysed in detail in the study.