ABSTRACT… Introduction: Laparoscopic cholecystectomy is a standard and widely used procedure in the treatment of chronic cholecystitis for quite a long time now but there is a recent development in technique because of advent of harmonic scalpel (HS). Thus this study was conducted with an objective to compare frequency of post-operative complications in patients undergoing laparoscopic cholecystectomy by conventional versus harmonic technique. Data Source: Primary data based on patients presenting with chronic cholecystitis to the surgical department at tertiary care hospital. Study Design: Randomized Control Trial. Study Setting:The study was conducted in surgical unit-I, Jinnah Hospital Lahore. Duration of Study: Study was conducted in duration of one year i.e. January 2015 to December 2015. Subjects & Methods: After approval from the hospital ethical review board, 400 patients of either sex with age from 16 to 60 years and a diagnosis of chronic cholecystitis were included using purposive non-probability sampling technique. They were then randomly assigned to either conventional or harmonic group for laparoscopic cholecystectomy using lottery method at a ratio 1:1. . Information regarding their demographic characteristics and frequency of gall bladder perforation during surgery along with readmission in patients was noted in a structured proforma and data was analyzed using SPSS version 21.0. Results: The mean age of patients was 48.19 ± 6.484 years with about 156 (39%) male patients while 244 patients (61%) were female. About 15 (7.5%) patients in harmonic group and 16 (8%) patients in conventional group of laparoscopic cholecystectomy had gall bladder perforation during the procedure while 20 (10%) patients of harmonic group and 27 (13.5%) patients in conventional group were readmitted. On application of chi square test it was seen that the differences were statistically insignificant in both groups for the complications related to the procedure. Conclusion: It can be concluded from this study that both treatments are equally effective in terms of gall bladder perforation and rate of readmission. Thus, any of the techniques can be selected without much fear of complications depending upon the health care facility and financial constraints of health system in a resource depleted developing country. Key words:Laparoscopic Cholecystectomy, Harmonic Scalpel, Gall Bladder Perforation, Electrocautry.
Background and Objective: Trauma remains the major cause of mortality and disability among young people across the world with penetrating trauma being a very common cause. Traditionally, penetrating abdominal trauma was managed with exploration. But now with the advent of minimally access surgery and advancements in laparoscopic expertise, more patients can be managed with minimally invasive methods. This approach can save many unnecessary laparotomies and large midline incisions. The role of laparoscopy in blunt abdominal trauma is well established. The aim of this study was to evaluate the role of diagnostic laparoscopy in penetrating abdominal injuries. Methods: All the penetrating abdominal trauma patients presenting to the emergency department of Rawal Medical and Dental hospital from January 2019 till December 2020 for a period of 2years (a total of 102 patients) and who were hemodynamically stable, between the ages of 20 to 50 years of either gender were included in the study. All these patients had equivocal abdominal findings with no signs to suggest serious intraabdominal injury. These patients were prepared as standard for general anesthesia and diagnostic laparoscopy was performed. A predesigned performa was used for entering the patients’ details and operative findings. All patients gave written informed consent in urdu. Main outcome measures were the conversion rate, missed injuries leading to reexploration. Results: 85%of the patients were males with only 15% females. Mean age of the population was 38.7 years .Conversion to open was required in only 6.12 % of the cases .Laparoscopy alone was sufficient for all other patients. In about 36% of the patients no intraabdominal injury was found. In rest 58% patients the surgeons were able to repair the injuries laparoscopically.18 patients had minor liver injury,10 patients had minor hemoperitoneum<100 ml without any significant injury and 2 patients had single small bowel perforation which was repaired laparoscopically and cavity was irrigated. No patient had post operative complications of peritonitis due to missed injury or bleeding leading to re exploration. Conclusion: Laparoscopy is a very effective procedure to deal with penetrating abdominal trauma patients who are stable and with equivocal abdominal findings without increasing risk of missed injury with minimal rates of conversion to open laparotomy if patients are selected vigilantly. Keywords: Penetrating, Diagnostic Laparoscopy, Abdominal Trauma
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