Background: In laparoscopic cholecystectomy prevention of certain life-threatening complications are dependent on proper patient selection. Some reliable factors to predict difficulty, conversion or complications in laparoscopic cholecystectomy are needed. In the present research attempt was made to study correlation between pre-operative abdominal ultrasonographic findings and difficultly in laparoscopic cholecystectomy.Methods: Sixty patients above age of 18 years with gall stone admitted for elective laparoscopic cholecystectomy were included. Pre-operative ultrasonographic parameters such as gallbladder wall thickness and size, gallstone mobility, common bile duct (CBD) diameter, size and number of calculi, presence of pericholecystic fluid collection were given score of 0 or 1 based on findings being negative or positive respectively. Total score was correlated to intraoperative difficulty of surgery. Operative findings were graded as difficult laparoscopic cholecystectomy if there were presence of dense peri gall bladder adhesions, difficulty in dissection of Calot triangle, tear of gallbladder, bleeding that hindered visual field, abnormal anatomy of biliary tree and buried or intrahepatic gall bladder.Results: Pre-operative USG findings such as gall bladder wall thickness and size, impacted and size of gall stones, CBD diameter, presence of pericholecystic fluid collection were significantly associated with difficult laparoscopic cholecystectomy. Gall bladder wall thickness, pericholecystic fluid collection and impacted gall stones were accurate predictors for difficult laparoscopic cholecystectomy. Higher the pre-operative USG score, higher were the percentage of difficult laparoscopic cholecystectomy and conversion to open cholecystectomy.Conclusions: Pre-operative ultrasonography in the form of the formulated score is a good predictor of difficulty in laparoscopic cholecystectomy.

The optimal management, surgical or otherwise, of a patient following a spontaneous intracerebral haemorrhage (ICH) remains controversial. A survey of British neurosurgeons was carried out to assess current attitudes and practice. Patient management was most consistently influenced by the depth (71% agreement), dominance (74.3% agreement) and site (44.7%) of the haematoma. Almost half of neurosurgeons said they would evacuate an ICH in a deteriorating patient, but management choice was very varied in stable patients. However, 80% of the same respondents felt evacuation was helpful in reducing mortality, and 71.3% morbidity. Fifteen per cent of respondents were not influenced by the size of an ICH, but 31% would readily operate on haematomas with volumes of between 50 and 80 ml. Over 30% felt that there was no optimal time for surgical evacuation, but 66.9% felt delayed evacuation was helpful. Premorbid dependency was a stronger influence than age on management choice. Despite these variations, over half felt that they were consistent in their treatment of ICH. However, 81% expressed surgical uncertainty. Furthermore, respondents demonstrated a significant tendency to intervene surgically more readily in ICH related to aneurysm or AVM. Results from a prospective randomized controlled trial to assess the role of surgery are urgently needed.

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Background: Laparoscopic cholecystectomy is now the procedure of choice for patient presenting with acute cholecystitis unless it is contraindicated for technical reason or safety. An attempt was made to compare the outcome and postoperative complications of early vs delayed laparoscopic cholecystectomy in acute cholecystitis.Methods: Fifty patients aged 18 to 64 years having acute cholecystitis admitted for laparoscopic cholecystectomy were included. They were divided into two groups, early (less than 72 hours) and delayed (more than 72 hours up to 6 weeks) laparoscopic cholecystectomy. The patients were followed for three months after the surgery. The primary outcome measures were conversion to open surgery and postoperative complications whereas secondary outcome measures were hospital stay and return to full activity. Comparison of quantitative variables and qualitative variables was done using unpaired student’s “t” test and chi-square test/ Fisher’s exact test respectively.Results: Conversion to open cholecystectomy (p = 0.007) and post-operative complications (p = 0.032) were significantly less in early laparoscopic cholecystectomy group compared to delayed laparoscopic cholecystectomy group. Mean days of hospital stay (4.9 versus 7.4 with p = 0.001) and mean days of return to full activities (12.6 vs 16.3 days with p = 0.001) was significantly less in early laparoscopic surgery group compared to delayed laparoscopic cholecystectomy group. Mean duration of surgery was significantly less in early laparoscopic surgery group as compared to delayed laparoscopic surgery group (69.3 versus 108.5 minutes, with p = 0.001).Conclusions: Early laparoscopic cholecystectomy is better choice than delayed laparoscopic cholecystectomy in acute cholecystitis.

Fire and explosions in the operation theatre during surgery in the era of cautery usage have been reported since many years. Significant complications or death can ensue as a result of such fires or explosions and surgeons should be aware of these hazards. A 38 year old female patient on the 6th day of admission, developed abdominal distension. Patient was managed conservatively with flatus tube insertion and serial x-ray monitoring. On the 8th day, repeat      x-ray showed gas under diaphragm. Emergency laparotomy was undertaken. On opening the peritoneum using cautery, a hissing escape of gas was heard and this caught fire. On attempting to stem gas flow from the peritoneal hole, the operating surgeon sustained burn to his index finger and the glove melted. The peritoneal cavity was surprisingly free of any spilled contents. Small bowel was opened through a small enterotomy and decompressed. The colon steadfastly refused to collapse. This necessitated a transverse colotomy which, after decompression, was converted into a loop transverse colostomy. She underwent colonoscopy after three weeks wherein the colon was found to be free of any obstruction. The colostomy was closed. If there is free gas on entering a peritoneum, it will be wiser to avoid electro surgery. Instead, scissors or a scalpel should be used.