Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease. Symptoms of abdominal pain, nausea, food intolerance, and others are common, and their relationship to biliary disease is often well known but other Gastro-Intestinal conditions may cause them also. Continuation of such symptoms postoperatively is the target of this study. Aim of study: To assess the incidence, etiology, management and preventing measures of persistent dyspeptic symptoms following laparoscopic cholecystectomy. Patients and methods: This is a Prospective study performed in Al-Fallujah teaching hospital on 136 patients undergoing laparoscopic cholecystectomy between September 2016 and September 2017. They were evaluated using a questionnaire for data collection; inquiring about: indication for laparoscopic cholecystectomy, characteristics of pain, and other associated dyspeptic and colonic symptoms. The patients were re-evaluated with the same questionnaires after surgery during a period from 2-12 weeks, and classified into two groups: first group includes patients get benefit of surgery (relieved symptoms) and those whom symptoms not eliminated by surgery (persistent symptoms). 21 patients were excluded from our analysis; five of them had conversion to open surgery & we lost contact with sixteen patients post-operatively. Results: The median age of the remaining 115 patients was 34.4 year (range 17-55) years; 20 were men. All were diagnosed to have symptomatic gall stones disease and all were scheduled for laparoscopic cholecystectomy (L.C.). 16 patients (13.9%) had persistent symptoms post-operatively during the follow-up period. Our study concentrated on the correlation between the preoperative presentation and the continuation of post-operative symptoms. Statistical analysis showed that food intolerance and nausea were more common among those with a poor outcome after laparoscopic cholecystectomy. Patients with persistent dyspeptic symptoms despite operation; their symptoms were indeed belongs to GERD and P.U disease in the majority of them. Conclusion: Nonspecific dyspeptic symptoms like heartburn, food intolerance and nausea are not adequate reasons for taking the decision of laparoscopic cholecystectomy.
Reconstruction of hand injury is the challenge for the surgeon especially in rural settings. This case report is about a 10-year-old boy, who sustained large degloving wound of dorsum of right hand with extensor tendon injury following a road traffic accident. We performed a staged abdominal flap with tensor fascia lata graft for tendon reconstruction as microsurgery facilities was not available. Post-operatively he was subjected to physiotherapy and he has a functional right hand. This case report aimed to highlight abdominal flap as reconstructive option as compared to skin grafting which is reproducible with limited resources. Besides that, overall exposure to all surgical options is of paramount importance in the training of trainees to equip them with skills to serve in rural setting.
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