Background: Laparoscopic Cholecystectomy (LC) has become the treatment of choice for symptomatic gallstone disease. But it becomes difficult to perform safely and some cases require conversion to Open Cholecystectomy (OC). There is no clear consensus among the laparoscopic surgeons to determine preoperative parameters that can predict difficult laparoscopic cholecystectomy. The aim of this study is to predict the difficult laparoscopic cholecystectomies by correlating with preoperative clinical and radiological findings. Materials and methods: This prospective observational study was performed in the Department of Surgery at Chittagong Medical College Hospital for a period of one year from April 2018 to March 2019. The sample size was 151. Pre-operative clinical and ultrasonographic criterias were correlated with intraoperative difficulties encountered. Peroperative difficulties were considered in terms of pericholecystic adhesion, difficult callots triangle dissection, difficult GB bed dissection and unusual bleeding during surgery. Results: Out of 151 patients underwent LC in this study; 93 (61.6%) cases the procedure was uneventful and the other 58 (38.4%) procedures were difficult. Among those difficult 58 cases, 13 (8.6%) patients required conversion to open cholecystectomy. Difficult LC were found in BMI >30kg/m2, hospitalization for 3 or more times due to acute painful attack and GB wall thickness >3 mm. Conclusion: Pre-operative prediction of difficult LC can be determined by correlating with clinical and radiological findings that help the surgeons to better prepare for intra-operative difficulties and risk of conversion to open cholecystectomy. IAHS Medical Journal Vol 4(2), December 2021; 70-73
Background: Stoma closure is one of the most frequently performed surgery. The common complications are surgical site infection (SSI) and poor scar cosmesis. Compared to the conventional linear closure, the pursestring closure technique is expected to have less wound infection, smaller size scar and good patient satisfaction. The aim of this study is to evaluate the feasibility of PSC of stoma site at a tertiary hospital and comparing it with LC of stoma. Materials and methods: This study was performed in the Department of General Surgery, Chittagong Medical College Hospital for a period of one year with a sample size of 72. About 36 subjects were enrolled in each group, Group-A (Linear closure) and Group-B (Purse string closure). Each patient of both group were observed for wound infection, post-operative pain, scar formation, patient satisfaction, and length of post-operative hospital stay. Results: The level of pain according to VAS score was 4 in 36 (100.0%) in Group A and 6(16.7%) in Group B. One third (33.3%) patients had wound infection in Group A and 4(11.1%) in Group B. The mean duration of hospital stay was 9.72±3.46 days in Group A and 7.97±2.46 days in Group B which is statistically significant (p<0.05). The mean patient satisfaction score was 17.75±1.59 in Group A and 22.12±0.73 in Group B which is statistically significant (p<0.05). The mean patient scar assessment scale was 42.47±0.99 in Group A and 35.88±2.81 in Group B which is statistically significant (p<0.05). The mean observer scar assessment scale was 41.97±1.28 in Group A and 36.22±2.73 in Group B which is statistically significant (p<0.05). Conclusion: Purse-string skin closure for stoma reversal had significantly less incidence of surgical wound infection, improved the scar outcome, good patient satisfaction, reduce complications and better cosmesis. JCMCTA 2022 ; 33 (1) : 25-28
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