Objective:To deteremine the incidence, nature and management of extra-biliary complications of laparoscopic cholecystectomy.Materials and Methods:This study presents a retrospective analysis of extra-biliary complications occuring during 1046 laparoscopic cholecystectomies performed from August 2003 to December 2006. The study population included all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was performed. The extra-biliary complications were divided into two distinct categories: (i) Procedure related and (ii) Access related.Results:The incidence of access-related complications was 3.77% and that of procedure-related complications was 6.02%. Port-site bleeding was troublesome at times and demanded a re-do laparoscopy or conversion. Small bowel laceration occurred in two patients where access was achieved by closed technique. Five cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot's triangle. In 21 (2%) patients the procedure was converted to open surgery due to different complications. Biliary complications occurred in 2.6% patients in the current series.Conclusion:Major extra-biliary complications are as frequent as the biliary complications and can be life-threatening. An early diagnosis is critical to their management.

No abstract

Aims: To assess medical students’ perception of online teaching to suggest transforming the future curriculum in low-economic countries. Study Design:  Cross-sectional online interview study. Place and Duration of Study: A team of collaborators interviewed final year medical and dental students of Pakistan from 07/08/2020 till 17/09/2020. Methodology: A questionnaire was developed based on open and close-ended questions in Google forms; focusing on institutional preparedness, views on online education, the institute’s closure and COVID-19, and long-term effects of closure of the institute. Independent fellow researchers systematically analyzed the unaltered transcripts of the responses, and themes were then identified and coded to conclude the results. SPSS version 23 used for analysis. As this study was based on final year students. Results: In response to an invitation email, 2442/2661 (91.77%) students voluntarily participate in this qualitative study. Most participants were females (1614, 66.10%). Closing down institutes was directly linked to a lack of motivation and feel of helplessness. As most showed dissatisfaction with online teaching compounded by psychological effects, students feared losing clinical skills and life during the pandemic. Conclusion: The psychological impact of the crisis led to resistance to accepting the change for a better outcome. Incorporating telemedicine, different interactive learning style to online teaching, and resilience training would result in fruitful outcomes. Developed countries may also guide build infrastructure in developing countries to develop a more robust online teaching methodology in the long-run.

Aims After superficial parotidectomy, the incidence of facial nerve injury, for pleomorphic adenoma of the parotid gland, remains the topic of interest despite different techniques to identify the nerve during surgery. We aim to evaluate the incidence of facial nerve injury in patients undergoing superficial parotidectomy in the absence of nerve conductor. Methods After calculating sample size, 101 patients irrespective of age and gender were included in this cross-sectional study at the Department of Surgery, for nine years, from 1st January 2012. The primary outcome was the incidence of temporary or permanent facial nerve injury with a follow-up period of 12 months. The data was calculated using SPSS version 23, where mean and standard deviation were calculated for continuous variables, and frequencies were calculated for categorical data. Results Facial nerve injury was evident in 16/101 (15.8%) patients. Among these, the main truck of facial nerve was involved in 6(5.9%); temporary loss of function in 4(4.0%) while permanent injury in 2(2.0%). Most common branch of facial nerve affected was marginal mandibular nerve (6, 5.9%), of which 4(4.0%) had a permanent loss. Additionally, four (4.0%) patients developed salivary fistula whereas (2%) patients developed Frey’s syndrome. Conclusion Facial nerve injury should be clearly explained, in the consent, to the patient as a medicolegal purpose. Where the nerve stimulator is not available, identification of the proposed anatomical landmarks allows a safe recognition of the facial nerve.