Objective: To evaluate our experience of laparoscopic cholecystectomies at the Aga Khan Hospital, Nairobi over a three-year period from the inception of the technique, and to assess its value and advantages to the patients. Design: A prospective case series study. Setting: The Aga Khan Hospital, Nairobi. Patients: One hundred and thirty five cases operated from February 1996 to April 1999. All patients were subjected to the American method of laparoscopic cholecystectomy, which is described in detail in this paper.
Blunt trauma by motor vehicle accidents and falls, followed by penetrating injuries comprise the common mechanisms of renal injury. Unilateral Penetrating Renal Trauma (UPRT) is extremely rare. Here, we reported a unique case of Right Penetrating Renal Trauma (RPRT). A nine-year-old male child, with a 124 cm height and 30 kg weight without any medical history, had a history of falling down from tree with right side penetrating abdominal injury. On admission, patient was vitally stable. Patient had macroscopic haematuria with haemoglobin count of 10 gm/dL, creatinine 1.2 mg/dL. The Computed Tomography (CT) demonstrated right-sided penetrating renal injuries by some foreign material perinephric haematoma with surrounding air foci with renal vascular pedicle injury. An emergency exploratory laparotomy was executed immediately. According to the American Association for the Surgery of Trauma (AAST) organ injury scale grading system, it was considered grade IV renal injury. Nephrectomy was done. Piperacillin and tazobactam was injected to prevent bacterial infection. The postoperative course was uneventful. Patient was discharged after seven days without any complications.
Introduction: This study proposes to compare the use of the low pressure pneumoperitoneum/LPLC (< 9 mm Hg) with the use of standard pressure pneumoperitoneum/SPLC (14 mm Hg) in patients undergoing laparoscopic cholecystectomy in a prospective randomized manner in an attempt to lower the impact of pneumoperitoneum on human physiology. Method and Materials: The study was carried out with a sample size of 50 patients randomised into two groups, one with 25 patients-SPLC while the other group with 25 patients LPLC. To compare post-operative pain incidence of shoulder tip pain, average operation duration, need of additional analgesia post-operatively, duration of hospital stay, change in Pulse rate, SBP & DBP in both groups. Result: Incidence and intensity of post-operative pain, postoperative pain referred to the tip of the right shoulder were significantly lower in LPLC group compare with SPLC group. The average change in SBP in patients who underwent LPLC was an increase of 0.83 ± 8.66 mm Hg and in SPLC group was an increase of 0.91 ± 14.67 mm Hg. Average change in DBP in patients who underwent LPLC was increase of 1.75 ± 8.33 mm Hg and in SPLC group was an increase of 2.64 ± 8.34 mm Hg and in LPLC group was a decrease of 0.8 ± 12.01 beats per minute and in SPLC group was an increase of 1.8 ± 5.33 beats per minute. The average change in SBP, DBP & heart rate in patients who underwent LPLC & SPLC was not statistically significant. Average hospital stay for LPLC group are 1.92 days and for SPLC group its 2.48 days. Conclusion: An uncomplicated gall stone disease can be treated by low pressure laparoscopic cholecystectomy with reasonable safety by an experienced surgeon. It is significantly advantageous in terms of post-operative pain, use of analgesics, less shoulder tip pain and hospital stay.
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