Early laparoscopic cholecystectomy is safe and feasible for acute cholecystitis with the additional benefit of shorter total hospital stay. Apart from a shorter operating time, treating patients with delayed laparoscopic cholecystectomy does not offer additional benefit.

ObjectiveThis study compares laparoscopic versus open repair and suture versus sutureless repair of perforated duodenal and juxtapyloric ulcers.

SUMMARY BackgroundPrognostic scores in an intensive care unit (ICU) evaluate outcomes, but derive from cohorts containing few cirrhotic patients.

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Aim: Recurrent bleeding after initial haemostasis is an important factor that directly relates to the outcome in the management of peptic ulcer bleeding. Conflicting reports have been published concerning the effectiveness of scheduled second therapeutic endoscopy on ulcer rebleeding. We investigate the use of scheduled second endoscopy with appropriate therapy on peptic ulcer rebleeding. Methods: From August 1999 to January 2001, we prospectively randomised patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of acute bleeding, visible vessel, or adherent clot into two groups. Endoscopic therapy was standardised to initial epinephrine injection and subsequent heater probe application. The study group (n = 100) received scheduled second endoscopy 16-24 hours after initial haemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. The control group (n = 94) were observed closely. Those patients that developed rebleeding in either group underwent operation if further endoscopic therapy failed. Outcome measures included ulcer rebleeding, transfusion, duration of stay, and mortality. Results: After initial endoscopic haemostasis, 194 eligible patients were randomised into two groups. Thirteen patients in the control group developed recurrent bleeding within 30 days while five patients in the study group sustained recurrent bleeding (p = 0.0314) (relative risks 0.33, 95% confidence interval 0.1-0.96). The number of patients that required surgery for recurrent bleeding was six in the control group and one in the study group (p = 0.05). There was no difference in duration of hospital stay, transfusion, or mortality between the two groups. Conclusions: A scheduled repeat endoscopy with appropriate therapy 16-24 hours after initial endoscopic haemostasis reduces the number of cases of recurrent bleeding.T he aim of a scheduled second endoscopy is to detect and retreat ulcers that are at risk of recurrent bleeding. By doing so, we hope that we can reduce the number of episodes of recurrent bleeding and hence decrease the number of operations necessary to treat recurrent bleeding, and lower mortality. The concept of a scheduled second endoscopy is not new. In one of the earliest trials on endoscopic therapy for ulcer bleeding, Chung et al employed an approach of a routine repeat endoscopy within 24 hours after initial endoscopic haemostasis.2 On the second endoscopy, he found that six of 32 ulcers were still having persistent stigmata of haemorrhage, and retreatment achieved haemostasis in all. Although this earliest study gave encouraging results, subsequent prospective randomised controlled trials reported conflicting results on the use of scheduled second endoscopy.3-6 Some of the trials consisted of a small sample size, and the definition of recurrent bleeding varied between the different studies. The endoscopic techniques were also different in these studies. Because of the conflicting results in the literature, we conducted a prospective, randomised, controlled t...

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