Objective:To evaluate the intra-operative scoring system to predict difficult cholecystectomy and conversion to open surgery.Methods:This descriptive study was conducted from March 2016 to August, 2016 in the Department of Surgery, Shalimar Hospital. The study recruited 120 patients of either gender, age greater than 18 years and indicated for laparoscopic cholecystectomy (LC). Intra-operatively all patients were evaluated using the new scoring system. The scoring system included five aspects; appearance and adhesion of Gall Bladder (GB), distension or contracture degree of GB, ease in access, local or septic complications, and time required for cystic artery and duct identification. The scoring system ranges from 0 to 10, classified as score of <2 being considered easy, 2 to 4 moderate, 5–7 very difficult, and 8 to 10, extreme. Patient demographic data (i.e. age, gender), co-morbidities, intra-operative scores using the scoring system and conversion to open were recorded. The data was analysed using statistical analysis software SPSS (IBM).Results:Among one hundred and twenty participants, sixty seven percent were females and the mean age (years) was 43.05 ± 14.16. Co-morbidities were present in twenty percent patients with eleven diagnosed with diabetes, six with hypertension and five with both hypertension and diabetes. The conversion rate to open surgery was 6.7%. The overall mean intra-operative scores were 3.52 ± 2.23; however significant difference was seen in mean operative score of converted to open and those not converted to open (8.00 ± 0.92 Vs. 3.20 V 1.92; p-value = 0.001). Among eight cases converted to open, three (37.5%) were in very difficult category while five (62.5%) were in extreme category. Moreover, age greater than 40 years and being diabetic were also the risk factors for conversion to open surgery.Conclusion:The new intra-operative scoring system is a valuable assessment tool to predict difficult laparoscopic cholecystectomy and conversion parameters to open surgery and its utility could improve patient's clinical outcome indicated for laparoscopic cholecystectomy.
Objective: The aim of this study was to determine the occurrence of cholelithiasis in the city of Lahore and its surrounding area. Material and Methods: This study was conducted at Shalamar Medical and dental college Lahore and data for this study was collected from different hospitals of Lahore and the duration of this study was from 2019 to 2021. The participants of this study were from both genders’ male and female from of the age of 10 years to 80 years, and the sample size for this study was 483 and 1583. The main focus of our study was to examine the occurrence of Cholelithiasis surgical in the duration of our study. A questionnaire was used to analyses the occurrence of gall stone, and also the sex, age and dietary habits of the patients. Results: In the results of this study the frequency of gall stones were observed 4.0% in males and 12.0% in females and the percentage of occurrence of gall stones in both these genders were 1% to 3.3%. the high occurrence rate of gall stones in the months are May and November, in both these months the observation of gall stones in these were very high. Both the genders were divided into two main age groups in which male age group were from 10 years to 78 years and the females age group were from 11 years to 80 years. The ideal age for the occurrence of gall stones in male were 45 years to 59 years and in females were 3 years to 44 years respectively. Conclusions: In the conclusion of this study, we examine that the overall occurrence of gall stones in both the genders were 7.01%, but at same the time occurrence rate in the females were very high as compared to the male which were 1% in males and 3.3% in females. Keywords: Cholelithiasis, Surgical Incidence, Gallstones.
Introduction: In Pakistan and worldwide, there is a lack of literature on the role of ligation clips in controlling hemostasis in laparoscopic sleeve gastrectomy. ligation clips are being used to secure hemostasis and act as staple line reinforcement to prevent intra-operative and postoperative bleeding. Data can be utilized to reflect the role of staple line reinforcement with ligation clips so as to guide surgeons about its safety and efficacy.Methodology: This retrospective observational study was conducted at the Shalamar Hospital, Lahore, Pakistan, and included 120 patients. The patients' demographic parameters, BMI, intra-operative and postoperative bleeding in terms of hematemesis, melena, and fall in hemoglobin (Hb) postoperatively were compared to preoperative Hb and recorded.Result: One hundred and twenty cases of laparoscopic sleeve gastrectomy (LSG) were included with a mean age of 44.77±12.05 years. The mean BMI was 52.06±13.85 preoperatively. The mean drop in hemoglobin was 0.04±0.26 with a p-value of 0.07, which is statistically insignificant. Among 120 cases, two (1.7%) patients reported episodes of melena, and four (3.3%) patients reported hematemesis. Postoperative hypotension was recorded in six (5%) patients and eight (6.7%) patients had postoperative tachycardia. Conclusion:This study shows ligation clip application along the staple line is an effective means of hemostasis similar to suture application.
Background The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams. Materials and Methods The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed. Results A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001). Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation. Conclusion This study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic. Graphical abstract
Objective: To determine the outcome of rubber band ligation in third degree hemorrhoids. Methods: - This design of this study was cross sectional study. The study was conducted at Shalamar medical and dental college, Lahore and the duration of this study was from April 2020 to September 2021. 215 patients were seen with complain of hemorrhoids, of which 47 had 3rd degree hemorrhoids. All patients with 3rd degree hemorrhoids underwent for rubber band ligation and were enrolled in the study. Outcome in our study was defined as pain, bleeding, constipation, anal fissure/fistula and infection. Chi- square test (χ2) of all qualitative variables was applied by taking p-value < 0.05 as significant. Results: - Of 47 patients admitted with 3rd degree hemorrhoid, 30 were males and 17 were females. The mean age of males was 38.78±12.71 while mean females age were found to be 22.73± 7.25 respectively. The most common complaint following rubber band ligation (RBL) was pain. 19 out of 47 patients were presented with pain followed by bleeding (14), constipation (13), anal fissure/fistula (10) and infection (8) which constitutes about 22.34 %, 22.78%15.32% and 14.03% respectively. There was significant relationship found between gender and anal fissure/fistula with p-value of <0.05. Conclusion: - Patients with 3rd degree hemorrhoids after RBL procedure showed fewer complications comparable to other surgical procedures in the treatment of hemorrhoids. It is the best possible options in third degree internal hemorrhoids. Moreover, this procedure is simple and cost-effective and requires no hospitalization, no anesthesia and no post-operative care. Keywords: - 3rd degree Hemorrhoids, Outcome, Rubber Band Ligation.
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