No abstract

Calculous cholecystitis is a major and common health problem, and nowadays laparoscopic cholecystectomy is the preferred approach for its surgical management but timing of surgery is a matter of debate especially in presence of acute inflammation of the gall bladder. The aim of this study is to compare the outcome of early and delayed laparoscopic cholecystectomy for acute cholecystitis. This retrospective comparative study was done in two tertiary hospitals in Basrah from July 2010 to July 2017. It involved 122 cases (98 females 80.3% and 24 males 19.7 %). Forty two (34.5%) underwent early laparoscopic cholecystectomy within 4 days of symptoms and 80 patients (65.5%) underwent delayed operation within 6-12 weeks of first presentation. The two groups were comparable in regard to demographic and clinical points of view. The age of studied patients lies between 20-65 years. The operative time was not identical for the two groups (P=0.004), early treated cases tended to take longer operative time. Hospital stay was significantly longer in early cases as compared to delayed cases (p=0.000). Bile leak happened in only one case (2.4%) of the early group and was managed successfully and discharged well. Bleeding and respiratory infection were extremely rare in both groups. Conversion rate was 4.8% and 5% for the early and delayed group respectively and the difference was statistically not significant (p value 0.661). In conclusion, early laparoscopic cholecystectomy in acute cholecystitis is safe and feasible in selected patients with no difference in morbidity and mortality if it done during the 1 st four days of beginning of symptoms, but the operative time is longer than delayed operation.

Closure of the wound after surgery is a routine procedure and one of the first things that a surgeon in training should learn. A surgeon will successfully closes a thousand of wounds during his career, but the problem of wound infection remains challenging. This study was conducted to compare between two methods of skin closure which are subcuticular alone and combined subcuticular with interrupted suturing regarding; wound infection, cosmesis &speed of wound closure. Between December 2006 and October 2009, two hundred and two patients were admitted in Basrah General Hospital, department of surgery. They underwent elective abdominal operation and were randomized into two groups, group A (abdominal skin closure by subcuticular suturing only) and group B (combined subcuticular with interrupted suturing). There were 102 cases in the subcuticular group, 50 cases of them were males and 52 cases were females, while in group B there were 100 cases,42 cases of them were males and 58 cases were females. Mean age was 38.9 (range 4-66) for group A and 41.6 (range 8-67) for group B. The mean BMI was 25.2 (range 17.4-34.8) for group A and 26.4 (range 18.7-39) for group B. Results: Wound infection: The total number of early wound infection for the six-weeks followup period was 12 cases (11.7%) for the subcuticular (group A),and 4 cases (4%) for the combined (group B)_(P=0.036). Cosmoses: There was no significant difference in cosmetic result in both groups. Speed of wound closure: Combined (group B) closure was accomplished at significantly faster rate (mean 35.6 sec/cm) than subcuticular (group A) closure (mean 46.8sec/cm) (p=0.001). Conclusion: From this study we conclude that the choice of technique for wound closure did not affect the final cosmetic outcome of the wound but the incidence of postoperative wound infection significantly reduced by combined subcuticular and interrupted suturing. The closure of wound is rapid in combined group than in subcuticular group alone.

No abstract

No abstract