Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. There are lot of advances in closure of cystic duct and artery (clip ligation, suture ligation), but it remains an enigma regarding efficacy, safety and postoperative complications for using non-absorbable suture material or Liga clip for the operating surgeon in laparoscopic cholecystectomy. Objectives: Our study aimed to evaluate the efficacy, safety and complications of non-absorbable sutures ligation versus clips application in laparoscopic cholecystectomy, and to compare the operative time and cost effectiveness of the two surgical approaches in laparoscopic cholecystectomy. Methods: This prospective study was performed between August 2014 and February 2015 in M. M. Institute of Medical Science and Research, in a rural center, Mullana, India. The study included 160 patients who were diagnosed with chronic cholecystitis in a single unit. Subjects were divided into two groups and all cases were operated by a single surgeon. The cystic pedicle was tied with non-absorbable material (silk 2-0) in group A and with Titanium clips using a clip applicator in group B. Results: The application of silk and clips for cystic duct and artery ligation in laparoscopic cholecystectomy can be safely used. The mean time for ligation of cystic duct was 2.50 (SD ±0.25) in group A and 1.50 min (SD ±1.85) in group B, with P<0.001, which was significant. Similarly, the mean time for ligation of cystic artery was 1.50 min (SD±0.20) in group A and 1.36 min (SD ±0.11) in group B, with P>0.001. There were no postoperative complications, such as wound infection or bile leakage, in any of the two methods. The cost of material for silk suture (40-60 Rupees or 0.62-0.92 $) is definitely much lower than that for Liga clips (790-1000 Rupees or 12.28-15.55 $). For the use of clips, a clip applicator is required, but in case of silk ligation no special instrument is required and silk is also easily available. Conclusion: In laparoscopic cholecystectomy, ligation of cystic duct and cystic artery with clips takes less time than by silk suture. We conclude that both ligation techniques can be safely and effectively used. Training for junior surgeons is necessary to avoid potential complications.

BackgroundLaparoscopy is widely practiced and offers realistic benefits over conventional surgery. Port closure is important after a laparoscopic procedure to prevent port site incisional hernia. Larger port size and increasing numbers of ports needed to perform more complex laparoscopic procedures are likely to increase the incidence of port site hernias (PSHs). PSHs tend to develop more frequently at umbilical and midline port sites due to the thinness of the umbilical skin and weaknesses in the linea alba. More than 90% of PSHs occur through 10 mm and large ports can occur through 5 mm ports also. The aim was to study the outcomes and complications in laparoscopic surgery without fascial sheath closure of port site. We compared the results with another group in which fascial closure was done by a standard method.MethodsThis was a prospective study carried out in the Department of Surgery, MMIMSR, Mullana, Ambala, from August 2013 to 2015 in a single unit by a single surgeon. A total of 200 patients were selected randomly for the different laparoscopic procedures. Patients were divided into group A (only skin closure was done without fascia closure) and group B (fascial closure of the port in addition to skin closure). In both groups, we used blunt trocar for the 10 mm port. Skin of the 5 mm port was closed simply. The results in two groups were compared in terms of complications like PSH, bleeding, and wound infection.ResultsThe outcomes in two groups were compared with and without fascia closure of 10 mm trocar port site. Patients operated for lap cholecystectomy were 170 (85%), 10 (5%) for lap appendicectomy, and 20 (10%) for lap hernia. The study compared the results in two groups mainly for PSH formation. The P value was insignificant and Fischer’s exact test result came as 1.00. There were no significant differences between the two groups in terms of PSH, bleeding and infection in non-obese cases.ConclusionIn both groups, blunt trocar was introduced into the abdomen. We concluded that this is safe, without visceral injury, and no bleeding was seen in both the groups. We had not encountered any case with PSH formation in follow-up of 6 - 8 months. There was no infection over the port site.

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Aims and Objectives:This study aims to evaluate the efficacy of tamsulosin and alfuzosin for the distal ureteral stone. This study assessed the spontaneous passage and expulsion of the stone.Materials and Methods:The study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, from May 2013 to May 2014. A total number of 136 patients diagnosed as distal ureteric stone (US) of size <10 mm were included in this study. It was divided into two groups (I and II) out of which 36 cases were excluded. Group I received tablet tamsulosin 0.4 mg/day, and Group II received alfuzosin 10 mg/day. The efficacy of tamsulosin and alfuzosin as an adjunctive medical therapy was determined.Results:Both the drugs can be safely used for the distal USs. The stone expulsion rate was seen in 36 patients (72.0%) in Group I, and in 34 patients (68.0%) in Group II (P = 0.545). The passage of stones noticed by 32 patients in each Groups I and II (P = 1.000). The mean number of pain attacks was 2.91 ± 1.01 for Group I, and 1.8 ± 0.83 for Group II (P < 0.001 and P < 0.001). Thus, we propagate the use of alfuzosin significantly lower number of pain attacks. The drug-related side-effects were postural hypertension (four in Group I and one in Group II) and retrograde ejaculation (eight in Group I, and one in Group II). Thus, the difference was statistically significant in terms of retrograde ejaculation but insignificant for postural hypotension.Conclusion:There is no difference between both medications in term of efficacy (passing stones) for the management of distal ureteral stones. Both medications are safe and effective. In addition, alfuzosin was better tolerated than tamsulosin as it has fewer side effects.