BACKGROUNDOpen appendectomy is still the most common method of treating appendicitis. Laparoscopic procedures for removal of the appendix by the “in” technique as an alternative to conventional appendectomy have gained wide popularity, but have been criticized for their technical difficulty and high cost. We assessed the safety and efficacy of the laparoscope-assisted appendectomy (the two-trocar technique) in adults.PATIENTS AND METHODSWe retrospectively studied 129 patients who had appendectomy using the laparoscope-assisted two-trocar technique between July 2002 to December 2003. The procedures were done by consultants and surgeons-in-training with experience in minimally invasive and open techniques. Locally modified endoloop and reusable trocars were used to reduce the cost. Appendectomy was performed extra-abdominally after the appendix was identified by using a laparoscope through one port and then delivered outside through the second port using reusable laparoscopy instruments.RESULTSThe two-trocar technique was successful in 101 (78.3%) cases; 14 (10.8%) needed a third trocar to complete the operation extra-abdominally, 6 (4.6%) were converted to open surgery, and 5 (3.8%) had an intra-abdominal laparoscopic appendectomy. The mean operation time was 35 minutes (range, 30–90 minutes). Six cases (4.6%) had infection. The mean hospital stay was 2.8 days (range, 2–7 days). No case of port hernia was reported during the follow-up period (range, 14–30 months).CONCLUSIONThe laparoscope-assisted two-trocar technique for removal of the appendix can be performed as safely and efficiently as the open technique, but at a lower cost than the complete laparoscopic ‘in” method and does not need much technical expertise. This method is recommended as an alternative procedure to open appendectomy or the complete laparoscopic “in” technique in adults.

One hundred eighty-three young Saudi females (92 patients with gallstones, 91 controls) mean age and (SD), 30.2 (6.1) and 29.7 (6.4) years respectively were studied in detail for possible risk factors for gallstone formation. No statistically significant difference was found when the two groups were compared with regard to past history of jaundice, HBsAg carrier status, use of oral contraceptives, parity, diabetes mellitus, obesity (as Body Mass Index > 30), hypercholesterolemia and hypertriglyceridemia. However, it was noted that both groups were overweight; mean (SD) BMI of 27 (5.9) and 26.7 (6.8) for patients and controls respectively and both had high parity rates; mean and (SD) pregnancies of 4.7 (2.6) and 4.3 (2.9), respectively. Family history of gallstones in first degree relatives of patients was significant (.0027 < P < .01) more than in the controls (95% confidence interval of 3% to 23% ). This may suggest a genetic or an environmental factor that strikes the balance toward gallstone formation in the obese and fertile young female population. A larger nationwide, population-based study is surely justified and needed. AF Ahmed, OM El-Hassan, ME Mahmoud, Risk Factors for Gallstone Formation in Young Saudi Women: A Case Control Study. 1992; 12(4): 395-399 It is our impression that gallstones are remarkably common in Saudis; no exact prevalence figures are available.Comparison of the prevalence of gallstones among different populations is notoriously difficult not only because of differences in availability of diagnostic facilities and attitudes toward treatment, but many patients who have gallstones remain symptom-free [1]. Thus, in Britain, only one in seven individuals with gallstones results in cholecystectomy [2], whereas in one population-based Italian study, 78% of subjects found to have gallstones were asymptomatic [3].According to our local statistics in Almadinah Almounawarah, approximately 350 to 400 cholecystectomies are performed each year in King Fahd Hospital and Ohud Hospital (Al-madinah Almounawarah's two main Ministry of Health (MOH) general referral hospitals, bed capacity 500 and 200, respectively); approximately 50% of elective laparotomies. A similar rate was reported from Riyadh, Saudi Arabia [4].Gallstone risk factors that could not be manipulated were female sex and advanced age [5][6][7][8][9]. We report a case control study of Saudi females, younger than 40 with and without gallstones; in relation to the following factors: parity, contraceptive pill, previous liver disease and HBsAg carrier state, family history of gallstones, obesity, diabetes mellitus, plasma lipids and total cholesterol and triglycerides. Subjects and Methods Definition of Cases and ControlsSaudi females younger than 40 who had a positive abdominal ultrasound scan for gallstones (cases) and sexand age-matched subjects with negative scan (controls) were studied. The presence or absence of symptoms or other diseases were not considered as an inclusion or exclusion criteria in selection of the cases and the...

The charts of 304 cases of four-port laparoscopic cholecystectomy (LC) without cholangiography were studied retrospectively at King Fahad Hospital, Al Medinah Al Munawarah, Saudi Arabia, during a 2-year period. Electrocautery was used in all the cases. The majority of the patients (89.8%) had symptomatic chronic cholelithiasis and 68.4% of them had multiple stones. Thirty-three patients (10.86%) had 36 pre-operative endoscopic-retrograde-cholangiography (ERCP) procedures done on them. Fifteen patients (4.94%) had common bile duct (CBD) stones and the procedure was negative in the remaining patients. Two patients (0.66%) had CBD injury and three patients (O.99Y0) had bile leakage secondary to cystic duct injury. One patient (0.33%) had a retained CBD stone and he presented with biliary colic 1 month after his LC. The stone was removed endoscopically.There was no mortality. We believe that LC without cholangiography could be a safe procedure in a set-up equipped with appropriate endoscopic services.