BACKGROUND AND AIMS: Many surgeons worldwide had challenging experience of facing an unexplainable and uncertain diagnosis or staging of abdominal malignancies. Laparoscopic visualisation techniques have improved dramatically and had led to reassessment of the laparoscope for use in the staging of intraabdominal malignancies. To evaluate place of preoperative laparoscopy as an additional tool to diagnose, assess staging and operability of intraabdominal tumors. SETTINGS AND DESIGN: A prospective observational case series. MATERIALS AND METHODS: Thirty five consecutive cases undergoing preoperative staging laparoscopy from December 2008 to September 2010 were reviewed in order to determine the value of laparoscopy as a staging tool. Indications for staging laparoscopy were predominantly hepatopancreaticobiliary (45%); however, other primaries such as stomach and colon were included. RESULTS: Unnecessary laparotomies prevented in 57.14% of cases. Metastatic spread detected by laparoscopy was in 40% of cases. The sensitivity and specificity of laparoscopy in Abdominal malignancies to detect resectable disease is 65.3% and 100% respectively. CONCLUSIONS: laparoscopy is a useful preoperative staging tool and can help avoid unnecessary laparotomy for abdominal malignancy in one-half of cases.
OBJECTIVES AND AIMS: Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for video thoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication in patients in fibrothorax stage is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS: From September 2007 to march 2012, 126 patients diagnosed with empyema thoracis were treated in NKP Salve Institute of medical sciences. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Fifty six patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS AND STATISTICS: Thirty nine patients (69.6%) were males and the mean age of study group was 31.4 years. Etiology was synpneumonic effusion in 49 patients (87.5%), subpleural malignancy in 3 patients, traumatic haemothorax in 2 patients and ruptured hydatid cyst in 2 patients . The mean duration of symptoms and signs before definitive treatment averaged 42 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. There were 3 patients (5.4%) with complications and one mortality. The postoperative length of stay averaged 11.2 days. There were no recurrences of empyema. Complete expansion of lung was noticed in 53 patients at end of 3 months on follow up. CONCLUSION: Treatment for patients with chronic empyema thoracis with fibrothorax can be achieved with Open thoracotomy and decortication with low complication rates and low mortality with good results.
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