Introduction Laparoscopic appendicectomy (LA) is considered as the mainstay of treatment in acute appendicitis. LA is a basic laparoscopic procedure and therefore can be used as a training tool for surgical trainees. It is considered an index operation for junior surgical trainees. This study aims to assess whether LA is safe to be carried out by a junior surgical trainee. Methodology The study was conducted at a tertiary care unit in Colombo. Data were collected retrospectively. A total of 152 LA (including those which were converted to open appendicectomy) performed between January 2018 to May 2019, by surgical trainees (both junior and senior) were included. Gender, age, initial investigation findings, intraoperative findings, operative time, hospital stay, postoperative complications and histology data were analysed. Findings were compared in two groups-operated by junior and senior surgical trainees. Results One hundred and three surgeries were performed by junior trainees while 49 were performed by senior trainees. There was no significant difference in complicated appendicitis (21.4% vs 34.7%), operative time (71m vs 68m), conversion rate (12.6% vs 16.3%) and hospital stay (3d vs 3d) between these two groups. The overall complication rate was 3.9%. Conclusion Our findings were comparable to previously published data and no statistically significant difference was noted between the two trainee groups in terms of operative finding, hospital stay and postoperative complications. The results suggest that LA can safely be performed by the junior surgical trainees with acceptable outcomes.
IntroductionCholangiocarcinoma is a malignancy arising from the epithelial lining of the biliary tree, which is associated with a poor outcome. ObjectivesTo describe the relative incidence of each type of cholangiocarcinoma, gender distribution, common presenting symptoms, the prevalence of metastatic disease and assess the resectability rates and to assess the relationship of different types of cholangiocarcinoma with CA19-9 levels. Methods: A descriptive cross-sectional study, of patients diagnosed with cholangiocarcinoma, whose details were obtained from the hepato-pancreato-biliary database that is maintained in a tertiary care unit, in Sri Lanka. Quantitative variables expressed as the mean and standard deviation (SD) and qualitative variables expressed in percentages. The statistical analyses were carried out using SPSS version 25 with statistical significance defined as P<0.05. ResultsOne hundred and twenty patients (n=120) were studied. There was a higher incidence of cholangiocarcinoma among males. Average age of presentation was 61.8 years, with males presenting at a slightly older age. Hilar cholangiocarcinomas were the most common type, followed by distal and intrahepatic. Jaundice was the most common presenting symptom among distal and hilar cholangiocarcinomas. CA 19-9 levels were found to be elevated in 71.9% of the patients. Patients with hilar and intrahepatic cholangiocarcinomas had a higher incidence of advanced disease at the time of presentation with relatively low resectability rates observed among these patients.
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