LC is effective and safe in patients with morbid obesity. As it carried low risks of conversion and perioperative complications, we suggest that LC is the select approach for these patients. Moreover, the rapid mobilization and hospital discharge following LC may provide extra benefit to these patients.

Previous abdominal operations, even in the upper abdomen, are not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with an increased need for adhesiolysis, a higher open conversion rate, a prolonged operating time, an increased incidence of postoperative wound infection, and a longer postoperative stay.

The relationship between sex and outcome after laparoscopic surgery for symptomatic cholelithiasis remains unclear. The purpose of this study was to determine the influence of sex on the clinical presentation of patients with symptomatic gallstone disease and the clinical outcomes of laparoscopic cholecystectomy. The rates of conversion to open cholecystectomy, complication rates, operative times, and lengths of hospital stay were compared between the sexes. Compared with female patients, males were significantly older and more likely to have coexisting cardiovascular disease, previous upper abdominal surgery, previous hospitalization for acute cholecystitis and pancreatitis, acute cholecystitis, and suppurative cholecystitis (such as empyema), conversions, and complications. The mortality rate was nil. Analyses revealed an independent effect of sex on the prevalence of complications, even when including all of the major confounding factors in the model. In contrast, the effect of sex on conversion to open cholecystectomy was not significant when controlling for patient age. Operative time and postoperative hospital stay were significantly longer in males than in females. The tendency of male patients to have cholecystitis of greater severity should remind surgeons of the need to inform patients about the higher conversion rate among male patients, to reduce the disappointment of a large laparotomy wound or prolonged recovery period. On the other hand, there may be an increased need for surgeons to strongly advice male patients with symptomatic cholelithiasis to undergo early intervention.

Abstract. Background: Isothiocyanates are constituents of cruciferous vegetables which have been associated with reduced cancer risk partially through their ability to induce apoptosis in malignant cells including melanoma. Materials and MethodsMalignant melanoma is the fifth most common cancer in UK with its incidence rates being continuously rising faster than any other malignancy (1). Epidemiological studies suggest that an increased dietary consumption of cruciferous vegetables can reduce cancer incidence. These effects can be attributed to the high levels of glucosinolates (GSLs) present which are sulphur-containing glycosides and precursors for a group of compounds called isothiocyanates (ITCs) (2). Briefly, upon mechanical disruption of the plant cell wall (e.g. by chewing), the enzyme myrosinase is released which then catalyses the hydrolysis of GSLs to ITCs, with subsequent release of HSO 4 -and D-glucose (3). Different GSLs can form different ITCs, since glucoraphanin acts as the precursor for sulforaphane (SFN), gluconasturtin for phenethyl isothiocyanate (PEITC) and glucotropaeolin for benzyl isothiocyanate (BITC) (4). There is much speculation as to how ITCs may exhibit their chemotherapeutic effects, but the likelihood is that multiple molecular events are responsible. Potential biochemical mechanisms include (i) inhibition of carcinogen activity via suppression of phase I enzymes in xenobiotic metabolism, (ii) stimulation of phase II enzymes and (iii) induction of apoptosis (5, 6). Despite many reports demonstrating ITCs' effectiveness against different cancers there have been a limited number of studies investigating their ability to induce apoptosis in human malignant melanoma cells (7) which their results are dependent on the utilization of high concentrations of ITCs. 6303

We report a case of delayed perforation of the large bowel because of thermal injury during a laparoscopic cholecystectomy. A 78-year-old male with symptomatic cholelithiasis underwent a difficult laparoscopic cholecystectomy because of multiple adhesions resulting from two previous cholecystitis episodes. The patient recovered well after surgery and was discharged on post-operative day 2. On postoperative day 10, the patient returned to the hospital with peritonitis. An exploratory laparotomy revealed perforation of the wall of the hepatic flexure of the large bowel, which was centred in a necrotic area 1 cm in diameter. The perforation was sutured and a temporary ileostomy performed, which was closed at a later date. The patient was doing well at a 10-month follow-up review. A delayed rupture of any part of the bowel after laparoscopic surgery can be potentially fatal if not treated during an emergency exploratory laparotomy, even if the clinical signs are not severe.