Circumcision or No Circumcision: An Old Controversy Into the New Millennium

Abstract

The role of laparoscopic cholecystectomy in management of acute cholecystitis remained controversial. Unless contraindicated or refused, early laparoscopic cholecystectomy was offered to patients suffered from acute cholecystitis in our department. Patients data and outcome were collected and analyzed to assess the safety and efficacy of the procedure and to identify predictive factors for conversion.From January 1999 to December 2000, a total of 78 patients with diagnosis of acute cholecystitis were operated. 18 patients had immediate open operation due to previous upper abdominal surgery, or presence of septic shock/peritonitis.Laparoscopic cholecystomy (LC) were successful in 41 (68.3%) of the remaining 60 patients and converted in 19 (31.7%). No mortality was found in the successful or attempted laparoscopic group but 3 patients died in the open group, probably due to poorer premorbid state. The successful LC group had the best outcome in terms of shorter postoperative stay (mean 8.2 days) and less complication rate (7.3%). The only statistically significant predictive factor for conversion are WBC count >19 ¥ 10 9 /L and duration of symptoms of more than 72 hours after onset. Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and effective when operated within 72 hours of symptom onset before significant sepsis occur. 2.A consecutive series of 26 free fibular flaps in 25 patients performed by the Division of Plastic Surgery in Kwong Wah Hospital between 1995-2000 was presented. There were 15 male and 10 female patients. Age ranged from 11 to 84 years old (median 56). Pathology involving the mandible included 18 squamous cell carcinoma, five radiation-induced sarcoma, one radionecrosis and one ameloblastoma. After surgical ablation, all these oromandibular defects were reconstructed using free fibular flaps with closing wedge osteotomies and double-miniplates fixation. Concerning the fibular flaps, there were one straight osteal flap, 12 osteo-cutaneous flaps, and 13 composite osteo-myo-cutaneous flaps. Among the composite osteo-myo-cutaneous flaps, there were eight stacked bone flaps, three double skin islands composite flaps and two double muscles composite flaps. Hospital mortality of these advanced cancer patients was 7.7%. Success rate of free fibular graft was 96.2%. There was one total loss (3.8%), two flaps skin necrosis (7.7%) and three re-operations for major complications (11.5%). Minor complications that included wound infection and selflimited salivary fistula was 23%.The additional craftsmanship for the complex oromandibular reconstruction required careful three-dimensional planning and meticulous protection of individual components of the osteomyo-cutaneous flaps so as to restore the lower face with form and function. 3.