International journal of surgery
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As with any technology-driven field, laparoscopic surgery has made tremendous progress in recent years. Since the performance of first laparoscopic cholecystectomy by Prof Dr Med Erich Mühe of Böblingen, Germany 1985, this procedure has overtaken open cholecystectomy as the treatment of choice in cholelithiasis. However due to the cost incurred thereof and surgical training needed, open cholecystectomy is still performed on a very large scale in most parts of the third world countries. We tried to modify the conventional cholecystectomy to a minimal access approach (with minimal required infrastructure) to suit majority of patients with cholelithiasis in lieu of cost and morbidity. ⋯ These results confirm that mini-lap cholecystectomy by our modified approach is safe, feasible and has lesser morbidity and postoperative pain as compared to conventional open cholecystectomy. The technique is cost effective, easy to practice and can benefit majority of patients who otherwise cannot afford the laparoscopic surgery. Hence it can serve as an alternative to the gold standard laparoscopic cholecystectomy with almost comparable results.
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Evidence suggests that switch from spinal/general anaesthesia (SA/GA) to perianal block (PAB) may prove advantageous for proctologic surgeries. This study evaluates the practicability of this evidence based switch. ⋯ Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia for ano-rectal surgeries. Its evident efficacy justifies its adoption as anesthesia of choice.
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Comparative Study
Peri-operative blood glucose management in general surgery - a potential element for improved diabetic patient outcomes - an observational cohort study.
Hyperglycaemia impairs many of the physiological processes involved in recovery from surgery but there is limited research on the effect of optimal peri-operative glucose control in diabetic general surgery patients. The objectives of this study were to assess blood glucose management in diabetic general surgical patients and to determine if protocol deviations were associated with adverse outcomes. ⋯ Although not statistically significant, optimal glucose homeostasis according to hospital protocol was associated with a 25.4% reduction in peri-operative complications. We recommend careful blood glucose management according to pre-defined guidelines in all diabetic patients undergoing general surgical procedures.
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Diagnostic evaluation and management of patients with rectus sheath hematoma. A retrospective study.
Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain. It may mimic a wide variety of intraabdominal disorders thus frequently leading to delay in treatment, increased morbidity or even in an unnecessary surgery. ⋯ RSH should be considered in the differential diagnosis of the elderly patients under anticoagulation therapy presenting with acute abdominal pain and a palpable mass. CT is the diagnostic modality of choice. Conservative treatment is feasible in most cases. Early diagnosis is mandatory in order to avoid morbidity or unnecessary surgery. In order to prevent a traumatic RSH, trocar insertion under direct vision during laparoscopic surgery and careful attention in the abdominal administration of LMWH are essential.