Day case Laparoscopic Cholecystectomy: experience at the Bangabandhu Sheikh Mujib Medical University

Day case surgery offers convenience to the patients and cost saving to the healthcare institutes. In this prospective study, the authors reviewed their experience with day case Laparoscopic Cholecystectomy (LC) to determine its outcome in the government healthcare settings of Bangladesh. Selection criteria's for the day case LC were patients with symptomatic cholelithiasis with ASA (American Society of anesthesiologists) grade I or II, the availability of a responsible carer, absence of morbid obesity, low risk for concomitant presence of bile duct stones and domicile within Dhaka and around. Patients were admitted in the post operative ward as day case (DC) in the morning and were discharged on the next morning with a standard analgesia. Two hundred ten patients were admitted for LC as day cases over the last 7 years from October 2003 to October 2010 on the morning operation theatre lists. Five patients later required admission to the inpatient department for conversion to the open procedure. None of the patients was readmitted after discharge. Majority patients were followed up after 1st and 6th week. Two hundred seven patients attended for the follow up at the 1st week and 158 patients were reported for the 6th week. One hundred ninety six patients resumed their normal job or activities after one week. Patient's satisfaction was assessed by questionnaires. Two hundred five patients were either satisfied or very satisfied with the day-case procedure. It appears that for selected groups of patients, day-case LC can be safely done in government healthcare settings of Bangladesh with good patient satisfaction.

Metabolic and stress responses of the body to trauma: produced by the laparoscopic and open cholecystectomy

Laparoscopic cholecystectomy is regarded as gold standard therapy for symptomatic gall stone disease. This study was done to compare the metabolic and stress responses between open and lapraroscopic cholecystectomy and to evaluate their significance in postoperative recovery. Thirty patients with symptomatic gall stone disease were treated with open and laparoscopic cholecystectomy on elective basis (14 versus 16). Three samples of blood were collected from each patient to investigate serum cortisol, adrenaline, nor-adrenaline, C-reactive protein and blood glucose level. The mean age of patients was 41.86+/-10.13 blood glucose and stress hormones (cortisol, adrenaline, nor adrenaline) and C-reactive protein all were found significantly raised in the postoperative period in open cholecystectomy than laparoscopic cholecystectomy group. The postoperative recovery was also prolonged in the open group. The obvious clinical advantages of laparoscopic cholecystectomy over open cholecystectomy is mainly because of less metabolic and stress response.

Assessment of vitamin A status by the deuterated-retinol-dilution technique and comparison with hepatic vitamin A concentration in Bangladeshi surgical patients

Hepatic stores of vitamin A were estimated in 31 Bangladeshi surgical patients (15 males and 16 females) by the deuterated-retinol-dilution (DRD) technique and by analysis of the vitamin A concentration of a liver biopsy specimen obtained during previously scheduled abdominal surgery. Patients ranged in age from 21 to 65 y and had an average body mass index (BMI: in kg/m2) of 17.7 +/- 3.4. They received 0.753 mumol [2H4]retinyl acetate/kg body wt orally 9-11 d before surgery. Hepatic vitamin A reserves were estimated according to Furr et al (Am J Clin Nutr 1989;49:713-6) by using a single plasma isotopic-ratio measurement (18-25 d postdose). Estimated mean hepatic vitamin A stores were similar by both techniques, 0.110 +/- 0.072 mmol (by DRD) compared with 0.100 +/- 0.067 mmol (by biopsy). Regression analysis was used to compare results of the DRD and biopsy techniques. A significant linear relation was found between the two techniques (r = 0.75, P < 0.0001), and the least-squares regression line was not significantly different from y = x (P = 0.09). The results indicate that the DRD technique provided a very good estimate of hepatic vitamin A reserves for this population. However, a wide prediction interval was observed for estimates of hepatic vitamin A reserves for individual subjects. Thus, further refinement of the prediction model is necessary to improve estimates of hepatic vitamin A reserves for individual subjects.