Pylorus Preserving Pancreaticoduodenectomy vs. Standard Whipple's Procedure in Case of Carcinoma head of the Pancreas and Periampullary Carcinoma

Pancreatic carcinoma is a life threatening condition. Surgical resection is the only hope of cure. Advances in surgical technique have reduced the mortality rate. Nevertheless, operative complications related with morbidity still remains high. Two operation techniques in the treatment of periampullary and pancreatic head cancer: the Standard Whipple operation (SW) and Pylorus Preserving Pancreaticoduodenectomy (PPPD) are performed predominantly. This study was performed to compare the results of Pylorus Preserving Pancreaticoduodenectomy (PPPD) with that of the Standard Whipple's (SW) procedure. This prospective study was carried out in the Department of General Surgery, BSMMU in two years duration. All admitted patient's with periampullary carcinoma and carcinoma of the head of the pancreas were included and randomized for a SW or a PPPD resection. Data regarding patients demographics, preoperative assessment, intraoperative and postoperative findings were collected and analyzed. Less blood loss (2.67±0.65 units in Group I and 2.88±0.64 units in Group II), fewer need of blood transfusions and shorter hospital stay in the PPPD group were observed. Gastrointestinal leakage was similar in both groups of patients (1:1). One pancreatic fistula (8.3% in Group I) was observed in PPPD group and one intra-abdominal abscess developed in Standard Whipple's procedure (00.0% in Group I and 12.5% in Group II). Bile leakage was higher in standard Whipple procedure (8.3% in Group I and 37.5% in Group II). Morbidity was more or less similar in both groups (58.0% in Group I and 50.0% in Group II) but one patient (12.5% in Group II) died in standard Whipple's resection. PPPD procedure is more effective treatment for periampullary carcinoma and cancer of the pancreatic head region than the standard Whipple's operation.

Laparoscopic assisted appendicectomy in District Hospital, Joypurhat, Bangladesh

"Laparoscopic assisted appendicectomy" refers to visualization of abdominal cavity, identification of appendix, drawing the appendix out through the port wound and appendicectomy. The objective of this study is to evaluate the outcome of the procedure of laparoscopic assisted appendicectomy. In this prospective study patients with appendicitis were randomly selected for laparoscopic assisted appendicectomy from August 2007 to February 2009 in the Department of Surgery, Modernized District Hospital, Joypurhat, Bangladesh. Out of 73 patients Laparoscopic assisted appendicectomy was performed successfully in 95.89% cases and conversion rate was 4.11%. Male to female ratio was almost 1:2 with mean±SD age 18.62±9.16 years. The wound infection rate was 8.2% and urinary retention 2.7%. Early postoperative feeding was started within 24 hours in 86.3% cases and mean duration of hospital stay was 2 days in 76.71% patients. More than 82% returned to their home and started social activities within 5 days. Duration of surgery was almost similar in emergency and interval appendicectomy group (19.35±10.13 vs. 23.66±9.43) minutes. Postoperative morbidity in emergency appendicectomy group showed significantly higher morbidity than interval appendicectomy group (p=0.003). This study indicates that the laparoscopic assisted appendicectomy is feasible for the majority of the patients with appendicitis in both emergency and interval settings. It reduces the operative time, shortens hospital stay and helps in early resumption of normal activities with good cosmetic outcome and patients' satisfaction.

Dieulafoy's lesion: an overview

Dieulafoy's lesion accounts for 1-5.8% of cases of acute upper GI bleeding. The two largest retrospective series, both from North America, found Dieulafoy's lesion as the source of hemorrhage in 1.9% and 1.2% of all endoscopies performed for acute GI bleeding. In the prospective study of Chung et al., Dieulafoy's Lesion was found in 3.4% of all patients with acute GI bleeding referred to their unit. The Dieulafoy's Lesion accounted for up to 40% of all causes of nonvariceal upper GI bleeding not caused by gastric or duodenal ulceration or esophageal varices in the prospective study of Matsui et al. In the study of Schmulewitz and Bailli, colonic Dieulafoy's Lesion were only found in 0.09% of all colonoscopies performed for lower GI bleeding. The actual incidence of both upper and lower GI bleeding from Dieulafoy's Lesion is likely higher than estimated because the diagnosis remains difficult. Recent advances in endoscopy have led to an increased detection of Dieulafoy's lesions. Initial GI endoscopy is effective in diagnosing up to 70% of patients. Several endoscopies may be required with 6% of patients, requiring three or more to establish the diagnosis. Angiography and/or red cell scanning can be used when endoscopy fails to diagnose a doubtful case. There is no definite unique policy for the treatment of Dieulafoy's lesions. Therapeutic endoscopy remains the first line of treatment option for controlling the bleeding while angiography is considered as a valuable alternative. Surgical intervention is kept for failure cases where it should be guided by preoperative localization. The mortality rate has decreased dramatically from 80% to 8.6% in recent times due to advancement in both diagnostic and therapeutic tools.