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Male and female ratio was 2.78:1. The age range was 48-88 years (65.5).

BACKGROUND Less than four ports laparoscopic cholecystectomy (LC) has been accepted and has become the popular procedure for safe and cosmetically better outcome. But there are few studies comparing the number of ports used in laparoscopic cholecystectomy. This observational study was done to compare LC by two ports with four ports. We wanted to determine the advantages of minimum port laparoscopic cholecystectomy over conventional cholecystectomy. METHODSIt is a descriptive study. This study was carried out over a period of 1 year at Gauhati Medical College from 1/1/17 till 4/1/18. All patients with cholelithiasis who attended the surgical OPD were evaluated. A total of 60 consecutive patients undergoing LC were analysed who had been executed a four-port conventional/two-ports LC. 10-mm umbilical and a 5-mm epigastric port were used in two ports technique. Time period of operation was noted. Along with cosmetic effect, the post-operative pain, requirement of analgesic to reduce pain, total hospital stay, and complications if any were meticulously studied. RESULTSOut of 60 patients, the M: F ratio was 1:4 with average age being 39 and 22 years respectively. The mean operative times were similar. Post-operative pain was minimal in the two-ports group at up to a maximum 24 hrs. The overall analgesia required, and return to day-to-day work were significantly lower in two-ports group of patients. Cosmetically two-ports group was much better than four-ports group. However, post-operative hospital stay and operative complications were similar between the two groups. CONCLUSIONSTwo ports laparoscopic cholecystectomy (LC) resulted in reduced pain, minimum need for analgesics, better cosmesis without increasing the operative time period and reduced complication rates compared to that in four-ports LC. Thus, it can be recommended as an acceptable technique in selected patients. It is the procedures of choice so far as cosmesis and scar are concerned. HOW TO CITE THIS ARTICLE: Choudhury P, Sarma A. Laparoscopic cholecystectomy by minimum ports technique gives better outcome-an observation. BACKGROUND Laparoscopic cholecystectomy (LC) is the standard and universally accepted procedure compared to open cholecystectomy. The main advantages of laparoscopic surgery over open technique include better cosmetic outcome, reduced post-operative pain and rapid functional recovery. Innovative techniques like Natural Orifice Endoscopic Surgery (NOTES), Single-Incision Laparoscopic surgery (SILS) along with two-ports and three-ports laparoscopic surgeries have also been adopted to remove gallbladder as a procedure of choice in comparison to conventional four-ports surgery. Many surgeons prefer two ports to remove gallbladder when cosmesis and postoperative recovery are placed primarily. These newer techniques represent popularity in terms of the results as scarless, more pain-free, better cosmesis, early return of functional work and better quality of life for the patient.

BACKGROUND Embryologically, gallbladder is developed from pars cystic of ventral duodenal bud. During its rotation in clockwise direction towards dorsal bud, it fails to give rise to develop gallbladder or its different parts. But it is a very rare anomaly. Incidence is 1 in 1000. Gallbladder agenesis is an isolated finding in more than two-thirds (70%) of people. The person with isolated gallbladder agenesis is healthy. No treatment is needed and the prognosis is excellent. The aim of this study is to describe the clinical profile of patients with agenesis of gall bladder. MATERIALS AND METHODS It is a descriptive study. Twenty two patients of agenesis of gallbladder admitted at GMC between 2009-2017 were studied in a descriptive way that was carried out at Gauhati Medical College with the help of much skilled and experienced surgeons in laparoscopic surgical procedure. This type of congenital anomalies of biliary tree and very particularly absent or agenesis of gallbladder can be managed by the aid of laparoscopic procedure itself without any difficulties, which is the accepted procedure of choice in comparison to laparotomy. But laparotomy was usually used to adopt in the past and by inexperienced surgeon in this field and the center where laparoscopic and laparoscopic ultrasound are not at all available. By accepting this procedure of laparoscopy, morbidity and different probable complications following open procedure can be minimised considerably. Most of the patients had typical right hypochondriac pain, which was colicky and referred to right shoulder and back, off and on vomiting, nausea and flatulent dyspepsia. The clinical features suggestive of gallstone diseases which were further confirmed by transabdominal ultrasonography and depicted very small contracted gallbladder with few stones having its posterior acoustic shadow. RESULTS Gallbladder was found to be absent during initial diagnostic laparoscopic assessment of intraperitoneal organs in all the patients resulting in conversion to exploratory laparotomy in five patients. Gaining much confidence on laparoscopic surgery, the other patients of congenital agenesis of gallbladder were able to diagnose exclusively by conventional laparoscopic means to have the developmental defect like agenesis of gallbladder. But with much experience and skill in hand, instead of conversion it was able to do by laparoscopic only and further confirmed by post-operative imaging evaluation. CONCLUSION Congenital absent or developmental defect like agenesis of gall bladder is very uncommon. With much confidence in laparoscopic surgery, the condition no longer becomes mandatory for the procedure to be converted to laparotomy for finalising its diagnosis. All the patients showed sign of improvement after surgery.