Background: Laparoscopic cholecystectomy is commonly performed for cholelithiasis. In spite of strict aseptic technique and preoperative antibiotic prophylaxis, there is risk of port site wound infection. Aim: To study the incidence of positive bile culture and the most common pathogen involved after laparoscopic cholecystectomy in patients of cholelithiasis and its correlation with port site wound infection. Study design: Cross sectional study Setting and duration: Bahawal Victoria Hospital Bahawalpur, from 01-01-2019 to 31-12-2020. Method: One hundre patients of cholelithiasis between 18-75 years of age underwent laparoscopic cholecystectomy. Prophylactic antibiotic was given. Bile with gall bladder was collected and sent for culture. Bacterial growth was recorded as positive bile culture. Organism type was recorded. Stone/stones size was also measured. Data was collected on a proforma which included demographics details like name, age, gender, BMI, clinical features, size of calculi, culture report (positive bile culture if some bacteria is isolated and negative no growth) and type of bacteria isolated and frequency of port site wound infection. Data was analyzed on SPSS version 21. Results: The mean age of the patients was 42.44±16.58 years and male to female ratio of the patients was 1:1.8. The mean BMI of the patients was 25.93±4.67 kg/m2. Bile culture for bacteria was positive in 30(30%) patients and the most common organism was E coli 13(43.33%.78%). Positive bile culture was detected in 20 (20%) male patients and 10 female patients. There was significant correlation between positive bile culture and gender (p value < 0.001). Port site wound was infected in 6 (6%) patients and in all the patients bile culture was also positive. Conclusion: Bile culture was positive in 30% patients of cholelithiasis undergoing laparoscopic cholecystectomy and wound infection was present in 6% patients and all the 6% patients were bile culture positive . Keywords: Cholelithiasis, Culture, Organism, Laparoscopic cholecystectomy
Background: Obesity is a risk factor for primary ventral hernia. Surgery is deferred in obese patients because of overweight but most of patients present in emergency with obstructed /strangulated hernia in which outcome is poor. Aim: To compare the primary outcomes (seroma ,surgical site infection and recurrence) and secondary outcomes (duration of surgery and postoperative pain) in obese and non obese patients after laparoscopic primary ventral hernia repair. Study design: Prospective comparative study Setting & duration: B V Hospital /Quaid-e-Azam Medical College Bahawalpur, 01-01-2019 to 31-08-2021 Method: This study was done on 70 patients above the age of 25 years undergoing laparoscopic IPOM (intraperitoneal onlay mesh ) after closure of fascial defect for primary ventral hernia. Patients with history of obstructed /strangulated hernia were excluded. Patients were divided into 2 groups( Patients with BMI <30 kg/m2 - Group A and patients with BMI ≥ 30 kg/m2- Group B). Data was calculated regarding patient’s age ,sex, BMI, comorbidities, type of hernia, hernia size, primary outcome (postoperative complications-seroma ,surgical site infection and recurrence) and secondary outcome (duration of surgery and pain). Statistical analysis using SPSS version 22 was done and it was considered significant when p value was <0.05. Results: 29 (41.43%) had BMI < 30 kg/m2 and 41 (58.57%) had BMI ≥ 30 kg/m2 .The most common comorbidity was diabetes mellitus (17.1%) in both groups. 38 patients presented wiyh paraumblical hernia and 32 patients with epigastric hernia. A significant correlation between size of defect and post operative complications. (p value 0.042) was found. A significant correlation between comorbidities and complications was also found (p value 0.001). Complications being more common in group B patients but were not statistically significant (p value 0.979). Duration of surgery being higher in group B patients but was not statistically significant.(p value 0.194). There was no significant difference in postoperative pain in both groups. Conclusion: Obesity has no significant effect on postoperative complications ( seroma, surgical site infection and recurrence), duration of surgery and postoperative pain after laparoscopic IPOM repair. Comorbidities are significantly associated with postoperative complications rather than increased BMI. So surgery should not be delayed in obese patients. Key words: Primary Ventral Hernia, Obesity, BMI (Body Mass Index), IPOM (Intraperitoneal Onlay Mesh)
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