No abstract

Prediction of post operative complications from pre operative HbA1c levels & its relation on post op. morbidity & overall recovery of patient after major gastro-intestinal surgery.Materials and Methods: A total no. of 60 patients who were planned for major GI surgery were taken into study and were divided into two groups as per pre-op HbA1c level (<6% or >6%).The clinical data & final results were analysed in relation to pre op. and post op. hyperglycemia. Observation: It is observed that post-op. day1 FBS is raised in all patients, however post-op day 1 hyperglycemia is present in 60% of patients in HbA1c> 6% and 22.5% in patients in HbA1c < 6%. The postop. complications occur more i.e. 65% in HbA1c >6% and 20% in HbA1c <6%. The infectious complication is more i.e. 50% in HbA1c >6% and 5% in HbA1c <6%. The post-op. recovery i.e. early bowel movement, early oral feeding are also delayed in HbA1c >6% group. The post-op. hospital staying is also more in this group. The post-op. CPR response is also significantly raised in HbA1c > 6% group. Conclusion: That pre operative HbA1c may be used to identify patients at higher risk of poor post-op. glycemic control and prediction of post-op. complications, recovery & morbidity after major gastrointestinal surgery.

Aim: Laparoscopic cholecystectomy (LC) has become the gold standard of treatment of gall bladder disease, but conversion to open cholecystectomy is still inevitable certain cases. The knowledge of the rate& impact of the causes for conversion could help the surgeon during preoperative assessment & inform the patients accordingly .In this study we review the causes and rate of conversion to open from laparoscopic cholecystectomy. Method and Materials: A total no. of 50 patients who were primarily posted for laparoscopic cholecystectomy, subsequently got converted to open cholecystectomy for various reasons were taken into the study. At the end of the study the various factors were assessed for the strength of association and a scoring system was formulated for prediction of conversion from LC to OC. Observation: The conversion rate is 8.34% in this study. T he commonest cause were dense adhesion (40%), and obscure anatomy at calot"s triangle (36%).Pre-operative high WBC count is also another cause leading to conversion. The no. of attacks with co-morbid conditions was also leads to conversion. This study includes twelve no. of parameters to formulate a scoring system to predict conversion from laparoscopic cholecystectomy to open cholecystectomy. Conclusion: A composite scoring system was formulated comprising detail history, USG findings, and laboratory values along with co-morbid conditions which when present would help us in predicting conversion from laparoscopic to open cholecystectomy in any given patient.