The significant risk factors for conversion were male gender, advanced age (> 60 years), higher body weight > 65 kg, acute cholecystitis, previous upper abdominal surgery, junior surgeons, and diabetes associated with Hba1c > 6. Chronic liver disease was not found to be a risk factor (P = 0.345), and performing laparoscopic cholecystectomy in cirrhotic patients is safe. Identifying risk factors will help the surgeon to plan and counsel the patient and introduce new policies to the unit. Some of the risk factors are similar to those reported from international centers, but others may be unique to our department.

Laparoscopic varicocelectomy is safe and effective, causing minimal discomfort and allowing patients an early return to activity.

This programme is effective in training junior surgeons and does not compromise patient safety.

Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics, is a safe and viable alternative in all patients who require surgical drainage following failed medical or percutaneous treatment, and in those with large abscesses.

IndicationsSpontaneous rupture of the bladder is a rare occurrence and therefore unlikely to be diagnosed pre-operatively. The majority of ruptures are due to blunt trauma or iatrogenic causes [ 1,2]. Pre-operative diagnosis can be made in such cases and suitable patients selected for laparoscopic repair, bringing the advantages of minimal access surgery to these patients.We report two cases of intraperitoneal rupture of the bladder, one spontaneous and the other of traumatic,' non-iatrogenic cause; both were repaired laparoscopically. The first patient was a 22-year-old lady who was admitted in August 1992, with a 1 week history of painful micturition culminating in severe abdominal pain. She had generalized peritonitis and catheterization revealed blood-stained urine. Emergency diagnostic laparoscopy performed after resuscitation revealed 1.5 L of bloody ascitic fluid and a 2 cm rupture at the dome of the bladder. Biopsy revealed acute innammation with perforation.The second patient was a 54-year-old man who presented with abdominal pain and an inability to pass urine following a car accident. There was no evidence of pelvic fracture or any other intra-abdominal injury. An urgent cystogram revealed an intra-peritoneal bladder rupture. Emergency diagnostic laparoscopy revealed a 3 cm rupture at the dome of the bladder with bloodstained urine in the peritoneal cavity. MethodUnder general anaesthesia, three working ports were placed a 5 mm port was sited above the suprapubic area and two other ports of 5 mm and 10 mm, at the same level as the sub-umbilical port on either side along the mid-clavicular line. The rupture was repaired laparoscopically with two layers of absorbable suture. The bladder was distended with 300 mL of saline to test for leaks. The peritoneal cavity was then lavaged thoroughly with saline before withdrawal of the ports and closure of the incisional wounds. 50Catheter drainage was continued for 1 week after the operation to allow adequate healing. No complications were encountered and there was little need for postoperative pain relief. Both patients recovered quickly with the second one returning to work after 2 weeks. The first patient had total bladder failure and was taught intermittent self-catheterization. Comparison with other methodsIn accodance with our practice, we performed a diagnostic laparoscopy to confirm the diagnosis and exclude other pathology or injury. Using established laparoscopic suturing techniques, we repaired the rupture as for open methods. Similar laparoscopic repairs have been reported for iatrogenic perforation of the bladder [2] and perforated peptic ulcers [3]. If laparoscopic surgery is not available, the only other surgical option would be conventional laparotomy followed by open repair of the bladder perforation. Advantages and disadvantagesWe feel that intraperitoneal rupture of the bladder from any cause can be safely repaired laparoscopically avoiding the problems associated with a large abdominal incision. The benefits of minimal access surgery to the pa...