European Journal of Cardiovascular Medicine

Aim: The aim of this study to comparing low-pressure with normal-pressure pneumoperitoneum. Materials and methods: This research comprised a total of 100 patients who were hospitalised for elective laparoscopic cholecystectomy. Patients undergoing open cholecystectomy after conversion. The research did not include patients with acute inflammation or any other choledocholithiasis or gallstone-related complications. Every patient was asked for written informed permission after being told about the research.  Results: The average surgical time was 36.58±6.66 minutes. The visual analogue scale pain ratings for postoperative shoulder tip pain were 4.6±0.34, 2.5±0.13, and 0.23±0.05, respectively, at 5, 10, and 24 hours. In 91% of the patients, oral feeds were begun on the first postoperative day. On the postoperative day, 95% of the patients were ambulating. The average length of stay after surgery was 1.3±0.11 days. On average 6 months of follow-up, no serious problems were noted.  Conclusion: LPPLC is a safe procedure, especially in the hands of an experienced surgeon with clinically insignificant systemic effects. But the comfort level of surgeon is better in normal pressure when compared with low pressure.

Background: Acute appendicitis is one of the most common surgical emergencies, and a significant proportion of patients present with complicated appendicitis, including perforation, gangrene, abscess, or peritonitis. While laparoscopic appendectomy has become the standard of care for uncomplicated appendicitis, its role in complicated appendicitis remains debated due to concerns regarding operative difficulty, infectious complications, and cost. Comparative evaluation of laparoscopic versus open appendectomy in complicated appendicitis is essential, particularly in tertiary care settings where advanced surgical facilities are available. Aim: To compare laparoscopic and open appendectomy in patients with complicated appendicitis with respect to operative parameters, postoperative recovery, complications, and cost. Materials and Methods: This comparative analytical study included 92 patients diagnosed intraoperatively with complicated appendicitis at a tertiary care hospital. Patients were equally divided into two groups: laparoscopic appendectomy (n = 46) and open appendectomy (n = 46). Demographic data, intraoperative findings, operative time, postoperative recovery parameters (pain score, time to oral intake, ambulation, and length of hospital stay), postoperative complications, and cost details were recorded. Results: Baseline demographic characteristics were comparable between the two groups. Operative time was significantly longer in the laparoscopic group (58.74 ± 12.36 minutes) compared to the open group (51.28 ± 10.94 minutes; p = 0.004). Laparoscopic appendectomy demonstrated significantly lower postoperative pain scores, earlier resumption of oral intake, shorter hospital stay, and higher rates of early ambulation (all p < 0.001). Surgical site infection was significantly lower in the laparoscopic group (8.70% vs 23.91%; p = 0.047), and overall complication rates were also reduced (15.22% vs 36.96%; p = 0.018). Although operative costs were higher for laparoscopic appendectomy, postoperative costs were significantly lower; however, total treatment cost remained marginally higher in the laparoscopic group. Conclusion: Laparoscopic appendectomy is a safe and effective approach for complicated appendicitis, offering superior postoperative recovery and lower morbidity compared to open appendectomy, with acceptable overall cost implications in a tertiary care setting.

Background: Distal humerus fractures constitute a challenging injury for orthopaedic surgeons due to their complex anatomy and the need for stable fixation to allow early mobilization. Various surgical techniques have been described, among which single extra-articular humerus plating and bipillar plating are commonly practiced in tertiary care teaching hospitals. Aim: To assess the effectiveness of using either single extra-articular humerus plating or bipillar plating for treating distal humerus fractures in a tertiary care teaching hospital. Material and methods: Present Study was conducted at SIMS, Hapur during May 2012 to May 2013. This study was conducted in the Department of orthopaedics. Total 100 patients were included in this study. Patients were grouped into two groups. 50 patients in group A included humerus fracture treated with single extra articular plating and 50 patients in group B included patients treated by bipillar plating. Results: Mean duration of surgery was significantly less in Group A (91.43± 12.27mins) than Group B (182.53± 4.38 mins) (P<0.05) Mean operative blood loss in Group A was 177± 42 ml while in Group B it was 214± 36 ml. Difference between these two groups is statistically significant   Mean fracture union time was 22.2±1.1 and 21.4± 1.2 in Group A and Group B respectively. Bone impingement was not seen in Group A. only one patient had Bone impingement in Group B. Score of > 90 was considered as excellent and score of 75-89 was considered as good. In our study we found that 49 patients from group A were with excellent score and 347 patients from Group B were with excellent score. Good score was achieved by 1 patient in Group A and 3 patients in Group B. Conclusion: Single extra articular humerus plating is better than bipillar plating for distal humerus fracture as it has less duration of surgery and less blood loss with good performance score.

Background: Ankle fractures are among the most common lower limb injuries treated by orthopaedic surgeons. Postoperative rehabilitation protocols, particularly timing of weight-bearing, remain controversial. Early weight-bearing may enhance functional recovery but raises concerns regarding implant stability and fracture union. Ankle fractures are common injuries that frequently require open reduction and internal fixation (ORIF) to restore ankle stability and articular congruity. Postoperative rehabilitation protocols vary widely, particularly regarding the timing of weight-bearing. Early weight-bearing may enhance functional recovery and reduce stiffness, but concerns remain about implant failure, loss of reduction, and delayed union. Aim: To prospectively evaluate and compare the functional outcomes of early versus delayed weight-bearing following surgical fixation of ankle fractures.Materials and Methods: This prospective comparative study included 58 skeletally mature patients with closed ankle fractures treated with ORIF. Patients were divided into two equal groups: early weight-bearing (n = 29) and delayed weight-bearing (n = 29) based on postoperative rehabilitation protocol. Standardized fixation techniques were used according to fracture pattern, and syndesmotic stabilization was performed when required. Outcomes were assessed using a functional ankle scoring system, Visual Analog Scale (VAS) for pain, goniometric measurement of ankle dorsiflexion and plantarflexion, and serial radiographs to evaluate union and alignment. Complications such as infection, ankle stiffness, delayed union, nonunion, malalignment, implant failure, and post-traumatic arthritis were documented. Data were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Results: Both groups were comparable in baseline characteristics including age (41.32 ± 10.24 vs 42.18 ± 9.86 years; p = 0.734), gender distribution (p = 0.789), side of injury (p = 0.794), fracture type distribution (p = 0.812), and syndesmotic injury (p = 0.771). Functional outcomes were significantly better in the early weight-bearing group, with higher mean functional ankle score (88.24 ± 6.18 vs 80.67 ± 7.42; p = 0.001) and lower VAS pain score (1.84 ± 0.92 vs 2.96 ± 1.12; p = 0.002). Range of motion was also superior with early weight-bearing, showing greater dorsiflexion (16.42 ± 3.12° vs 13.68 ± 3.46°; p = 0.004) and plantarflexion (33.86 ± 4.91° vs 29.47 ± 5.28°; p = 0.003). Radiological union rates were comparable (96.55% vs 93.10%; p = 0.553) with no significant differences in malalignment or implant failure. Overall complications were significantly lower in the early weight-bearing group (20.69% vs 48.28%; p = 0.028), and ankle stiffness was significantly less frequent (10.34% vs 24.14%; p = 0.041).  Conclusion: Early weight-bearing after ankle ORIF leads to significantly improved functional recovery, reduced pain, better ankle range of motion, and fewer overall complications without compromising fracture union or implant stability in appropriately selected patients