Objective : Poverty, pressing priorities and tropical diseases prevailed added to the factors that delay the implementation of Laparoscopic Cholecystectomy (LC). The objective of this study was to assess the feasibility and safety of LC in this country (Sudan). Subjects and methods: From June 1995-May 1999, we enrolled 288 patients presented with symptomatic gallstone disease without pre-selection criteria. 242 were females and 46 were males, mean age 48.1 years. Results : LC was successful in 201 (94.81%) patients including 49 patients with acute cholecystitis. The operation was done the same day of admission and 60 (29.35%) were able to leave as a day case. There was no mortality and no common bile duct injury. Conclusion: LC is feasible, safe and cost effective in Sudan.

Back ground: This is a prospective study to evaluate the tolerance and acceptability of patients for diagnostic ultrathin transnasal esophagogastroduodenoscopy compared with the standard peroral route. Patients and Methods : Both types of endoscopic procedures were explained to the patients. Sixty patients were included in this study and subsequently, 30 unsedated patients in each group underwent upper gastrointestinal endoscopy. An evaluation and questionnaire form both the endoscopist and the patient was recorded. Out of the 30 patients who had transnasal endoscopy, 15 had previous peroral endoscopy. Oximetry was recorded during the procedure. Results: All patients in both groups tolerated the procedure well and it was successfully completed. In the transnasal group, three patients had mild epistaxis. Desaturation in the transnasal group was the same as compared to the peroral group. From the 30 patients of transnasal group, 21 were willing to repeat the procedure if required and eight patients were willing to repeat the procedure reluctantly. Only one patient expressed preference for the peroral route. The endoscopist's observation revealed that scope insertion in both groups was equally tolerated but lens washing and suction was not optimal in the transnasal approach. Conclusion: Both groups showed good tolerability, but the tranasal approach was found to be more acceptable to the patient. In the tranasal group, the patients found the procedure less distressing and were subsequently more willing for a repeat procedure. Therefore we believe that the tranasnal approach to esophagogastroduodenoscopy in diagnostic and follow up procedures will rapidly acquire increasing popularity.

Background: The epidemiology of acute pancreatitis in Saudi Arabia is greatly different from that in Western Countries. Aim: To evaluate and compare the risk factors and clinical features of acute pancreatitis. Patients and Methods: The course of acute pancreatitis was retrospectively analyzed in 218 patients who had their first attack and were admitted at Riyadh Armed Forces Hospital during the period 1.01.85-31.05.97. Results: From these 218, 130 patients were in the age group of 20-55 yrs. (74+, 56>), 76 were > 55 yrs. Of age (42 +, 34>) and only 12 were < 20 yrs. (6 Females, 6 Males). The precipitating cause was biliary disease in 147, post-operative in ten, hyperlipidemia in seven, post-ERCP in five, infection in four and alcohol in four. Four had rare causes and 37 no obvious cause. Severe pancreatitis diagnosed in 70 patients, 51 of them were > 55 yrs. of age and 45 were precipitated by biliary disease. Twenty six developed complications (21 were > 55 yrs. old) and four deaths. Twenty two patients of these who had severe form had diabetes mellitus, 37 had fever at presentation and 56 had leukocytosis. Conclusions: The commonest etiology of acute pancreatitis was biliary in 147 patients (67.5%) followed by postoperative pancreatitis in 10 patients (4.6%). Alcohol as etiological factor was rare (1.8%). The epidemiology and the risk factors differed markedly in Saudi Arabia, where alcohol is prohibited