Dr Mohinder Singh's blog

50 F with previous vertical upper abdominal midline incision (for hepatic hydatids, done many years back)

Now had gall stones and pain and repeatedly raised alkaline phosphate values, so ERCP was done; this however revealed CBD to be clear and so we proceeded to lap chole. At operation, very dense adhesions were encountered right in front of the telescope starting from just above the umbilicus right to the top to xiphoid and extending to all of RUQ. All of these adhesions were lysed, taking about 45 minutes. Only then it was possible to  introduce the subxiphoid port, and other two working ports. The distal stomach’s adhesions with the liver were then sharply divided. The gall bladder was still hardly visible. A little further dissection under the liver revealed that the subcostal port was actually in the fundus of the supposed gall bladder. This was reintroduced properly and the liver was then freed from the abdominal wall and made a little mobile so that the gall bladder now could be flipped over.

After this the calots triangle was rather easy.

Drained.

4.10.07

A submandibular sialadenectomy for ch sialadenitis.

 Excision and marsupialisation of a recurred pilonidal sinus.

5.10.07

Big ovarian mass 50 F (Dr Jagga’s case). Investigated in PGI. Mass stuck firmly in pelvis, and adherent with UB, sigmoid and ureter, causing hydronephrosis. Ureter released and mass excised with difficulty, along with TAHBSOP.

Bx – undifferentiated cystadenocarcinoma.

Later sent  for chemo.

6.10.07

Wrong diagnosis. 50 M (Dr Pawan’s case) – CT diagnosis – appx abscess (CT attached).  Pt had fever and leucocytosis too. At surgery, actually a hard mass in cecum firmly fixed to parietes in the paracolic gutter. Also had deposits in right half of omentum. Right hemicolectomy with removal of omentum (right half) performed.

Bx – Adenocarcinoma.

 

8.10.07

1. A cirsoid aneurysm in a 30 years old female. Excised with great difficulty. Bled like hell despite prior ligation of both superficial temporal arteries (photos).

2. A lap varicolectomy for oligospermia in a 30 years old male.

11.10.07

TG cyst was the wrong diagnosis –  30 F with a small cystic swelling in the midline of neck. At operation, while removing the supposed hyoid bone just above the swelling opened up the trachea. Repaired the trachea with vicryl sutures. Retrospectively decided the diagnosis must have been a thyroid cyst arising from the thyroid isthmus.

An 82 years old lady (mother of Raj Dhanetha)  with GOO, visible peristalsis and palpable mobile lump in the distal stomach. UGIE (Dr Parmod Mittal) reported a malignant looking ulcer and complete obstruction; but biopsies came out to be negative.

CT suggested a 3.5 cm tumor distal stomach; no mets.

An easy and quick resection of distal stomach, duodenal stump closed and GJ done.

4th POD – had dehiscence of the abdominal wound which was resutured.

5 lap choles one after the other

Assisted a pyelolithotomy for multiple kidney stones and 26% function on DTPA scan ( NFK on IVU); one stone in upper calyx could not be taken out by the senior resident. Being easily palpable through the thinned out cortex of the kidney, it was taken out through nephrolithotomy route