22.2.08

Planned LAVH actually became TLH, as dissection could be continued with simultaneous use of bipolar and monopolar diathermy with a single diathermy machine. enjoyed.

23.2.08

AMCA , AMDAANA meet at Amritsar; attended along with dr Ashok and Dr Bir Singh

25.2.08

Attended purchase committee meeting, along with dr Sharda,  in DRME office for purchase of sutures

1.3.08

lap chole in ASR

2.3.08

TLH using, for the first time, the harmonic scalpel. enjoyed.

5.3.08

Interesting case: obese 50M rural. h/o intestinal obstruction for 10 days. On exam, irreducible hernia left inguinal. Explored through inguinal incision first; foul smelling fluid in the hernial sac, sucked out. Loops of small bowel (had reduced) examined to find dusky and dark spots at several places and lot of foul smelling (feculent) fluid in the peritoneal cavity; so needed a full laparotomy. Opened through midline incision. Small bowel decompressed retrogradely thru nasogastric tube and eventually returned to healthy colour. However, further examination showed a small perforation in the caecum and a large patch of gangrene in the caecal wall; local resection of small ileocecal segment and EEA done.

Did well post op although did give some sleepless nights.

8.3.08

2 lap choles in Amritsar

12.3.08

Burch colposuspension. Obese 50F. difficult procedure

17.3.08

meeting in DRME office again for purchase of sutures

18.3.08

Tuberculosis nuisance: Young (20) F with almost completed anti-tubercular therapy (DOTS), presented with intestinal obstruction, not responding to conservative treatment for 5 days. Explored to find disseminated tuberculosis – ascites + tubercles all over serosa + adhesions of small bowel loops + old caseated mesenteric lymph nodes + transverse colon stuck to anterior abdominal wall. The transverse colon got injured in the upper part of the incision. Small bowel freed from bands and adhesions and  decompressed.  The rent in transverse colon repaired.