6.5.09

Day case lap chole no 3. apparently OK when sent home. Next morning, reported severe pain abdomen, called back and hospitalised for an IV drip (RL). Clinically found nothing wrong, the abdomen soft and non-tender. Sent back home. ? tense and unnecessarily worrying patient.

7.5.09

Lap chole after pancreatitis. Saponifications seen very clearly, otherwise satisfactory procedure, no problems caused by the soaps.

9.5.09

Conversion in lap chole. 55M. Difficult procedure, short thick cystic duct, bigger than the clip, so end-looped with vicryl. While doing so, the Maryland carrying the ligature must have gone too far into the liver right lobe across the Calot’s triangle area. The injury continued to bleed rather excessively, pressure over it and surgicel over it not helping and patient going into hypotension. Therefore converted, but found the bleeding had stopped! Sutured the tear by an underrunning suture of 1 catgut.