15.12.11 An adult intussusception in a 50 years old male. Ileocolic intussusception caused by a 3 cm tumor (histopath – fibrolipoma), REEA done.

26.12.11

A difficult lap chole for empyema. 50 F. GB opened up to remove stones, and had to be removed piecemeal in 6 pieces.

Another difficult lap chole, 60 M, father of Ratan, house keeper with Dr DNB. Gangrenous gall bladder, separation of adhesions from duodenum led to a leak from duodenum. Converted to open operation to repair the damage.

29.12.11

An interesting laparotomy, a difficult one. 55F. Had a difficult surgery at Columbia Asia, reportedly for intestinal obstruction, due to a sigmoid colon cancer, and only biopsy and colostomy had been done. Presently, at operation, had a dense fixed mass in left paracolic gutter, fixed to anterior abdominal wall, was excised, and colostomy refashioned. Biopsy reported ovarian cancer. Later it transpired that she actually had a huge ovarian cystic mass removed at PSC last year and the biopsy that time was not malignant. The same mass had now recurred and involved the left colon.

2.1.12

Total thyroidectomy for a recurred goiter, subtotal done 15 years back.

10.1.12 TLH using ehicon enseal.

2.2.12

TEP was difficult, because the sac got torn.

Lap chole again for gangrenous gall bladder, duodenum got a tear, converted to open to repair.

6.2.12

An infected hydatid cyst of liver, adherent with abdominal wall. Laminated membranes removed piecemeal. A biliary communication ligated. Capitonage, and omentoplasty.

9.2.12

TEP, 60 M, difficult due to difficulty in creating the lateral space. Lap chole, again for empyema. GB removed piecemeal.

16.2.12 Difficult lap chole, short thick cystic duct, ligated with Roeder knot.

23.2.12 TEP, 25m, easy.

1.3.12 TEP , 25 m, difficult again due to problems in creating the lateral space.

19.3.12 A wrong diagnosis of an ovarian cyst was made (on US findings) in a 35 y o female; turned out to be a big chronic pelvic abscess with thick adhesions, and a left TO mass; the mass was excised, and the pus drained. Recovery from GA delayed, had to kept in ICU on ventilatory support for two days.

22.3.12

Lap chole, again for empyema, the stone at neck removed first, and GB removed piecemeal.

24.3.12 Lap chole, converted to open, because of adhesions with duodenum, subtotal chole only possible.

26.3.12 Lap chole, 130 kg obese 35 female, wife of Sahib Singh Cheema from kheri, had to be converted for huge empyema. A small PUH repaired at the same time, on patient’s request; got into trouble later because of wound infection, which did not clear with dressings till 3 may, when it was explored again under GA and a deeper abscess drained.

29.3.12 DJ (Duodenojejunostomy), stapled, for SMA syndrome, in a young (15 years old ) girl, thin and emaciated. Recovered well.

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2.4.12 A very difficult lap chole, again for empyema, 50 F. Wall of gall bladder more than 1 cm thick, had to be bisected for the grasper to hold. Stones removed, and gallbladder had to be cut into 6 pieces to remove from the epigastric port. Took nearly 3 hours. Ileus for 2 days.

4.4.12

A unique cause of intestinal obstruction. A 30 year old young man, addicted to poppy husk (ver: bhukki), with small bowel obstruction, found to have a bolus of inspissated poppy husk ( bhukki) in the ileum, removed through an enterotomy.

9.4.12

Lap chole, 50 year old, c/o Surinder, staff nurse in OT. Thick-walled empyema, had to be converted due to dense fibrosis in Calot’s triangle. Stones removed after opening gallbladder and the GB ligated at its neck.

12.4.12 Another empyema of gallbladder, could be done laparoscopically.

26.4.12 Lap chole in a child  7 years of age. Difficult. Turned out to be a thick walled gall bladder with a walled off perforation at the fundus, discharging pus after removing adhesions. Dark sludge in the gallbladder. GB too thick to come out of the 10 mm port, had to be removed piecemeal.

Lap chole, 50 f, most difficult again, had to be converted due to dense adhesions in the triangle of Calot. Fundus first dissection deemed safe. Neck suture ligated. A small perforation in duodenum closed.

30.4.12 Lap chole, converted again, for thick-walled empyema. GB opened, stones removed, and the pedicle ligated. Small ooze of bile observed middle of liver bed from a small calibre cholecystohepatic duct, ligated. Still leaked bile for 3 days postoperatively, then dried up.

Lap nephrectomy, 30 M,  for NFK (PUJ) right kidney, pedicle dissection deemed too dangerous, so converted. At open operation too, the pedicle could not be separately defined.