Author Archive
went to ludhiana along with many others to attend meeting called by Dr Kuldip Singh in PAU campus where the president and secretary of ASI had come to inspect the preparations for the forthcoming ASICON 2008 in december.
2 lap choles
Posted on: July 8, 2008
two lap choles
first routine
second : w/o OTA jaswant singh, repeated attacks of pain continuing.
previous LSCS vertical incision, and a big open appendicectomy scar.
so umbilical port made supraumbilical, but it went to left of the long falciform and remaimed there, so port and telescope had to go under the ligament and lift it to enter the right side every time telescope was cleaned.
Lots of adhesions too. Big impacted stones in a Phrygian cap like thing in the fundus, their removal at the end was not possible in the usual manner; spilled in the peritoneal cavity and removed later with cup forceps.
open chole
Posted on: July 5, 2008
4.7.08
open chole after a long time.
40M admitted as acute cholecystitis, with palpable gall bladder. Recent impaction of stone at neck causing distended big oedematous gall bladder, aspirated nearly 150 cc of dark biliary contents. Big Hartmann pouch. Big stone at neck very close to CBD. Stone removed first and the neck of gall bladder suture ligated.
Sternomastoid tenotomy, femoral hernia, big hydatid, a big gynecomastia and a possible BDI.
Posted on: June 18, 2008
20.5.08
4 straightforward lap choles.
23.5.08: A femoral hernia in a 20 years old female, misdiagnosed as lipoma. Repaired.
24.5.08: An unusual appendix in a 30 years old female. Caecum and appendix nowhere in sight. Through the extended incision then, the whole of the caecum and appendix as well as the lower half of the ascending colon all were found to be retroperitoneal. All were then mobilized. The appendix was retrocaecal too.
27.5.08:
A big hydatid cyst with daughter cysts, removed.
Two TEP hernia repairs, one 20 years old thin male and very satisfactory repair ; the other obese and so not very satisfactory.
3.6.08:
A sternocleidomastoid tenotomy lower unipolar. 5 years old female child, c/o dr ravi dawra.
APR : 50 M lower rectal cancer, adherent anteriorly with the urethra which got injured. Repaired.
13.6.08
A big gynecomatia of the left breast in an 18 years old male (s/o dr Sukhraj). a proper simple mastectomy had to be done.
17.6.08:
A very close save at lap chole started by dr chawla who had dissected out what he thought was a long cystic duct and was about to clip it. joined just in time to dissect out the main hepatic and thus avoid a disaster. Was actually a sessile gall bladder which was, after the anatomy was defined, was endlooped at the neck.
lap heller’s; french lap chole!
Posted on: May 19, 2008
13.5.08
35F with cardiac achalasia. Did a Heller’s but the oesophagus got perforated; closed with 4-0 vicryl. Took a long time; nearly 3 hours. was my first lap heller’s.
two easy lap choles; but the first one was done the french way.
2 TEPs and an obese lap chole
Posted on: May 6, 2008
1. TEP for left inguinal hernia. actually turned out to be a big lipoma of cord. accidental pneumoperitoneum continues to occur.
2. Lap chole; obese 35F with gallstones. Dr Karnail Singh’s patient. turned out to be easy.
3. another TEP. 60 m, bilateral direct defects, bigger on left. Got lost in anatomy for some time. making space laterally continues to be a problem, as is unintentional pneumoperitoneum. took a long time (>2 h).
Noted on 8th to have bilateral pseudorecurrences.
trichilemmal cyst and a parotid
Posted on: April 25, 2008
1. TAH for DUB – patient did not want gynae to do the operation!
2. breast fibroadenoma – sonia 16F d/o kammo. excised under local
3. swelling on back, diagnosed as lipoma. 35F. excised under local. photo attached. the opened up cyst shows some hair too besides the pultaceous material, so thought ot be a dermoid, but the site (back) seems to be strange.
histopathology – trichilemmal cyst.
4. 40M from chupki with a parotid swelling and facial N palsy for 2 months. FNA – benign pleomorphic adenoma. the tumour densely adherent to the trunk and its bifurcation (cause of palsy) sharply excised here. thereafter the branches of the nerve were intact.
22.4.08
1. diagnostic laparoscopy: 45M fed up with no diagnosis being made for non-specific abdominal pain. the urologist had diagnosed a small ureteric stone which was allegedly removed (no record available). pain still continuing. At laparoscopy, had adhesions in both iliac fossae with abdominal wall; these were easily divided. Appendicectomy too carried out.
2. a quick, easy and neat lap chole
3. a submuscular lipoma left lower chest wall excised under local anaesthesia 25M
4. an extended right hemicolectomy for big tumor transverse colon. Young 25 M with family history of cancer, neglecting his symptoms for 2 years; now reported with bleeding per rectum and at Hb level of 4G%. had 5 blood transfusions.
ascites small amount present. liver clear. but the tumour was locally adherent with omentum and nearly encroaching upon the greater curve of the stomach. was also adherent with the very first part of jejunum being stuck in the DJ flexure. Palliative resection carried out with ileotransverse anastomosis.
nephrectomy
Posted on: April 14, 2008
13.4.08
60 M, diagnosed with tumor lower pole left kidney when US and CT were done for pain in the flank. Hypertensive patient with a previously scarred abdomen (operation details not known) was taken up under SA and in kidney position for the nephrectomy which was easy.
Dr Mohinder Singh's blog 