Dr Mohinder Singh's blog

28.3.15

A laparoscopic appendectomy in a 35 years old male had to be converted to open operation when the appendix could not be found. At open operation, the appendix could be palpated, buried in the retroperitoneum retrocecally. Thereafter, it was removed retrogradely.

1.4.15

A difficult TEP repair of a right inguinal hernia. The thick big sac contained omentum, which had to be reduced from below and then the sac could be dissected free, and was ligated with vicryl.

4.4.15

A testicular tumor in a young male (32 years old), with high level of tumor markers, was removed through inguinal approach.

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5.4.15

Laparoscopic cholecystectomy (dr Grover’s daughter-in-law, herself a doctor), recorded by dr Grover’s camera (handycam).

10.4.15

Anderson-Hyne’s pyeloplasty for right sided hydronephrosis due to congenital UPJ obstruction, in a 22 years old female.

11.4.15

Laparotomy for intestinal obstruction of 7 days duration, not resolving on conservative treatment, in an 85-years old lady (mother-in-law of dr Darshan pal Sharma). There was an omental band causing the obstruction, this was divided. The patient needed ICU care postoperatively due to bad lungs (crepts bilateral).

14.2.15

An elderly female (70 years old) admitted with intestinal obstruction (previous history of 2 caesarean sections) kept on conservative treatment but did not respond in about a week’s time. At laparotomy, a jumbled up mass of some 6 inches of ileum containing a tight stricture had to be excised, and an EEA made.

23 and 24.2.15

PG class on CRC and seminar on faecal fistula on consecutive days.

28.2.15

A lap chole for acute cholecystitis using Harmonic scalpel (for  thesis) throughout the dissection, helped in saving time and blood loss. Also made the operation easy by reducing the smoke compared with cautery.

4.3.15

Bilateral TEP repair for inguinal herniae in 40 years old mess servant.

A planned appendicectomy in a 60 years old female actually turned out to be a big twisted fibroid revealed at diagnostic laparoscopy. Converted to open to remove the big fibroid, the pedicle of which had taken three turns.

11.3.15

Lap chole following pancreatitis. Turned out to be quite difficult with a big Hartmann pouch hanging much below the level of the Rouviere’s sulcus. The notable feature of the sulcus was a visible pulsating vessel in its floor.

27.11.14

TEP repair of right inguinal hernia performed on a 70-year-old man referred from Khanna by Dr Bhasin. Needed to have a urethral meatotomy and bladder catheterization also  for narrow meatus associated with a glandular hypospadias.

1.12.14

TEP repair of right inguinal hernia in a young 20-year-old resulted in a pneumothorax and collapse of left lung. Kept in ICU for a few days after chest intubation for expansion of the lung.

10.12.14

A big sliding hernia (right inguinal) in a 60-year-old, contained cecum, appendix and omentum, repaired with a mesh.

29.12.14

MRM for a multicentric tumor in right breast in a 76-year-old lady (mother of dr Vinod, ex resident) from Sangrur.

Laparoscopic orchiectomy for undescended testis in a 20-year-old male.

TEP repair of bilateral inguinal herniae, 45-y-old male, worker in the hostel mess.

6.1.15

A very difficult open CBD exploration (55-year-old female) after a previous failed attempt at cholecystectomy at some civil hospital. Dense adhesions all around the shrunken gallbladder, eventually the GB and CBD were identified, a cholecystectomy was performed, a big stone found and removed from the bile duct and a T-tube inserted.

A wrongly diagnosed appendicitis (burst with diffuse peritonitis) in a very sick toxic patient (60-year-old female) actually turned out to be a caecal perforation due to a palpable tumour in the cecum. A right hemicolectomy was performed and the ileum and colon exteriorized after thorough peritoneal lavage. The patient stayed in ICU for 4 days and then recovered.

21.1.15

A hemorrhoidectomy (70-year-old female wit big prolapsed piles, mother of Dr Girish Sahni, ortho) performed with harmonic scalpel turned out to be neat and bloodless.

24.1.15

An anal fistula, diagnosed wrongly as a sinus only because its inner opening was not demonstrated clinically and even on a sinography and MRCP, was found to he a fistula, the whole tract of which was excised. The patient a government servant, 45-year-old male and a diabetic.

31.1.15

Two TEP repairs with harmonic scalpel very satisfactory and bloodless, one had a thin sac and the other a thick sac, both sacs ligated with an endo-loop and excised.

2.2.15

At lap chole, a RHD or the CHD was already found to be  injured (small hole) by  the diathermy hook before I reached the scene. Dissection completed by me and a drain left in the sub-hepatic space.

4.2.15

A difficult lap chole , started by dr Walia (A P), had to e completed by me.

5.2.15

An 11-year-old child (dr Jagga’s case), diagnosed wrongly with burst appendix (based on US report) actually turned out to have no appendix (agenesis) , but had some fluid in the pelvis, which was sampled for culture and microscopy.

7.2.15

A total thyroidectomy with lymphadenectomy in a 35-year-old-female for FNAC diagnosed papillary carcinoma (dr Usha Chhbra, HOD anatomy’s case). Strangely, biopsy was reported as Hashimoto’s thyroiditis!.

15.6.14
A wrongly diagnosed stone at lower end of ureter was found to have no stone, and actually a stricture for which the ureter was reimplanted into the bladder after excising the stricture. Dr Jagga’s case, a 7 years old male child.
8.7.14
A very bad chronic anal fistula with extensive suppuration and fibrosis all around the track, all of which had to be excised  leaving a deep defect in the ischiorectal fossa, that eventually healed satisfactorily. Patient reported to be very happy! Had been suffering for long and had a couple of surgical attempts earlier.
28.7.14
2 lap choles done with Harmonic scalpel, neat and clipless division of the cystic duct performed for the thesis work of a resident.
31.7.14
A disappointing day.
A presumably easy lap chole for chronic cholecystitis turned out to have what looked like extensive intraperitoneal deposits and some ascites. Transverse colon was found to be densely adherent with the anterior abdominal wall making entry of subxiphoid port dangerous. The ascitic fluid was sampled and omentum biopsied. Cholecystectomy was deemed not possible. The biopsy report surprising came out to be tuberculosis!.
A young female (35 years old, HIV positive), had a mobile big intraperitoneal mass, reported on CT as ovarian (CA 125 also elevated). At operation the clinically mobile mass was found to be a mass in the greater omentum between the stomach and colon, but had a more extensive fixed retroperitoneal component posteriorly. Only a biopsy only was possible; and this was reported as sarcoma.

11.8.14
Subtotal colectomy and ileostomy for severe ulcerative colitis (pancolitis). Young (25 years old) patient, with fulminant ulcerative colitis, which had had remissions earlier, but now had actually become more severe, with the patient having developed abdominal pain, as well as increase in the number of bloody stools (now more than 10 per day). Referred from medical ward for surgery.

14.8.14
Roux-en-Y duodenojenunostomy for SMA syndrome. The young patient (27 years old) had undergone an appendicectomy (perhaps a wrong diagnosis) at Samana about two weeks back, but continued to have abdominal pain and vomiting. Barium study revealed a dilated duodenum up to the third part.

The angle between the aorta and SMA was 15 degrees on CT angiography.

At operation, after mobilizing the duodenum, the patient was found to have omental adhesions in the right lower abdomen ( at appendicectomy site). These were lysed.  Interestingly, the upper small bowel had herniated through a hole created between the loops of proximal jejunum which were densely adherent to the posterior abdominal wall.

These adhesions were divided, and the jejunal loops released, only to find some stricturing in a loop at the site of adhesions. This upper jejunal loop was  excised to remove the strictures and  a Roux-en-Y DJ was made for cure of the SMA syndrome as well.

An unusual presentation for a small tubular duplication and stricture of jejunum causing obstruction in a 60 years old lady. The jejunal segment was excised and an EEA performed.

23.1.14

A difficult lap chole in 50 years old male (Bhupinder singh from kheri) with a thick-walled mucocele, removed piecemeal.

3.2.14

A pilonidal sinus (recurred after 7 years), in a 25 years old male (s/o Dr Avinash Gupta ortho), excised and sutured. close

5.2.14

Pyelolithotomy for a big staghorn stone left kidney, and a small impacted stone in lower calyx, removed through nephrolithotomy. 40 years old male with the other kidney nonfunctioning due to ureteric stone, drained through a nephrostomy tube, for later possible nephrectomy.

6.2.14

laparoscopic repair of a portsite hernia (through the umbilical port of lap chole 3 years back), repaired with proceed mesh.

11.2.14

MCI inspection in the college. The hospital turned 60 years old, the staff celebrated by cutting a birth day cake and having photos with the medical superintendent dr Sharda.

17.2.14

Superficial parotidectomy for a 4 cm mixed parotid tumour in a 30 years old female, investigated in PGI.

13.1.14

19.12.13

MRM for an a breast cancer with open excision biopsy done at Rajpura civil hospital, no record available.

An extended right hemicolectomy for a transverse colon cancer in a 55 years old male. The patient had an interesting history of left colectomy with ileostomy (closed later) in Columbia Asia hospital about 3 months back, and now reporting with features of colonic obstruction and endoscopically diagnosed colon cancer again, this time in the right colon. An extended right colectomy was carried out; however, the whole left colon seemed to be intact and there was no sign of left colonic resection.

20.12.13

A right tubal ectopic pregnancy had ruptured through leaving a small hole in the tube. The hole was loosely closed with 4-0 vicryl.

26.12.13

A strange looking Rouviere’s sulcus seen at lap chole.