Dr Mohinder Singh's blog

15.9.09

Meckel’s diverticulectomy 45M being operated for suspected appendicitis, actually had Meckel’s diverticulitis.

 

17.9.09

Burch colposuspension after TAH by dr Hans, colposuspension by me. Elderly obese lady. Used a mesh strip.

18.9.09

Cystogastrostomy and cholecystectomy. 45M with the cyst persisting for 6 months now.

 

9.5.09

55 M (uncle of dr Pawan)- Thick walled gall bladder and unclear Calot’s triangle, eventually dissected out to find a wide thick cystic duct which was endlooped with vicryl and tied. While passing the ligature through the window, the instrument carrying the ligature had gone too far into the right loge of liver which bled, continuously and vigorously. Coagulating with diathermy spatula and passing a suture under having failed and with the patient getting into hypotension, converted into open surgery. However, the bleeding had stopped by then. Nonetheless, the injury was underrun. safe result eventually.

11.5.09

Difficult lap chole again. 45F with thickwalled empyema with big stone impacted at the neck. Fundus first dissection and neck of gall bladder closed from within.

13.5.09

Another difficult lap chole. 50 F. Big multiple stones, with one impacted in the neck, could not be disimpacted. The neck was opened up and all  stones removed from within the gall bladder. Gall bladder cut up into 2 long ribbons to enable its removal without dilating the port.

15.5.09

2 lap appys at home.

A laparotomy for ileocaecal tuberculosis with intestinal obstruction. Had completed ATT. REEA done. Young (30) unmarried mentally disturbed patient (c/o Dr Phul Chandra).

17.5.09

day case lap chole 4

19.5.09

Vault prolapse following abdominal hysterectomy 12 years back. 60 F. Sacrocolpopexy with prolene 1.

20.5.09

Attempted TEP failed due to poor space maintenance. Converted to open.

21.5.09

Laparoscopic ovarian cystectomy left side. Medical student final year. Had pain lower abdomen, US showed a big ovarian cyst. Had ruptured leading to considerable blood loss.

 

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.

27.12.08 to 30.12.08

ASI conference at Ludhiana, actually a big mela. Attended for two days 26 and 27 december. Chaired a session on 27th.

1.1.09

25 M with presumed urethral stricture. Bouginage sounded a stone in the navicular fossa. The stone simply removed with a curved haemostat and a scoop.

4.1.09

A partial urethral duplication, just a small 1 cm tunnel above the actual urethra (with a septum between the two)  in the distal penile urethra at the tip. 20 M with no symptoms, but rejected from entry into military service on this account. The septum was excised with the tip of Bovie diathermy.

12.12.08

Rectovaginal fistula arising as a result of prolonged labour (home conducted delivery by dai) . Easily approached from below (vaginally) and easily repaired. Patient from some outside town.

16.12.08

In a busy lap day, had the horror of seeing the so-called safety trocar (used for the umbilical camera port entry) causing intraperitoneal bleeding, shock (sudden unrecordable BP) and a big retroperitoneal haematoma seen in front of the scope on introduction of the telescope. Immediately converted and the rent in the aorta controlled with finger pressure and then sutured with 3-0 prolene. Continued to do open cholecystectomy with the courageous anesthetist’s consent. Needed 2 units of BT immediately for resuscitation and 2 more in the ward later.

 Good quick recovery afterwards, although the patient was left with a long laparotomy incision.

25.11.08

TEP thought to be easy, turned out to be a real pain in the neck. Initial space created nicely, but the sac was big and  omentune in it adherent to sac , adhesions had to be divided after opening the sac. this led to loss of space and so struggled thereafter for a long time, what with the anaesthetist not helping also. Mesh spread also not satisfactory.

 

28.11.08

closed a transverse colostomy done in some other unit for unknown reasons. 55F with extensive adhesions between small gut loops with one another and with abdominal wall, the ileum got injured at 3 places in the process of liberating the small bowel, all three perforations closed and the colostomy closed.

 

3.12.08

attempted TAH had to be abandoned as soon as the abdomen was opened and intestines packed up. Patient in cardiorespiratroy arrest; revived with immediate intubation and CPR, kept in ICU till evening. ?spinal shock, anaesthetist not very vigilant.

 

7.12.08

a patient posted for AHpyeloplasty had a close save from the surgeon’s knife on the kidney. On looking at IVP, a questionable grade I hydronephrosis, history: no pain in lumbar area, ?haematuria, US reporting prostatic calculi. History more suggestive of RIF pain , so appendicectomy done instead.

 

 

 

4.11.08

three seemingly easy lap choles, spilles stones in all!!. retrieved.

 

big m n goitre, much bigger on left side, but small nodules with calcification on right side too. Dunhill – whole of left lobe and most of right lobe removed.  Patient a 35 F gynaecologist practising in Sunam.

17.9.08

Two lap appendicectomies.

19.9.08

Thyroid lobectomy(r) with isthmusectomy 30F

Thyroglossal fistula, previously operated and recurred. Sistrunk procedure done

Recanalisation of vasa deferentia, pt from Rampura Phul, wanted the op due to death of the only child.

vacation from 9-7-08 to 14-8-08

 

26.8.08

difficult day after the vacation

1. TEP converted into open Lichtenstein once it was found that the trocar entry had created a pneumoperitoneum.

2. lap chole easy

3. lap chole easy

4. lap chole male 50 M supposed to be routine became very difficult. Thick walled gall bladder with calots triangle not clear due to excessive fat. After a lot of effort to define the anatomy, the neck of gall bladder eventually end looped.

 

 

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.