Dr Mohinder Singh's blog

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.

27.6.08

5 yr old male child with solid mass left scrotum. high orchiectomy done.

 

 

 

 

60F (c/o Narinder in OT) with mass RIF. Cancer of cecum. Right hemicolectomy. ascitic fluid present.

 

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.

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.

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.

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.

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. 

1. Small umbilical hernia PUH, Dr Karnail Singh’s pt. 55 M. Mesh repair.

2. IGTN both sides of right big toe. Yadwinder Singh 20 M from bakrana

3. chole and CBDE open. 60F diabetic with jaundice due to CBD stones. c/o hardam OT employee. ERCP scope in GMC Chandigarh out of order, so decided to go open. Right decision in the end; big stone in neck ( mucocele) as well as 5 big stones in common duct. All extracted. Very wide cystic duct. Fogarty tried in the end to confirm clearance. T-tube put in.
4. Presumably simple parotidectomy became very difficult. 60 M Dr Karnail Singh’s patient. All tumour under the nerve trunk and its branches. Very big bossellated tumour, extending up to the right parapharyngeal space and right submandibular area. difficult procedure. The trunk of the facial N was longer than expected (possibly had become longer due to chronic stretching over the big tumour); its upper division was saved nicely but a branch from the lower division was avulsed.

7.1.08

did another TEP bilateral

the trocar for the camera went intraperitoneal;

redirected the trocar into the preperitoneal space and deflated the abdomen with a veress needle

Had a lot of trouble because of decreased space

the unrolling of the mesh continues to take a lot of time

 

10.1.08

had a meeting of Patiala IAGES members (dr sukhpreet, dr jagga, dr pawan, dr surinder singh participated) and unanimously decided to vote and support Dr AS Grover for the post of Zonal member of IAGES

19.11.07

TEP – RIH direct and indirect. The direct sac appeared as a pseudosac (stretched fascia transversalis) and the indirect one got torn. The dissection should have started higher up.

29.11.07 to 2.12.07

Attended the IAGES conference for fellowship (FIAGES) at Apollo, Delhi. Held by Dr Ajay Kriplani who did a nice demonstration of TAPP hernia repair, a PUH repair (TAPP type) and a splenectomy (had to be converted to open due to uncontrollable excessive bleeding).

Other procedures shown in workshop – Nissen fundoplication, TLH, TEP, lap chole, lap nephrectomy.

3.12.07

Lap chole started by SR but as the anatomy appeared strange, was called for help. The shape of gall bladder fundus appeared like a shrunken gallbladder and the body of gallbladder under it was then mistaken for the duodenum.

6.12.07

Splenectomy for huge spleen causing hypersplenism. 60 years old male with pain,  and CT showing a big infarct in a huge spleen.

Difficult procedure due to adhesions with diaphragm and colonic flexure.

8.12.07

Went to Ludhiana to attend a meeting called by Dr Kuldeep Singh of DMC for arrangements for the forthcoming ASICON at PAU Ludhiana

13.12.07

Wrong diagnosis of an ovarian cyst 25F.

Actually a chronic ruptured ectopic pregnancy ; reported on US as cyst.

Presacral tumour – possibly a chordoma- eroding the sacral ala on right side. Removal led to severe bleeding from avulsed vessels in the presacral space and tear in the iliac veins which were stretched over it (the internal iliac artery had been already controlled). Very difficult to control ; Pt remained in persistent hypotension. Eventually the external iliac artery was retracted laterally after ligating some of its branches so as to expose a tear in the internal iliac vein under it, the small hole was controlled with a single stitch of 5-0 prolene. Some other venous bleeders from some unidentified veins in the cavity after removing the tumour were also ligated and the wound packed with several (5) lengths of roller gauze. Even then it took some time (nearly an hour in ICU) for the BP to come up to 100. Thereafter she gradually recovered.

Biopsy: neurilemmoma.