Dr Mohinder Singh's blog

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.

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.