- In: operations
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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.
7.11.08
25M with bilateral undescended testes, right orichiopexy 3 weeks before now for left orchiopexy. Testis high, intraabdominal; could be brought down only after division of testicular vessels (FowlerStephen).
14.11.08
APR: 50 obese lady presenting with tight stenosis of anus, colostomy done 3 weeks before. CT low rectal tumor involving levators. At operation tumour adherent to pelvis side wall too on right side. Removed incompletely, for later radiochemotherapy.
18.11.08
4 lap choles, one after the other, all difficult.
21.11.08
retention cyst minor salivary glands floor of mouth (small ranula) excised under GA 50F.
Trichobezoar removed from a 16F psychotic. helped in stomach closure.
3 lap choles and a big thyroid
Posted on: November 6, 2008
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.
3.10.08
A pilonidal sinus was closed primarily after excision.
10.10.08
A one week old infant with advanced (grade III hydronephrosis) underwent AH pyeloplasty.
14.10.08 – 19.10.08
ICS conference:
Went to Delhi in the evening with 3 others. Then from Delhi to Chennai by air, Chennai to Trichi by train, reaching Trichi by 11 pm.
16,17,18: Stayed at Trichi for the annual conference of ICS (IS).
18th evening: from Trichi to Chennai by train.
19.10.08: Chennai to Delhi by air, and Delhi to Patiala by taxi, reaching back home by 7 pm.
21.10.08
At a lap appy, an area over ileum was inadvertently scored with diathermy , closed with 3-0 silk.
5 and 6 september
went to kullu to attend NCASI conference Midterm CME organised by dr Gautam
one month of vacation
Posted on: August 28, 2008
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.
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.
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