Transfer back from Amritsar
Posted on: March 25, 2008
Was transferred back from Amritsar to Patiala.
Was relieved from GMC Amritsar yesterday afternoon. Joined today before noon in GMC Patiala.
a month’s backlog
Posted on: March 21, 2008
22.2.08
Planned LAVH actually became TLH, as dissection could be continued with simultaneous use of bipolar and monopolar diathermy with a single diathermy machine. enjoyed.
23.2.08
AMCA , AMDAANA meet at Amritsar; attended along with dr Ashok and Dr Bir Singh
25.2.08
Attended purchase committee meeting, along with dr Sharda, in DRME office for purchase of sutures
1.3.08
lap chole in ASR
2.3.08
TLH using, for the first time, the harmonic scalpel. enjoyed.
5.3.08
Interesting case: obese 50M rural. h/o intestinal obstruction for 10 days. On exam, irreducible hernia left inguinal. Explored through inguinal incision first; foul smelling fluid in the hernial sac, sucked out. Loops of small bowel (had reduced) examined to find dusky and dark spots at several places and lot of foul smelling (feculent) fluid in the peritoneal cavity; so needed a full laparotomy. Opened through midline incision. Small bowel decompressed retrogradely thru nasogastric tube and eventually returned to healthy colour. However, further examination showed a small perforation in the caecum and a large patch of gangrene in the caecal wall; local resection of small ileocecal segment and EEA done.
Did well post op although did give some sleepless nights.
8.3.08
2 lap choles in Amritsar
12.3.08
Burch colposuspension. Obese 50F. difficult procedure
17.3.08
meeting in DRME office again for purchase of sutures
18.3.08
Tuberculosis nuisance: Young (20) F with almost completed anti-tubercular therapy (DOTS), presented with intestinal obstruction, not responding to conservative treatment for 5 days. Explored to find disseminated tuberculosis – ascites + tubercles all over serosa + adhesions of small bowel loops + old caseated mesenteric lymph nodes + transverse colon stuck to anterior abdominal wall. The transverse colon got injured in the upper part of the incision. Small bowel freed from bands and adhesions and decompressed. The rent in transverse colon repaired.
FIAGES
Posted on: February 18, 2008
feb 14-17 annual conference of IAGES (held at Jaipur) attended along with 5 others from Patiala – dr jagbir, dr sukhpreet, dr grover (with one of his residents) and dr pawan.
Reached jaipur on 13th and stayed at circuit house there.
On 15th saw some of surginet members – dr sayandev and dr ramana from calcutta, dr alexander shoucair from germany, dr samir johna from US and dr danny rosin from israel.
got fellowship of IAGES on 15th
good workshop and conference held at Mahatma Gandhi medical college.
Transfer to Amritsar
Posted on: January 20, 2008
17.1.08
Just when I had reached home after finishing the operation list ( a pyeloplasty and a ureterolithotomy), got a phone call from the Principal office. On reaching there, found transfer orders and relieving orders to Amritsar along with 2 other professors (dr Ashok Sharma and Dr Bir Singh); to report to Amritsar immediately.
18.1.08
Joined Amritsar medical college in the morning. The MCI team had arrived there and the 3 vacant posts of professors in surgery were filled for the MCI inspection.
TEP bilateral
Posted on: January 10, 2008
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
vacation and exam
Posted on: January 5, 2008
20.12.07 to 2.1.08
winter vacation; just slept around most of the time, the rest of the time playing chess on internet on zone.msn.com
5.1.08: conducted MS (gen surg) exam along with 3 other examiners. There was only one candidate; a retired senior doctor, Dr Rajinder Singh, 63 years of age. Strange. Wanted to emigrate to Canada and wanted an extra qualification for that.
17.12.2007: 3 lap choles
Lap chole in a 50 years old female from Ghagga. Easy.
Another lap chole in a 50 years old female from medical ward.
Lap chole and lap appy in a 55 years old female with persistent pain of appendicitis for more than a week and a previous history of attack of biliary pancreatitis (c/o pharmacist in store, Charanjit Singh).
TEP for bilateral inguinal hernias in a 50 years old male, apparently direct, but turned out to be both indirect sacs, right bigger than left. Quite satisfactory dissection at last. Took nearly 1.5 hours.
Chordoma / neurilemmoma – presacral tumour, a splenectomy for a huge spleen, a TEP and IAGES conference, and a fallacy of perception in lap chole
Posted on: December 13, 2007
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.
8.11.07
GJ for GOO (actually a benign stricture at D2 on UGIE and barium study). 50 years old male patient, a bhukki addict (relative of son of Mehnga Singh from village). GJ done.
19.11.07
TEP26 : after a long time. Young man (30) with a small indirect hernia clinically. At operation, was found to have a direct sac too. The indirect sac got torn ; perhaps the dissection was done too low. Otherwise easy.
25-28 October
Attended ICS-IS conference at Agra.
Very poorly attended conference.
acquired viral fever there too.
29.10.07
Out of 3 lap choles, had to convert 2 to open:
In the first one, after the gallbladder had been removed, bleeding continued alarmingly, could not be located. On opening up, the bleeding was found to be from the liver bed, which was sutured with catgut.
In the second one (60 years old female, mother of a class IV employee here), there was a CCD (cholecystoduodenal fistula) at the fundus of the gallbladder. Laparoscopic dissection had led to a tear in duodenum. On conversion to open surgery, the fistula was divided and repaired, besides repairing the iatrogenic injury too. She presented 2 weeks later with epigastric pain, S Alk Phos > 700 units. The plan of an ERCP was deferred for some time due to the repaired duodenum. However, in May 2008, at ERCP, 2 stones were extracted from the bile duct.
2.11.07
A congenital diaphragmatic (Bochdalek) hernia (CDH) in a 10 days old male child was repaired with prolene sutures. Its contents included a lot of small bowel loops, the splenic flexure of colon as well as the spleen.
Dr Mohinder Singh's blog 