26.9.15
Dense adhesions around the liver and gall bladder, including violin-string type (Fitz-Hugh-Curtis), made lap chole difficult, but the procedure was eventually satisfactory.
Another lap chole (Angoori devi, c/o Kammo) was complicated by falling oxygen saturation levels near the end of the procedure. A C-arm image showed left pneumothorax, which necessitated a chest tube insertion and overnight stay in ICU for ventilation to expand the lung. The anesthetist’s explanation was the pneumothorax was due to diaphragmatic injury at surgery!
7.10.15
Visit to Chandigarh with dr Sushil Mittal for purchase of ETO sterilizers for operation theatres by the health systems corporation. Besides this purchase, another momentous decision was taken here. A suggestion given by dr Sushil Mittal was to stop using cars and instead use the bicycle for visits to the college and back. This proposal was immediately accepted and it was decided that both of us from now onwards will use bicycles rather than cars as far as possible.
18.10.15
Attended a CME on hepatobiliary and pancreatic surgery at Ludhiana (organised by dr Kuldeep Singh) along with dr Grover and Dr Jagga.
24.10.15
A laparotomy for abdominal pain and obstruction due to adhesions, following a traumatic bowel perforation which was treated in DMC with a resection-anastomosis and an ileostomy. This was followed by ileostomy closure, which was complicated by a fecal fistula, which had healed with conservative treatment. But the patient continued to experience pain and distension.
At exploration, extensive bowel adhesions had to be lysed, besides excising the ileo-cecal segment which was too densely adherent with an underlying thick-walled chronic abscess.
abscess cavity
ileum opened up with abscess cavity above
31.10.15
An intended Whipple resection for a cancer of the head of pancreas ended up in only a palliative biliary bypass procedure (cholecystojejunostomy). Once the pancreas was mobilized, the tumor in the head of pancreas was found to be densely adherent with the portal vein and also the gastroduodenal trunk (This was suggested by the CT scan, but still it was decided to go ahead with resection if possible).
4.11.15
An extended right hemicolectomy for a big palpable cancer in the transverse colon in a 60 years old female. The peglec bowel preparation by the residents had resulted in gross distension of all bowel proximal to the tumor, making surgery difficult and prolonged. However, the anastomosis with staples saved some time.
A forgotten ureteric stent develops a stone in the bladder, Anandpur sahib VVIP duty, a lap nephrectomy and an Ileal pouch anal anastomosis
Posted on: September 13, 2015
18.6.15
Attended the 350th year celebrations of founding of the city of Anandpur Sahib, as a member of the VVIP medical team. The PM was supposed to attend the same, but instead the home minister Rajnath Singh came.
24.6.15
Laparoscopic nephrectomy in a young (23 years old) female for non-functioning hydronephrotic kidney (congenital PUJ stenosis). The procedure was rather easy.
1.7.15
IPAA made in a young male, who had earlier (on 11.8.14) undergone subtotal colectomy for severe fulminant ulcerative colitis not responding to medical therapy. The completion proctectomy was difficult. The stapled ileal pouch anal anastomosis was not satisfactory, so a proximal ileostomy was added.
4.7.15
Completion thyroidectomy in a 35 years old female following a right thyroid lobectomy and the pathology reporting a papillary carcinoma. Surprisingly, the pathology report this time was not malignant.
8.7.15
A day of difficult cholecystectomies. The first was a young female with a thick-walled mucocele which had to removed piecemeal, after its cystic duct was ligated. The second and third were middle aged females with choledocholithiasis for which they had undergone ERCP, stone extraction and biliary stenting. The gallbladders too were thick-walled and the cystic ducts wide, needing ligation with no 1 vicryl suture.
Summer vacation from 9 July to 16 August
7.8.15
Court evidence at Dhuri through a warrant rather than a summon for expert evidence!
12.8.15
Attended the first meeting of the newly constituted Punjab chapter of ASI at Jalandhar.
22.8.15
Failed to create extraperitoneal space in an attempted TEP repair of inguinal hernia due to obesity and poor muscle relaxation. Converted to open procedure.
12.89.15
A stone grown on a forgotten DJ ureteric stent. The stent had been there for more than 10 years. Both the stent and stone were removed via a cystostomy.
Neurilemmoma of the thigh, disseminated intraperitoneal hydatids, gangrenous perforated gallbladder with bile peritonitis, and a rare conversion to open chole.
Posted on: June 21, 2015
16.5.15
An unexpected finding at an apparently routine lap chole. The gallbladder was found to be perforated and gangrenous with lot of bile in the peritoneal cavity. Postoperatively patient continued to have tachycardia and some fever for 2 days, then settled.
27.5.15
An attempted lap chole in a 45 years old lady failed due to dense adhesions from previously laparotomy (long midline incision going right up to xiphoid, done for liver laceration 2 years back). Even at open cholecystectomy, the procedure was difficult.
3.6.15
Disseminated intraperitoneal hydatid cysts in an 85 years old male presenting with abdominal masses and fever. The cysts had become infected and developed thick walls which were densely adherent all around. All cavities cleaned of pus, debris and grape-skin like small cysts, and drained with wide bore tubes on both sides. postoperatively, drained thick dark bile on second day, and continued to drain for many days.
10.6.15
Neurilemmoma of the thigh, recurred after excision twice. 50 years old female. The big tumor was excised along with sacrifice of the medial cutaneous nerve of the thigh from which it was arising, and along with some of the fascia lata with which it was adherent.
The cremasteric reflex
Posted on: May 10, 2015
The cremasteric reflex in the 7 years old boy with right-sided undescended testis was nicely captured in a short video clip by a final year medical student.
15.4.15 Right sided undescended testis, in a 7 years old boy, was found to be impalpable and not shown up on the ultrasound scan. However, on exploration by assistant professor (dr djs walia), was found in the inguinal canal and was fixed in the scrotum after mobilization.
An 11 years old girl with torticollis – the tight band of the fibrosed sternocleidomastoid was released from its sternal and clavicular heads, and also from its mastoid attachment, using the harmonic scalpel.
A failed lap appy, a testicular tumor, an omental band causing intestinal obstruction and a lip swelling
Posted on: April 12, 2015
28.3.15
A laparoscopic appendectomy in a 35 years old male had to be converted to open operation when the appendix could not be found. At open operation, the appendix could be palpated, buried in the retroperitoneum retrocecally. Thereafter, it was removed retrogradely.
1.4.15
A difficult TEP repair of a right inguinal hernia. The thick big sac contained omentum, which had to be reduced from below and then the sac could be dissected free, and was ligated with vicryl.
4.4.15
A testicular tumor in a young male (32 years old), with high level of tumor markers, was removed through inguinal approach.
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5.4.15
Laparoscopic cholecystectomy (dr Grover’s daughter-in-law, herself a doctor), recorded by dr Grover’s camera (handycam).
10.4.15
Anderson-Hyne’s pyeloplasty for right sided hydronephrosis due to congenital UPJ obstruction, in a 22 years old female.
11.4.15
Laparotomy for intestinal obstruction of 7 days duration, not resolving on conservative treatment, in an 85-years old lady (mother-in-law of dr Darshan pal Sharma). There was an omental band causing the obstruction, this was divided. The patient needed ICU care postoperatively due to bad lungs (crepts bilateral).
Adrenal indicentaloma
Posted on: March 18, 2015
18.3.15 A frustrating experience with laparoscopic attempt at removal of a large (>6 cm) adrenal incidentaloma of the right adrenal gland in an obese 40 years old man (c/o dr sandhu, senior resident). Poor unhelpful liver retraction of a large pendulous liver by the absent-minded assistants who would rather injure the liver than retract it strongly upwards, poor camerawork by the other unhelpful assistant who would just fail to concentrate on his job, and poor anaesthesia by the junior residents who would just not accept that the patient needs good relaxation, led eventually to conversion to open procedure at which the tumour was easily removed. 
the biopsy was reported as benign – myelolipoma.
Adhesive intestinal obstruction, a lap chole using harmonic scalpel, a twisted big fibroid misdiagnosed as appendicitis, and a pulsatile vessel seen in the floor of the Rouviere sulcus
Posted on: March 11, 2015
14.2.15
An elderly female (70 years old) admitted with intestinal obstruction (previous history of 2 caesarean sections) kept on conservative treatment but did not respond in about a week’s time. At laparotomy, a jumbled up mass of some 6 inches of ileum containing a tight stricture had to be excised, and an EEA made.
23 and 24.2.15
PG class on CRC and seminar on faecal fistula on consecutive days.
28.2.15
A lap chole for acute cholecystitis using Harmonic scalpel (for thesis) throughout the dissection, helped in saving time and blood loss. Also made the operation easy by reducing the smoke compared with cautery.
4.3.15
Bilateral TEP repair for inguinal herniae in 40 years old mess servant.
A planned appendicectomy in a 60 years old female actually turned out to be a big twisted fibroid revealed at diagnostic laparoscopy. Converted to open to remove the big fibroid, the pedicle of which had taken three turns.
11.3.15
Lap chole following pancreatitis. Turned out to be quite difficult with a big Hartmann pouch hanging much below the level of the Rouviere’s sulcus. The notable feature of the sulcus was a visible pulsating vessel in its floor.
A thyroid cancer, a few TEP hernia repairs and a few wrongly diagnosed cases
Posted on: February 7, 2015
27.11.14
TEP repair of right inguinal hernia performed on a 70-year-old man referred from Khanna by Dr Bhasin. Needed to have a urethral meatotomy and bladder catheterization also for narrow meatus associated with a glandular hypospadias.
1.12.14
TEP repair of right inguinal hernia in a young 20-year-old resulted in a pneumothorax and collapse of left lung. Kept in ICU for a few days after chest intubation for expansion of the lung.
10.12.14
A big sliding hernia (right inguinal) in a 60-year-old, contained cecum, appendix and omentum, repaired with a mesh.
29.12.14
MRM for a multicentric tumor in right breast in a 76-year-old lady (mother of dr Vinod, ex resident) from Sangrur.
Laparoscopic orchiectomy for undescended testis in a 20-year-old male.
TEP repair of bilateral inguinal herniae, 45-y-old male, worker in the hostel mess.
6.1.15
A very difficult open CBD exploration (55-year-old female) after a previous failed attempt at cholecystectomy at some civil hospital. Dense adhesions all around the shrunken gallbladder, eventually the GB and CBD were identified, a cholecystectomy was performed, a big stone found and removed from the bile duct and a T-tube inserted.
A wrongly diagnosed appendicitis (burst with diffuse peritonitis) in a very sick toxic patient (60-year-old female) actually turned out to be a caecal perforation due to a palpable tumour in the cecum. A right hemicolectomy was performed and the ileum and colon exteriorized after thorough peritoneal lavage. The patient stayed in ICU for 4 days and then recovered.
21.1.15
A hemorrhoidectomy (70-year-old female wit big prolapsed piles, mother of Dr Girish Sahni, ortho) performed with harmonic scalpel turned out to be neat and bloodless.
24.1.15
An anal fistula, diagnosed wrongly as a sinus only because its inner opening was not demonstrated clinically and even on a sinography and MRCP, was found to he a fistula, the whole tract of which was excised. The patient a government servant, 45-year-old male and a diabetic.
31.1.15
Two TEP repairs with harmonic scalpel very satisfactory and bloodless, one had a thin sac and the other a thick sac, both sacs ligated with an endo-loop and excised.
2.2.15
At lap chole, a RHD or the CHD was already found to be injured (small hole) by the diathermy hook before I reached the scene. Dissection completed by me and a drain left in the sub-hepatic space.
4.2.15
A difficult lap chole , started by dr Walia (A P), had to e completed by me.
5.2.15
An 11-year-old child (dr Jagga’s case), diagnosed wrongly with burst appendix (based on US report) actually turned out to have no appendix (agenesis) , but had some fluid in the pelvis, which was sampled for culture and microscopy.
7.2.15
A total thyroidectomy with lymphadenectomy in a 35-year-old-female for FNAC diagnosed papillary carcinoma (dr Usha Chhbra, HOD anatomy’s case). Strangely, biopsy was reported as Hashimoto’s thyroiditis!. 
An adult intussusception, a TEP hernia repair converted to open repair and an anomalous Luschka’s duct identified after division
Posted on: November 20, 2014
10.11.14 An anomalous duct of Luschka was identified only after division, at a lap chole in a 55-years old female. The proximal end was sought in the liver bed and clipped (Dr GS Sandhu (senior resident)’s case).
13.11.14
A planned LIH repair by TEP approach had to be abandoned and converted to open hernia repair due to a hole in the peritoneum at the time of creation of space, and loss of space thereafter.
20.11.14 An adult intussusception, diagnosed on US and CT, in a 50-years old female, presenting with sub-acute intestinal obstruction of many weeks, was treated by resection of the segment of distal ileum bearing the intussusception. On cut section, it was found to contain a big pedunculated benign-looking tumour arising from the ileum. 
Dr Mohinder Singh's blog 