Catecholamine induced lactic acidosis after a laparoscopic resection of pheochromocytoma

Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla, and most commonly originate from adrenal gland. Most tumors secret large amount of norepinephrine, and epinephrine to a lesser extent. The clinical presentations are due to the over activity of catecholamines. Classical presentations are paroxysmal or sustained hypertension with palpitations, headaches and profuse sweating. Both open and laparoscopic approaches are used for the tumor resection. Anesthetist pays a significant role in the peri-operative management. Hyperlactaemia and lactic acidosis can be complications of the surgery. This can have a significant impact on the outcome.

Laparoscopically Assisted Pancreaticoduodenectomy First Sri Lankan Experience

Pancreaticoduodenectomy (PD) is the curative surgical option for periampullary tumors. Minimally invasive pancreaticoduodenectomy (MIPD) is gaining popularity as the open PD has considerable morbidity and mortality. MIPD was first described in 1994 by Gagner and Pomp. Since then the literature is flourishing with case reports and systematic reviews and are rapidly increasing in recent past. The first Sri Lankan report of laparoscopic pancreatico-duodenectomy with all anastomosis done by mini-laparotomy is in 2015. The patient presented in this report underwent pancreaticoduodenectomy and the hepatico-jejunostomy laparoscopically followed by mini-laparotomy for the other two anastomoses.

Use of Thoracoscopic Splanchnicectomy for the Relief of Chronic Pancreatic Pain: a Case Series

Chronic pancreatitis may cause disabling pain not responding to oral analgesics and/or drainage procedures. Although pancreatectomy is a definitive treatment, it carries a significant morbidity and mortality. Celiac plexus ablation is beneficial, although it is a temporary method for pain relief. While bilateral splanchnicectomy provides a more permanent pain relief, it is a difficult procedure requiring thoracotomy and results in significant morbidity. Thoracoscopy is an attractive alternative to perform splanchnicectomy. The results of a case series on video assisted thoracoscopic sympathectomies performed at the university surgical unit, Peradeniya, Sri Lanka from January 2011 to June 2013 was analyzed to evaluate the surgical technique and to quantify the efficacy of pain relief. Operating time, blood loss, intraoperative complications, conversion to open surgery, pre-operative and post-operative pain assessment using visual analogue scale score (VAS) were recorded. Seven patients who underwent video assisted thoracoscopic splachnicectomy were analyzed. All had an acceptable operating time (6omin), no measurable blood loss, no conversions to open surgery, no intercostal drainage, early mobilization and feeding. All had an average VAS of 8-10 pre-operatively. This reduced to a VAS of 1 or no pain in all, on post-operative day one, at one and six months. The few who experienced mild pain needed occasional use of paracetamol or diclofenac sodium. Non required narcotic analgesics. Bilateral thoracoscopic splanchnicectomy is a safe, effective and more attractive alternative as it carries a minimum morbidity, mortality and provides an excellent relief of chronic agonizing pancreatic pain.