ABSTRACT
Background: Laparoscopic cholecystectomy is a commonly performed procedure in general surgical practise, which can sometimes be tedious and can have high morbidity. Ultrasound abdomen is a routinely performed radiological investigation for every case of cholecystectomy. This study intends to find correlation between the ultrasound findings and the perceived difficulty during surgery.Methods: This is a prospective study of 100 patients who underwent cholecystectomy after a preoperative ultrasound. Difficult cholecystectomies were defined and sonographic findings and intraoperative difficulties recorded and tabulated.Results: Fifty one cholecystectomies were classified as difficult cholecystectomy (20 converted to open procedure and 31 took more than 90 min to complete laparoscopically). The commonest ultrasound finding that was encountered was multiple calculi (62%) followed by gallbladder (GB) wall thickness of >4 mm (33%), stone size >1 cm (22%), contracted GB (17%), intrahepatic biliary radicals (IHBR) dilatation (15%) and the least common finding was empyema of the gallbladder seen in 7% of the cases.Conclusions: This study is a reflection of surgeries performed by a single team over 3 years which included 100 cases. It was started with an idea to identify the findings on a preoperative ultrasound that predicted a difficult cholecystectomy (laparoscopic or open). In our experience we found that empyema GB, pericholecystic fluid, IHBR dilatation and wall thickness of GB are excellent predictors of a difficult cholecystectomy.
ABSTRACT
Background: Oesophageal cancer is a common gastrointestinal malignancy in our country and transhiatal oesopahgectomy is popular choice of surgery for lower oesophageal cancers. This study aims at identifying the feasibility and effectiveness of this surgery in our setting.Methods: This prospective study was performed in Department of Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India. It included a total of 10 cases operated during the study period. Various pre-operative, intra-operative and post-operative parameters were observed and results tabulated.Results: In our study dysphagia (90%) was the most common presenting complaint and tobacco, either smoked (40%) or chewed (40%) formed a common risk factor. Lower oesophageal growths (80%) were more common than mid oesophageal (20%). The preferred incision was midline (80%) and average duration of surgery was 351min and average blood loss was estimated to be 521 ml. There was one mortality and a R0 resection in 90% of the cases with 10% positive for local lymphnodal malignant spread.Conclusions: Our statistics are not very different to the studies compared, and we believe they will only improve. We propose transhiatal oesophagectomy to be a practical and affective tool in a surgeon’s armamentarium, which certainly can be a formidable treatment modality in sub-carinal oesophageal cancer.
ABSTRACT
Enterocutaneous fistulas are potentially life-threatening complications of gastrointestinal surgery. Nutritional support is the mainstay of management. We report a 32-year-old man who developed an enterocutaneous fistula following surgery for ulcerative colitis. Enteral feeding was attempted by introducing a Foley's catheter through the midjejunal fistula.