An Observational Study on Causes of Conversion on the Basis of Intra-Operative Findings in Patients Scheduled For Elective Laparoscopic Cholecystectomy

Since the discovery of laparoscopic cholecystectomy, it has become the gold standard treatment for gall bladder pathology, especially cholelithiasis. Various complications can lead to open conversion and in our study we aim to study the various factors that can lead to open conversion. Aims & Objectives: 1. To identify the intra operative findings of difficult laparoscopic cholecystectomy which leads to conversion to open procedure. 2. To contribute experience to the existing data in the literature concerning several important aspect of laparoscopic cholecystectomy. Methods: Patients were recruited as per inclusion and exclusion criterion. The intra-operative findings for those patients undergoing open conversion were documented. Documentation of ultrasonographical (USG) findings i.e., gall bladder wall thickness, contracted / distended gall bladder, stone at the neck of gall bladder, pericholecystic collection etc. Results: In our study, 52 patients required open conversion leading to a conversion rate of 7.5 % which is found comparable with literature on similar studies. Conclusion: Surgeon experience, better patient selection etc. can lead to lower rate of conversion of laparoscopic cholecystectomy to open procedure.

A Novel Technique for Protection of Facial Nerve during Parotidectomy

Identification and protection of Facial Nerve is of prime importance during surgery of parotid glands. Several techniques are available in literature to identify and preserve FN. We present here a case series with dissection of FN in a novel technique during parotidectomy which has significantly lowered the morbidity due to injury of the FN. Methods: All data, from all the patients who underwent Parotidectomy in our unit (conducted or supervised by a single surgeon) in the Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, between March 2014 to March 2019, using our novel technique for identification and protection of FN, was retrospectively analysed. Outcome measurement was expressed in terms of type of surgery, duration, estimated blood loss, any intra-operative or post-operative complications, length of hospital stay, duration of drain in place, Histopathological (HPE) reports, size of the tumour, margin and lymph node status, Facial Nerve weakness and other complications. Results: Total 13 patients underwent Parotidectomy (Total or Superficial) following our technique of identifying and protecting Facial Nerve (FN). Four of them had temporary FN paresis in immediate post-op period. None of the patients had FN paresis on follow-up at 1 year. Conclusion: The novel technique described in our study for identification and protection of FN is a promising technique for Parotid Surgery.

Role of Biochemical Parameters and GFR as Prognostification Factors in PUV Patients

Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in the male child with broad spectrum of clinical presentation, disease severity and associated sequelae. Methods: Baseline investigations included pre fulguration blood renal profile, radiological (DTPA) investigation followed by post fulguration blood renal profile and radiological investigation. The outcome has been studied by the analysis of the biochemical markers & GFR & statistical tests shall be applied where ever necessary Improvement in quality of life in terms of dribbling, enuresis, pant wetting, school dropouts, growth & development. Results: The mean urea, Hb and creatinine level at different interval was non- significant (P> 0.05). The most common case of USG was B/l HDN (5) and B/L hydronephrosis (5). Conclusion: Aggressive surgical treatment is better policy to treat the patients with PUV. Urine cultures should be done in the follow up of PUV patients to prevent the recurrent UTI as it adversely effects the kidneys.

A Prospective Study to Assess the Role of Diagnostic Laparoscopy and Special Emphasis on Staging in Patients with Intraabdominal Malignancy

Aim of this study is to use staging laparoscopy to accurately define the extent of disease, direct appropriate therapy and avoid unnecessary intervention. Routine laparoscopy before laparotomy, especially in cancers which have equivocal operability helps to avoid unnecessary laparotomies. Methods: Patients with intra abdominal malignancies (carcinoma of gall bladder, stomach, and colon) who have operable disease on preoperative imaging will be taken for diagnostic laparoscopy and the findings will be corroborated with the findings in laparoscopy. Laparoscopy will include assessment of distant metastasis (liver/peritoneum/omentum), resectability of the disease, and biopsy from lesions of uncertain diagnosis. Results: Out of 35 patients taken in this study, 29 patients were operable on radiology and 6 patients had uncertain operability. Out of these 29 patients, only 15 patients were found to be resectable on diagnostic laparoscopy and underwent definitive resection. Out of the rest 14 patients, 7 had isolated peritoneal metastasis, 3 had only liver metastasis (single or multiple) and 4 had both liver and peritoneal metastasis which was confirmed on frozen section and histopathological examination. Conclusion: Diagnostic laparoscopy can reduce the number of unnecessary laparotomies that seem resectable on radiology but are found to be irresectable on laparoscopy. It can aid in diagnosis of uncertain malignancies in which image guided biopsy is not recommended in operable disease on radiology (e.g. gall bladder malignancy). It also helps to prove metastatic disease by taking biopsy from peritoneal nodules, or liver nodules along with avoiding a morbid unnecessary laparotomy.

Acquired tracheo-oesophageal fistula: a case report.

This is a case report of a girl aged 4 years who presented with repeated attacks of chocking and dysphagia. She was diagnosed to be having an acquired tracheo- oesophageal fistula caused by fish bone impaction. She was treated successfully. In this report, the literature was reviewed of this rare condition.

Incidence of associated congenital anomalies in anorectal malformations.

The study was undertaken to review the incidence and types of associated congenital urogenital anomalies in patients with anorectal malformations (ARM) and compare the results with previously published world literature. Retrospective review was done of 220 cases of ARM, treated during May 2002 to April 2003. All patients routinely underwent ultrasound study of the KUB region and pelvis and lumbosacral radiography. Voiding cystourethrography, nuclear renography and other investigations like buccal smear and karyotyping were done in selected cases only. Genital anomalies were found in 30 cases (13.63%) and urologic anomalies in 25 cases (11.36%), a direct correlation being found between the level of ARM and the incidence of urogenital anomalies. The high incidence of associated anomalies (24.54%) makes careful clinical examination and evaluation of the urinary tract during the neonatal or early infantile period mandatory in all cases of ARM, particularly to avoid deterioration of renal function in future.