A Profile of Fundus First Laparoscopic Cholecystectomy.

Fundus first laparoscopic cholecystectomy is becoming an option with experienced laparoscopic surgeons to deal with difficult anatomy at Calot's triangle and thereby reducing the conversion rate and rate of complications. Fundus first laparoscopic cholecystectomy was done in 40 patients between three year. There were 26 female & 14 male patients with mean age of 36 years (range 29-64). Reasons for opting for fundus first method were: dense adhesions at Calot's trianglein 26 patients, stones in Hartmann's pouch with short cystic duct 8 , small contracted gall bladder in 4 and Mirizzi's syndrome in 2 patients. Mean operating time was 96 minutes (range 80-135 mts). 3 Patients were converted to open cholecystectomy because of obscure anatomy, intraoperative hemorrhage and CBD injury. The Patient with CBD injury was managed by hepaticojejunostomy. 5 Patients developed postoperative biliary fistula and one Patient had prolonged ileus. Out of the 5 Patients 2 were managed with percutaneous drainage and the biliary leak stopped and 3 Patients required ERCP and stenting. The Patient with ileus was managed conservatively and was discharged on the 6th day. The average hospital stay was 4 days. Fundus first laparoscopic cholecystectomy offers the surgeon the same safety and versatility during laparoscopic cholecystectomy that it confers during open cholecystectomy. It is a viable and a safe option in the hands of an experienced laparoscopic surgeon and it helps in reducing the conversion rate and may also decrease the risk of injury to biliary system.

Enterocutaneous Fistula of the Scrotum.

Inguino-scrotal hernia is a very common surgical entity. Though much common in pediatric population, yet no age is exempted. Enterocutaneous fistula in an inguino-scrotal hernia is a very rare surgical entity in both developing as well as developed countries. Comparatively commoner in pediatric age group but no age is exempt, the information gathered from few cases available in the surgical literature. About 08 cases in pediatric age group and 06 cases in adult population are available in the literature that could be revealed from Pubmed/Medline as well as medical library shelf search. We report here two rare cases of scrotal enterocutaneous fistula in an adult in inguinoscrotal hernia.

Post ERCP Surgical Emphysema.

Endoscopic Retrograde Cholangio Pancreatography(ERCP) is increasing in popularity due to its obvious advantages. Therefore, as treating physicians and surgeons, we ought to be aware of not only its common but also uncommon complications. We report here a case of post-ERCP surgical emphysema on the right side extending from the umbilicus to the face.