Laparoscopic Management of Colonic Diverticular Disease and its Complications: an Analysis.

Dense inflammatory reactions, loss of tissue planes and sepsis make surgical treatment of diverticulitis complex and difficult. Experience with laparoscopic management of this disease is scanty in our country. This study aims to assess the pattern of presentation, the site of involvement and complications of diverticulitis coli. This study also aims to audit the results of laparoscopic approach for complicated colonic diverticulitis. A retrospective analysis of all patients who had laparoscopic management of complicated diverticulitis patients from August 2007 to October 2014 was done from the database. The site of involvement, extent and presence or absence of complications of diverticular disease was noted. The surgical approach, intraoperative parameters and short-term outcome measures were analysed. There were 38 (8.8 %) patients with diverticular disease out of 427 patients who had laparoscopic colorectal surgery in the study period with a median age of 59 years. Out of 38 patients, 50 % had comorbid conditions. Internal fistulae were seen in 9 (23.6 %) patients, 6 with colovesical and 3 with colovaginal fistulae. Elective laparoscopic colectomy with primary anastomosis was done in 34 (89 %) cases of which, and 10 (26 %) patients had abscess on presentation requiring drainage. Four patients required emergency laparoscopic surgery of which primary resection and anastomosis was done in 3 (7.8 %), and Hartmann's operation was done in 1 (2.6 %) patient. Two patients required stoma. The morbidity was seen in 15 % cases, and the mean hospital stay was 9.54 days. Laparoscopic approach for diverticular disease and its complication is feasible and safe. Careful selection of patients, judicious use of diverting stoma and appropriate selection of the procedure help to achieve good results even in those with septic complications and fistulising disease.

A Precise Method of Measuring Simultaneous Intrusion and Uprighting of Mandibular Molar Using Denta Scan - A Case Report.

A commonly encountered problem in prosthetic dentistry is the supra eruption of teeth due to absence of opposing teeth. Consequently, replacement of the missing teeth with prosthesis becomes difficult due to lack of vertical dimension of the edentulous area. This article describes the space regaining procedure in a 14-year-old female patient who wanted a fixed prosthesis for her missing maxillary 1st molar. On examination, it was observed that mandibular 1st molar had supraerupted and tipped lingually. After considering the various treatment modalities it was decided to simultaneously intrude and upright the mandibular molar using a mini-implant. The precise measurements of intrusion and uprighting were done using Dentascan software. Intrusion of 1.8mm and buccolingual uprighting of 2.3mm was achieved in 45 days. The mini-implant is an efficient non-compliance device to intrude and upright the tooth simultaneously. Dentascan is an accurate and very precise method of measuring the intrusion and uprighting of teeth.

A Unique Bonding Technique for Immediate Orthognathic Surgery.

INTRODUCTION: A challenge in orthodontics is achieving ideal bracket position which determines treatment results and finishing. A new bonding method is done indirectly on the cast and bonded directly on the teeth, but it does not require conventional trays to carry the brackets to the teeth. MATERIALS AND METHODS: Heavy sized archwires like 0.019″x0.025″ or 0.018″ SS are bent to the malocclusion to generate a template which comprises of an Bracket -Archwire Assembly (BAA). This assembly is transferred onto the teeth using the molar bands with tubes which serves as a jig for proper orientation of the BAA, then the adhesive is cured at one shot to complete the bonding procedure. RESULTS: Two surgical cases successfully bonded with this technique is presented in this article. CONCLUSION: This bonding method finds specific advantages in surgical orthodontics - when the surgeon decides on a surgery-first treatment objective, management of single or a couple of periodontally extruded teeth, management of impacted teeth and in patients needing fixed functional appliance immediately before the completion of growth spurt.

Octreotide Does Not Prevent Pancreatic Fistula Following Pancreatoduodenectomy in Patients with Soft Pancreas and Non-dilated Duct: A Prospective Randomized Controlled Trial.

BACKGROUND: Whether octreotide prevents pancreatic fistula following pancreatoduodenectomy is controversial and it is believed to be beneficial in soft glands and normal-sized ducts. The aim of this study is to assess the potential value of octreotide in reducing the incidence of pancreatic fistula, postoperative complications, morbidity and hospital stay in patients with soft pancreas and non-dilated ducts. METHODS: A total of 109 patients undergoing elective pancreatoduodenectomy with soft pancreas and non-dilated duct were randomized to octreotide group versus no octreotide-the control group. Surgical steps were standardized and incidences of pancreatic fistula, complications, death and hospital stay were assessed. RESULTS: There were 55 patients in octreotide group and 54 in the control group. Demographic features and pancreatic duct diameter of the groups were comparable. The rates of clinically significant pancreatic fistulae (grades B and C) were 10.9 and 18.5 % (p = ns), and morbidity was 18 and 29.6 % (p = ns), respectively. Patients who received octreotide resumed oral diet early and had a shorter hospital stay. CONCLUSION: This study demonstrated no statistical difference in pancreatic fistulae with the use of octreotide, though there was a trend towards fewer incidences of pancreatic fistulae, morbidity and shorter hospital stay. ClinicalTrials.gov Identifier: NCT01301222.

Laparoscopy in suspected abdominal tuberculosis is useful as an early diagnostic method.

BACKGROUND: Establishing a histological diagnosis in abdominal tuberculosis can be difficult, frequently delaying treatment. The aim of the study was to evaluate the role of laparoscopy for ascertaining the diagnosis in suspected abdominal tuberculosis. METHODS: A retrospective review was undertaken of patients who underwent diagnostic laparoscopy for suspected abdominal tuberculosis over a 6-year period, analysing its usefulness in establishing a histological diagnosis. RESULTS: From May 1999 to April 2005, 131 patients underwent diagnostic laparoscopies in our institution, of which 41 patients had unknown aetiologies for ascites or abdominal pain. This subset of patients had been investigated for suspected abdominal tuberculosis with biochemical tests of serum and ascitic fluid; ultrasound and computed tomography scanning, upper and lower gastrointestinal endoscopies and contrast series, before being considered for diagnostic laparoscopy. None had manifest extra-abdominal tuberculosis. At laparoscopy, 39 of these patients (95%) had peritoneal nodules. Frozen-section biopsy from the peritoneal nodules established the diagnosis of tuberculosis in 33 patients (80%) whereas metastatic adenocarcinoma was reported in 6 (14%). Permanent sections confirmed the diagnosis of tuberculosis in all 33 patients. Only 2 (5%) patients had no findings on laparoscopy; nevertheless, on continuing follow up, no sinister diagnoses were made for these patients. CONCLUSION: In patients suspected to have abdominal tuberculosis without evidence of extra-abdominal disease, early laparoscopy may be useful to establish a histological diagnosis with acceptably low morbidity (8%). Frozen section is useful to assess adequacy of biopsy and sampling. An extensive work-up may hence be averted by a timely laparoscopy and early treatment can be instituted.

A rare complication of appendicitis: appendiculorenal sinus with renal cellulitis.

This report describes a rare complication of appendicitis, renal cellulitis, which led to a diagnostic dilemma in a 2-year-old girl who presented with fever of long duration.