Practical application of using local anaesthetics: surgical perspectives.

With reduction in surgical training, surgical trainees may find it difficult deal with local anaesthetic agents because of lack of exposure and knowledge. We have summarised the common usage of local anaesthetics in various situation. The trainees need to gain competence by understanding the basics and practising them under supervision.

Simple technique of selecting the correct feeding gastrostomy button.

Feeding gastrostomy is often performed in children with neurological conditions e.g. cerebral palsy or cystic fibrosis. A feeding button is often used to replace the gastrostomy tube for convenience. The button often leaks and the correct size and length is difficult to choose. The authors describe an easy and perfect way of choosing the correct size and length button by using Foley catheters.

Laparoscopic retroperitoneal/mesenteric lymph node sampling: a safe and effective technique.

INTRODUCTION: Needle aspiration and core biopsies are commonly used to assess retroperitoneal lymph nodes. However, the tissue obtained by this method is insufficient to define and type the tumour. This article demonstrates the feasibility and safety of the laparoscopic approach in obtaining an adequate volume of lymph node tissue for typing. METHODS: Laparoscopic retroperitoneal lymph node biopsy was performed on 12 patients over a period of five years. A pneumoperitoneum was induced with a Veress needle, and an initial 10-mm trocar was inserted in the sub-umbilical region in order to carry a 30-degree telescope. Two or more 5-mm ports were inserted into the targeted areas under laparoscopic guidance to achieve optimal triangulation in order to access the nodal tissue. RESULTS: The procedure was successful in 11 out of the 12 patients. An average volume of 1.7 cm3 of tissue was harvested for each patient. In one patient with preoperatively undiagnosed portal hypertension, laparoscopy was converted to an open procedure due to bleeding. In all patients, the histology was adequate and contributed to the diagnosis, allowing rapid institution of treatment. The diagnosis was reactive lymphadenopathy in three patients and sarcoidosis in one patient. Seven others suffered from various conditions, including lymphoma, leukaemia, secondary from unknown origin and Castleman's disease. CONCLUSION: Laparoscopy allows access to perihepatic and perisplenic areas, and is a procedure of choice when needle biopsy is not possible or fails to provide an adequate sample.

Perineal pilonidal sinus after an antero-posterior resection of rectum: case report.

INTRODUCTION: Pilonidal sinus is common in sacroiliac region and occasionally occurs in the interdigital web space. METHOD: We describe an unusual case of an acquired implantation pilonidal sinus involving the perineal wound which occurred after an anteroposterior resection of the rectum. RESULT/DISCUSSION: This patient was successfully treated by excision of the sinuses. Recognition and treatment of this condition may cure the patient with a persistent post operative perineal sinus.

Outcome of laparoscopy-assisted feeding tube insertion in elderly stroke victims.

BACKGROUND: When percutaneous endoscopic gastrostomy (PEG) is not possible, or fails, the patient is referred for laparoscopic gastrostomy or jejunostomy (LAG/J). METHOD: During 2005-2008, we performed laparoscopy-assisted feeding tube insertion on 15 patients. We assessed the outcome in terms of leaks, infection, longevity etc. The patients were followed-up for up to 12 months. RESULTS: The procedure was successful in 14/15 patients. However, thirteen died within little more than a year, of whom seven suffered from pneumonia or aspiration. DISCUSSION: Our study confirms that LAG/J is technically possible, carries a high morbidity, is a last ditch attempt and that it does not change the general prognosis of these debilitated patients.

Duodenal ulcer perforation: a district hospital experience.

BACKGROUND: Duodenal ulcer perforation still occurs frequently in the 21st century inspite of the wide availability of proton pump inhibitors. METHOD: During 2005-2008, 34 patients underwent treatment of duodenal ulcer perforation at the University Hospital Lewisham, London. Laparoscopic or open repair of the perforation was used. In this study, we analysed the outcome of treatment in terms of complications, mortality and hospital stay with relevant to laparoscopy and open approach. RESULTS: Ten patients underwent laparoscopic closure and the remaining 24 patients underwent laparotomy. The mean hospital stay for the laparoscopic group was 6.6 days and for open repair group was 12.8 days. There were two wound infection related to open approach and four patients died during the post operative period however the cause of death was not related to the procedure. DISCUSSION: Laparoscopy has the advantage of avoiding a big incision and will enable the patient to get discharged home early. However, the only limiting factor is availability of expertise and competency of the surgeon.

Novel combination combining J-Vac and VAC sponge for draining a rectal wound.

Active drains, which work by negative pressure, require a closed space for retaining the vacuum. Here the authors describe their novel technique of combining a J-Vac drain and the sponge of a vacuum assisted closure dressing pack to drain a rectal wound. This modification may be useful for rectal wounds and anastomotic leaks.

Role of angio-embolisation in trauma--review.

BACKGROUND: Exsanguination from solid organs and from the venous system is one of the commonest causes of mortality in trauma. This review focuses on the role of angioembolisation in trauma. METHOD: A review of the literature was undertaken in PubMed and Embase databases using the key words 'angioembolisation', 'splenic injuries', liver injuries 'pelvic injuries' and 'trauma'. RESULTS: When angioembolisation (AE) is successful, patients with liver and splenic injuries can be managed nonoperatively. AE can also be used as an adjunct to damage control surgery in polytrauma patients with pelvic fractures. Patients with vertebral artery injuries in the neck leading to hypotension are also good candidates for AE. CONCLUSION: AE is very useful in managing patients with isolated spleen and liver injuries non-operatively. It can be used alone or as an adjunct to damage-control surgery in complex polytraumas and may decrease the blood loss in pelvic injuries. Whenever a trauma patient with splenic injury is treated non-operatively, subsequent splenic artery pseudoaneurysm should not be forgotten and the patient should be followed up with caution.

Catheter administered deep intestinal enema--case series.

Enemas are often used in a variety of surgical conditions. We describe the outcome of deep intestinal enema administered either through a flatus tube or a Foley catheter. Deep enemas are useful in constipation, pseudo intestinal obstruction, ileus and colonic volvulus either as an adjunct or an alternative to other procedures such as endoscopic decompression.

Bridge vacuum-assisted closure: a novel technique of using a single vacuum machine for multiple adjacent wounds.

AIMS: To describe a simple method of applying the VAC dressing to multiple wounds. METHODS: Applying a VAC dressing using a sponge bridge to allow the simultaneous treatment of multiple wounds. RESULTS: Successful healing was achieved using this simple method. CONCLUSION: The use of a simple sponge bridge allowed the simultaneous treatment of two adjacent wounds.