Experience of surgical management of rare cases of choledochal cyst in last five years-tertiary care reflection.

Choledochal Cyst (CC), also known as the biliary cyst, is one of the rare inherited anomalies of intrahepatic and/or extrahepatic biliary system characterised by varying degrees of cystic dilatation of the biliary tract without acute obstruction. The prevalence ranges from 1 in 13,000 people to 1 in 2 million people with preponderance in Asia1, particularly in Japan. Moreover, the presentation also varies in children and adults, and is usually vaguer and non-specific in adults. The prevalence is even lower in males, with female to male ratio being 3:1-4:12. We present here three cases of adult choledochal cysts excised in our surgical unit in the last five years. We discuss the aetiopathogenesis, presentation, diagnosis, surgical treatment, and complications of choledochal cysts based on the available literature. It is crucial to establish a multidisciplinary group of professionals, that comprises paediatric surgeons, pathologists, paediatric gastroenterologists, physiotherapists, nutritionists, oncologists, and radiologists, to get acceptable outcomes in diagnosing and treating children with choledochal cysts.

An Experience Of Percutaneous Peritoneal Drainage In High-Risk Perforated Peritonitis In General Surgical Ward Of Tertiary Care Hospital Lahore, Pakistan.

BACKGROUND: Although conservative treatment has shown a good reduction in mortality and morbidity the majority of patients still need definitive surgery to get rid of the disease completely. It is of note that immediate laparotomy in high-risk patients who have a prolonged history or have multiple comorbidities or in organ failure is not advisable as it is associated with higher morbidity and mortality, besides improved postoperative intensive care. METHODS: We categorized these high-risk patients based on their comorbidities and then performed percutaneous peritoneal lavage to reduce the septic load from the peritoneal cavity before performing the definite procedure. RESULTS: Out of the high-risk patients who survived after the PPD and underwent definitive surgery, 61% survived (n=8/13) while the rest of these, 38.5% expired (n=5). CONCLUSION: Percutaneous peritoneal drainage initially instituted in high-risk patients to optimize their pre-op condition significantly, improves the outcome and has better results than to operate on such patients straightaway.

A ruptured seventeen weeks' ectopic pregnancy: A case report.

Ectopic pregnancy is a common condition with a prevalence of 2% in all pregnancies. Implantation of the developing blastocyst outside the uterine cavity leads to ectopic pregnancy. About 95% of ectopic pregnancies occur in the different segments of the fallopian tubes. Usually, an ectopic pregnancy grows up to 1.5-3.5 cm and any size greater than this leads to rupture. We present a case of ruptured ectopic pregnancy in which the foetus had a crown-rump length(CRL) of 12 cm was retrieved. To our knowledge, this is the largest foetus recovered from a ruptured ectopic pregnancy at the ampulla of fallopian tube reported in the literature. Timely diagnosis and proper management is the key to reduce morbidity associated with it.

Past, present, and future of surgical simulation and perspective of a developing country: A narrative review.

Healthcare systems around the globe have been revolutionised in the last few decades, resulting in a greater need and demand for surgical education outside the operation theatres. Surgical education through simulations started around 2,500 years ago when they were first used in the planning of unique and innovative surgeries while ensuring the safety of the subjects. Currently, simulations include animal models, cadaveric models, benchtop models and complex robotic models. In a programme involving surgical simulators, four requirements are followed to optimise their effectiveness, including mandatory involvement, skill-based instruction, standardised training plan, and overtraining. We can make a reasonable estimation that the future is technology-based. The speed with which we anticipate the fusion of these virtual reality and robotics-based simulation technology with medical educations and practices largely depends on the affordability and economics of these tools. The current narrative review was planned to highlight the historical aspects of simulations, their role in surgical education, and their importance in the future as an essential adjunct to surgical education.

Surgical smoke; an occupational hazard.

Surgical smoke is part of the environment during operative and invasive procedures. Electric diathermy is a very important tool for a surgeon and is used in every surgical treatment nowadays. It assists the surgeon to dissect the tissue or enables securing haemostasis in lesser time and with larger delicacy. But at the same time, it has harmful effects on surgeon as well as patients. Although there is a substantial amount of evidence and guidelines from various authors and societies, yet there are no clear policies and preventive measures towards surgical smoke handling. This article presents potential harmful effects of surgical smoke and aims to build guidelines for the surgical personnel based on current evidence in literature.

Transmigration of an intrauterine device into sigmoid colon-surgical management: A case report.

We present the case of a 30 years old woman who had an Interauterine Device placed in a fragile uterus (puerperal period) 5 years ago and presented with dull abdominal pain and disturbed bowel habits. Failure to pull out IUD strings on gynecological examination made us suspicious of translocated IUD and its ectopic placement in sigmoid colon was confirmed on colonoscopy and a CT abdomen with contrast. The transmigrated IUD was removed following laparotomy.