Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% women. It can occur in the absence of visible pelvic disease. Most common sites are gastrointestinal and urinary tract. Common sites of involvement are rectosigmoid (51%), appendix (15%), small bowel (14%), rectum (14%), cecum and colon (5%). Cyclical hematochezia is a definitive, but rare association of intestinal endometriosis. The diagnosis of colonic endometriosis is also difficult owing to the poor diagnostic yield of colonoscopy.
Inguinal herniae are the most common herniae encountered in the Surgical OPD or even the emergency setting. The indirect variety has a higher rate of bowel obstruction due to the constriction of the sac at the superficial ring. Direct herniae, owing to the larger defect, are relatively safe from complications. Busoga hernia (1) is a rare subtype, which is prone to strangulation of contents, owing to the extremely narrow neck under continual tension within a tough fascial sling.
Background: Cholecystectomy is the most common major abdominal surgery of the biliary tract and the second most common abdominal surgery performed in recent times. Today, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Ultrasound is a non-invasive, painless investigation that will show stones in the gallbladder with sensitivity and specificity of more than 90%. The study aims at evaluating the accuracy of certain ultrasound parameters to predict a difficult laparoscopic cholecystectomy. Methods: Prospective observational study. The selected patients were explained about the procedures of ultrasonography and laparoscopic cholecystectomy, and about the advantages and disadvantages of laparoscopic cholecystectomy, along with the possibility of conversion to open procedure. Informed consent was taken. General particulars of patients, relevant history & findings on physical examination, laboratory investigations, ultrasonographic features and operative findings were noted in the study proforma. For data analysis, categorical variables were expressed as frequencies and percentages. Sensitivity, specificity and p values were calculated. P value<0.05 was considered to be statistically significant.Results: Significant association was found between all the independent ultrasound parameters and a difficult laparoscopic cholecystectomy. Presence of contracted gall bladder was found to be significantly associated with conversion to open cholecystectomy.Conclusions: It was found that ultrasonography can be a useful tool in predicting a difficult laparoscopic cholecystectomy.
Weight-loss surgery is usually recommended to those who walk into our specialist bariatric outpatient department, and intense and often exhaustive counseling, along with a thorough preoperative workup, is undertaken prior to the surgery. All this often fails in the emergent scenario, where the focus shifts to a damage-control mode, and the possibility of a metabolic procedure in this setting, especially one as challenging as gastric bypass, is seldom actively pursued. We discuss two patients presenting to the emergency department with different surgical ailments, but also being obese, with comorbidities, finally undergoing the primary surgeries along with Roux-N-Y gastric bypass, via conventional and laparoscopic methods respectively, with positive immediate outcomes and favorable 1-year excess-body-weight-loss as well. This shows that if patient selection is wise, and adequate expertise is available, gastric bypass can be offered in the emergent scenario as well, with favorable outcomes.
Introduction. We have come a long way from the era of conventional rectal surgery, with most high-volume centres now practising various degrees of laparoscopy assisted colorectal surgeries, via extracorporeal suturing, ex vivo anastomoses, hand-assisted laparoscopic resection anastomoses to robotic rectal resections. However, the limitation to most such techniques remains the fact that these are not ‘completely’ laparoscopic, with varying degrees of open assistance being required, from mobilization, suturing and anastomoses to specimen extraction via separate abdominal incisions or port-site enlargements. These ‘large’ incisions negate some of the advantages of minimal access surgery and lead to complications at such sites, such as wound breakdown, infections, and incisional herniae. This led to the origin of NOTES (Natural Orifice Translumenal Endoscopic Surgery) and the still fairly new concept of NOSE (Natural Orifice Specimen Extraction).Aim. We aim to describe our application of this new frontier in laparoscopic colorectal surgery, doing away with large scars prone to complications.Materials and methods. We describe a case of completely laparoscopic resection rectopexy and trans-rectal extraction of the specimen, with a modified technique of anvil insertion, enabling the faster creation of a larger anastomosis with probably lower anastomotic morbidity.Results and discussion. The patient underwent a ‘completely’ laparoscopic resection rectopexy and had an uneventful immediate post-operative recovery. She had no delayed post-operative complications or recurrence of the rectal prolapse and remained free of constipation as well, over a follow-up period of 6 months.Conclusion. We conclude that this modification of the surgical technique reduces operative time, allows use of larger circular staplers, theoretically reducing the incidence of anastomotic stricture, and being easily reproducible, can be widely applied for better cosmetic and functional outcome.
Background: The type of wound closure plays a critical role in patients of perforation peritonitis, since many of these patients also have poorly controlled co-morbidities and risk factors for wound dehiscence. Though many studies have evaluated abdominal wound closures in the elective scenario, similar studies in the emergent scenario are rather scarce. Hence, we have dealt with this issue in patients presenting with hollow viscus perforation peritonitis.Methods: This was a prospective randomized case control single-centre study with 120 patients performed at St. Stephen’s Hospital, New Delhi, India between February 2016 and January 2019. These patients were randomized divided into two groups; group A comprising those patients in whom, the abdominal wound was closed with continuous sutures, and group B comprising those in whom it was closed with interrupted sutures. Informed consent was taken from all the patients. A detailed proforma included all parameters. Follow up was conducted at 2, 4, 6 and 12 weeks from the date of surgery. Data analysis was done using S.P.S.S. version 17.Results: The time taken for continuous suture fascial closure was significantly less than the interrupted technique. There were no significant differences in other parameters, immediately or on follow-up.Conclusions: The continuous method of abdominal closure was faster than interrupted suturing on account of the use of only two terminal knots, this difference being statistically significant. The outcomes were comparable to other studies that have dealt with this issue in elective surgeries.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.