Introduction: Contraindication to laparoscopic surgery is decreasing with time, expertise and innovation. One such uncommon condition is cholecystoduodenal fistula (CDF), now increasingly managed with laparoscopic technique. We are reporting eight such incidentally diagnosed cases during laparoscopic operation, which were successfully and cost-effectively managed with traditional laparoscopic instruments.Materials and Methods: During March 2008 to March 2017, 1500 patient underwent laparoscopic cholecystectomy for benign gall bladder condition or their complications, eight of these having chronic dyspeptic symptoms of gallstone, were found to have cholecystoduodenal fistula, intraoperatively. All cases were managed laparoscopically using common laparoscopic instruments without any special gadgets and extra costs. Medical records of eight cases were reviewed for age, sex, operative technique, intra and post-operative complications and length of stay in hospital.Results: Five patients were male and three were female with a mean age of 63 years. All of them had gall stones at abdominal ultrasound and cholecystoduodenal fistula were found intraoperatively. Fistula tract was dissected, cleaned and sealed with combination of intracorporeal simple transfixation ligation and interrupted stitches to invert the stump within the duodenal wall in transverse fashion. All eight had uneventful postoperative course with hospital stay of 4-7 (mean 5) days.Conclusion: In expert hands cholecystoduodenal fistula can successfully and safely be managed laparoscopically using common instruments and logistics with slight modification of open technique without extra cost.Bangladesh Crit Care J September 2017; 5(2): 110-112
Background : Full thickness rectal prolapse are treated by multiple procedures through perineal and abdominal approach. Consensus is lacking as to the best option. Each procedure is associated with significant recurrence rate.Objective : The aim of this study is to report the effectiveness, complications following laparoscopic ventral mesh rectopexy in patients with full thickness rectal prolapse.Methods : The study is a retrospective evaluation of 6 consecutive patients by a single attending surgeon in a general and laparoscopic surgery unit,between July 2014 to June 2016. Peritoneum was incised at the pouch of Douglas or rectovesical pouch, space created between the rectum and the vagina or urinary bladder, polypropylene mesh was fixed to the rectum with non-absorbable suture and to the promontory of the sacrum with same suture instead of staples. In females, the mesh was also fixed anteriorly with posterior fornix of vagina. The peritoneum was suture closed over the mesh. Patients were reviewed at 1 and 6 months, then annually to assess recurrence, morbidity and mortality.Result : There was no recurrence or mortality among four female and two male patients. Morbidity consistedof chronic deep perineal pain in one youngmale patient who was treated conservatively with oral analgesic.Conclusion : LVMR seems to emerge as a safe and effective procedure to treat full thickness rectal prolapse, but large series and long term results are needed and we are continuing the study for the same.Bangladesh Crit Care J September 2018; 6(2): 71-73
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