The branchial arches are the embryological precursors of the face, neck and pharynx. Second most common congenital lesions of the head and neck in children are the anomalies of the branchial arches, with second arch anomalies by far the most common. Clinically, these congenital anomalies may present as cysts, sinus tracts, fistulae or cartilaginous remnants with typical clinical and radiological findings. We report the case of 11-month-old male child with congenital Type I Second branchial fistula on the left side of neck.
Background: With the establishment of laparoscopic cholecystectomy as gold standard for management of cholelithiasis, the current stress is on increasing patient safety. Hence, this study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10mm Hg) versus high pressure pneumoperitoneum (HPP >14mm Hg) in a prospective randomized manner on intraoperative safety, assessing the working space and safety by seeing contact of parietal peritoneum to underlying viscera during secondary port insertion.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14mm Hg) group (n=60) prospectively. Available working space assessed directly, safety by contact of parietal peritoneum to underlying viscera during secondary port insertion and operative difficulty assessed by visualization, dissection and grasping, total duration of surgery; intra-operative gas consumption, and bile spillage were assessed.Results: There was no significant difference in terms of available working space, operative duration, consumption of carbon dioxide, surgeon’s operative difficulty and intraoperative bile spillage. Out of 180 secondary ports inserted, there was evident contact of 20 (11.1%) secondary ports in high pressure groups and 14 (7.7%) secondary ports in low pressure group, which is suggestive of adequate exposure and working space available for surgery at both pressures.Conclusions: Low-pressure cholecystectomy did not compromise intraoperative safety and should be the standard of care in day care surgery.
Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10 mm Hg) versus high pressure pneumoperitoneum (HPP > 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p<0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.
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