We present a patient who was managed surgically for cholecystogastric fistula. The patient was presented with nonspecific symptoms (upper abdominal pain, belching) and, after being investigated, was proceeded for laparoscopic cholecystectomy for gallbladder stones. Unexpectedly, intraoperative, she was found to have cholecystogastric fistula, which was operated with open single-stage approach. We highlight the incidence of these cases, the difficult preoperative clinical presentation and possible diagnostic imaging; explain further about the different surgical approaches to manage these cases and finally review the literature regarding the presentation and the management of bilioenteric fistulas.
Objectives: To evaluate the long-term impact of ilioinguinal neurectomy on the incidence of postoperative neuralgia and paraesthesia following the tension free Lichtenstein`s hernia repair. Study design: Case Descriptive Study. Place and duration of study: DHQ Hospital, Faisalabad (January 2003 - January 2005). Patients and methods: A total of 200 patients having unilateral inguinal hernia were included in the study. After a detailed history, patients were subjected to standard Lichtenstein inguinal hernioplasty. All patients underwent elective ilioinguinal neurectomy at the time of hernioplasty. Postoperative pain and paraesthesia were recorded and categorized on a mild, moderate or severe scale. Patients were followed 1 month, 6month and 1 year postoperatively. Results: The incidence of chronic pain was 9% at 1 month & 6% at 6 months and 1 year postoperatively. None of the patients developed severe persistent pain in inguinal region. The incidence of post operative paraesthesia showed a continuous decli ne. It was 32% at 1 month, 24% at 6 month and 19% at 1 year of follow up. The paraesthesia was never severe or bothersome at the end of the follow up period. Conclusion:Routine ilioinguinal neurectomy significantly reduces the chronic post-hernioplasty inguinal pain. Moreover it is safe to perform & well tolerated by the patients.
To prospectively evaluate the results of modified Karydakis procedure with subcuticular skin closure in presacral pilonidal sinus disease patients. Design: Prospective cohort study. Setting: Armed Forces Hospital Dhahran. Period: Jan.2007 and Jan 2013 were prospectively followed for 2 & ½ yrs. Methodology: 243 patients having pilonidal sinus disease who underwent surgery by modified Karydakis technique with subcuticular skin closure. They were evaluated for age, sex, BMI, duration of symptoms, hospital stay, morbidity, recurrence and cosmetic satisfaction. The patients having acute pilonidal sinus abscess were excluded from the study. Results: Out of 243 patients, 230 were males and 13 females with a mean age and BMI of 24.7, 26.3, 29.4 and 30.8 respectively. The most common symptom was seropurulent discharge from the sacrococcygeal area. 232 (95.5%) patients completed their follow up whereas 11 (4.53%) patients (5 females and 6 males) could not be traced in follow up calls after 3 months. 22/243 patients (9%) had minor wound related complications like minor wound infection, partial wound or skin disruption and seroma formation. There were only 3 (1.23%) recurrences (2 males and 1 female). All patients were fully satisfied with the cosmetic result. Conclusion: Karydakis asymmetrical flap closure using subcuticular skin closure is a simple technique which gives best outcome in terms of morbidity and Cosmesis.
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