Background: The vast majority of common bile duct (CBD) stones was secondary, formed within the gall bladder (GB) and migrates down the cystic duct into CBD or rarely due to primary stones formed in CBD. Intra-operative bile culture prevents development of infectious complications and guide selection of future appropriate antibiotic prophylaxis. Hence, this study focussed on investigation of microbiological profile of routine bile cultures in endo-biliary stenting patients undergoing cholecystectomy.Methods: In this study, 50 patients with CBD stone(s) were undergone endoscopic retrograde cholangio-pancreatography (ERCP) followed by stenting and then cholecystectomy (either laparoscopically or open). GB extraction was done in a sterile bag and after opening sterile bag; bile was collected and sent for microbiological culture and sensitivity for analysis.Results: Most of the cases had cholelithiasis with choledocholithiasis (38.0%) which were significantly higher than other diagnosis (Z=2.51; p<0.05) and there was no significant association found between surgical site infections and bile culture positivity of studied patients (Z=9.61; p<0.0001). Among 35 patients with positive bile cultures, E. coli in 26 patients followed by Klebsiella species in 5 patients were the most prevalent bacteria isolates and over all, colistin (91.4%) and tigecycline (91.4%) were found as sensitive antibiotics. Also, certain strains of multi drug resistance E. coli in 6 patients were resistant to gentamicin/amikacin only sensitive to tigecycline and colistin, which was high.Conclusions: Most prevalent isolates microorganism is gram negative bacteria that were mostly gut bacteria and the incidence of post ERCP infection is high and drug resistance among the causative organism is common.
Background: Laparoscopic repair of duodenal perforation using the omental patch is one of the traditional techniques, which gives better postoperative recovery in patients with little chances of abdominal wound infection. This article is about the technique used for the laparoscopic repair of the duodenal perforation by Grahams patch with a twist in the conventional technique. Methods: In Hanging method of duodenal repair first, an intra-corporeal suture is taken at the upper margin of perforation and both end of the thread is taken out of anterior abdominal wall and duodenum is pulled up. Now under vision the next two parallel sutures are passed, thus avoiding the posterior duodenal wall incorporation. Finally omentum flap is used for the closure of perforation. Conclusions:The laparoscopic closure of the duodenal perforation by "Hanging Method" is an appropriate Laparoscopic technique, as "hanging" the anterior wall of duodenum gives us better vision of the posterior wall of duodenum, while taking the suture through anterior duodenal wall. Further since the gall bladder is retracted there is an easy available working space for intracorporeal suturing.
Sleeve gastrectomy is one of the most commonly performed procedure for treatment of morbid obesity. The surgery evolved from two step procedure of biliopancreatic bypass/duodenal switch. The procedure is safe and associated with symptoms of gastroesophageal reflux, food intolerance and vomiting. These symptoms are attributed to the improper sleeve position and deformity, due to the loss of natural attachments of the stomach. We here by present a case with morbid obesity in which we did sleeve gastrectomy with sleeve fixation. Post operatively patient had benefit from complications which are previously attributed due to sleeve rotation .Our patient was 51 year old male with the history of morbid obesity since 10 years with the BMI of 44.20 . Patient has the history of Smoking, hypertension, Obstructive sleep apnea, Diabetes Mellitus with renal failure. After preoperative workup and anaesthetic check up patient was taken up for surgery and sleeve gastrectomy procedure with sleeve fixation was done. Gastrograffin study done on post op day 1 was normal and Patient was started orally liquids on day 1 and discharged on day 2. On follow up patient was doing fine, lost 36 kg weight in 8 months. There was no problem of gastroesophageal reflux, heart burn, food intolerance and vomiting. Aim -To devise the gastric sleeve fixation for the laparoscopic sleeve gastrectomy. Technique -The gastric tube is fixed along the new greater curvature with the gastrocolic omentum using the PDS 3-0 in continuous fashion. The interrupted suture is used to fix at the lower part of the tube with the transverse mesocolon near the lower edge of pancreas. Conclusion -the gastric fixation stratergy is safe and easy. It can reduce the problems arising from the improper gastric tube position, reducing the incidence of food intolerance and gastroesophageal disease.
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