Chronic pancreatitis (CP) is a chronic inflammation of pancreas that leads to progressive fibrosis of pancreatic parenchyma. Commonest indication of surgery in chronic pancreatitis is intractable pain. Choice of procedure depends upon the main pancreatic duct (MPD) morphology. Decompression is useful in dilated and obstructed ducts. Traditional form of decompression is construction of a pancreatico-jejunal anastomosis (LPJ). Another method to achieve ductal decompression is by a pancreaticogastrostomy (LPG) and this study will try to evaluate its effectiveness against pancreaticojejunostomy. To compare the effectiveness of LPG and LPJ in relieving intractable abdominal pain in patients with CP and their respective postoperative complications. This prospective study was done over a period of 4 years from Jan 2007 to Dec 2010 at IPGME & R (SSKM), a tertiary hospital of eastern India. Patients with diagnosis of CP with or without duct calculi and MPD diameter ≥7 mm with intractable pain were included. 70 patients were randomly allocated for LPJ and LPG operation by lottery method. Study tools were questionnaires, blood and radiological investigations and standard instruments for open surgery. The patients were prospectively analyzed for duration of surgery and hospital stay, operative/postoperative complications and assessment of postoperative pain relief. Pain relief was assessed as complete (no analgesic requirement), satisfactory (tolerable pain with normal daily activities) and unsatisfactory (hospitalization, narcotics or hampered daily activities). 1. Operative time was shorter in LPG than LPJ (Median 85 vs. 110 min). 2. Incidence of ileus was lesser in LPG group (p0.054). Other complications were comparable in both groups. 3. LPG was associated with shorter duration of hospital stay (Mean 6 vs. 8 days). 4. Pain relief was comparable in LPG and LPJ. LPG is a good alternative to LPJ for CP.
Laparoscopic cholecystectomy has revolutionized the management of symptomatic gallstone disease since its introduction more than 20 years ago. It has gained widespread acceptance and is presently the gold standard for its management. This large study spanned over last 10 years and includes prospective data on 950 elective cases of laparoscopic cholecystectomy since 2002. All cases were operated personally by the author in different teaching hospitals of West Bengal. The following were looked into: profiles of the patients including major comorbidities requiring special precautions, the frequency of "difficult cholecystectomies," conversion rate, and operative and postoperative complications. The results showed that 75 % of the patients were females. The mean age of the female patients was 35 years (range15-75), while that of the male patients was 42 (range 18-68). Thirty-two patients had major comorbidities which required special precautions in the perioperative period. Twenty-six percent of the cases were categorized as "difficult," and 6 % of the cases had to be converted to open procedure. Major complications occurred in 11 patients of which five had to be converted. Fiftyfive patients had port-site infection due to atypical mycobacteria species of which majority occurred in the last 1 year of the study. All of them responded to second-line antitubercular medications.
A 65-year-old male presented with painless hematochezia associated with episodic cramps in upper abdomen, watery diarrhea, and a slowly growing mass in upper abdomen. Examination revealed a firm 6 x 5 cm, intra-abdominal, epigastric mass. Colonoscopy up to 90 cm showed a stenosing, ulcero-proliferative lesion in the transverse colon. No synchronous lesion was detected. Biopsy revealed mucin secreting adenocarcinoma. Exploration showed the growth involving the transverse colon proximal to the splenic flexure with a part of ileum, approximately three feet proximal to ileo-caecal junction, adherent to it. No significant mesenteric lymph node enlargement was evident. The patient underwent resection of the growth along with the segment of adherent ileum. Continuity was re-established by a colo-colic and ileo-ileal anastomosis respectively. Patient received adjuvant chemotherapy. Post-operative histopathology demonstrated a composite histological pattern with an admixture of carcinoid tumor and adenocarcinoma, invasion of ileal serosa and adenocarcinomatous deposits in mesocolic lymph nodes, the tumor staging being (T4, N0, M0/Stage II) for carcinoid and (T4, N1, M0/Stage III) for adenocarcinoma. Patient was followed-up for a year and was doing well without any evidence of recurrence.
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