Video assisted surgery: a unique approach for non-resolving retroperitoneal abscess

Abdominal gunshot injuries and its management has always been challenging for surgeons. Challenges start from diagnosis and extent of injury and its immediate management and further its long term complications and their management. Injuries extending up to retroperitoneal space complicated by abscess formation are difficult to manage because the retroperitoneal space is relatively inaccessible leading to very poor outcome, and a tailor made approach is the best method of treatment for an individual patient. Current study report a rare case of video assisted approach for non-resolving retro-peritoneal abscess caused by abdominal gunshot injury with previous laparotomy and unilateral nephrectomy (left-side) with retro-peritoneal abscess along with sepsis, acute renal failure and hemopneumothorax.

Completion total gastrectomy with intracorporeal robot-sewn esophago-jejunal anastomosis

Many technical reports concern minimally invasive surgery for stomach cancer; however, there is poor evidence about employing this approach for gastric stump cancer, which can arise at the anastomotic site in patients who have undergone previous partial gastrectomy for benign diseases such as gastric ulcer. Such surgery was quite common before the introduction of proton pump inhibitors (PPIs), and so today, according to different statistics, gastric stump cancer can be revealed in up to 8% of these patients. This report seeks to highlight the possibility of employing a minimally invasive approach in patients who already had an operation for gastric resection. The video shows technical notes about the hybrid laparoscopic-robotic approach performed in a patient who previously underwent open distal gastrectomy. Is the previous laparotomy an absolute or relative counterindication to reperform a surgery through a minimally invasive approach?

Laparoscopic approach for huge benign ovarian cyst in woman with history of previous 5 laparotomies (including 4 cesarean section)

An adnexal mass (mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic problem. In the United States, it is estimated that there is a 5 to 10% lifetime risk for women undergoing surgery for a suspected ovarian neoplasm. Adnexal masses may be found in females of all ages, from fetuses to older adults, and there are a wide variety of types of masses. Today, the surgical treatment has become more conservative and less invasive; hence, a laparoscopic approach in the presence of benign cysts has become a golden standard. In the past, patients with previous abdominal surgery were discouraged from undergoing laparoscopic surgery because of its increased risk of bowel injury caused by needle and trocar insertion. Complications occur two times more frequently in patients with previous laparotomy in a study of long series. The potential risk for injury of organs adherent to the abdominal wall during veress needle or trocar insertion as well as the necessity for adhesiolysis and its attendant complications are the two major specific problems constraining surgeons from performing laparoscopic cystectomy/ oophorectomy for patients with previous abdominal surgery. Herein, we report a case of a 32-year-old woman P4 + 2 with history of previous four cesarean section and a following laparotomy for interval sterilization presented to our clinic with abdominal mass, discovered by ultrasound scan, managed by a laparoscopic approach.Keywords: Benign ovarian cyst, laparoscopy, ovary, previous cesarean section, previous laparotomy

P394 Preoperative factors associated with prolonged postoperative in-hospital length of stay in patients with Crohn’s disease undergoing intestinal resection or strictureplasty

Background Postoperative complications might not be accurately registered, leading to weakness in registry data studies. Aim To investigate factors that influence postoperative in-hospital length of stay (LOS) in patients with Crohn’s disease (CD) undergoing bowel surgery. Furthermore, the study aimed to evaluate LOS as a surrogate for postoperative outcome. Methods A multicentre retrospective cohort study. Inclusion criteria were adult patients with CD who underwent bowel surgery with either anastomosis or stricturoplasty. All timings of surgeries are regardless of the method of access to the abdominal cavities. Patients with stoma were excluded. Demographic data, preoperative medications, previous operations for CD, preoperative sepsis, and operation was recorded. The primary outcome was LOS while the secondary outcome variable was postoperative complications. Results 449 patients who underwent abdominal surgery for CD were included. 265/449 (59%) were female. Median age was 37 years (IQR =20), median LOS was seven days (IQR =6). Patients with longer LOS had higher rates of re-laparotomy/re-laparoscopy (45/228 (19.7%) vs. 9/219 (4.1%) p = 0.01). In multivariate analysis, age (OR = 1.024 [CI 95% 1.007–1.041], p = 0.005), preoperative intra-abdominal abscess (OR =0.39 [CI 95% 0.185–0.821], p = 0.013), and previous laparotomy/laparoscopy (Or = 0.57 [CI 95% 0.334–0.918], p = 0.021) were associated with prolonged LOS. LOS correlated with postoperative complications after adjustment for age, gender, previous laparotomy/laparoscopy, and preoperative intra-abdominal abscesses (OR = 1.28 [CI 95% 1.199–1.366], p < 0.0001). Conclusion Age, preoperative intra-abdominal abscess, and previous laparotomy/laparoscopy significantly prolonged LOS. LOS correlated with postoperative complications and can, therefore, act as a surrogate for the postoperative outcome.

Current Spectrum of Intestinal Obstruction in a Teaching Hospital

Intestinal Obstruction is a common surgical emergency and constitutes a major cause of morbidity and financial expenditure in hospitals around the world. This study aimed to provide the current spectrum of intestinal obstruction in a tertiary care hospital with a special view to identify any change in the aetiologic pattern. This prospective observational study was carried out in all four surgical units of Rajshahi Medical College Hospital from September 2010 to August 2011. The study included 250 adult patients with clinical and radiological evidence of complete intestinal obstruction. Out of 250 consecutive patients ranging between (13-90) years with a male to female ratio of 2.1:1, the maximum cases were within (31-40) years and (51-60) years of age group. In this study 175 cases (70%) were presented with small bowel and 75 cases (30%) with large bowel obstruction. The main causes of obstructions were bands and adhesions (44%) followed by volvulus (18%), external hernias (16%), neoplasm (12%), intussusceptions (3.2%), intestinal tuberculosis (2.8%) and miscellaneous (4%). Approximately, 86% patient with adhesive obstructions had previous laparotomy while 42% needed surgical exploration for failed conservative management. The overall mortality was 8%; mainly owing to strangulating obstruction and old age. Varying degrees of wound infections were the common post-operative complications. There was a significant change in the aetiologic pattern of intestinal obstruction. Post operative adhesions were the commonest cause of obstruction and appendicectomy was the most common previous operation causing adhesion. TAJ 2019; 32(1): 62-69

Study of infective morbidity following gynecological surgeries

Background: Post-operative wound infection is a common nosocomial infection all over the world. It is responsible for increase in physical and psychological stress to the patient. It also increases the cost of treatment due to prolonged hospitalization. Present study was carried to find out the post-operative wound infection, morbidity and the risk factors.Methods: Prospective cross sectional study was carried out at tertiary care teaching hospital for a period of six months. Consecutive 57 cases of surgical site infections (SSI) following obstetric and gynecological abdominal surgery were analyzed.Results: It was observed that the incidence of SSI was 2.8 percent. Overweight, previous laparotomy scars, emergency surgery and prolong labour were the common risk factors associated with the development of SSI. Certain epidemiological and environmental factors like under nutrition, rural area residence, poverty, illiteracy, ignorance, poor general hygiene, Surgical site infections(SSI) were more commonly observed following emergency operations; laparotomies performed for large ovarian tumours, malignancies and ruptured ectopic pregnancies. Caesarean sections performed for prolong labour, prolong premature rupture membranes, prolonged second stage had more likelihood of development of sepsis. Occurrence of SSI resulted in significant prolongation of hospital stay.Conclusions: The incidence of SSI in the present study was within acceptable limits. Regular surveillance for SSI in the hospital and sensitization of staff regarding consequences of SSI would go a long way in further reduction in the rate of SSI.

Laparoscopic cholecystectomy: Conversion rate and complcation

Introduction and Objective: Laparoscopic Cholecystectomy is the standard surgical treatment for gallbladder disease. However, conversion to open surgery is not the complication. Different centers have reported different conversion rates and post operative complications. The objective of this study is to identify conversion rate and post operative complication of laparoscopic cholecystectomyMaterials and Methods: This retrospective study included all laparoscopic cholecystectomies attempted in Dhulikhel hospital during the year 2015. Files of all patients were reviewed to find out the demography of the patients and the indication of Laparoscopic cholecystectomy. The rate of conversion to open cholecystectomy, the underlying reasons for conversion and postoperative complications were analyzed.Results: Out of 324 cases attempted laparoscopic cholecystetomies, two cases with the history of previous laparotomy were excluded to rule out the bias in the result. Out of 322 cases 226(70.18%)were female and 96(29.81%) were male . The mean age was 38 years. Over all conversion rate to open cholecystetomy was 1.86% with frozen calot’s triangle as the most common reason for conversion. The over all postoperative complication was 1.24% with no major bile duct injury.Conclusion: Laparoscopic cholecystectomy can safely be done with low conversion rate and complication.

Skin Metastasis from Malignant Ovarian Tumor - A Rare Entity

Skin metastasis from malignant ovarian carcinoma is rare and seen in only 3% of patients. Hence, we report a case of ovarian cancer with scar metastasis. The patient, a 31 year old woman presented with two skin nodules in the previous laparotomy scar which revealed metastatic papillary serous cyst adenocarcinoma on histopathology. So, it should be considered that ovarian malignancy is not always confined to pelvis and may present with associated skin lesion.J Bangladesh Coll Phys Surg 2015; 33(1): 41-43

Conservative treatment of bronchobiliary fistula evaluated with magnetic resonance imaging

Introduction. Bronchobiliary fistula (BBF) is a pathological communication between the bronchial system and the biliary tree that presents with bilioptysis. Many conditions can cause its development. There is still no optimal therapy for BBF. Conservative treatment is rarely indicated, as was published before in a few cases. Case report. We presented a 71-year-old Caucasian Serbian woman with BBF secondary to previous laparotomy due to multiple echinococcus liver cysts. The diagnosis was established by the presence of bilirubin and bile acids in sputum and magnetic resonance cholangiopancreatography (MRCP). A repeat MRCP performed after conservative procedure, did not reveal fistulous communication. Conclusion. We suggest that in small and less severe fistulas between the biliary and the bronchial tract, conservative treatment may be used successfully, and invasive treatment methods are not needed in all patients.