Arrodált gyomorgyűrűk kezelése – irodalmi áttekintés egy eset kapcsán

Összefoglaló. Bevezetés: 70 éves férfi beteg kóros kövérség (BMI: 50,1) miatt 2005-ben gyomorgyűrű beültetésben részesült. 2020 decemberében hasfali phlegmone hátterében igazolt port infekció miatt más intézetben subcutan incisió, lavage történt. CT-vizsgálattal, majd gasztroszkóppal a gyomorgyűrű arrosióját, intramurális elhelyezkedését igazoltuk. A műtét során laparoszkópos technikával a gyomor corpus nagygörbületén ejtett, kb. 2 cm nagyságú nyíláson keresztül távolítottuk el a gyűrűt. A beteg szövődménymentesen került emisszióra. Megbeszélés: Mintegy 20 évvel ezelőtt a laparoszkópos állítható gyomorgyűrű (LAGB) rendkívül népszerű volt. A LAGB azonban számtalan rövid és hosszú távú szövődménnyel jár, ezért egyre inkább kikerül a bariátriai sebészet tárházából. A gyűrű arrosiója ritka, súlyos szövődmény. Eltávolításának többféle módja lehet. A gyomorgyűrű eltávolítása általában a testsúly jelentős növekedésével jár. A betegeknél konverziós bariátriai műtétet, laparoszkópos gyomor sleeve reszekciót, vagy gyomor bypass műtétet lehet végezni. Summary. Introduction: Extreme obese (BMI: 50.1) 70 year old male patient after LAGB procedure in 2005, with abdominal wall and port infection underwent subcutaneous incision drainage of the area in December 2020. CT and Gastroscopy confirmed gastric penetration and intramural position of the Band. Using laparoscopic approach with incision of 2 cm of the stomach at the gastric greater curvature the band had been removed. Patient had been discharged without any complications. Discussion: LAGB was a very popular bariatric approach at the first decade of laparoscopic bariatric surgery. The increased incidence of short and long term complications reduced worldwide the number of LAGB procedures. Band penetration is a rare but dangerous complication. Laparoscopic removal is recommended. Usually, the intervention is followed by significant weight gain which can be treated with conversion of LAGB to Sleeve Gastrectomy or LGBP procedure.

Role of intrastromal vancomycin in recalcitrant corneal abscess after phacoemulsification

Side port infection and corneal abscess after cataract surgery can produce devastating outcomes. Topical antibacterial drugs are the mainstay in management of these cases. Although intrastromal antifungal agents are an established modality for fungal keratitis, such use of antibacterial agents is rarely reported due to better pharmacokinetic profile of antibacterial agents.We report a case of methicillin-resistant Staphylococcus aureus corneal abscess following phacoemulsification that responded to intrastromal vancomycin injection in addition to conventional therapy.This case of postphacoemulsification corneal abscess highlights the importance of postoperative hygiene practices, use of anterior segment optical coherence tomography for monitoring these patients and use of intrastromal vancomycin as an adjunct to topical and systemic therapy.

TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR INGUINAL HERNIAS: A FIVE YEARS EXPERIENCE IN A TERTIARY CARE HOSPITAL

Objective To evaluate the efficacy of Transabdominal pre-peritoneal repair in the treatment of inguinal hernias Materials and Methods: This retrospective study was conducted in Surgical A Unit, Khyber Teaching Hospital from January 2015 to December 2019. A total 114 patients were included in the study. All of the patients underwent Laparoscopic Trans-abdominal pre-peritoneal(TAPP) repair. After six months follow up, their outcome variables were analysed. Results: Mean age of the study population was 41±7.8(SD) years(range 21-67 years). 104 patients had unilateral while 10 patients had bilateral hernias. 89(78.07%) patients had primary hernia while 25(21.92%) patients had recurrent hernia. Mean postoperative hospital stay was 1.21±0.3(SD) days. Umbilical port infection was noted in 2(1.75%) patients while no case of deep/ mesh infection was noted. Recurrence was noted in one case only. Chronic groin pain was noted in 5(4.38%) cases. Conclusion: TAPP is a safe and effective treatment modality for the treatment of primary and recurrent inguinal hernias.

Laparoscopic management of perforated appendicitis-a study of 90 cases

Introduction: Acute appendicitis is the most common general surgical emergency in the world. It may cause potential risk for patients due to its life threaten complications like burst (perforation). The perforated appendicitis often leads to serious infectious complication like abdominal sepsis, pelvic abscess & etc. There are concerns of using laparoscopic appendectomy to perforated appendicitis. Now a days laparoscopic management of perforated appendicitis is the standard surgical option in many countries. Laparoscopic procedure has tremendous advantages over the open procedure regarding its diagnosis, exclusion of additional pathology, surgical treatment, wound infection (port infection), hospital stay & overall patient’s satisfaction. The aim of this prospective study was to evaluate the role and application of laparoscopy in the management of complicated appendicitis (perforation). Methods: It is a prospective study conducting during January 2011 to May 2019 in BSMMU and some private hospitals of Dhaka, Bangladesh. It includes 90 patients in whom laparoscopic appendicectomy & peritoneal lavage was performed. Three ports technique were usual. Sometimes 4th port is required. 10 mm port is telescopic port. The other one is 3/5 mm port and another one is 5/10 mm port.Energy source is unipolar diathermy. Intracorporeal knotting, endoloop and haemoclip are used for haemostosis& ligating appendicular stump. Results: Age distribution of the study is 3-90 years, mean 17 years. Male is predominant. Duration varies 10-120 minutes, mean 70 minutes. Duration varies 30-120 minutes, mean 70 minutes. Hospital stay varies from 48-96 hours, mean 64 hours. There were 8 complications- single (5, 5.55%) or multiple (3, 3.33%) port infections, paralytic ileus (2, 2.22%) and diarrhea (1, 1.11%), port TB was identified (3, 3.33%) cases among the port infection. Conversion was 1 (1.11%) for controlling haemorrhage of burst appendicitis. All complications are managed conservatively. Conclusion: Total management of perforated appendicitis by laparoscopy is excellent. So it is achievable, feasible & can be done by expert hand in any center. Now it is considered as standard procedure. Journal of Surgical Sciences (2019) Vol. 23(2): 59-66

Complications of Two Port Laparoscopic Cholecystectomy-Studyof 50 Cases

Background: For the management of Gallstone disease, laparoscopic cholecystectomy has been the the gold standard and is preferred over open cholecystectomy. As patients’ demand has increased for improved postoperative quality of life and cosmesis, surgeons have continued to decrease the number of ports for laparoscopic cholecystectomy. To meet these expectations we adopted two-port techniques at Comilla, Bangladesh. For the last three years we have selected 50 patients where two-port laparoscopic cholecystectomy was trialled. The procedure were successfully performed in 47(94%) & conversion were required in 3(6%) with some accepted complications like epigastric port infection & herniation, post cholecystectomy syndrome, reactionary haemorrhage, bile leakage & biloma, significant epigastric port pain postoperatively & stricture of CBD. The present two port technique not only overcoming specimen extraction difficulties but also contributes to good cosmesis. Objectives: To see the outcome of two port laparoscopic cholecystectomy. Methods: Consecutive 50 patients were admitted in surgery ward of Central medical college, Comilla with gallstone disease over a 3 years period. Diagnosis is confirmed by ultrasound with the assessment of operative feasibility. Data collection sheet was maintained by Microsoft Excel. Data were analyzed manually. Results: In this study 50 patients were included. Among them 34 (68%) were females and 16 (32%) were males (ratio = 2.1:1). Mean age was 35.7 years (range 20–55years).All patient were undergone two port laparoscopic cholecystectomy & successfully accomplished in 47 (94%),conversion were required in 3 (6%) patients. Most common (62%) sonological findings were cholelithiasis with normal size & shape of gall bladder. Mean operative time was 50 minutes. Among the per operative difficulties bleeding were 14%, perforation of gall bladder 10%, spillage of gallstones 6%, epigastric forceps manipulation difficulties 4%,conversion to open cholecystectomy 6%. Most of the patients(80%) admitted in hospital for 2-3 days. 4 (8%) patient had epigastric port infection & 1 (2%) patient developed this site herniation, 3 (6%) patient had post cholecystectomy syndrome,1 (2%) patient had reactionary haemorrhage, 1 (2%) bile leakage & biloma,4(8%) patient had significant epigastric port pain postoperatively, 1 (2%) patient developed delayed stricture of CBD. In all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no problem so far in 3 years follow up. Most patients (90%) returned to work within 2 weeks. Conclusion: Two-port laparoscopic cholecystectomy is a safe procedure & cosmetically rewarding. TAJ 2018; 31(1): 29-37

Port catheter complications and thrombosis issues: assessment of 114 patients with port catheter implantation by single surgeon

Background: We provided a comparative presentation of complications seen in 114 patients with port catheter implantation. In addition, we addressed whether patients with catheter-related thrombosis have distinctive features by assessing patients who developed thrombosis either at the catheter implant site or vascular bed. Methods: In this study, we analyzed data from 114 patients who underwent subclavian venous port catheter implantation by a single surgeon at Kayseri Teaching Hospital (Turkey) during 2013 to 2016. Subclavian port catheter was inserted in all cases. The diagnosis of port thrombosis was made by Doppler sonography or thorax CT scan with contrast enhancement in patients presenting with edema at upper extremity, swelling or pain at neck, and/or dysfunctional port. Results: Seroma was detected in only one case, lymphedema developed in one case (0.8%), and pneumothorax was observed in 3 cases. The subclavian vein was implanted on the right side in all patients with pneumothorax. None of these cases were associated with thrombosis. Port infection was observed in one case (0.8%). There was also one case (0.8%) of skin necrosis. The port was removed in 15 patients due to several reasons, which are indicated in Table 2. Thromboembolic events were observed in 11 of the 114 patients while port thrombosis was observed in 7 patients. The rate of hypertension in the thromboembolism group was 61.1% (11/18 individual) while the rate of hypertension in the group without thromboembolism was 28.1% (27/96 individuals); this difference was statistically significant (p = 0.006). Conclusion: In this study, based on complications observed in patients with catheter-related thrombosis, factors such as smoking or diabetes mellitus were seen to be linked to thromboembolism and should be taken into consideration. Moreover, it was observed that hypertension had a significant association with thromboembolism.