Three Port Laparoscopic Cholecystectomy by a Modified Technique

Introduction:Since the introduction of laparoscopic cholecystectomy (LC) several modifications have been introduced to its procedure. Main aim of these modifications is to improve cosmesis & reduce pain. Several institutes are routinely performing conventional 3 ports laparoscopic. In modified 3 ports LC, the third port was moved from right hypochondrium to umbilicus, to conceal it in the umbilical scar, thereby giving the three port comfort to the surgeon and two port benefits to the patient. Methods: This observational study was conducted in the Department of Surgery of Shaheed Suhrawardy Medical College & Hospital from September 2015 to October 2016. After taking valid consent a total 45 patients were selected for modified 3 ports LC. Here we tried to see the safety and benefit of this modified technique by assessing operating time, intra-operative complications, open conversion rate, postoperative wound infection, post-operative hospital stay, pain score and satisfaction with cosmetic outcome. Results: 3 patients were excluded from study due to different reasons. So, among total 42 (N) patients 30 (71.4%) were female & 12 (28.6%) were male. Operative time was 58.48 ± 32.52 minutes (range 34 to 180 minutes). 2 patients required conversion to open surgery. Pain score was 2.07 ±1.71 and cosmetic score was 8.67 ± 1.99. Conclusion: Modified 3 port laparoscopic cholecystectomy can be performed safely with a higher cosmetic satisfaction in selected cases by expert surgeon. J Shaheed Suhrawardy Med Coll 2020; 12(2): 90-94

Clinical Evaluation of Abdominal Wall Hernias

Hernia is defined as protrusion of a viscus or part of a viscus through a weakening or defect in the wall of its containing cavity. Areas of potential anatomical weakness includes inguinal canal, femoral canal, linea alba, umbilical scar, as well as acquired surgical trauma. The weakening/defect may be acquired (like surgical scar) or congenital (like deep inguinal ring). Raised intraabdominal pressure is the most important factor that leads to the development of hernia through the weak areas. Clinically, the hernia usually presents with an abdominal swelling that progresses gradually over time. The sites of hernia are characteristic and usually points towards the diagnosis. While evaluating a hernia clinically, it is important to identify the content of the hernia sac and whether it suffers any complication, as well as the cause of the hernia development. Failing to identify these prior to surgery, will likely result in morbidity as well as recurrence. This chapter will focus on the clinical art of history taking and examination of different abdominal hernias.

HELICAL COMPUTERIZED TOMOGRAPHY CAN MEASURE SUBCUTANEOUS, VISCERAL AND TOTAL FAT AREAS?

ABSTRACT Background: Abdominal obesity or android obesity, that is, the increase in adipose tissue in the abdominal region, is considered a risk factor for several morbidities. Different ways of quantifying it have been proposed, one method is the measurement of the abdominal fat area by computed tomography. Aim: To establish correspondence between the groups defined by degree of obesity in relation to the total, subcutaneous and visceral fat area. Methods: Cross-sectional observational study carried out through the analysis of tomographic examinations. Horos v3.3.5 medical image visualization software was used, with abdominal tomography in a single cut including the L4 vertebral body and the umbilical scar, to obtain the areas of total, visceral and subcutaneous fat. Results: Of the 40 patients, 10 had grade II obesity, 23 grade III and 7 superobese. The amount of total fat showed an increase in relation to the degree of obesity. Visceral fat did not show significant differences between the degrees of obesity, but the data showed a lower average in the group of obesity grade II. The area of subcutaneous fat, as well as total fat, showed an increase in its measurements, according to the progression of the patients’ BMI, but there was no statistical significance in this difference between the groups of grade II and super-obese individuals. Conclusion: The area of total and subcutaneous fat showed an increase in its measurements according to the progression of the BMI groups, which did not happen with visceral fat.

Prepubic tendon rupture in Santa Inês ewe – case report

Prepubic tendon rupture may lead to the loss of pelvic floorsupport. A four-year-old Santa Inês ewe had been reported suffering fromapathy, progressive weight loss throughout ten days, and prolongedpregnancy. Physical exams showed an excessive pendulous abdomen, amild ventral edema between the udder and the umbilical scar (xiphoidregion). Also, the udder was cranially displaced and with hematomas.Other symptoms noticed were walking reluctance, pelvic asymmetry,tachycardia, and tachypnea. The urinalysis findings indicated the presenceof ketone bodies. The ultrasound examination confirmed the presence offetuses with normal development, and a potential rupture of theabdominal muscles was excluded. Eight days following its hospitalization,labor induction was carried out using dexamethasone (20mg, IM, singleapplication). She went into labor three days after the initial dose ofcorticosteroid. The ewe had difficulty expelling the lambs, making theirtraction necessary. Although the animal has recovered from its injuries,the clinical picture shows prepubic tendon rupture, and in order to preventfuture complications, the ewe is not going to breed anymore. The report ofthis case works as an alert to the possibility of the occurrence of thisaffection in ewes and demonstrates the need of parturition assistance inanimals with this condition, which can be diagnosed through clinicalevaluation and ultrasound examination.

Maternal provisioning gives young-of-the-year Hammerheads a head start in early life

For species that do not provide parental care after birth, excess maternal provisioning during development, beyond what is required for embryogenesis, provides offspring with resources to increase their chances of survival. Maternally derived resources are expected to be important for buffering offspring against limited food resources at birth or time needed to learn how to properly feed. Young-of-the-year (YOY) cryptic Scalloped Hammerheads (Sphyrna lewini) and Carolina Hammerheads (Sphyrna gilberti) were sampled from nurseries along the US Atlantic Coast and compared for a number of biological condition metrics across three developmental stages. Large declines in liver lipid content and hepatosomatic indices were found in neonatal sharks, using umbilical scar healing as a proxy for time since birth. Feeding commenced quickly as 96% of sharks had prey remnants in their stomachs. The combination of rapid exhaustion of maternally provided resources and high occurrence of stomachs with prey contents indicate that nursery quality, with respect to prey availability, may be important for YOY hammerhead survivorship. While externally the two species are morphologically similar, longer length-at-birth in S. lewini and higher hepatic condition in neonatal S. gilberti suggest that aspects of reproductive biology, including physiology, may differ between species. While more information is needed to distinguish life history differences between these two species, data collected from YOY may serve as a useful proxy to inform management when adult samples of cryptic species are difficult to collect.

Evaluation of Adhesions Underneath Laparoscopic Sterilization Scar in Patients Undergoing Abdominal Surgery

Introduction: The minimally invasive approach has become the method of choice for treating most benign abdominal diseases that require surgery. However, it is obvious that laparoscopic procedures are not risk free. The aim of this study was to evaluate the prevalence of intra abdominal adhesions underneath umbilical scar following laparoscopic sterilization, in patients who are undergoing abdominal surgeries. Materials and Methods: The present study was a hospital based prospective observational study conducted in the Department of Surgery, Dr Rajendra Prasad Government Medical College (Dr. RPGMC), Kangra at Tanda (HP). The study group consisted of patients admitted to department of surgery during a period of one year and who fulfilled inclusion criteria. During intraoperative period, they were examined for presence or absence of adhesions at the site of previous laparoscopic sterilization scar at Periumblical area. Results: Total of 60 patients were taken in this study. Two out of 60 (3.3%) patients had adhesions underneath previous Laparoscopic Sterilization scar around umbilicus and adhesive structure was omentum in both cases. Conclusion: Adhesion formation is expected in any abdominal surgery whether open or laparoscopic surgery. In our study only 3.3% of patients had adhesions underneath previous laparoscopic sterilization scar in periumblical region. Therefore umbilical port can be considered for re-entry of index port in next laparoscopic surgery, in patients with history of laparoscopic surgery through umbilical region.

ADDITIONAL ABDOMINAL MEASUREMENTS ARE A USEFUL TOOL TO EVALUATE BODY COMPOSITION IN OBESE WOMEN

ABSTRACT BACKGROUND: During weight gain, most of the excess adipose tissue accumulates in the trunk. This alters the body shape and makes collection of anthropometric measurements, especially waist circumference (WC), difficult. OBJECTIVE: To evaluate the sensitivity and applicability of additional abdominal measurements in order to assess body composition of obese women. METHODS: A total of 30 women between 20 and 50 years of age and BMI above 30 kg/m² were assessed. Three WC measurements, were performed: at the umbilical scar designated as WC1 and at 8 and 16 cm above the umbilical scar, designated as WC2, and WC3 respectively. The correlation (r) between these anthropometric measurements and their sum was assessed against the parameters fat mass (FM), free fat mass (FFM), body fat percentage (%BF), and trunk fat percentage (%TF), obtained by total and trunk segmental bioelectric impedance analysis (BIA) as well as by the golden standard total and trunk dual energy X-ray absorptiometry (DXA). RESULTS: The measurements WC1, WC2, WC3, and their sum correlated strongly and moderately with the parameters FM, FFM, and %BF in total BIA and in both total DXA and trunk DXA. CONCLUSION: The results demonstrated a robust correlation between the sum of the three WC measurements and total and trunk DXA in obese women suggesting that such measurements may be a good indicator of body and trunk fat in women, actually superior to BIA results. The use of these three measurements may be an alternative for the assessment of body and trunk fat, in those cases in which the body shape due to adipose tissue trunk accumulation makes accurate classical measurement (WC1) difficult.

Late complications in patients with intestinal ostomies who underwent a preoperative site marking

Objectives: Describe late complications related to intestinal ostomies in patients undergoing a preoperative site marking. Method: Descriptive study with a quantitative approach. The convenience sample and was composed of 15 people with intestinal ostomies who underwent a preoperative site marking. Data collection was performed between January and March 2014 through a pre-established script that guided the physical examination and a questionnaire containing 13 questions related to the sociodemographic profile, diagnosis, and preoperative site marking. Results: It was verified that in 13 (87.7%) people who had site marked ostomies, it was located at a distance of more than 5 cm of surgical scars, iliac crest, umbilical scar, and waistline. Two people with ileostomy (13.3%) had intestinal loop protrusion short of recommended. Regarding postoperative complications, three participants (20%) presented peristomal dermatitis and one (6.7%), in addition to dermatitis, prolapse of the ostomy. Conclusion: The study showed that the postoperative complications reported by patients who underwent a preoperative stomatal site marking were poorly observed and that these was consisted of peristomal dermatitis and prolapse of the ostomy.

Care for children under six months at domicile: primiparae mother's experience

Objective: To understand how the primiparous mother exercises maternal care of the child under six months of age at home. Method: Descriptive research with a qualitative approach. A research was carried out at the Primary Health Care Unit in Fortaleza/CE, between the months of May and June 2017, with 20 primiparous mothers. It was used thematic content analysis to analyze the data. Results: Through the organization of the speeches, we obtained the category Maternal Experience in Care. It was noticed that fear, insecurity and doubts were present in the daily life of the interviewees, interfering with care such as bathing and holding the baby; the cleaning of the umbilical scar was ceased after the stump fell; babies slept on their stomachs; pain and stress contributed to the failure of lactation; cleaning of the umbilical stump was ceased after its fall; babies slept in the ventral position; previous experience in caring for younger siblings influenced maternal care. Conclusion and implications for practice: It was understood that the orientations made by the nurses are fundamental for the qualification of the primiparous mothers in the care of the child.