FEATURES OF SURGICAL TREATMENT OF GALLSTONE DISEASE AND PREVENTION OF ITS COMPLICATIONS

The aim. To analyze the results of surgical treatment of gallstone disease (GD), methods of prevention of complications. Materials and methods. To analyze the results of surgical treatment of gallstone disease (GD), methods of preventing complications. Results and discussion. The data of 204 patients with GD who underwent laparoscopic cholecystectomy (LC) at the Kiev City Hospital No. 6 and the Medical Center “Universal Clinic Oberig” for 2018 were analyzed. Conclusions. The only radical method of treatment of CD is LC. To reduce the complications of LC, it is necessary to conduct the correct selection of patients and apply bail-out strategies to overcome complex LHE.

P-BN53 The ‘Difficult Gallbladder’: do no harm!

Background Laparoscopic cholecystectomy (LC) for a ‘difficult gallbladder’ can incur increased risk of biliary complications. In these challenging conditions where anatomical delineation (commonly through the critical view of safety) is unachievable, it is important to recognise when to proceed and when to consider a bail-out strategy. Subtotal cholecystectomy (SC), cholecystostomy insertion, conversion to open or abandoning the procedure are accepted solutions. In this study we review the outcomes of patients who underwent LC following previous intervention. Methods We retrospectively reviewed patients who underwent LC under a single surgeon between January 2009 to July 2020 following a previous intervention with LC, SC or cholecystostomy tube insertion. Data was collected with regards to demographics, clinical presentation, intraoperative details, imaging, conversion to open, length of hospital stay and complications. Results 40 patients with previous intervention underwent LC. Previous intervention included abandoned LC in 24(60%), on-table cholecystostomy in 8 (20%) and SC in 8 (20%), with 5(13%) converted to open. Reasons for referral included adhesions, intrahepatic gallbladder, possible malignancy, empyema and abnormal anatomy. Laparoscopic approach attempted in 39/40 (98%), conversion to open in 25%. Reasons for conversion included cholecystoduodenal fistula, and suspected malignancy. Median hospital stay was 4 days (1 – 22). Morbidity was seen in 2(4%) with no biliary complications. Completion of treatment, from previous intervention to definitive LC was 9 months (1-48). Conclusions In patients with previously attempted cholecystectomy, LC is feasible and can be performed with low morbidity. When faced with a difficult gallbladder intra-operatively, aborting the procedure and re-attempting at a later date, locally or referral to a specialist Unit, should be considered.

SOCIAL PHENOMENON OF PRE WEDDING PHOTO TRENDS AT DENPASAR COMMUNITY WEDDING CEREMONY

The social phenomenon of pre-wedding photos has now begun to be widely discussed by some people who are starting to be sensitive to social changes in the area of Denpasar City. Infact, in Denpasar City at this time almost all bride and groom couples carry out pre-wedding photo sessions before their wedding ceremony takes place. The bride and groom couples even really focus their attention on the results of their pre-wedding photos. This eventually became a conversation that raised pros and cons among parents whose children were going to have a wedding ceremony. Some parents feel that pre-wedding photos cost too much money and costs that they should be able to spend to bail out funds when preparing a series of wedding ceremonies. In contrast to people who feel capable in terms of costs, they will certainly take the pre-wedding costs lightly compared to the satisfaction they will get later after seeing the results of the pre-wedding photos they take. The bride and groom did a pre-wedding photo session with the theme and concept they specified. When going to do a pre-wedding photo session, the bride and groom have to prepare a lot of money. Depending on the theme, concept and place they will use later. In Bali, especially in Denpasar City, the cost for the “pawiwahan”or wedding ceremony is quite high, with the addition of a new tradition, namely pre-wedding photos, it will make people spend even more. The meaning of this pre-wedding photo session is still not much can explain, prospective brides who do pre-wedding photo sessions only say they take pre-wedding photos to follow today's trends. The new trend that is entering Bali is slowly making it a mandatory tradition. Keywords: pre wedding photo, wedding ceremony, trends, traditions

South African Airways – born again?

Study level/applicability MBA, Exec-ed. Case overview This case focuses on the business rescue of South African Airlines. SAA, four times rated the best airline in Africa (SAA, 2019), was already insolvent when in early 2020 COVID-19 decimated the world. The state-owned airline, which had last made profits in 2011, continued to lose millions of passengers to competitors over the next decade and, despite bailouts of more than R40bn, entered Business Rescue in December 2019, still owing creditors more than R26bn. To the surprise of many, Public Enterprises minister Pravin Gordhan was determined to rescue the airline. In May 2021, the business rescue practitioners handed SAA back to the interim board and Thomas Kgokolo (CA) (MBA) was appointed interim CEO. In June 2021, Gordhan announced a “born again” SAA, “almost ready to take off” and promised no more bailouts. But, with several billion rand outstanding to complete the rescue plan, a grounded fleet, unresolved labour problems, an critical but unnamed “strategic-equity partner” and a largely unvaccinated country entering its third COVID wave – what were the chances? Expected learning outcomes Within the framework of a country desperately in need of jobs and short of capital, the case raises questions about ethics, accountability, responsibility, management, economics and strategy. Should retrenched workers in airlines feel the consequences of their unfortunate career choices? Ought government’s bail-out already failed industries? Should governments run airlines? What sources of funds are available? Have all the necessary requirements for “restructuring” to succeed been satisfied? Supplementary materials Teaching notes are available for educators only. Subject code CSS 11: Strategy.

Bail-out intravascular lithotripsy for severe stent underexpansion during primary angioplasty: a case report

Background Intravascular lithotripsy is safe and effective for the treatment of de novo coronary artery calcifications. Its bail-out use in acute coronary syndrome and for underexpanded stents, although currently off-label, could be the best option when other conventional techniques fail. Case summary A patient with an inferior ST-segment elevation myocardial infarction underwent a primary percutaneous coronary intervention. Stent underexpansion due to a heavily calcified lesion was refractory to high-pressure balloon dilatations. Complete stent expansion was achieved with intravascular lithotripsy, as evidenced by intravascular ultrasound, and no acute complications occurred. Discussion Treatment strategies for stent underexpansion due to coronary artery calcifications are still debated. High-pressure non-compliant balloon dilatations are rarely sufficient to gain a complete stent expansion. Rotational and orbital atherectomy are contraindicated in presence of thrombus. Given the possible risks of stent damages, intravascular lithotripsy is currently not indicated in acutely deployed stents but could be the best bail-out technique for otherwise undilatable stents due to severely calcified plaques.