Surgical blade retrieval from Abdomen by Laparotomy after 5 yrs! - Case report and Review of literature on retained foreign bodies in abdomen

Foreign bodies forgotten or missed in abdomen include cotton sponges, artery forceps or other instruments, pieces of broken instruments or irrigation sets and rare tubes. Presence of retained surgical blade as foreign body is uncommon and significant patient safety challenge. Most common etiologies for presence of such foreign bodies are accidental, traumatic or iatrogenic. Most common surgically retained foreign body is the laparotomy sponge. We report the management of a case with a rare foreign body in the abdomen i.e. surgical blade and repair of congenital diaphragmatic hernia. A 38 yrs female reported to us with X-ray lumbo-sacral spine showing radio-opaque object in abdomen. We further investigated the patient and CT scan abdomen revealed –A metallic foreign body in the left hypochondrium just beneath the left lobe of liver; it was seen in close proximity to the transverse colon gut loops and left Diaphragmatic Eventration hernia –herniation of stomach, large bowel loop and omental fat into left hemithorax. Traditionally, diaphragmatic hernia was repaired by laparotomy and foreign body was removed after exact localization on C-arm

Prospective clinical study: mass closure versus layer closure of abdominal wall

Most common abdominal wall incisions are midline or paramedian and its closure technique should be efficient to provide strength for prevention of incisional hernia and should be a barrier to infection. Incisional hernia is commonest complication as high as 39.9 % after abdominal surgery. Integrity of sutured abdominal wound rests on balance between suture holding capacity of tissues and tissue holding capacity of sutures (1). Objective: objective of study is evaluate comparison between mass closure and layered closure of midline and paramedian incisions for operative time and postoperative complications after performing single layered closure and conventional layered closure of laparotomy wounds like seroma ,wound infection ,wound gaping ,burst abdomen and incisional hernia. Results : Meantime for closure of laparotomy wound through midline or Para median incision by single layered closure technique was 14 minutes and by layered closure technique was 23 minutes . There was difference of 9 minutes statistically significant (p=0.001). In postoperative period patients closed by mass closure technique 8 patients(16%) had postoperative complications in the form of seroma in 2 patients(4%), infection in 3 patients(6%), wound gaping in 2 patients(4%) and incisional hernia in 1 patient(2%)and no patient had burst abdomen where as in layered closure total 16(32%) patients had complications as seroma in 5 patients(10%) ,wound infection in 4 patients(8%)., gaping in 4 patients(8%) burst abdomen in 1 patient (2%) and incisional hernia in 2 patients(4%). Conclusion: Single layered closure technique is better than layered closure in term of operation time and postoperative complications like seroma, infection, wound gaping, burst abdomen and incisional hernia

Tightening of seton using Roeder’s knot in Complex Fistula - in - ano : with knot pusher (specially designed)

There are two main complications after surgery of complex fistula-in-ano: i.e. faecal incontinence and recurrence. To prevent incontinence of stools and flatus we require saving the anal sphincter muscle with tightening of seton using Roeder’s knot with knot pusher (specially designed). Method: The study includes 40 patients who had undergone treatment of complex and high fistula-in-ano at Civil Hospital, Jalandhar from January, 2010 to September 2012 and from September, 2012 to January, 2014 at Punjab Institute of Medical Sciences (PIMS). Results: 40 patients of complex fistula-in-ano were taken up for study with the age (mean ± standard deviation) of 35 ± 10.6 years. The Roeder’s knot was tightened with a median of 5 times (3-10 times) as OPD procedure. All the patients were on follow up for minimum period of 6 months and none of the patient had any incontinence. Recurrence occurred in one case. There was breakage of thread at knot site with knot pusher in two cases. Conclusion: Tightening of seton using Roeder’s knot is safe, cost effective treatment for complex fistula-in-ano and follow up is easy and tightening of fistula is an outdoor procedure rather than replacing the loose seton. Fistula-in-ano or recurrent fistula or fistula encircling more than 30% of external anal sphincter. Patients were on follow up every week and seton with Roeder’s knot tightened in O.P.D after application of 2% xylocain jelly. Incontinence was assessed according to wexner’s score

Sutures versus staplers for skin closure of midline incision in laparotomy patients and their outcome

Aim of the study is to compare the clinical outcome of staplers versus skin sutures in skin closure of midline incision in laparotomy patients in term of superficial surgical site of infection, pain, wound dehiscence, time of skin closure and cosmetic satisfaction and thus verify the authenticity of previous studies. Though many studies have shown the superiority of staples for speed of closure, it is unclear if staples give a superior cosmetic result or reduce pain. Several studies show that sutures are superior for cosmoses and that they decrease post-operative pain and are more cost effective. So cost of procedure should also be considered. Closure should serve both functions and aesthetic purposes. Aesthetically poor scar can have a negative impact on overall quality of life causing considerable distress and unhappiness. Precaution of would infection is also necessary as it may lead not only an ugly scar but also occurrence and recurrence of hernia. In our study we found

Breast hamartoma with intrathoracic extension in a 13-year-old boy

Breast hamartoma is a rare tumor that has been reported only thrice in a male breast. The pediatric age group is seldom involved. We present a case of breast hamartoma in a 13-year-old boy, which interestingly, extended through but without definite involvement of the chest wall into the thoracic cavity. In view of occasional recurrence and documented malignancy in hamartomas, tumor was excised along with two ribs

Breast hamartoma with intrathoracic extension in a 13-year-old boy

Breast hamartoma is a rare tumor that has been reported only thrice in a male breast. The pediatric age group is seldom involved. We present a case of breast hamartoma in a 13-year-old boy, which interestingly, extended through but without definite involvement of the chest wall into the thoracic cavity. In view of occasional recurrence and documented malignancy in hamartomas, tumor was excised along with two ribs

Laparoscopic transperitoneal pyelopyelostomy and ureteroureterostomy of retrocaval ureter: Report of two cases and review of the literature

We report two cases of retrocaval ureter that were successfully treated by a laparoscopic transperitoneal approach. Presentation of both these cases was with flank pain. Ureteroureterostomy using an intracorporeal suture technique was performed for one, and pyelopyelostomy for the other case. Operative time was 120 min and 110 min, respectively. Pyelopyelostomy was technically easier to perform than ureteroureterostomy that required an extra fourth port insertion to facilitate dissection. With increasing experience with the intracorporeal suturing laparoscopic technique of either pyelopyelostomy or ureteroureterostomy should be the first choice for retrocaval ureter