Visualisation of Rouviere’s Sulcus during Laparoscopic Cholecystectomy

Introduction: Safe dissection of Calot’s Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere’s sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot’s triangle. Methods: This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere’s sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized. Results: A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere’s sulcus was visualized in 150 patients (75 %).Type I (open type) was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type) in 25%. Conclusions: Rouviere’s Sulcus is an important extra biliary land mark for safe dissection of Calot’s triangle during laparoscopic cholecystectomy.  Keywords: Rouviere’s Sulcus, laparoscopic cholecystectomy, bile duct injury

A study of gastrointestinal tumors at kathmandu medical college teaching hospital

Background: Gastrointestinal tract tumour is responsible for more cancers and death than any other cancers.  The tumour in GIT include the tumour of the Oral cavity, Esophagus, Stomach, Colon, Rectum, Liver, Gallbladder, Pancreas and Biliary tree.Materials and methods: A cross sectional study was carried out among all the gastrointestinal tract tumours specimens received for histopathological examination in between January 2016 to June 2017 in Department of Pathology, Kathmandu Medical College Teaching Hospital. All tumors diagnosed either benign or malignant were included in this study. Ethical clearance was obtained from the Institutional Review Committee in KMCTH.Results: Colorectum was found to be the most commonly involved site for malignant lesion comprising 40.2% among all malignant lesions followed by stomach comprising 28.6%. Malignancy was found to be more prevalent among male with M:F ratio of 1.6:1 in colorectal region and 1.4:1 in stomach cancers. Regarding benign lesions (polyps), rectum was found to be the commonest site (57.5%), followed by colon (20.0%) and stomach, the least common site.Malignant lesions were more common among the age group of 51-60 years (37.66%) with 70.13% above 50 years. Benign lesions were also found to be the most common above 50 years comprising 40.0 percent.Conclusion: Rectum &amp; colon was found to be the most commonly involved site for both malignant and benign lesion. Malignancy is more prevalent among male and common above 50 years of age. However, malignant cases noted in the adult age group are a matter of great concern.</p

Inguinal Vasal Obstruction Following Polypropylene Mesh Repair

Inguinal vasal obstruction following hernia repair is related to either direct injury to vas or ischemic injury leading to delay stricture. Not much has been described regarding the long term impact of synthetic mesh as far as integrity of the cord structure is concerned. Here, we report a case that underwent mesh explantation for posthernioplasty inguinodynia as well as recurrence and found to have total occlusion of the lumen of vas segment adherent to the explanted mesh on microscopic examination. Key Words: inguinal hernia, polypropylene mesh, vas obstructio

Visualisation of Rouviere’s Sulcus during Laparoscopic Cholecystectomy

Introduction: Safe dissection of Calot’s Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere’s sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot’s triangle. &#13; Methods: This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere’s sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized. &#13; Results: A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere’s sulcus was visualized in 150 patients (75 %).Type I (open type) was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type) in 25%. &#13; Conclusions: Rouviere’s Sulcus is an important extra biliary land mark for safe dissection of Calot’s triangle during laparoscopic cholecystectomy. &#13; Keywords: Rouviere’s Sulcus, laparoscopic cholecystectomy, bile duct injury

Effectiveness of 0.2% Glyceryl trinitrate and 0.5% Nifedipine in the Treatment of Chronic Anal Fissure

Introduction: Anal fissure is an ischemic ulcer caused by combination of spasm of internal anal sphincter and poor blood supply to the posterior midline of anal canal. This study aimed to assess the efficacy of Glyceryl Trinitrate and Nifedipine in the treatment of chronic anal fissure. Methods: Ninety patients with symptomatic anal fissure in Kathmandu Medical College Teaching Hospital are allocated for study in two groups of 45 each from March 2013 to April 2014. The patients are assigned alternatively to GTN group and Nifedipine group. All patients were assessed every week till 8 weeks in regards to headache, compliance, healing and recurrence. The patients who had complete healing in 8 weeks were further followed up for 6 weeks to detect recurrence. Results: Patients in the two groups were comparable in regard to demographic data (age and sex) as well as clinical factors. Headache was main complaint of patients using GTN in high percentage (16.6%) than complained by patients using topical Nifedipine (6.9%). This factor led to poor compliance with GTN compared with Nifedipine.  Nifedipine showed better healing rate 82.5% compared with GTN 60%. Recurrence was comparable among the two groups. Conclusions: Nifedipine ointment showed better results than GTN ointment in chronic anal fissure regarding headache, compliance, healing and recurrence in 6 weeks of follow up period after complete healing of fissure in 8 weeks. Keywords: anal fissure; glyceryl trinitrate; nifedipine

Comparative Study between Tramadol and Dexamethasone as an admixture to Bupivacaine in Supraclaivcular Brachial Plexus Block.

Abstrac

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study

Background Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbidity and mortality following GBC surgery in high income countries (HIC) and low and middle income countries (LMIC).Methods The multicentre, retrospective Operative Management of Gallbladder Cancer (OMEGA) cohort study included all patients who underwent GBC resection across 133 centres between 1st January 2010 and 31st December 2020. Regression analyses assessed factors associated with OS, RFS and morbidity.Findings On multivariable analysis of all 3676 patients, wedge resection and segment IVb/V resection failed to improve RFS (HR 1.04 [0.84-1.29], p = 0.711 and HR 1.18 [0.95-1.46], p = 0.13 respectively) or OS (HR 0.96 [0.79-1.17], p = 0.67 and HR 1.48 [1.16-1.88], p = 0.49 respectively), while major hepatectomy was associated with worse RFS (HR 1.33 [1.02-1.74], p = 0.037) and OS (HR 1.26 [1.03-1.53], p = 0.022). Furthermore, EBDR (OR 2.86 [2.3-3.52], p &lt; 0.0010), resection of additional organs (OR 2.22 [1.62-3.02], p &lt; 0.0010) and major hepatectomy (OR 3.81 [2.55-5.73], p &lt; 0.0010) were all associated with increased morbidity and mortality. Compared to LMIC, patients in HIC were associated with poorer RFS (HR 1.18 [1.02-1.37], p = 0.031) but not OS (HR 1.05 [0.91-1.22], p = 0.48). Adjuvant and neoadjuvant treatments were infrequently used.Interpretation In this large, multicentre analysis of GBC surgical outcomes, liver resection was not conclusively associated with improved survival, and extended resections were associated with greater morbidity and mortality without oncological benefit. Aggressive upfront resections do not benefit higher stage GBC, and international col-laborations are needed to develop evidence-based neoadjuvant and adjuvant treatment strategies to minimise surgical morbidity and prioritise prognostic benefit.Funding Cambridge Hepatopancreatobiliary Department Research Fund.Copyright &amp; COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)