Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-Pressure Pneumoperitoneum - Prospective Study of 150 Cases

Objective of study: Laparoscopic cholecystectomy under general anesthesia has attained the status of a gold standard for uncomplicated symptomatic gall stone disease; we therefore performed this study to assess its feasibility under spinal anesthesia with low-pressure pneumoperitoneum. Lower pressures are claimed to be safe and effective in decreasing cardiopulmonary complications and pain. Materials and Methods: In a private rural medical college, 150 patients were selected prospectively for laparoscopic cholecystectomy, under low-pressure (8mmHg) pneumoperitoneum and under spinal anesthesia over a span of one and a half years. Injection bupivacaine (0.5%) was used for spinal anesthesia. All ports were made in a head-down position to avoid hypotension. Shoulder pain was managed by reassurance as well as by diverting the attention and sedation in a few cases. Results: We successfully performed the operations in 145 patients without major complications. Spinal anesthesia was converted to general anesthesia in five patients due to severe shoulder pain. Age varied between 21 and 75 years. Duration of operation time (skin to skin) was between 40 and 80 minutes. Twenty-nine patients complained of right shoulder pain. Most of them were managed by reassurance from the anesthetist and a few needed an injection of fentanyl along with midazolam. Conclusion: Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum is feasible and safe under spinal anesthesia. Incidence of postoperative shoulder pain and complications are comparable with laparoscopic cholecystectomy under general anesthesia. [Arch Clin Exp Surg 2012; 1(4.000): 224-228

Surgical Management of Enteric Perforation by Using Omental Patch : A Prospective Study of 60 Patients

Enteric perforation is a serious complication of typhoid fever. Depending upon the bowel condition, primary closure of perforation is the treatment of choice. Development of fecal fistula is the key apprehension in primary closure. The purpose of this study is to find out the benefit of an omental patch when used over primary closure. It is a small study of 60 patients, which were divided into two groups: Group I - Primary closure with omental patch, and Group II - only primary closure. The outcomes were measured in relation to wound infection, fecal fistula, wound dehiscence, and intra-abdominal abscess. The incidence of complications including fecal fistula and mortality is significantly lower in the group-I patients. Fecal fistula occurs in 13.33% in group II, while in only 3.3% in group I. There was no significant difference in the incidence of wound infection and wound dehiscence. Primary closure with an omental patch is a better option compared with only primary closure in enteric perforation patients. It can be suggested as an alternative method to primary closure only in selective enteric perforation patients. [Arch Clin Exp Surg 2013; 2(2.000): 80-84

Case Report - Torsion in a paediatric wandering spleen: Case report and review of literature

Pediatric wandering spleen is a clinical rarity. Generally it remains asymptomatic, but may present as a painless migratory lump in the left hypochondrium. Rarely it may present as acute abdomen after undergoing torsion over its pedicle leading to infarction and gangrene. Available treatment options include splenectomy or splenopexy. Splenectomy at times is associated with post-operative infections. Splenopexy may result in recurrent torsion

Gross hematuria with tuberous sclerosis: Case report and review of literature

Tuberous sclerosis complex is a genetic (autosomal dominant) disorder affecting cellular differentiation, proliferation, and maturation. This cellular process gets disarranged and results in hamartomas formation in multiple organs of body including, the kidneys. Kidney involvement is usually bilateral and asymptomatic. We report a case of bilateral renal angiomyolipomas who presented at late age with gross hematuria and pain

Clinical and management profile of thoracic trauma patients

Background: Field of traumatology has been developing over the past 25 years or so, it is only recently that trauma has come to be recognized as a discrete disease entity by the medical and lay communities. Trauma represents a significant portion of the world’s morbidity and mortality. Of the 11 million deaths each year in the developed world, 0.8 million are the result of trauma. Aims and Objectives: To study the clinical profile of thoracic trauma patients and compare various management options. Material and Methods: This prospective study was carried out on one hundred consecutive patients of thoracic injuries who required indoor admission due to chest trauma. Results: Males predominated females in thoracic trauma patients. Blunt trauma mainly road accidents formed the commonest cause of thoracic trauma with right side of chest as most commonly while left side was more commonly involved in penetrating injuries. Out of total 17 patients of flail chest, 3 had mortality. Duration of tube thoracostomy and its complications were more in blunt thoracic injury patients as compared to penetrating injury patients. 68% patients underwent tube thoracostomies and haemothorax was the commonest indication. Operative intervention was required in 12% cases. Six cases underwent splenectomy mainly for associated abdominal injuries. Overall mortality rate in the present study was 6% and it was more in blunt injuries as compared to penetrating injuries. Conclusion: Chest injury constitutes a significant number of trauma patients and commonly affected victims are males of productive age. Majority of these patients can be managed by conservative management and simple intervention like intercostal chest drainage