GALLBLADDER CARCINOMA

Polypoid Mass Gallbladder. 

POST LAPAROSCOPIC BILATERAL INGUINAL HERNIA REPAIR EARLY SUBACUTE INTESTINAL OBSTRUCTION DUE TO INTERNAL BOWEL HERNIATION.

A patient underwent Bilateral Laparoscopic Inguinal Hernia Surgery, started to have meals on postoperative day 1 and Discharged.
He had a severe bout of cough at home on day 5 and started having Abdominal distension.

He was admitted with a diagnosis of Subacute Small Bowel Obstruction. 
He was managed for 48 hours conservatively but symptoms persisted. 
He was again taken for Diagnostic Laparoscopy and internal herniation of Distal Small bowel into a defect in lower flap of left side repair was noticed. It was Successfully reduced and the defect repaired primarily.
Patient recovered quickly and was discharged on 2nd postoperative day.
This is a very rare complication after Bilateral Laparoscopic (TAPP) inguinal hernia surgery.

Thanks to God almighty, due to timely intervention, could be managed laparoscopically.

TAKE HOME MESSAGE- The EARLY Small bowel obstructions after a minimally invasive surgery rarely get successfully managed conservatively. It is always prudent to do Diagnostic Laparoscopy after a trial of 24-48 hours. This is contradictory to general rule followed in case of Early Small bowel Obstruction in open surgeries, which states that most of early small bowel obstructions can be successfully managed conservatively.
 

CHOLEDOCHAL CYST SURGERY

CHOLEDOCHAL CYST

BILE DUCT CYST IS MORE APPROPRIATE TERM THAN CHOLEDOCHAL CYST AS THE CYST CAN OCCUR ANYWHERE IN THE BILIARY TREE.

TYPE 1 CHOLEDOCHAL CYST- UNDERWENT COMPLETE CYST +GB EXCISION WITH ROUX-EN-Y HEPATICOJEJUNOSTOMY AT THE LEVEL OF HEPATIC HILUM.

How to Control Liver Bed Venous Bleed?

Sometimes, there is unexpected bleeding from Liver bed during Laparoscopic Cholecystectomy.
Whether we try Monopolar/ Bipolar or Harmonic Energy source, still sometimes we are unable to control bleeding. That that time, Instead of Frying the tissue again and again, just ask your anaesthetist to keep systolic BP below 100 mm Hg. And Wait. The bleeding will automatically stop within few seconds.  Meanwhile, remove the Gallbladder and use it to Apply Mild pressure over the bleeding area. The bleeding will stop as a Rule.

Recto-Signoid Growth, 20 cm from Anal verge.

Biopsy- Poorly Differentiated Adenocarcinoma with Signet Ring Cells.

LOW ANTERIOR  RESECTION WITH COMPLETE MESORECTAL EXCISION DONE.

RICHTER'S HERNIA:-
Not that Uncommon.

LARGE BOWEL CANCER SURGERIES

Low Anterior Resection Specimen

Right Hemicolectomy for Adenocarcinoma Ascending Colon

Right Hemicolectomy for Large Mucocele Appendix