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Vaddavalli VV, Girdhani B, Savlania A, Behera A, Rastogi A, Kaman L, Abuji K. Effectiveness of incisional negative pressure wound therapy after major lower extremity amputation: a randomised controlled trial. Ann R Coll Surg Engl 2024; 106:418-424. [PMID: 37435705 DOI: 10.1308/rcsann.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION The aim was to study the effect of incisional negative pressure wound therapy (iNPWT) in wound healing compared with standard sterile gauze dressings after major lower extremity amputation in patients with peripheral arterial disease (PAD). METHODS This prospective, randomised controlled trial included 50 patients undergoing major lower extremity amputations for PAD. Patients were randomised into iNPWT and standard dressing groups. The patency of blood vessels at the level of the stump was ensured with or without revascularisation. The primary outcome was wound-related complications such as surgical site infection (SSI), wound dehiscence, seroma/haematoma formation or the need for revision amputation. The secondary outcome was the time taken for the eligibility of prosthesis placement. RESULTS It was found that only 12% of the patients in the iNPWT group had SSI compared with 36% in the standard dressing group (p = 0.047). Rates of wound dehiscence, seroma/haematoma formation and revision amputation were decreased in the iNPWT group but this was not statistically significant (p > 0.05). There was a significant reduction in the time taken for eligibility of prosthesis placement in the iNPWT group (5.12 ± 1.53 vs 6.8 ± 1.95 weeks, p = 0.002). CONCLUSIONS iNPWT is effective in reducing the incidence of SSI and the time taken for rehabilitation in patients undergoing major lower limb amputation due to PAD.
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Affiliation(s)
- V V Vaddavalli
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Girdhani
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Savlania
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Behera
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Rastogi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - L Kaman
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Abuji
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Bansal VK, Misra MC, Agarwal AK, Agrawal JB, Agarwal PN, Aggarwal S, Aslam M, Krishna A, Baksi A, Behari A, Bhattacharjee HK, Bhojwani R, Chander J, Chattopadhyay TK, Chintamani, Chowbey P, Dalvi A, Dash NR, Dhawan IK, Gamangatti S, Garg PK, Gupta NM, Gupta R, Gupta SK, Gupta V, Kaman L, Kapur BML, Kataria K, Khan M, Khanna AK, Khullar R, Kumar A, Kumar A, Kumar S, Kumar S, Lal P, Maurya SD, Moirangthem GS, Pal S, Panwar R, Parshad R, Pottakkat B, Prajapati OP, Puntambekar S, Ranjan P, Rathore YS, Sahni P, Sarangi R, Seenu V, Sharma R, Shukla VK, Singh DP, Singh J, Singh R, Sinha R, Sikora SS, Srivastava A, Srivastava A, Srivastava KN, Thomas S, Verma GR, Wig JD, Kapoor VK. SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B. Indian J Surg 2021. [DOI: 10.1007/s12262-019-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Thakur UK, Kaman L, Singh C, Kumar M, Bhukal I, Shree R. Whipple's pancreaticoduodenectomy for cancer of the head of the pancreas in a patient with amyotrophic lateral sclerosis: perioperative challenges. Ann R Coll Surg Engl 2021; 103:e72-e73. [PMID: 33185456 PMCID: PMC9773894 DOI: 10.1308/rcsann.2020.7009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 11/22/2022] Open
Abstract
The association of amyotrophic lateral sclerosis and pancreatic cancer is rare. Amyotrophic lateral sclerosis is a neurodegenerative disease characterised by pure motor symptoms in the form of progressive muscle weakness and wasting, and can involve the bulbar and respiratory muscles, leading to significant morbidity. Successful surgery for patients with amyotrophic lateral sclerosis for pancreatic cancer has rarely been reported. Surgery in such patients is a dual-edged sword and is decided based on risk-benefit ratio. Patients are at high risk for general anaesthesia because of muscular weakness, increased sensitivity to muscle relaxants and certain anaesthetic drugs. There is a high chance of prolonged postoperative ventilatory support, aspiration pneumonia and pulmonary complications. We report a patient with cancer of the head of the pancreas who underwent successful elective pancreaticoduodenectomy.
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Affiliation(s)
- UK Thakur
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - L Kaman
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - C Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Kumar
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - I Bhukal
- Department of Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Shree
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Dahiya D, Kaman L. 607. Gastroduodenal gastrointestinal stromal tumor: A case series. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Nada R, Gupta R, Bhasin DK, Rana SS, Kaman L, Yadav TD, Kumar A, Joshi K. Title-autoimmune pancreatitis in pancreatic resections done for presumed pancreatic malignancies-An experience of tertiary centre from North India. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2055-091x-1-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kumar S, Sarkar D, Prasad S, Gupta V, Ghosala P, Kaman L, Yadav T, Ganesamoni R, Singh S. Large Pelvic Masses of Obscure Origin: Urologists Perspective. Urol Int 2012; 88:215-24. [DOI: 10.1159/000334332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 09/19/2011] [Indexed: 11/19/2022]
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Medhi B, Prakash A, Upadhyay S, Xess D, Yadav TD, Kaman L. Comparison of observational and controlled clinical trials of diltiazem in the treatment of chronic anal fissure. Indian J Surg 2011. [PMID: 23204700 DOI: 10.1007/s12262-011-0340-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diltiazem has been extensively studied in the treatment of chronic anal fissures, but efficacy in clinical practice is not fully established. The aim of the present study was to evaluate the safety and efficacy of topical application diltiazem in observational studies as well as in controlled clinical trials in the treatment of chronic anal fissures. A systematic literature search was carried out from 1966 to 31 December, 2007 on PubMed, Medline, Embase and Cochrane database, using the appropriate search words. We found six observational studies with 392 patients and five controlled clinical trials with 289 patients in which topical diltiazem treatment was given. Efficacy was found to be very high in observational studies (56.88%), whereas it was found to be modest in controlled clinical trials (29.41%). In observational studies, most of the patients reported complete healing of fissures within 6-12 weeks, whereas in controlled trials healing was reported within 8 weeks, with tolerable adverse effects of diltiazem. On the basis of the above studies, it can be concluded that topical application of diltiazem is useful in the treatment of chronic anal fissure, but to fully establish its efficacy, larger prospective double-blind study is required in the near future.
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Affiliation(s)
- Bikash Medhi
- Department of Pharmacology and General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India ; Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kaman L, Yhoshu E, Dahia D. 40 comparison of cusa and kelly's clamp crush technique as liver parenchymal techniques in liver resection. J Clin Exp Hepatol 2011; 1:150-1. [PMID: 25755368 PMCID: PMC3940179 DOI: 10.1016/s0973-6883(11)60177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Kumar P, Kaman L, Singh G, Singh R. Therapeutic role of oral water soluble iodinated contrast agent in postoperative small bowel obstruction. Singapore Med J 2009; 50:360-364. [PMID: 19421678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Nonoperative measures using an oral water soluble contrast agent is a significant development in the management of patients with postoperative small bowel obstruction. METHODS In this prospective randomised trial, patients were randomised into two groups: Group A patients were given an oral water soluble contrast agent and Group B patients were managed conventionally. Surgery was performed as and when indicated. The end-points of the study were to evaluate the time interval between admission and relief of obstruction, the length of hospital stay and the need for surgery. RESULTS Of a total of 41 patients, 21 were in Group A and 20 were in Group B. The mean age of Group A patients was 40.48 +/- 14.96 years and it was 43.40 +/- 16.33 years for Group B patients (p-value is 0.553). There were 17 males and four females in Group A, and 14 males and six females in Group B (p-value is 0.441). In Group A, 14 patients had relief of obstruction after administration of the contrast material, and the mean time for relief of obstruction was 7.47 hours. In Group B, 18 patients had relief of obstruction and the time interval was 35.20 hours (p-value is less than 0.001). The mean length of hospital stay was 3.43 +/- 1.08 days for Group A and 5.33 +/- 2.95 days for Group B (p-value is 0.029). Seven patients in Group A and two in Group B were operated on (p-value is 0.071). CONCLUSION Administration of an oral water soluble contrast agent in postoperative small bowel obstruction helps in the earlier resolution of the obstruction and decreases the length of hospital stay.
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Affiliation(s)
- P Kumar
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Sireesh I, Kaman L, Singh R. Pentoxifylline as an adjuvant to surgery and antibiotics in the treatment of perforation peritonitis: a prospective, randomised placebo-controlled study. Singapore Med J 2008; 49:619-623. [PMID: 18756344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION In animal models and human trials, pentoxifylline has shown beneficial pharmacological effects in the treatment of septic shock. We evaluated the role of pentoxifylline in the treatment of perforation peritonitis, as an adjuvant to surgery and standard antibiotic treatment. METHODS A prospective, randomised placebo-controlled trial was conducted on 50 patients with perforation peritonitis. 25 patients were randomised to the test group and 25 patients to the control group. In addition to standard treatment, the test group of patients received pentoxifylline 200 mg per day as an adjuvant for three days. The endpoints of the study were to evaluate the condition of the wound in the postoperative period, APACHE II score and total duration of hospital stay. RESULTS Both groups were comparable in all aspects. There were 23 male and two female patients in the test group, and 20 male and five female patients in the control group (p-value is 0.021). Mean age was 37.9 +/- 10.5 years in the test group and 33.8 +/- 11.0 years in the control group (p-value is 0.186). The APACHE II score in the test group and in the control group was statistically not significant (p-value is 0.661). In the test group, seven (28 percent) patients had wound infection and in the control group, 13 (52 percent) patients had wound infection (p-value is 0.083). The mean postoperative hospital stay in the test group was 6.8 +/- 2.1 days and in the control group, it was 11.2 +/- 5.2 days (p-value is 0.001). CONCLUSION Pentoxifylline improved the outcome by significantly decreasing the length of the hospital stay and the rate of wound infection.
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Affiliation(s)
- I Sireesh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Sodhi KS, Kumar R A, Radotra BD, Kaman L, Khandelwal N. Editor's quiz: abdominal distention in a 36-year-old with a gastric ulcer. Gut 2007; 56:575, 592. [PMID: 17369386 PMCID: PMC1856847 DOI: 10.1136/gut.2005.086561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Verma GR, Lyngdoh TS, Kaman L, Bala I. Placement of 0.5% bupivacaine-soaked Surgicel in the gallbladder bed is effective for pain after laparoscopic cholecystectomy. Surg Endosc 2006; 20:1560-4. [PMID: 16897291 DOI: 10.1007/s00464-005-0284-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 10/12/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to determine the character of pain after laparoscopic cholecystectomy and its relief with 0.5% bupivacaine-soaked Surgicel placed in the gallbladder bed. METHODS For this study, 60 patients with chronic cholecystitis were divided into four groups of 15 each: group A (bupivacaine-soaked Surgicel kept in gallbladder bed), group B (bupivacaine infiltrated at trocar sites), group C (bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with visual analog scale (VAS) scoring. RESULTS The findings showed that 78.33% of the patients had visceral pain, 70% experienced parietal, and 23.33% reported shoulder pain after laparoscopic cholecystectomy. The visceral pain was significantly less in the group A patients than in the control subjects (p < 0.05), and none of them experienced shoulder pain. The mean VAS score at 4, 8, and, 24 h in the group A patients also was less than in control group D: 26.37 +/- 16.24 versus 38.30 +/- 9.51, 23.23 +/- 14.28 versus 33.73 +/- 7.96, and 18.36 +/- 13.00 versus 28.60 +/- 9.42, respectively. Trocar-site infiltration alone was not effective in relieving the parietal pain. CONCLUSION Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked Surgicel in the gallbladder bed alone. Trocar-site infiltration alone is ineffective.
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Affiliation(s)
- G R Verma
- Department of Surgery and Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kaman L, Behera A, Singh R, Katariya RN. Management of major bile duct injuries after laparoscopic cholecystectomy. Surg Endosc 2004; 18:1196-9. [PMID: 15457377 DOI: 10.1007/s00464-003-9246-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 02/19/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries (MBDI) after laparoscopic cholecystectomy (LC). METHODS We performed a retrospective analysis of 27 patients who were treated between January 1995 and December 2002 for MBDI after LC at a single unit in a tertiary center. Major bile duct injury was defined according to the Strasberg classification. All patients underwent magnetic resonance cholangiography (MRC), percutaneous transhepatic cholangiography (PTC), or endoscopic retrograde cholangiopancreatography (ERCP) to delineate the biliary anatomy and assess the level of injury. On the basis of the cholangiographic findings, all patients underwent Roux-en-Y hepaticojejunostomy after a waiting period of 8-12 weeks. RESULTS A total of 29 hepaticojejunostomies were performed in 27 patients. Seventeen patients (63%) presented with biliary fistula and ascites; 10 (27%) presented with obstructive jaundice. In 14 patients (52%) the MBDI was identified during the LC. Twenty patients (74%) had undergone one or more procedure before referral. Eight patients (30%) had E1, five patients (18.5%) had E2, nine patients (33%) had E3, and five patients (18.5%) had E4 injury. Two patients had early anastomotic stricture, for which redo hepaticojejunostomy with access loop was performed. CONCLUSIONS Major bile duct injury after LC commonly presents with biliary fistula and ascites. High-injuries are common after LC. Hepaticojejunostomy repair yields excellent results in these cases.
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Affiliation(s)
- L Kaman
- Department of Surgery, Postgraduate Institute of Medical Education and Research, 160 012, Chandigarh, India.
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Abstract
BACKGROUND Internal pancreatic fistulas are well recognized complications of chronic pancreatitis. METHODS Six patients with internal pancreatic fistulas were treated over a period of 5 years from 1995 to 1999. Four patients presented with ascites, one patient presented with ascites and bilateral pleural effusion and the sixth patient presented with left-sided pleural effusion. Five patients were chronic alcoholics and in one patient the cause of pancreatitis was not clear. Although the serum amylase was mildly elevated the levels of amylase in the aspirated fluid were consistently elevated (more than 800 Somogyi units/100 mL), along with the level of proteins (> or = 3 g/100 mL), and on this basis the diagnosis was made. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated pancreatic ductal disruption in four cases. Initial treatment was conservative, consisting of nasogastric aspiration, nil per oral, antisecretory drugs, repeated paracentesis or thoracocenthesis and total parenteral nutrition (TPN). In two patients naso-pancreatic drains (NPD) were placed across the disrupted pancreatic duct. RESULTS In one patient conservative treatment with NPD was successful, and the remaining five patients required surgical intervention. There was no mortality. Two patients developed surgery-related complications that were successfully managed, but they required an extended hospital stay. CONCLUSION Internal pancreatic fistulas should be treated initially non-operatively; if this is not effective, operative therapy should be considered without delay.
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Affiliation(s)
- L Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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16
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Kaman L, Singh R, Aggarwal R, Kumar R, Behera A, Katariya RN. Diagnostic and therapeutic approaches to carotid body tumours: report of three cases and review of the literature. Aust N Z J Surg 1999; 69:852-5. [PMID: 10613283 DOI: 10.1046/j.1440-1622.1999.01717.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Carotid body tumour is a rare neoplasm of the carotid body. Three cases of carotid body tumour presenting as a painless progressive mass in the neck region are reported here. A review of the relevant literature regarding carotid body tumours is also presented. METHODS Angiographic features were diagnostic of carotid body tumour and complete surgical excision was done. RESULTS There was no mortality and minimum morbidity. There were no malignant tumours. All three patients belong to the high-altitude area of Himachal Pradesh. CONCLUSIONS A high degree of clinical suspicion of upper posterior triangle neck masses and an accurate diagnostic work-up are needed for operative planning.
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Affiliation(s)
- L Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Kaman L, Singh R, Kaplish B, Virk SS, Patel F. Gracilis repair for a case of radiation induced rectovaginal fistulae. Trop Gastroenterol 1999; 20:92-3. [PMID: 10484901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- L Kaman
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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18
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Makharia GK, Behra A, Kaman L, Vaiphei K, Singh K, Kochhar R. Watermelon stomach: a rare cause of upper gastrointestinal bleeding. Indian J Gastroenterol 1999; 18:86-7. [PMID: 10319542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Watermelon stomach is a rare cause of upper gastrointestinal bleeding. We report a middle-aged woman who had been having recurrent bleeding from watermelon stomach. She was treated surgically by gastrectomy and Billroth II anastomosis.
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Affiliation(s)
- G K Makharia
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
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19
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Abstract
A case report of a patient who underwent submucosal injection sclerotherapy for hemorrhoids is presented. Subsequently developed necrotizing fascitis of the anorectum, perianal region, and scrotum necessitated emergency debridement and defunctioning colostomy. Postoperatively, the patient developed septicemia and renal failure requiring an extended hospital stay. Restoration of bowel continuity was done after three months. A brief review of known complications of this technique was made. It would appear that necrotizing fascitis can be added to this list.
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Affiliation(s)
- L Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Abstract
Aneurysms are a rare cause of hemobilia, and usually involved are branches of the hepatic and gastro-duodenal arteries. A case of a patient with hemobilia secondary to a pseudoaneurysm of the cystic artery is presented. Fewer than 10 cases have been reported in the literature, and in all of them the condition was associated with inflammation of the gall bladder, as in our case. Selective hepatic angiography is the procedure of choice for diagnosis. Upper gastrointestinal endoscopy with side-viewing scopy can demonstrate bleeding from papilla. Color-Doppler ultrasonography also may prove to be useful in equivocal cases. Cholecystectomy and ligation of cystic artery with proximal control of the hepatic artery was done at laparotomy after diagnosis was made.
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Affiliation(s)
- L Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Behera A, Aggarwal S, Kaman L. Spontaneous rupture of normal spleen. Indian J Gastroenterol 1997; 16:71-2. [PMID: 9114582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spontaneous rupture of a normal spleen is very rare. We report a case where multiple episodes of spontaneous bleeding from the spleen gave an 'onion skin' appearance on CT scan.
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Affiliation(s)
- A Behera
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
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