Case 1.
A 25 year old lady who was a chronic patient of gastro esophageal reflux disease with large hiatus hernia, irresponsible to continuous medical management. The severity was so much that due to her recurrent vomiting she had undergone missed abortion last year. After complete mobilization of distal esophagus, crural repair with complete wrap done and wrap is sutured to diaphragmatic crura.
Case 2.
7 Years old baby presented with progressive neck pain, shortening of neck and lateral tilt for last 4 months. Treatment taken from local PP. Now had restricted neck moments, difficulty in respiration, swallowing & speech for last 4 days. Developed weakness (2-3/5) in all 4 limbs over 2 days. X-Ray Cervical Spine was done which revealed Collapse C3/4/5 & Anterolisthesis with angulation of C3 & C4 with large prevertebral collection. Patient stabilized with contoured cervical collar applied. MRI Cervical Spine was done which revealed Lytic-destruction of C3, C4 & C5 vertebral bodies with Retropulsion of C4 & C5 vertebral bodies. Peripherally enhancing large well-defined hyperintense thick fluid collection in the region of C3-C5 vertebral bodies, prevertebral region and anterior subligamentous space from C2-C7 level causing central canal stenosis with cord compression and cord edema.
Patient taken for emergency surgery through Anterior Cervical approach. Approx 60cc of thick pus drained and Lytic C3/4/5 vertebral bodies removed. Dura seen clearly good Pulsations presented. Post Operative patient put on ventilation and traction applied. Patient settled in 24 hrs, respiration stabilized and power improved. After 2 days patient was put on Cervical Halo, physiotherapy and mobilization started. Power improved all limbs is 5/5 and discharged on 10th day with cervical holo.
Case 3.
A 40 years old gentleman admitted in Sarvodaya Hospital with C/O headache, palpitations, diaphoresis, severe HTN, frequent episodes of tremors, weakness, anxiety, and flank pain since last 2 yrs. His BP was 200/130 initially. He was thoroughly investigated and was diagnosed Left adrenal pheochromocytoma. USG and MRI showed left adrenal mass of 3.4×3.2×3.3 cms. His 24 hr urine Normetenephrines were 5927 micrograms/24hrs. Syndromic associations with MEN and VHL were ruled out. Patient was started on alpha blockers and later on beta blockers were added. Patient was seen by physician and anaesthetic team, and planned for Laparoscopic adrenalectomy. All necessary measure were taken including invasive BP monitoring and Laparoscopic left adrenalectomy was done successfully. Thanks to whole team for this achievement.
Case 4.
Complex urinary reconstruction: of neourethra with anterior bladder flap30 year old female with bilateral lower limb deformities
- Still born childàH/o Obstructed Labor
- Presented with vaginal stenosis to gyanecologist
- Planned for – Vaginoplasty
- taken up for vaginoplasty à1st Surgery
- Accidental opening of rectumàThin fibrosed tissue b/w rectum and vagina
- opened up à Fibrosed bladder neck accidentally à No urethral meatus identified
- Urethra created from vaginal flap over foley’s catheter with Diversion sigmoid colostomy and rectal repair.à Call for surgeon
- Post Surgery:
- Patient had giveaway of neourethral sutures with expulsion of foley’s catheter
- Patient became incontinent.
- Call for urologist (Dr. Kshitij)
- Examination under anesthesia done
- CPE – No urethra distal to fibrosed bladder neck – wide open bladder neck with no coaptation. Bladder normal. Foley’s catheter placed over guidewire.
- Further Plan :
- Mitrofanoff Procedure (cutaneous diversion) with bladder neck closure
or
- Neourethra formation with bladder flap (Tanagho Flap)
Options discussed with patient – patient opted for neourethra with bladder flap
Patient successfully underwent Tanagho flap based urethral reconstruction in Feb 2020. Now presenting you the follow up and outcome of surgery.
- 9 months post Sx
- Underwent vaginoplasty after 2 months of Tanagho Flap Procedure
- Underwent colostomy closure 1 month back
- Patient is continent with self voiding and having occasional stress and postural incontinence
Further plan – Rehabilitation with reassessment at 1 year post surgery for residual stress and postural incontinence
Case 5.
A 13 year old male presented with continuous epigastric pain and dyspnea after a 2days of fall from height and fell down of almirahs on him. Immediately after the injury the patient had been diagnosed with right pneumothoraxand a CT scan of thorax had revealed fracture of the 8th–10th rib with limited ambilateral pleural effusion with evidence of diaphragmatic rupture with stomach, spleen, colon and small bowel as content inside the left hemithorax. The patient was guided to the operating room and he underwent laparoscopy during which a sizeable rupture of the left hemidiaphragm (‘T’ shaped) was evident with prolapse of above mentioned contents. The prolapsed content were reduced to the peritoneal cavity, pleural effusion was aspirated and the diaphragmatic lesion was repaired with clips and inabsorbable sutures reinforced with mesh. The patient had a normal postoperative course and he was discharged the 7th postoperative day.
Case 6.
A 62-year-old male patient suffering from right hemiperesis was admitted to Sarvodaya hospital. Doppler ultrasonography (US) and MR angiography (MRA) were performed and fibrofatty, short plaque was seen causing stenosis over more than 90% of the proximal part of the left internal carotid artery (ICA). He had been on medicine for hypertension for about 2 years and had been smoking half a pack a day for about 40 years. Daily, 150 mg Aspirin and 75 mg of Clopidogrel were prescribed and the CAS was planned. Diagnostic angiograms obtained under local anesthesia showed 90% stenosis consistent with the Doppler US and MRA. A tapered, closed-cell carotid stent 8–6×40 mm in size (X-Act, Abbott) was implanted and a 6x 20mm monorail balloon was inflated inside the stents in the ICA part, both for proper apposition of the proximal and distal ends of the covered stent, for full opening of the stenosis without leaving any residue. The filter was extracted and there was no debris inside it. Physical examination showed no neurological deficit. There were no new ischemic lesions. The patient was discharged without any neurologic problems.
