Tuesday, March 8, 2011

CASE: ACUTE MESENTERIC VENOUS THROMBOSIS & BOWEL GANGRENE^-www.drkeyurbhatt.in*

28 yrs male with pain in abdomen for 3 days
distension, nausea, Melena
Rising TLC and agony

CECT:

SURGERY: Laparotomy and resection of gangrenous segment of jejunum (as stated in scan with venous thrombosis) and stoma.
(1.5 liters of toxic fluid and gangrenous distal jejunum)





Pt about to go home... with distal mucus fistula feeding....

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Dr. Keyur Bhatt - Best Gastro Surgeon

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CASE: LAP. RETROPERITONEAL NECROSECTOMY^-www.drkeyurbhatt.in*


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Dr. Keyur Bhatt - Best Gastro Surgeon

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Dr. Keyur Bhatt - Best Gastro Surgeon

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Monday, March 7, 2011

CASE: LAP. RETROPERITONEAL NECROSECTOMY^-www.drkeyurbhatt.in*

38 yrs male with Acute Necrotising pancreatitis
 TLC ; > 18,000, & Fever...Pain in abdomen with distension and discomfort...

S/O Infected Pancreatic necrosis.

CECT:
Infected pancreatic necrosis inlasser saac, and retroperitoneum
going in mesentery and behind descending colon


SURGERY: Total Retroperitoneoscopic necrosectomy
TIME : 3 hrs. BLOOD LOSS: 50 ML
1 Tray full necrosis & 500 ml of pus.
ICU STAY: 1 DAY  ORAL DIET : From day 2.

Surgery:

pre op left flank buldge
main lesser sac cavity
Infected necrosis

Total baring of mesenteric vessels and removal
of necrosis
drain placement
necrotic material

post op with just two drains

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Dr. Keyur Bhatt - Best Gastro Surgeon

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Dr. Keyur Bhatt - Best Gastro Surgeon

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LAP SPLENECTOMY IN ITP with platelate of 8000^-www.drkeyurbhatt.in*

lap splenectomy video link........



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Dr. Keyur Bhatt - Best Gastro Surgeon

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Thursday, March 3, 2011

Bariatric Surgery^-www.drkeyurbhatt.in*

Long-term Prevention of Mortality in Morbid Obesity Through
Bariatric Surgery. A Systematic Review and Meta-analysis of
Trials Performed With Gastric Banding and Gastric Bypass

Antonio E. Pontiroli, MD, and Alberto Morabito, PhD

(Ann Surg 2011;253:484–487)

Background: Bariatric surgery has been reported to reduce long-term mortality in operated participants in comparison with nonoperated participants.
Methods: We performed a systematic review and meta-analysis of clinical trials published as full articles dealing with cardiovascular (CV) mortality, all-cause mortality (noncardiovascular), and global mortality (sum of CV and all-cause mortality). Pooled-fixed effects of estimates of the risk of mortality in participants undergoing surgery were calculated compared with controls.
Results: Of 44,022 participants from 8 trials (14,052 undergoing surgery and 29,970 controls), death occurred in 3317 participants (400 in surgery, 2917 in controls);when the kind of deathwas specified, 321 CV deaths (118 in surgery, 203 in controls), and 523 all-cause deaths (218 in surgery, 305 in controls) occurred. Compared with controls, surgery was associated with a reduced risk of global mortality (OR = 0.55, CI, 0.49–0.63), of CV mortality (OR = 0.58, CI, 0.46–0.73), and of all-cause mortality (OR = 0.70, CI, 0.59–0.84). Data of all-cause mortality were not heterogeneous; heterogeneity of data of
CV mortality decreased when studies were grouped according to size (large vs small studies). The reduction of risk was smaller in large than in small studies (OR = 0.61 vs 0.21, 0.63 vs 0.16, 0.74 vs 0.35 for global, CV, and all-cause mortality, respectively). The effect of gastric banding and gastric by-pass (3797 vs 10,255 interventions) was similar for global and all-cause mortality (OR = 0.57 vs 0.55, and 0.66 vs 0.70, respectively), different for CV mortality (OR = 0.71 vs 0.48). At meta-regression analysis, a trend for a
decrease of global mortality (Log OR) linked to increasing BMI appeared.
Conclusion: This meta-analysis indicates that (1) bariatric surgery reduces long-termmortality; (2) risk reduction is smaller in large than in small studies; and (3) both gastric banding and gastric by-pass reducemortality with a greater effect of the latter on CV mortality.

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