Simultaneous Laparoscopic Cholecystectomy and Appendectomy

These are samples taken from the same patient during an operation. 

The most left is the removed Appendix. 

The middle is the removed Gallbladder. 

The most right is the soft gallstones removed from the gallbladder. 

This patient presented with one month history of right-sided abdominal pain in the middle. 

Typically, upper right-sided abdominal pain is caused by inflamed gallbladder(Acute Cholecystitis). 

Typically, lower right-sided abdominal pain is caused by inflamed appendix(Acute Appendicitis). 

So, the middle right abdominal pain give rise to the suspicion of simultaneously inflamed gallbladder and appendix(concomitant Acute Cholecystitis and Appendicitis). 

Since the gold standard operation to remove the gallbladder is by Laparoscopic Cholecystectomy, during the procedure, the appendix was also explored and confirmed to be inflamed. 

Laparoscopic Appendectomy was also attempted but due to adhesions and the retrocaecal location, dissection was hazardous and hence the procedure was converted to conventional Open Appendectomy.

Alternative Therapy in Colorectal Cancer

The picture above is a CT scan view of a pelvis in a patient with locally advanced rectal cancer. The red  circle indicates the lateral extent of the rectal tumour. It appears that almost the whole lumen has  been obliterated by the tumour.The remaining compressed lumen is reflected by only three black dots in the centre of the mass.

The patient was diagnosed one year earlier in another hospital when he presented with just painless bleeding in the stools.

After colonoscopy and histological confirmation of the diagnosis, the patient refused the standard surgical operation offered, but instead went for an "Alternative Therapy" in Gerik, Perak.

He came to my clinic asking for a CT scan to check on his disease. 

From the CT scan, he soon will suffer Intestinal Obstruction that will require an emergency surgery. 

I am yet to find a cancer patient successfully treated by an "Altetnative Therapy".

Wound Infection - A Common Complication Of Surgery

Wound infection is one of the commonest complications of any surgical  procedure.

Although most wound infections are superficial and mild, rarely it can be large, deep and lethal.

Most wound infections follow surgery in areas that are not clean(dirty or clean contaminated environments). Emergency Appendectomy is one such common environment, especially if the Appendix is already perforated.

Most straight forward Acute Appendicitis under the cover of perioperative antibiotics recover well without complication of wound infection.

Some perforated appendix develop wound infection postoperatively regardless of any antibiotics given.These patients will require wound dressings on a regular basis for about 1-2 weeks until the wound is clean enough(picture above) before it is ready for Secondary suturing.

Some patients may opt for regular periodic dressings till 

Golds In Gut

In the midst of global economic slump,bordering on recession if not depression, any glitter that resembles that precious metal asset Gold is very attractive indeed.

Unfortunately,that gold-like structures above is a picture of multiple bile duct stones being extracted endoscopically during a procedure called Endoscopic Retrograde Cholangio-Pancreatography, or in short ERCP.

These stones originated in the Gallbladder.

Patients with symptomatic Gallbladder Stones(=Gallstones) who delay treatment in the form of Laparoscopic Cholecystectomy may be complicated by Bile Duct stones.

Usually,patients will experience excruciating abdominal pain in the area of the Upper Right abdominal region associated with Jaundice(Yellow Eyes) and sometimes Fever.

The treatment consist of 2 steps;

1.ERCP to remove the Bile Duct stones

2.Laparoscopic Cholecystectomy to remove the diseased gallbladder containing the original stones

Is colon cancer preventable? - Western Focus - Jamaica Gleaner - Saturday | January 4, 2014

Is colon cancer preventable? - Western Focus - Jamaica Gleaner - Saturday | January 4, 2014

Breast-Preserving Cancer Surgery

One of the most important reason why breast cancer patients refuse mastectomy or decide late for the operation is the notion that one has to part with a very sentimental organ if ones body( especially female).

Mastectomy can be likened to limb amputation. There is a lot if emotions involved in dealing with diseases that require radical removal of organs that shape the individual personality.

It is not a common knowledge to most people that some breast patients may not need a complete(total) mastectomy.

Some patients are suitable to undergo a Partial Mastectomy/Quadrantectomy preserving some portion of the breast.

Patients with small primary tumour located in the outer portion if a big breast is most suitable for Breast-Preserving Cancer Surgery.

This picture is showing skin markings surrounding a small primary breast cancer located in the upper outer quadrant of a large breast.

This picture shows the portion if the breast removed together with the axillary tissues.

The picture shows the specimen cut open demonstrating the small tumour in the centre(the whitish tIssue) surrounded by normal breast tissues.

The picture shows the remaining breast being reconstructed at the end of the operation. 

Is The Breast Tumour Dangerous?

Every so often I am being asked the question whether its necessary to remove a small benign lump from breasts of young female patients.

This is compounded by a very common advice by many doctors that a small benign lumps in low risk patients may not  be removed.

Benign breasts lumps and cysts are very common among female patients young and old.

For patients above 35 years of age, any lump in the breast should be examined by Surgeons, then fully investigated with Ultrasound and Mammogram/Mammography.Then, the surgeon would decide whether to perform a Needle Biopsy or a Operative Biopsy depending in the Imagings findings.

Benign images suggest a benign tumour regardless of size( pics above), and the surgeon will decide on direct Surgical Excision of the whole tumour.

Pic 1 : A large breast tumour of 20 years duration in an old lady

Pic 2 : Mammogram  picture of large benign breast tumour

Pic 3 : a large benign breast tumour removed at surgery preserving the breast