No abstract

Although each classification system has its merits and demerits, some anatomical variations cannot be classified using any of the previously described classifications. The Ohkubo classification system is the most applicable as it considers most clinically relevant variations pertinent to hepatobiliary surgery.

To study the role of prophylactic antibiotics in open inguinal hernia repair. A total of 200 patients were included, they were randomised in two groups. Group 1 was given prophylactic dose of inj amoxy-clav while group 2 was given placebo only. Results were compared and Data analysed using the Chi-square test. Complications in both the groups were compared. Rate of serous discharge and seroma formation was 1% and 22% respectively in group 1 while 2% and 26% in group 2 also the rate of erythema and stitch abscess were 1% and none in group 1 and 2% and 1% in group 2 respectively. On statistical analysis these differences were not significant. Addition of prophylactic antibiotics in elective open inguinal hernia repair has no significant benefit over placebo although larger studies are required to prepare some uniform guidelines.

The complications of laparoscopic cholecystectomy include those related to the laparoscopy and the specific risks of cholecystectomy. The complications of laparoscopy are related to pneumoperitoneum, subcutaneous emphysema, mediastinal emphysema, bleeding, gastrointestinal tract perforation, liver or spleen injury, and cardiac arrhythmia'. In addition, laparoscopic cholecystectomy may be associated with bile duct injury, bile. leakage, perihepatic collections and perforation of the transverse C O~O~~-~. Parietal seeding of carcinoma of the gallbladder has also been reported4. Four patients who developed abdominal wall tuberculosis following laparoscopic cholecystectomy are described. Patients and methodsFour patients presented with sinuses discharging pus at the ports of entry 4-6 weeks after laparoscopic cholecystectomy. Operation was undertaken for symptomatic cholelithiasis at three workshops organized at three different centres. The same instruments (Olympus, Tokyo, Japan) have been used in several laparoscopic cholecystectomy workshops in the country. Preoperative evaluation of cardiopulmonary status was combined with chest radiography, electrocardiography, liver function testing and abdominal ultrasonography. N o serological tests for tuberculosis were performed. ResultsThe four patients were three men and one woman of mean age 56 (range 45-70) years. All four had initial healing of the ports of entry but developed discharging sinuses 4-6 weeks later. The operation records revealed no laparoscopic evidence of ascites or peritoneal tuberculosis. The operation time varied between 1.5 and 2.5 h. Details of the other patients who were operated on during these workshops are not known; one of the 12 patients operated on at Jaipur had laparoscopic evidence of tubercular ascites but did not develop abdominal wall tuberculosis. Paper accepted 23 September 1993The four patients presented with pyrexia and pusdischarging sinuses at the ports of entry, and one had right inguinal adenopathy. The epigastric port alone was involved in two patients, while all four ports were involved in the other two. Biopsy of the sinuses in three patients and of the lymph node in one revealed caseating granuloma. Patients responded well to antituberculous treatment after 15-30 days. Histopathological examination of the gallbladder confirmed chronic cholecystitis, but there was no evidence of tuberculosis. DiscussionThese patients developed tuberculosis in the abdominal wall without any evidence of peritoneal tuberculosis at the time of laparoscopic cholecystectomy. As the operating instruments had also been used in patients with confirmed tubercular ascites, the most likely cause of transmission was a contaminated laparoscope. In support of this association it should be noted that: (1) only the portals of entry were involved; (2) there was no evidence of tuberculosis at another site to suggest haematogenous spread; and (3) spread from adjacent lesions was unlikely as there was no evidence of peritoneal tuberculosis.Presumably there was im...

A case of surgically created splenorenal shunt complicated with shunt myelopathy was successfully managed by placement of a stent graft within the splenic vein to close the portosystemic shunt and alleviate myelopathy. To our knowledge, this is the first report of a case of shunt myelopathy in a patient with noncirrhotic portal fibrosis without cirrhosis treated by a novel technique wherein a transjugular intrahepatic route was adopted to deploy the stent graft.