World Laparoscopy Hospital

Chyle leak after laparoscopic cholecystectomy is an extremely rare post operative complication, usually related to inadvertent lymphatic injury in patients with distorted anatomy. We report a 70-year-old male with type 2 diabetes mellitus, hypothyroidism, and a recent history of necrotizing pancreatitis, who underwent elective laparoscopic cholecystectomy. Intraoperatively, frozen Calot’s anatomy and dense adhesions were encountered. A postoperative subhepatic drain revealed milky fluid, which was confirmed biochemically as chyle. The patient was successfully managed conservatively with dietary modifications, medium-chain triglyceride supplementation, and octreotide. Although rare, chyle leak should be considered in patients with postoperative milky drain output after laparoscopic cholecystectomy. Conservative management is effective in most cases, but requires early recognition, multidisciplinary input, and close follow-up.

Abstract Background The WHO, reported world widespread coronavirus disease (COVID-19) as an international public health emergency. Pregnancy is associated with immunological changes that may make women susceptible to COVID-19. The present study was conducted to clarify the impacts of the pandemic on intra uterine growth restriction (IUGR) and other complications of pregnancy. Material & methods In a historical cohort study, COVID-19-positive cases who were hospitalized and a subgroup of Intensive Care Unit (ICU)-admitted (severe) cases were compared with those who had no history of COVID-19 infection, regarding IUGR and other complications of pregnancy. Results Among 1010 pregnant women enrolled in the study, 43 (4.3%) had a history of hospitalization due to COVID-19 (including 28 ICU-admitted severe cases) through pregnancy and the other 967 cases who had no history of infection were compared. In the comparison of COVID-19 with non-COVID-19 groups, IUGR, and preterm laborwere more frequent in the COVID-19 group(16.3% versus 6.9%) and (51.2% versus 19.9%), respectively. Also, the cesarean section rate was higher (75% versus 55.3%) and the low APGAR score was more frequent (16.3% versus 3.3–3.7%) Conclusion Complications of COVID-19 infection in pregnancy such as IUGR, preterm labor, higher rate of cesarean section,and low APGAR score might make pregnant women more vulnerable to the COVID-19 pandemic and probable future versions of viral pandemics.

Context:While laparoscopy has been the standard procedure for gallstone treatment, recent advances including the use of indocyanine green (ICG) in laparoscopic cholecystectomy have made it easier to understand the biliary tree and reduce the risk of bile duct injury.Aims:In this retrospective study, we aim to determine the efficacy of ICG in near-infrared fluorescence cholangiography (NIRFC) for visualising biliary anatomy.Settings and Design:A total of 90 patients with the symptoms of cholelithiasis were enrolled for this retrospective study.Subjects and Methods:All the patients underwent cholecystectomy approximately 53.8 min (40–90 min) after the intravenous administration of mean volume 1.6 ml (1–2 ml) ICG. The surgeons used NIRFC along with ICG for real-time visualisation of biliary anatomy.Results:The mean operative time for the surgery was 65.7 min (25-120 min) with no post-surgical complications observed in the patients. The average length of stay was 2 days (1–3 days). ICG usage with NIRFC enabled identification of cystic duct, common hepatic and common bile duct, the junction between common hepatic and bile duct, right and left hepatic duct in 87.7%, 94.4%, 80% and 14.4% of cases, respectively.Conclusions:ICG fluorescence allowed successful visualisation of at least 1 biliary structure in 100% of cases.