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"Hot" Laparoscopic Cholecystectomy: 🔴Principles remain the same 🔴Know bailout options ➡️Subtotal 🔴Gallbladder decompression 🔴Rouviere's important landmark 🔴Endo pledget very useful in these cases 🔴Suction/irrigation ➡️Blunt dissection 🔴Demonstrate CVS #FOAMed #GITwitter #surgery #SoMe4Surgery #MedEd #chole

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Derby Pancreaticobiliary & Robotic AWR Unit

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𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗼𝗻 𝗼𝗳 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 𝗳𝗼𝗿 𝗟𝗮𝗿𝗴𝗲 𝗖𝗕𝗗 𝗦𝘁𝗼𝗻𝗲 🔴CBD diameter key 🔴Extend choledochotomy with choledochotome 🔴CBD stone trapped in basket under slight tension and brought to choledochotomy 🔵Other options ➡️EHL ➡️Laser Lithotripsy 🔵Caution when extending choledochotomy ➡️Experience and training critical #FOAMed #GITwitter #MedEd #Surgery #SoMe4Surgery

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𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙋𝙚𝙧𝙛𝙤𝙧𝙖𝙩𝙚𝙙 𝘿𝙪𝙤𝙙𝙚𝙣𝙖𝙡 𝙐𝙡𝙘𝙚𝙧 𝙬𝙞𝙩𝙝 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘾𝙡𝙤𝙨𝙪𝙧𝙚 & 𝙊𝙢𝙚𝙣𝙩𝙖𝙡 𝙋𝙖𝙩𝙘𝙝 Presentation: 🔵1 day history of sever upper abdominal pain 🔵Smoker and excess ETOH 🔵CXR ➡️Pneumoperitoneum 🔵CT ➡️Perforated duodenal ulcer 🔵Time from ED➡️theatre 3 hours Operative Approach: 🔴Thorough peritoneal lavage ➡️Lap washout allows for thorough removal of intra-abdominal contamination ➡️Modern OR table tilting can provide better view then open in select cases 🔴If fragile tissue then omental patch only ➡️This approach is a modified version of Grahams patch repair ➡️When suitable, we prefer primary closure with patch after 🔴For large perforations kocherisation of duodenum may be indicated 🔴Convert to open if: ➡️Large ulcer ➡️Associated ulcer bleed 🔴H. Pylori eradication therapy on discharge 🔴OGD in 6-8 weeks to confirm healing Key Points: 🟢Timely intervention critical 🟢Lap approach in EGS should be encouraged 🟢Compared to open, advantages of lap are: ➡️Reduced pain ➡️Reduced LOS ➡️Reduced incisional hernia rate 🟢Trainees should be exposed to lap EGS early to develop skills and confidence #FOAMed #GITwitter #MedEd #SurgEd #EGS #SoMe4Surgery

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Fabien Gay

474,595 Aufrufe • vor 3 Jahren

➡️Süreçten kim ne bekliyor? 🔴Erdoğan: Yeniden cumhurbaşkanı seçilmek 🔴Bahçeli: Az bir oyla iktidarı elinde tutmak 🔴DEM+ Öcalan+ PKK: Özerklik! 🔴Ortak hedef: Yeni anayasa 👉Yeni Mesaj'dan MURAT ÇABAS anlattı
2:51

➡️Süreçten kim ne bekliyor? 🔴Erdoğan: Yeniden cumhurbaşkanı seçilmek 🔴Bahçeli: Az bir oyla iktidarı elinde tutmak 🔴DEM+ Öcalan+ PKK: Özerklik! 🔴Ortak hedef: Yeni anayasa 👉Yeni Mesaj'dan MURAT ÇABAS anlattı

Meltem TV

49,654 Aufrufe • vor 1 Jahr

On this day in 2012: Arsenal recorded their second 5-2 victory over Tottenham in the same calendar year. 🤩 ⚫️ Adebayor (10’) 🟥 Adebayor (18’) 🔴 Mertesacker (24’) 🔴 Podolski (42’) 🔴 Giroud (45+1’) 🔴 Cazorla (60’) ⚫️ Bale (71’) 🔴 Walcott (90+1’)
2:12

On this day in 2012: Arsenal recorded their second 5-2 victory over Tottenham in the same calendar year. 🤩 ⚫️ Adebayor (10’) 🟥 Adebayor (18’) 🔴 Mertesacker (24’) 🔴 Podolski (42’) 🔴 Giroud (45+1’) 🔴 Cazorla (60’) ⚫️ Bale (71’) 🔴 Walcott (90+1’)

afcstuff

118,637 Aufrufe • vor 1 Jahr