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K P Balsara

Publications and source records attributed to K P Balsara.

9 recordsLinked to original sources
PubMed2005

Laparoscopic-assisted ileo-colectomy for tuberculosis.

BACKGROUND: Laparoscopic-assisted colon resection (LACR) for benign disease has gained acceptance and has a lower morbidity than open surgery. Reports in Western literature have outlined the use of LACR for diverticulosis, ulcerative colitis, and Crohn's disease. We evaluated the use of LACR in patients with ileo-cecal tuberculosis (IC-TB) and describe our technique and results. METHODS: Twenty-six patients (20 F) between 16 and 45 years of age underwent a LACR for IC-TB over a 4-year period. Three access ports were used in 22 patients, four patients needed four ports. The cecum, ascending colon, proximal transverse colon, and terminal ileum were mobilized completely. The right colic vessels were divided intracorporeally. The specimen was delivered using a 5- to 6-cm incision. The ileo-colic pedicle and bowel were divided outside and an ileocolic anastomosis performed. After placing the bowel within the abdomen the pneumoperitoneum was recreated, saline irrigation done, and hemostasis achieved. RESULTS: No patient needed a formal laparotomy. Peristalsis returned within 48 h in 19 patients and after 72 h in the remaining seven. Oral liquids were started on all patients by the 3rd postoperative day (POD) and a soft diet by the 5th POD. Twenty patients had a bowel movement by the 4th POD and the rest by the 5th POD. Eighteen patients were discharged by the 5th day and the remaining by the 7th day. Three patients developed wound sepsis. Twenty-one patients could resume normal activity within 2 weeks, the rest within a month. CONCLUSION: Laparoscopic-assisted colon resection seems to be an ideal operation for patients with ileo-cecal tuberculosis. It has minimal morbidity and allows a quick return to normal activity.

Adolescent↗
PubMed1998

Pseudoaneurysm of the hepatic artery along with common bile duct injury following laparoscopic cholecystectomy. A report of two cases.

Arterial injuries during laparoscopic cholecystectomy have been described frequently in literature. However, arterial injuries presenting in a delayed fashion as pseudoaneurysms are uncommon and the literature on the subject is also scant. Two patients are described here who developed pseudoaneurysms of the right branch of the hepatic artery following laparoscopic cholecystectomy along with lacerations of the common bile duct. One patient presented 7 days after the initial procedure with a bile fistula and bleeding from the drainage tube. The second presented as obstructive jaundice 4 months after the laparoscopic procedure. Both patients were operated upon after appropriate radiological evaluation. These are unusual complications but need to be kept in mind whenever patients present with bleeding or jaundice after laparoscopic cholecystectomy.

Aneurysm, False↗
PubMed1998

Complicated sigmoid diverticulosis.

BACKGROUND: To evaluate the outcome of patients treated for complications of sigmoid diverticular disease. METHODS: Fifteen patients (11 women; aged 54-80 years) were treated over a 6-year period in a community hospital. Five patients presented with perforation and peritonitis, 3 with colovesical fistula, 2 with colovaginal fistula, 2 with recurrent phlegmon and 3 with bleeding. Six patients (5 with perforation, 1 colovesical fistula with hematuria) underwent emergency surgery. Six patients (2 with colovesical fistula, 2 colovaginal fistula and 2 recurrent phlegmon) underwent planned sigmoid resection. All 3 patients with bleeding were treated conservatively. RESULTS: One patient with a colovesical fistula and severe hematuria died 72 hours later with septicemia. All 5 patients with peritonitis survived; two had an eventful post-operative period and were in hospital for nearly 3 months. All 5 developed wound sepsis. Six patients who had a planned procedure had uneventful recovery. The 3 patients who presented with bleeding recovered. CONCLUSION: Complicated diverticular disease carries a high morbidity and mortality especially when operated on as an emergency. Interval sigmoid resection should be offered to patients who have recovered from an acute complication.

Aged↗
PubMed1996

Endoscopic retrograde cholangiography in the era of laparoscopic cholecystectomy.

OBJECTIVE: To assess the value of endoscopic retrograde cholangiography (ERC) as an adjunct in patients undergoing laparoscopic cholecystectomy (LC). METHODS: Four hundred and sixty consecutive patients with cholelithiasis were evaluated for LC over a four-year period (January 1991 to January 1995). Forty four (9.6%) patients underwent pre-operative ERC on a suspicion of harboring common bile duct (CBD) stones. Ten other patients who presented with acute gallstone pancreatitis also had pre-operative ERC as soon as the acute attack had settled. Endoscopic sphincterotomy (ES) and stone extraction were done if indicated. After LC, four patients underwent ERC for cystic or CBD related complications. RESULTS: Cannulation was possible in all patients undergoing ERC. Of 44 patients with suspected CBD stones, 33 (75%) actually had stones. In 30 patients the stones could be extracted. Three patients had large stones which could not be extracted. Of 10 patients with acute gallstone pancreatitis, CBD stones were found in only one. In the 4 patients who developed ductal complications, ERC was used to place stents in three and to extract a missed CBD stone in one. Three patients developed fever after ERC and three others had transient hyperamylasemia. There were no other ERC related problems. CONCLUSION: In patients undergoing LC, ERC is a useful adjunct both pre- and post-operatively.

Adult↗
PubMed1994

Laparoscopic cholecystectomy: analysis of 100 cases.

OBJECTIVE: To study the efficacy and safety of laparoscopic cholecystectomy. METHODS: One hundred patients with symptomatic cholelithiasis were subjected to laparoscopic cholecystectomy. Preoperative ERCP and sphincterotomy were performed to detect and treat patients suspected to have associated common bile duct (CBD) stones on clinical, biochemical and imaging methods. RESULTS: Ninety patients underwent successful laparoscopic cholecystectomy. The mean operating time was 90 minutes. There were no deaths and morbidity was minimal (6%). Eighty five patients were discharged within 48 hours of surgery. In ten patients the procedure was converted to open surgery. Previous upper abdominal surgery; associated CBD stones; empyema gall bladder; and shrunken, non distensible gall bladder could make the laparoscopic procedure difficult and forewarn the surgeon about a possible conversion to open surgery. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective method of gall bladder removal.

Adolescent↗
PubMedDate not supplied

Laparoscopic surgery for reflux esophagitis and paraesophageal hernia.

BACKGROUND: Laparoscopic surgery has become the standard for treatment of several abdominal diseases. We analyzed our data on laparoscopic treatment of reflux esophagitis and paraesophageal hernia. METHODS: Twenty patients (mean age 61 y; 14 men) - 18 with reflux esophagitis and sliding hiatus hernia, and two with paraesophageal and sliding hernia - were operated on using laparoscopy between March 1999 and March 2001. All patients were investigated by upper GI endoscopy, barium study and routine pre-operative work-up. Nineteen patients underwent a modified Nissen fundal wrap along with repair of the diaphragmatic crura; one patient had only crural repair with no fundal wrap. RESULTS: All procedures were completed laparoscopically. The mean operating time was 140 min (range 90 to 240). Eighteen patients were discharged on the third postoperative day and two on the fifth day. One patient had perforation of intrathoracic part of the esophagus during passage of an esophageal bougie; he presented with empyema 10 days after discharge and was treated by intercostal drainage. There were no other complications. All patients have been followed up on an outpatient basis for 3 months to 2 years. All are presently off acid-suppressive therapy. Seventeen patients are free of symptoms; two patients have gas bloat-like symptoms and one has occasional grade I dysphagia. CONCLUSIONS: Laparosopic surgery is a safe and effective method of treating esophagitis and paraesophageal hernia.

Adult↗