laparoscopic nissen fundoplication

a 31 yr old female having c/o persistent reflux and vomiting since last 3 years, initially improved with ppi therapy but gradually required higher doses. upper gi endoscopy revealed gross reflux with grade 3 reflux esophagitis ,grossly open g.e junction throughout the procedure , allowing complete  retroflexion up to mid esophagus.after 3 three years of failed conservative trial , wt loss and intractable gerd and vomiting, pt was planned for laproscopic nissen fundoplication. three stiches at crura, two for fundoplication and one for crura hitch taken with ethibond 2.0. after 25 days of surgery, pt has improved drametically. done by me, dr rahul naik and dr chetan morawala at naveli hospital.

mirizzi's syndrome with impected 2.7 cm size commen hepatic duct stone

 a 42 yr female with diabetes mellitus with hypertension presented with pain in rt upper abdomen with fever with jaundice. c/o itching with white stool.on ct scan complete mirizzi's syndrome with impected stone in common hepatic duct was detected, cbd was normal in size with dilated ihbr.on open exploration, gb empyma with 40 cc of pus drained, subtotal cholecystectomy was done .impected stone in c.h.d was found with difficulty as it had migrated deep posteromedially to infundibulum of gb. no cystic duct or cystic artery found.stone retrived and feeding tube cannulation done in c.h.d proximately as well as distally, 12 no t- tube was placed in c.h.d and a 32 no abdodrain in sub hepatic region. after 6 days post op , pt is fine, orally. pre op total bilirubin was 4.7, with raised sgpt and alk phosphatase . today total bilirubin is 1.1, t tube is draining 100 cc bile per day with no bile in abdomen drain. done by me, dr rahul naik and dr sameer desai.T-tube graphy from a slightly displaced t-tube suggestive of normal cholangiogram, no residual stone. t-tube and drain were removed on 12th and 15th post op day respectively. pt is absolutely fine and discharged on normal l.f.t .                                                 .