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Intraoperative cholangiography during Laparoscopic cholecystectomy in the GrandMed Hospital

Bulgan Ch ; Batkhuu A ; Enkhbayar D ; Altankhuyag B ; Saruul E ; Mishigdorj L

Journal of Surgery.2016;19(1):19-22.

Introduction: In gallstone diseases, common bile duct stones and thickened bile could cause hepatitis or other difficulties. Therefore intraoperative cholangiography is helpful in many operations besides detecting and diagnosing the gallstones in common bile duct. Materials and Methods: Out of 266 patients who had undergone Laparoscopic Cholecystectomy surgery in GrandMed Hospital, 14 patients were found to have jaundice and cholestasis after undergoing laboratory and radiology tests. Results: These 14 patients have all undergone IOC. 7 out of 14 patients were found to have positive cholangiogram and the other 7 - negative. Biliary tract tumor and anatomic anomalies were not identified among these patients. Conclusion: Making analysis using only laboratory data is not adequate for directly detecting choledocholithiasis. IOC not only shows bile tract obstruction and determines cholestasis causes, but it also identifies the anatomy biliary tract, which is a procedure that facilitates dissection. Therefore IOCcan prevent the most serious complication of laparoscopic cholecystectomy - common bile duct injury. The sensitivity of IOC ensures the gathering of important information on time, so suggest to use it for every suspicious case.

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A comparative study between laparoscopic versus open choledocholithotomy

Yan bo Qi, Sanchin U

Journal of Surgery.2016;19(1):23-28.

Introduction: Choledocholithiasis is present in approximately 15-20% of patients with gallstone and laparoscopic common bile duct exploration has been effectively employed many cases currently. National Center for Health Development, Mongolian Ministry of Health, registered 23180 cases of bile duct diseases which were 3.4% of total diseases, 2.5% of total surgery, 12.2% of total gastrointestinal disease, 46.9% of total liver and biliary tract diseases between 2000 and 2006. Biliary tract diseases increased 2.4 times and bile duct surgery increased 5.2 times than 15 years ago in Mongolia. To compare open choledocholithotomy and laparoscopic choledocholithotomy for common bile duct stones. Materials and Methods: This study was carried out in Mongolian national second central hospital and Inner Mongolian first medical university hospital. The clinical data of the106 patients with common bile duct stones were analyzed between Арril 2015 and Арril 2016. Duration of operation, blood loss, postoperative complication, period of hospital stay and expenditure of treatment were compared in open choledocholithotomy and laparoscopic choledocholithotomy. All patients were placed on a “T” tube drainage. Results: In results of the duration of operation (p=0.001), blood loss (p=0.001) and period of hospital (p=0.01) were significantly lower in laparoscopic choledocholithotomy group Postoperative complications and gastrointestinal function recovery time were lower in laparoscopic group whereas expenditure of treatment were lower in open choledocholithotomy. Conclusion: In conclusion main advantages of laparoscopic choledocholithotomy were reduced duration of operation, blood loss, period of hospital stay and lower postoperative complications however costly.

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ХҮҮХДИЙН МЭСЗАСЛЫН ӨВЧИН

Дашжамцын АВИРМЭД

Journal of Surgery.2016;20(2):103-104.

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THUNDERBEAT IN USE THYROID SURGERY

Tumur-Ochir Ch ; Shim Woo Jeong ; Munkhbat D ; Baasanjav D ; Bayarkhuu A ; Enkhbat G ; Erdene-Bolor B ; Naranbat L

Journal of Surgery.2016;19(1):64-69.

Introduction: Last Decades, Date by date medical developments providing friendly, high-efficiency treatment equipment and services in developed countries are working toward an advanced, as our country medical services are trying to that country’s technology has been introduced. In our country every day there is only surgical care necessary to endocrine gland disorders, including most common thyroid surgery. It is open and robotic assistant endoscopic surgery in the world. But robotic assistant endoscopic surgery is too expensive and impossible in our country. Thus we chose Thunderbeat for open thyroid surgery in especially huge enlarged goiter and vascularized goiter to try prevent bleeding, recurrent laryngeal nerve palsy and post operation hematoma and other complications Thunderbeat is new generation instrument combines an advanced bipolar clamp to the existing ultrasonic cutter. Materials and Methods: M 51-years-oldwoman was admitted to Mongol Hyundae hospital because of front of neck pain, multi nodular goiter, tachycardia, sweaty and not controlling emotion. Anamnesis: She diagnosed to Thyrotoxicosis in 2005 and she took medicine last ten years but not controlling that poisoning. Status locals: Huge enlarged goiter in front of her neck Treatment plan: 1. Preoperative Preparation 2. Operation: Open total thyroidectomy 3. Medicine 4. Wound dressing 5. Observation We did operation after day of admission day, Patient is placed in a Semi erect position with a folded sheet underneath the shoulders so that the head is sharply angulated backward on the multifunctional surgical table under general anesthesia. We used thunderbeat from muscular to all procedures, dissection both thyroid gland and isthmus after Kocher skin incision and sub skin tissue dissected. There is no complication while procedure and post operation days Result: Nodular hyperplasia of thyroid gland with focci of micro adenomatous change Conclusion: Thunderbeat in use open thyroid surgery first outcomes blood loss than 30ml, no injury of recurrent laryngeal nerve and no penetration ligament of Berry while procedure, second outcomes no hematoma, painless, wound healing process faster and short time hospitalization.

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NEW SURGICAL MANAGEMENT OF BPH: HOLEP

Liu Suo ; Munkhbayarlakh S ; Ankhbold G ; Iderchimeg D ; Shiirevnyamba A

Journal of Surgery.2016;19(1):77-.

Introduction: Transurethral resection of the prostate (TURP) has been considered as the gold standard treatment for obstructive voiding dysfunction in men with benign prostatic hyperplasia. This standard treatment has been challenged by consistent data demonstrating the superiority of Holmium enucleation of the prostate (HoLEP). We review summarizes the literature comparing HoLEP to traditional therapies TURP, open prostatectomy (OP) for BPH these are widely used and have long term efficacy data. Patients undergoing HoLEP have significant shortened catheterization times, decreased length of hospital stay, fewer serious postoperative complications, greater reduction in post-operative IPSS, greater improvements in post-operative Qmax and lower rates of repeat endoscopic procedures for recurrent symptoms compared with TURP and OP. Furthermore, HoLEP can be used to resect more than 100 grams tissue and it is equivalent efficacy to open prostatectomy. Conclusion: HoLEP as the new gold standard treatment for surgical BPH therapy further. HoLEP remains its difficult learning curve when compared with traditional transurethral resection.

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HYPERBILIRUBINEMIA MIGHT BE A MARKER OF GANGRENOUS/PERFORATED APPENDICITIS: A RETROSPECTIVE STUDY

Buyantugs Ts ; Taivanbat J ; Nasanbat G ; Orgil N ; Erkegul B ; Odonchimeg B ; Bayarsaikhan B ; Davaadorj N ; Lkhagvabayar B

Journal of Surgery.2016;20(2):18-24.

Introduction: Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum total bilirubin may be a useful marker for appendiceal perforation. The aim of this study was to determine and compare pre-operative total bilirubin level and other diagnostic tools (patient age, duration of symptoms, Alvarado score, white blood cell, C-reactive protein, ultrasound and contrast enchanced CT scan) in cases of acute appendicitis in order to improve the clinical decision making. Materialsand methods: We identified 102 patient with acute appendicitis after excluding those with other causes of hyperbilirubinemia among the 180 patients that underwent a laparoscopic or an open appendectomy from June, 2011 to March, 2015 in UB Songdo Private Hospital. These cases were also subjected to liver function tests and clinical diagnosis was confirmed perioperatively and postoperatively by histopathological examination. According to histological results, these cases were classified two groups: positive(acute appendicitis with perforation and/or gangrene) and negative(acute appendicitis without perforation or gangrene). Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using independent sample t test, Chi square test, and direct logistic regression. The level of significance was set at P< 0.05. Results: Serum total bilirubin was found to be significantly increased(1,5mg/dL) in case of negative group and much higher (3,6mg/dL) in cases of positive group (P <0.001). The level of total bilirubin was higher than 3 mg/dL in cases of gangrenous/ perforated appendicitis while in cases with acute appendicitis it was lower than 3 mg/ dL. Also Alvarado score (P <0.01), C-reactive protein (P <0.001) and contrast enchanced CT scan (P <0.05) were statistically significant diagnostic tools for acute appendicitis. Conclusion: Assessment of preoperative total bilirubin is useful for the differential diagnosis of gangrenous/perforated appendicitis.

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MULTI DRUG RESISTANT TB PATIENTS SURGICAL TREATMENT

Rentsenmygmar Ts ; Sukhee E ; Munkhzul B ; Tsagaan B ; Batbayar D ; Javzandulam O ; Batzaya Ts ; Uuganbayar G

Journal of Surgery.2016;20(2):25-29.

Introduction: We began treatment of multi drug resistant tuberculosis first from 2003. At that time there was a 1960 cases and most of the cases were from Ulaanbaatar, Darkhan, Selenge, Tuv, Dornod provinces. From all the cases only 62% or 1058 cases were included in treatment. From that 336 patient or 19% deceased, 296 patient or 18% didn’t get a treatment. We did this study because there were never done any research or study of surgical treatment of multi drug resistant tuberculosis in Mongolia. Materials and Methods: We studied cases of patients who undergone lobectomy, since 2007. There were 48 cases of 46 patients, 2 patients surgery were done on both sides. Respondents aged between 14- 45, 25 male (52%), 23 female (48%), all patients got a first - line anti-tuberculosis treatment, such as cat-1, cat-1+cat-2 and 10 variants of these drugs. It was done based on sputum culture test results of NCCD TB surveillance and research department’s laboratory. Results: From the all patients only 77.08% had undergone surgery within the first 3 years. 92% patients were diagnosed with multi drug resistance TB only with the sputum and sputum culture test results, and the rest of the patients were diagnosed using a tissue analyses on the above tests. It was revealed that HR resistant -91.66%, HR+(Z,E,S) -3 drugs resistant -18.78%, HR+(ZSE)-4 or 5 drugs resistant. In the patients TB lesion locations was on the right upper lobe 54%, left upper lobe 31%, on a both upper lobes 85%, cavernous fibrosis tubercles 60%, combined TB lesions 77%, tubercles 21%.87.5% of total patients received a multi - drug resistant TB treatment between 7 - 24 months prior surgery. All 48 patients had a totally 69 surgeries. Surgeries included 9% pneumonectomy, 28% lobectomy, 30% Wedge resection, 23% pleurectomy decortication, 7% Wedge resection on both sides, one bilobectomy. There were no complications during the surgery but 5 of patients had an empyema after surgery. No fatal cases.Three patients out of 5 who had a surgery due to pulmonary hemorrhage developed an empyema after surgery. Drainage tubes were taken after the surgery within 2-3 months.Therewere no complication and escalations in the patients who received a surgical treatment, after the surgery from 6 months to 5 years. Conclusion: In study it shows that surgical treatment is effective to do after 6 months of anti-tuberculosis drug treatment in multi -drug resistant TB patients.Also it shows that combining of medical and surgical treatment is healing up to 98% in the patients who were rightly chosen according to surgical indications.This research result shows that in our country multi - drug resistant TB surgical treatment complication is only 10.41%, which is below in the other countries who have same anti-tuberculosis drug treatment.

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BRAIN ABSCESS IN CHILDREN

Orkhontuul Sh ; Avaajigmed L ; Tsetsegdelger J ; Bolormaa I ; Dolgorjav B ; Amartuvshin B ; Enkhbold D

Journal of Surgery.2016;20(2):37-41.

Introduction: A brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses. Materials and Methods: A retrospective chart review of pediatric patients diagnosed with brain abscesses from November 2000 to Jаn 2016 was performed at Shastin Medical Hospital neurosurgery department. Results: Twenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were S. intermedius (n=3), S. aureus (n=3), S. pneumoniae (n=1), Group B streptococcus (n=2), E. coli (n=1), P. aeruginosa (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied. Conclusion: Although uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.

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RISK FACTORS THAT INFLUENCE THE CLOSED REDUCTION MANAGEMENT OF THE COLLES’ FRACTURE

Bulgan Ts ; Baasanjav N ; Munkhjargal B ; Chuluunbaatar O ; Baatarjav S

Journal of Surgery.2016;20(2):87-91.

Introduction: In 1814 Irish surgeon Abraham Coll first introduced distal radial bone fracture in clinical practice as a colles fracture. It is one of the most common fractures account for 10-20% of the total respectively fracture. Case of Colles fracture has being increased in the developed country year by year besides the increasing number of elderly patients. Depending on severity displaced of the fracture, management includes closed reduction or surgical procedure. The aim of study was to study result of risk factors that influence the closed reduction management of the Colles fracture. Materials and Methods: From hospital based population 80 patients aged between 5-76 years (mean age 47.31 years, male 61.25%, female 38.7%) were recruited by cross sectional and randomized method. Participants were divided into displaced and non-displaced groups which confirmed by refractive index difference on X-ray. Results: The risk factors that influence the colles fracture closed reduction management was osteoporosis (p=0.38), menopause (r=0.18, p=0.27), calcium supplement intake (r=0.21, p=0.05), received hospital care in 24 hour (p=0.39), apply plaster (p=0.64), hand sling immobilizer brace (p=0.5) and physical therapy (p=0.5). Conclusion: Osteoporosis and menopause were the risk factors that influenced the closed reduction management of Colles fracture. The patient cases that not receiving emergency medical care in first 24 hours, not applying plaster, not using the hand sling immobilizer brace and not receiving physical therapy was risk factors for extending the closed reduction management of the Colles fracture.

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Assessment of biliary complication after liver transplantation in Mongolia

Bat-Ireedui B ; Ganzorig B ; Batsaikhan B ; Erdene S ; Batchuluun P ; Amgalan L ; Sergelen O

Journal of Surgery.2016;19(1):10-18. doi:Article Digital Object Identifier

Introduction: A considerable proportionof adult living donor liver transplantation(LDLT) recipients experience biliarycomplication (BC), but there are few reportsregarding BC based on long-term studies ofa large LDLT population.Methods: The present study examinedBC incidence, from 16 adult and pediatricpatients (14 right liver and 2 left liver graft )between 2011 and 2016 First Central Hospitalof Mongolia.Results: The mean follow-up period was36±1 months. First Central Hospital has DDanastmosis (n=22) double DD (n=2) singlehepaticojejunostomy (n=3). There 3 caseshave biliary stricture after operation. One ofthe 3 cases has biliary laek 2 months laterafter the operation.Conclusion: Close surveillance for BCappears necessary for at least the first 3 yrafter LDLT. In terms of anastomotic stenosisrisk, HJ appears a better choice than DD forright liver grafts involving ducts less than 4mm in diameter.

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