Revision of strictured anoplasty

Some children develop a tight stricture at the junction of the skin and the neoanus after an otherwise successful posterior sagital anorectoplasty. If the scarring is truly skin level only ( a few mm thick), then a Heineke-Mikulicz type plasty at 3, 6, 9, and 12 o’clock is very useful.           … [Read more…]

Pilonidal Rhomboid Flaps

Pilonidal disease is usually surgically managed by elliptical off-midline excision and primary closure. Other options (negative pressure wound dressings, packing with healing by secondary intention, injection of tracts with fibrin glue, etc) are also used. Recurrent (and sometimes primary) disease may require rotational flaps. Many options are available. One of the simpler options is a … [Read more…]

Technique for safe cholecystectomy

Technique for safe cholecystectomy Misidentification is the #1 cause of bile duct injury. Seeing a funnel does NOT guarantee that this is the cystic duct: In the lower picture, the CHD is fused (inflammation) to the gallbladder wall, and the ‘funnel’ is from fusion, no the start of the cystic duct Safety first Two big … [Read more…]