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…]

Internal oblique flap for diaphragmatic hernia

Position the patient supine with the bump under the back more prominent on the left side. Mark the end of the costal margin on the left anterior axillary line with a dot Extend the incision transversely straight across the abdomen to the midline (just above the umbilicus usually) Make the incision transversely down through the … [Read more…]


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Ingrown Toenails (onychocryptosis)

Onychocryptosis (Ingrown toenail) occurs when occur when the periungual skin is punctured by its corresponding nail plate, resulting in a cascade of foreign body, inflammatory, infectious, and reparative processes. Risk factors (Suggested): Genetic predisposition and family history Hyperhidrosis Poor foot hygiene Diabetes Obesity Thyroid, Cardiac, Renal disorders that may predispose to LE edema Clinical recommendation … [Read more…]

STEP Procedure

Criteria: >= 4 cm bowel dilation, TPN dependence 1. Measure the duodenal width to obtain ‘standard’ width for the child 2. Cut a pledget to use as a measuring stick (to above length) 3. Mark the antimesenteric border of the bowel and always keep this up 4. Start distally (r/o stricture at sb-colon anastomosis) 5. … [Read more…]