Drainage of abscesses and fluid collections

Almost any fluid collection Medical Tourism in India in the chest, abdomen or pelvis may be considered for percutaneous catheter drainage Medical Tourism , which has largely replaced surgery as the treatment of choice. Initially percutaneous drainage was confined to large superficial postopera-tive collections, but use has broadened to include complex multilocular collections, multiple abscesses and collections in difficult locations (e.g. presacral space, psoas muscle). CT or ultrasound is used to define a safe access route avoiding the penetration of major vessels or bowel. Ultrasound is adequate for superficial collections Medical Tourism India and may be preferable where an angled approach is required, e.g. sub-phrenic collections (Fig. 2.31). Superficial collections, where there is little risk of misdirection, may be safely drained via a simple one-step trochar catheter India Medical Tourism system. More complex or deep collections often require the more precise guidance of CT, using the needle guidewire and catheter exchange system originally devised by Seldinger for arterial puncture (Fig. 2.32). Diagnostic fine needle aspiration should be performed before drainage to determine the nature and viscosity of the collection. Nonviscous fluid — ascites, cysts, seromas, biliomas, urinomas — can be satisfactorily drained  Knee Replacement in India via an 8—10 French catheter. Thick, inspissated, infected material often requires a larger bore catheter (10—14 French) with multiple side holes and, ideally, a double lumen for cavity irrigation. At catheter insertion,Knee Replacement Cost the cavity should be evacuated as completely as possible. Saline irrigation may help to decrease the viscosity of the contents and encourage drainage. Patients should

Knee Replacement Surgery Cost be given broad-spectrum antibiotic cover before and after the procedure. Following catheter placement, 

Hip Replacement Cost regular saline irrigation (10—20 ml tds) is important to maintain catheter patency. The catheter should be left in situ for several days until drainage ceases. Continued drainage of 50 ml Cancer Treatment In India or more suggests possible fistulous communication which may be confirmed by a contrast study via the catheter. Prolonged catheter IVF in India drainage over several weeks may be necessary in such cases to allow fistulae to close. Successful catheter drainage of simple postoperative collections or localised abscesses can be achieved in over 90 per cent of cases. The Stent in Heartcure rate for more complex collections such as pancreatic abscesses, abscesses caused by leak from enteric, biliary or urinary anastomosis and thoracic empyaema is lower, between 70 and 85per cent. The multilocular nature of many of these collections makes complete evacuation difficult. However, in many patients percutaneous

 Bariatric Surgery Cost drainage achieves palliation and allows the patient to undergo delayed, elective,Breast Surgery single-stage surgery in a more stable condition with a relatively clean operative bed.

Drainage of an obstructed biliary system is usually achieved by ERCP.Endoscopic cannulation of the ampulla allows the passage of guidewires and catheters, and the majority of strictures can be bypassed and stented by this approach. In gallstone obstruction of the common bile duct, endoscopic stone removal can be achieved following sphincterotomy by basket retrieval, mechanical lithotripsy or balloon sweepage of the duct. A proportion of patients with obstructive jaundice is not suitable for this endoscopic approach, because of previous gastric surgery, difficulties with cannulation of the ampulla or a tight stricture which cannot be negotiated from below In these patients, a percutaneous transhepatic approach is required. Percutaneous transhepatic cholangio-graphy involves puncture of an intrahepatic bile duct with a fine needle from a right intercostal approach. Successful visualisation of the ducts is achieved in almost all patients with dilated ducts and over 85 per cent of patients with nondilated ducts