Head injury: A serious surgical problem.

•

17 likes•1,875 views

Head injuries top the list of trauma patienrts coming to the casualty. The condition has to be immediately assessed and investigated. Depending upon the findings prompt medical or neurosurgical treatment has to be administered.

Health & Medicine Entertainment & Humor

Head Injuries Dr. Ketan Vagholkar M.S.(BOM)., D.N.B., M.R.C.S.(GLASGOW)., F.A.C.S. Consultant General Surgeon & Professor of Surgery

Head Injuries ,[object Object],[object Object],[object Object],[object Object],[object Object]

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Primary management of trauma patient ,[object Object],[object Object],[object Object],[object Object]

Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Neurological Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Coup and Contre- coup injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Examination of Neck ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Other Examinations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Admission to hospital for all head injury patients is a safe practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of raised intracranial tension due to cerebral edema ,[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment /prevention of convulsions ,[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of scalp injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

$Treatment of skull fractures ,[object Object],[object Object],[object Object],[object Object],[object Object]$

Treatment of intracranial hematomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of intracranial hematoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of intracranial hematoma ,[object Object],[object Object],[object Object]

Late Complications of head injuries ,[object Object],[object Object],[object Object],[object Object]

Medicolegal documentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pupillary Changes in head injury patients

$Skull fractures$

What's hot

Head trauma & Management

Uthamalingam Murali

Traumatic brain injury

Ghalib Hussain Khan

Intracerebral Haemorrhage.Dr NG NeuroEdu

slneurosurgery

Hemangioblastoma

Farrukh Javeed

Intracerebral hemorhage Diagnosis and management

Ramesh Babu

Supraorbital craniotomy.

saurav Singh

Head Injury: Common Issues

Amit Agrawal

Chronic Subdural hematoma

Gaurabmainali1

Subdural Hematoma

Monsif Iqbal

Craniovertebral junction cvj embryology

Mohamed E Elsebaey

Olfactory groove meningioma(case presentation) dr.mumtaz ali

Neurosurgeon Mumtaz Ali Narejo

Pterional craniotomy

Dr Fakir Mohan Sahu

Chronic subdural hematoma.pptx

RUTAYISIRE François Xavier

Facial nerve anatomy, pathology

Ahmed Koriesh

Subarachnoid hemorrhage

airwave12

Facial palsy

DrDivya Naveen

Superior Orbital Fissure Syndrome

DrRudra Chakraborty

Cerebellopontine Angle Tumors

Ade Wijaya

Head injury

Ministry of Health, Myanmar

Traumatic head injury

NeurologyKota

What's hot (20)

Head trauma & Management

Traumatic brain injury

Intracerebral Haemorrhage.Dr NG NeuroEdu

Hemangioblastoma

Intracerebral hemorhage Diagnosis and management

Supraorbital craniotomy.

Head Injury: Common Issues

Chronic Subdural hematoma

Subdural Hematoma

Craniovertebral junction cvj embryology

Olfactory groove meningioma(case presentation) dr.mumtaz ali

Pterional craniotomy

Chronic subdural hematoma.pptx

Facial nerve anatomy, pathology

Subarachnoid hemorrhage

Facial palsy

Superior Orbital Fissure Syndrome

Cerebellopontine Angle Tumors

Head injury

Traumatic head injury

Similar to Head injury: A serious surgical problem.

HEAD INJURY.pptx

MayarMagdy24

Decompressive Craniectomy in Traumatic Brain Injury A Review Article.pptx

BonySimbolon

Approach to traumatic brain injury

EM OMSB

Myths vs facts in head injury

Shailendra Anjankar

Initial Management of the Trauma Patient II.pptx

Hadi Munib

Stroke Care of Patient With Post Decompressive Craniectomy

Pei Yin (Charissa) Wong

Management Of Head Injury PK anesthesia.pptx

Anaes6

Anaesthesia for posterior fossa surgery

Dhritiman Chakrabarti

Head Trauma & ICP. SURGICAL AND MEDICAL MANAGEMENT OF

blessingmichael5

head injury.pptx

GrkReddy2

Traumatic Brain Injury

Abimanyu Sakthivelu

Brain & S Ci

mycomic

ayu w - PROBLEM 7 EMERGENCY MEDICINE.pptx

AyuWindyaningrum

Head injury finalized

Hidayat Shariff

HEAD INJURY- AN OVERVIEW Dear viewers, Greetings from “Surgical Educator” Today I have uploaded a video on Head injury- an important topic in trauma because 50% of trauma deaths are due to head injuries. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about pathophysiology, clinical approach, symptoms, signs, investigations, different individual types of head injuries and management of all the varieties of head injuries. My aim is after watching this video all of you should be able to arrive at a correct working diagnosis of the type of head injury and should also be able to institute immediate lifesaving treatment to the patients if there is a need. You can watch the video in the following links: Surgicaleducator.blogspot.com Youtube.com/c/surgicaleducator Thank you for watching the video.

HEAD INJURY- AN OVERVIEW

Selvaraj Balasubramani

neurosurgery.Cns infection.(dr.ali o. sadoon)

student

87801 article text-217748-1-10-20130425

Bhushan Kharche

87801 article text-217748-1-10-20130425 (1)

Bhushan Kharche

head injury

Simmedic UKM

Head injury

Sumit Hadgaonkar

Similar to Head injury: A serious surgical problem. (20)

HEAD INJURY.pptx

Decompressive Craniectomy in Traumatic Brain Injury A Review Article.pptx

Approach to traumatic brain injury

Myths vs facts in head injury

Initial Management of the Trauma Patient II.pptx

Stroke Care of Patient With Post Decompressive Craniectomy

Management Of Head Injury PK anesthesia.pptx

Anaesthesia for posterior fossa surgery

Head Trauma & ICP. SURGICAL AND MEDICAL MANAGEMENT OF

head injury.pptx

Traumatic Brain Injury

Brain & S Ci

ayu w - PROBLEM 7 EMERGENCY MEDICINE.pptx

Head injury finalized

HEAD INJURY- AN OVERVIEW

neurosurgery.Cns infection.(dr.ali o. sadoon)

87801 article text-217748-1-10-20130425

87801 article text-217748-1-10-20130425 (1)

head injury

Head injury

More from KETAN VAGHOLKAR

Meckel’s diverticulum in a hernia sac is designated as a Littre’s hernia. It is an uncommon type of hernia. The diagnosis is invariably made at the time of surgery. Resection anastomosis of the adjacent segment of the small bowel with the diverticulum is a contentious issue. A case of Littre’s hernia is reported. A case of Littre’s hernia in a 17-year-old boy is reported to highlight the diagnostic and therapeutic issues confronting the attending surgeon. A short segment resection anastomosis of the small bowel along with the Meckel’s diverticulum was done. A herniorrhaphy was done with no complications. The diagnostic challenges, the dilemma of selecting the best option for removing Meckel’s diverticulum, and the choice of hernia repair are discussed. Littre’s hernia is invariably diagnosed intraoperatively. A short segment resection anastomosis of the adjacent small bowel and Meckel’s diverticulum prevents complications arising due to the diverticulum. A herniorrhaphy for a young patient and the use of an absorbable mesh for other age groups is advisable.

LITTRE’S HERNIA: A SURGICAL DILEMMA

KETAN VAGHOLKAR

Post-traumatic wounds especially after run over accidents are difficult to manage. The vascularity and regenerative potential of the tissues is severely compromised. Surgical intervention is of limited value. A conservative approach with concomitant hyperbaric oxygen therapy (HBOT) serves as a great salvage in such cases. A case of post-traumatic forefoot gangrene in a 27-year-old laborer is presented to highlight and create an awareness of the potential benefit of HBOT in salvage of distal parts of the lower extremity where the blood supply is severely compromised.

Hyperbaric oxygen therapy a boon for complex post traumatic wounds

KETAN VAGHOLKAR

Deep vein thrombosis (DVT) usually affects the deep vein of the legs, though it may also occur in the veins of the arms, mesenteric and cerebral veins. Venous thromboembolism can cause sudden pulmonary embolism with instantaneous death. In patients who have developed deep vein thrombosis there is likelihood of recurrent thrombosis and post thrombotic syndrome. Deep venous thrombosis is preventable in majority of the cases. Understanding the etiopathogenesis, clinical presentation, evaluation and management is essential for both prevention and management thereby reducing the morbidity and mortality associated with the disease.

Deep Vein Thrombosis

KETAN VAGHOLKAR

Background: Fluid collection in a femoral hernia sac designated as a femorocele is an extremely uncommon surgical condition. Till date 9 cases of unilateral femorocele and one case of bilateral femorocele have been reported in English literature. Objective: Thus making the case presented the second case of bilateral femorocele in English literature. Case report: A case of bilateral femorocele in a patient suffering from rheumatic heat disease who had undergone dual valvular replacement with ascites due to cardiac cirrhosis is presented to highlight the surgical challenges in management of such a rare case. Discussion: Pathophysiology, clinical features, investigations and managemeny of femorocele are discussed. Conclusion: Contrast enhanced CT scan of the abdomen and scrotum is diagnostic. Open surgery in the form of dissection of sac with high ligation followed by obliteration of femoral ring is therapeutic. There is no scope of laparoscopy in such a case.

Bilateral Secondary Femorocele in a Case of Ascites Due to Cardiac Cirrhosis ...

KETAN VAGHOLKAR

Sliding inguinal hernia continues to be the most challenging hernia to treat. Both diagnosis and treatment pose a dilemma to the attending surgeon. Understanding the pathological anatomy of the sliding inguinal hernia is essential for optimal choice of surgical procedure without causing damage to the involved viscera. A case of sliding inguinal hernia is presented to highlight the diagnostic and technical challenges for repair of sliding hernia. Majority of sliding hernias are diagnosed at the time of surgery. Sigmoid colon is a commonest content in a left sided sliding hernia. Bevan’s technique is best suited to deal with the sac followed by Lichtenstein tension-free mesh repair.

Sliding hernia.pdf

KETAN VAGHOLKAR

Gallbladder carcinoma is fifth most common gastrointestinal malignancy. Main indication for cholecystectomy is gallstone disease. Majority of gallbladder carcinomas are diagnosed during the course of histopathological evaluation of specimens obtained at cholecystectomy. Accomplishing radical cholecystectomy is advisable in these patients. Technically difficult gallbladder dissection during the course of laparoscopic surgery should raise a high suspicion of malignancy. Specimen retrieval bags should be used in all cases to avoid external spillage of bile giving rise to port side metastasis. A good outcome depends on prompt diagnosis and radical surgical resection. It is essential for a general surgeon to be aware of predisposing factors, pathology, patterns of presentation, and surgical options in gallbladder carcinoma.

Carcinoma of the gall bladder.pdf

KETAN VAGHOLKAR

Fournier’s gangrene is a severe necrotizing fasciitis affecting the scrotum, perianal and perineal region. Development of this condition after inguinal hernia repair is extremely rare. A 54-year-old diabetic male patient who had undergone right inguinal hernia repair in a private clinic presented with severe necrotizing infection of the scrotum, predominantly of the right side. He was referred to our surgical unit. Initial resuscitation followed by broad spectrum antibiotic therapy and aggressive debridement of necrotic tissue followed by closure of scrotum was performed with excellent outcome. The purpose of presenting this case is to create awareness about this complication after hernia repair surgery especially in cases with comorbidities like diabetes mellitus.

Fournier’s gangrene of the scrotum after inguinal hernia repair: case report

KETAN VAGHOLKAR

Hydrocele of the Canal of Nuck (HCN) is a rare condition seen in adult females. Diagnosis of HCN poses a great challenge to the attending surgeon. There are various variants of embryological abnormality of the processes vaginalis manifesting in different forms. Understanding the embryological development of the processes vaginalis and the gubernaculum in female is therefore essential for determining the best surgical option for treating these rare cases.

Hydrocele of Canal of Nuck.pdf

KETAN VAGHOLKAR

Carbuncle is a confluent folliculitis that is infection affecting multiple hair follicles leading to multiple sinuses discharging pus. It is commonly seen on the back of immuno-compromised patients. Admission to hospital with aggressive treatment, both systemic and locally is necessary. Optimisation of co-morbidities such as diabetes, adequate hydration, and antibiotics and are mainstay of initial treatment. Surgical intervention in the form of debridement and desloughing followed by wound care is the next line of management. Patient education at the time of discharge is necessary for prevention of recurrence.

Carbuncle: A challenging infective lesion

KETAN VAGHOLKAR

Cases of self-inserted foreign bodies into the lower urinary tract are uncommon. They are associated with a mental illness called polyembolokoilomania. The site, size and nature of the foreign body determines both the symptomatology and complications. A case of self-inserted needle into the penile urethra by a 15-year-old boy is presented. A plain X-ray of the pelvis revealed the needle. The needle was successfully removed by cystoscopy. Plane X-ray imaging and CT scan are essential to locate the site, size, and nature of the foreign body. Endoscopic approach is preferred in majority cases. Psychiatric counselling in the post-operative period is required to prevent further episodes of reinsertion of such foreign bodies.

Foreign body in the male urethra: case report

KETAN VAGHOLKAR

Introduction: Morel-Lavalleé lesion is an uncommon closed degloving injury usually affecting the lower extremity. Although these lesions have been documented in literature, yet there is no standard treatment algorithm for the same. A case of Morel-Lavallée lesion following blunt injury to the thigh is therefore presented to highlight the diagnostic and therapeutic challenges in managing such lesions. The aim of presenting the case is to create awareness of clinical presentation, diagnosis, and management of Morel-Lavallée lesions, especially in the setting of polytrauma patients. Case Report: A case of Morel-Lavallée lesion in a 32-year-old male with history of a blunt injury to the right thigh caused by a partial run over accident is presented. A magnetic resonance imaging (MRI) was done to confirm the diagnosis. A limited open approach for evacuating the fluid in the lesion was performed followed by irrigation of the cavity with a combination of 3% hypertonic saline and hydrogen peroxide in order to induce fibrosis to obliterate the dead space. This was followed by continuous negative suction accompanied with a pressure bandage. Conclusion: A high index of suspicion is necessary especially in cases of severe blunt injuries to the extremities. MRI is essential for early diagnosis of Morel-Lavallée lesions. A limited open approach is a safe and effective option for treatment. The use of 3% hypertonic saline along with hydrogen peroxide irrigation of the cavity to induce sclerosis is a novel method for treating the condition.

Morel-Lavallée Lesion: Uncommon Injury often Missed

KETAN VAGHOLKAR

Background: The development of a pseudocyst after mesh repair of an incisional hernia is a rare complication. Both diagnosis and management pose a great challenge to the attending surgeon. Therefore, the need to report such an uncommon complication and its management in order to create awareness of this distinct though rare entity. Case report: A pseudocyst formation following an onlay mesh repair of an incisional hernia is reported. Contrast-enhanced CT scan was diagnostic. It revealed a well-formed cyst with no communication with the peritoneal cavity. Complete excision of the cyst was curative. Conclusion: Pseudocyst formation is a rare complication following mesh repair. Contrast-enhanced CT scan is essential for confirming the diagnosis. Complete surgical resection of the cyst is the mainstay of surgical treatment.

ABDOMINAL WALL PSEUDOCYST COMPLICATING INCISIONAL HERNIA REPAIR

KETAN VAGHOLKAR

Background: Traumatic lumbar hernia is due to shearing of bony insertions of the muscle in the lumbar region. In recurrent cases, there is more attenuation of muscles. This makes fixation of the mesh extremely difficult. Hence, the need to develop a new technique. Case report: A 27-year-old male presented with a recurrent post-traumatic right- sided lumbar hernia. He had a severe two wheeler accident. Following the accident he had undergone various surgical interventions for a fractured pelvis with a deglowing injury involving the right gluteal region and upper thigh. He had also developed a post-traumatic lumbar hernia for which he had undergone open mesh repair. Subsequently he developed recurrence of the post traumatic right-sided lumbar hernia. After complete investigation he underwent open mesh repair for the recurrent post traumatic lumbar hernia. The defect was wide and was devoid of healthy surrounding muscles. The mesh was fixed to the ileal bone with bone anchors and to the twelfth rib with trans-osseous fiber sutures passed through holes drilled in the twelfth rib. Flaps were created from the remnant surrounding attenuated muscles. They were double-breasted to cover the mesh. Postoperative outcome was excellent with no recurrence for the last six months. Discussion: The various anatomical and technical considerations of bone fixation of the mesh for hernia repair are discussed. Conclusion: Bone fixation of the mesh with bone anchors is a viable option especially in cases where there is severe attenuation of adjacent muscles for mesh fixation.

Novel Technique for Mesh Fixation to the Bone in Recurrent Post Traumatic Lum...

KETAN VAGHOLKAR

Background: Acute calculous cholecystitis is one of the commonest biliary tract emergencies. The advent of laparoscopic cholecystectomy has changed the treatment approach from conservative to emergency surgical intervention. As a result, emergency laparoscopic cholecystectomy is emerging as the standard of care. Therefore, the needs to evaluate the various factors that determine the procedure’s safety. Aims: The study aims to evaluate the efficacy and safety of laparoscopic cholecystectomy in acute calculous cholecystitis. Materials and methods: Consecutive patients who underwent laparoscopic cholecystectomy for acute calculous cholecystitis over a 2-year-old period were studied prospectively. Results: 75 patients were evaluated. The mean age was 49.48 years. Majority presented with right hypochondriac pain. 22 patients had hypertension. 26 had diabetes and 6 patients had both hypertension and diabetes. In 61 patients the mean duration of surgery was less than 60 minutes. 5 patients needed conversion to an open procedure. 10 patients developed complications. Mean hospital stay was 4.34 days. Conclusion: Early emergency laparoscopic cholecystectomy is a safe and viable option for treating acute calculous cholecystitis

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS (STUDY OF 75 CA...

KETAN VAGHOLKAR

Lipoma is one of the most common soft tissue tumor arising from the mesenchyme. It is slow growing, encapsulated, and usually benign in nature. Tumors over the back, shoulder, and neck region have a high propensity to assume large size thereby getting redefined as a giant lipoma when they exceed 10 cm in width or weigh more than 1000 grams. MRI is the investigation of choice for evaluating giant lipomas. Fine needle aspiration cytology (FNAC) or frozen section may be pertinent in suspected cases of liposarcoma. Complete surgical incision is the treatment of choice. A case of a giant lipoma on the back of a 64-year-old lady is presented with a view to revisit conceptual understanding of the clinical evaluation, investigation, and management of giant lipomas.

Giant lipoma over the back

KETAN VAGHOLKAR

Background: Appendicectomy is one of the common procedures performed by a general surgeon. However, the advent of laparoscopic appendicectomy has reduced the number of open appendicectomies performed. Therefore there is a need to study the advantages of the laparoscopic approach over the traditional open approach. Aims: The study aimed to compare laparoscopic appendicectomy with open appendicectomy based on various intraoperative and postoperative parameters Materials and methods: 50 patients undergoing interval appendicectomy were randomised into two groups. Group A comprised 25 patients who underwent laparoscopic appendicectomy and group B comprised 25 patients who underwent open appendicectomy. Results: Confirmation of diagnosis and evaluation of intraoperative findings was easier in group A patients. In addition, early commencement of feeds with early bowel movements, reduced need for postoperative analgesia due to less pain, lesser complications and shorter duration of hospital stay was observed in group A patients. Conclusion: Laparoscopic appendicectomy has better outcomes rendering it a preferable procedure for appendicectomy.

LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)

KETAN VAGHOLKAR

Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical intervention for complications is the mainstay of treatment.

ABDOMINAL TUBERCULOSIS (STUDY OF 50 CASES)

KETAN VAGHOLKAR

Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed by clinical and radiological investigations were included in the study and studied prospectively. On admission to the hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented in an advanced stage developed complications. The majority of patients were males. The interval between the onset of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process, were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication. Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.

PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...

KETAN VAGHOLKAR

Background: Skin approximation is a very important step in a surgical operation. The quality of skin approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications. Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation). The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation) had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction. Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.

COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...

KETAN VAGHOLKAR

Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively. Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60 years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B. The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic requirement, early commencement of oral feeds, and shorter duration of hospitalization

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...

KETAN VAGHOLKAR

More from KETAN VAGHOLKAR (20)

LITTRE’S HERNIA: A SURGICAL DILEMMA

Hyperbaric oxygen therapy a boon for complex post traumatic wounds

Deep Vein Thrombosis

Bilateral Secondary Femorocele in a Case of Ascites Due to Cardiac Cirrhosis ...

Sliding hernia.pdf

Carcinoma of the gall bladder.pdf

Fournier’s gangrene of the scrotum after inguinal hernia repair: case report

Hydrocele of Canal of Nuck.pdf

Carbuncle: A challenging infective lesion

Foreign body in the male urethra: case report

Morel-Lavallée Lesion: Uncommon Injury often Missed

ABDOMINAL WALL PSEUDOCYST COMPLICATING INCISIONAL HERNIA REPAIR

Novel Technique for Mesh Fixation to the Bone in Recurrent Post Traumatic Lum...

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS (STUDY OF 75 CA...

Giant lipoma over the back

LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)

ABDOMINAL TUBERCULOSIS (STUDY OF 50 CASES)

PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...

COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...

Recently uploaded

Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High profile Girls VIP Call Girl Pune As Enjoy Never Ending Pune VIP Call Girls is highly qualified professionals. #S10 They will offer only top quality services and never try to scam or drain you of money; in fact, they strive to give complete satisfaction so that each cent spent was worth its worth. Furthermore, these professionals pride themselves in keeping customer details confidential; any information gleaned will never be shared with any third party. Two shots with one girl: ₹4500/in-call, ₹7500/out-call Body to body massage with : ₹5500/in-call Full night for one person: ₹7000/in-call, ₹12000/out-call •𝐂𝐨𝐥𝐥𝐞𝐠𝐞 𝐆𝐢𝐫𝐥𝐬 •𝐇𝐨𝐮𝐬𝐞𝐰𝐢𝐯𝐞𝐬 •𝐇𝐢𝐠𝐡 𝐏𝐫𝐨𝐟𝐢𝐥𝐞 𝐆𝐢𝐫𝐥𝐬 •𝐑𝐚𝐦𝐩 𝐌𝐨𝐝𝐞𝐥𝐬 •𝐅𝐨𝐫𝐞𝐢𝐠𝐧𝐞𝐫 𝐆𝐢𝐫𝐥𝐬 𝐎𝐮𝐫 𝐞𝐬𝐜𝐨𝐫𝐭 𝐬𝐞𝐫𝐯𝐢𝐜𝐞𝐬 •𝐇𝐉 (𝐇𝐚𝐧𝐝 𝐉𝐨𝐛) •𝐁𝐉 (𝐁𝐥𝐨𝐰𝐣𝐨𝐛) # Completion # (Oral To Completion) # Special Massage # O-Level (Oral ) # Oral With A Noncondom) # COB (Come On Body) # Extraball (Have Many Times) # All Meetings 100%Safe Call Payal:-- 9352988975

Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...

chetankumar9855

Top Rated Bangalore Call Girls Mg Road ⟟ ⟟ Call Me For Genuine Sex Service At Affordable Rate Booking Contact Details Whatsapp Chat :+91- These professional and Call girls in Bangalore can satisfy your every desire - be it sensual massage or an erotic shower, they are always more than willing to meet them. Furthermore, they pay close attention to body language cues to ensure you enjoy every minute spent in their company - both in-call and outcall services are offered. Is an excellent choice for anyone seeking an exciting and thrilling night of fun and excitement The Oberoi, Bengaluru Taj West End The Leela Palace Bengaluru JW Marriott Hotel Bengaluru The Ritz-Carlton, Bangalore Sheraton Grand Bangalore Hotel at Brigade Gateway Conrad Bengaluru ITC Gardenia, Bengaluru Renaissance Bengaluru Race Course Hotel The Lalit Ashok Bangalore

Most Beautiful Call Girl in Bangalore Contact on Whatsapp

Inaaya Sharma

☑️░ 9630942363 ░ CALL GIRLS ░ VIP ░ ESCORT ░ SERVICES ░ AGENCY ░ 9630942363 THE GENUINE ESCORT AGENCY VIP LUXURY CALL GIRLS HIGH CLASS MODELS CALL GIRLS GENUINE ESCORT BOOK BOOK APPOINTMENT - 9630942363 THE GENUINE ESCORT AGENCY BEST VIP CALL GIRLS & ESCORTS SERVICE 9630942363 VIP CALL GIRLS ALL TYPE WOMEN AVAILABLE INCALL & OUTCALL BOTH AVAILABLE BOOK NOW 9630942363 VIP GENUINE INDEPENDENT ESCORT AGENCY VIP PRIVATE AUNTIES BEAUTIFUL LOOKING HOT AND SEXT GIRLS AND PARTY TYPE GIRLS YOU WANT SERVICE THEN CALL THIS NUMBER 9630942363 ROOM ALSO PROVIDE HOME & HOTELS SERVICE FULL SAFE AND SECURE WORK WITHOUT CONDOMS, ORAL, SUCKING, LIP TO LIP, ANAL, BACK SHOTS, SEX 69, WITHOUT BLOWJOB AND MUCH MORE FOR BOOKING 9630942363

Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available

GENUINE ESCORT AGENCY

Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Girl UKHBET Escorts Service Available ✔ All Day And Night Booking Details Are here 05-May-2024( Mj) Click On WhatsApp Chat +91-8445551418 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...

parulsinha

Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Rajasthan Booking Details Are here 05-May-2024( Mj) Click On WhatsApp Chat +91-8445551418 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...

parulsinha

8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad

GENUINE ESCORT AGENCY

Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Hyderabad Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Hyderabad Escorts are regular companions of elite gentlemen and can take them places they could only dream of visiting. These ladies take great care in maintaining themselves to look appealing; visiting salons and spas regularly keeps them looking their best; their portfolios can be found online via an escort’s agency website. EXCITING OPTIONS AVAILABLE AT OUR INDEPENDENT ESCORTS Candlelight dinner Evening date Night clubs or parties Hotels or your flats Business trip Business party Stripping party Hyderabad Escort Service are adept at performing wild anal sex, deep throat sex and cum eating - perfect for satisfying all your sexual needs and playing any game imaginable. Affordable professional assistants are readily available and ready to assist with any situation - be it romantic date or solo night. Their beautiful appearances and striking personalities will leave you speechless, while they can accompany you to restaurants or bars where their presence will surely leave an impression.

Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available

Dipal Arora

VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋 Call Mr Chirag Ji +91-7877925207 NORTH/SOUTH INDIANS HIGH CLASS MODELS/COLLEGE GIRLS/ HOUSEWIVES/BODY TO BODY MASSAGE, SANDWICH MASSAGE, SHOWER BATHING, BLOW JOB, LICKING, FRONT AND BACK SHOT, RUBBING, KISSING SMOOCHING ETC ETC... UNLIMITED FUN Call 24/7. Your assistance for your service... ☛ ✔✔ secure✔✔ 100% safe ✔✔ Vip Callgirl Service offers you the most beautiful High Profile sexy independent female Escorts in genuine ✔✔✔ To enjoy with hot and sexy girls ✔✔✔ A03524SW ★providing:- • Models • vip Models • Russian Models • Foreigner Models • TV Actress and Celebrities • Receptionist • Air Hostess • Call Center Working Girls/Women • Hi-Tech Co. Girls/Women • Housewife • Collage Going Girls. • Travelling Escorts. • Ramp-models • Foreigner And Many More.. ★OUR BEST SERVICES: - FOR BOOKING ★ A-Level (5 star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)

VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋

TANUJA PANDEY

(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Celebrity for 5* Hotels Booking Details Are here 05-May-2024( Mj) Click On WhatsApp Chat +91-8445551418 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...

parulsinha

Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Profile Most Luxurious Call Girl With Real Photos Booking Details Are here 05-May-2024( Mj) Click On WhatsApp Chat +91-8445551418 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...

parulsinha

Call Girls Jaipur Just Call 9521753030 Top Class Call Girl Service Available ★> Whatsapp Number-9521753030 <★ ★ CALL US High Class Luxury and Premium Escort Service We Provide Well Educated,Royal Class Female,High-Class Escort Service Offering a Top High Class Escort Service In The & Several Nearby All Places of . ★ To Enjoy With Hot and Sexy Girls . ★ We Are Providing :- • 3* 5* 7*Hotels Service in • Hygienic Full AC Neat and Clean Rooms Avail. • Daily New Escorts Staff Available • Minimum to Maximum Range Available. Our escort service •BJ (Blowjob) •FK (French kissing) •Kissing with tongue •O-Level (Oral sex) •Long Silky Brown Hair •69 (69 sex) •A-Level (5 start Escort) •Dating

Call Girls Jaipur Just Call 9521753030 Top Class Call Girl Service Available

Janvi Singh

Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts | 100% verified Why you Choose Us- +91-7427069034 Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable I Have Extremely Beautiful Broad Minded Cute Sexy & Hot Call Girls and Escorts, We Are Located in 3* 4* 5* Hotels. Safe & Secure High Class Services Affordable Rate 100% Satisfaction, Unlimited Enjoyment. Any Time for Model/Teens Escort in Delhi High class luxury and premium escorts agency. ★ CALL US High Class Luxury and Premium Escort Service We Provide Well Educated,Royal Class Female,High-Class Escort Service Offering a Top High Class Escort Service In The & Several Nearby All Places of . A060524ST ★ To Enjoy With Hot and Sexy Girls . ★ We Are Providing :- • 3* 5* 7*Hotels Service • Hygienic Full AC Neat and Clean Rooms Avail. • Daily New Escorts Staff Available • Minimum to Maximum Range Available. Our escort service •BJ (Blowjob) •FK (French kissing) •Kissing with tongue •O-Level (Oral sex) •Long Silky Brown Hair •69 (69 sex) •A-Level (5 start Escort) •Dating

Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...

chennailover

All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP Call Girl At Their Home & Hotels Booking Contact Details WhatsApp Chat: +91-9820252231 Mumbai Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable. Independent Escorts Mumbai understands the value of confidentiality and discretion - they will go the extra mile to meet your needs. Simply contact them via text messaging or through their online profiles; they'd be more than delighted to accommodate any request or arrange a romantic date or fun-filled night together. We provide - Flexibility Choices and options Lists of many beauty fantasies Turn your dream into reality Perfect companionship Cheap and convenient In-call and Out-call services And many more. 01-05-24 (Smt)

All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...

Arohi Goyal

Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine Sex Service At Affordable Rate Booking Contact Details WhatsApp Chat: +91-9332606886 Hyderabad Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable Independent Escorts Hyderabad understands the value of confidentiality and discretion - they will go the extra mile to meet your needs. Simply contact them via text messaging or through their online profiles; they'd be more than delighted to accommodate any request or arrange a romantic date or fun-filled night together. We provide - Flexibility Choices and options Lists of many beauty fantasies Turn your dream into reality Perfect companionship Cheap and convenient In-call and Out-call services And many more. 02-May(Ast)

Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...

chandars293

Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 100% verified Why you Choose Us- +91-7427069034 Escort Service includes providing maximum physical satisfaction to their clients as well as engaging conversation that keeps your time enjoyable and entertaining. Plus they look fabulously elegant; making an impressionable I Have Extremely Beautiful Broad Minded Cute Sexy & Hot Call Girls and Escorts, We Are Located in 3* 4* 5* Hotels. Safe & Secure High Class Services Affordable Rate 100% Satisfaction, Unlimited Enjoyment. Any Time for Model/Teens Escort in Delhi High class luxury and premium escorts agency. ★ CALL US High Class Luxury and Premium Escort Service We Provide Well Educated,Royal Class Female,High-Class Escort Service Offering a Top High Class Escort Service In The & Several Nearby All Places of . ★ To Enjoy With Hot and Sexy Girls . ★ We Are Providing :- • 3* 5* 7*Hotels Service • Hygienic Full AC Neat and Clean Rooms Avail. • Daily New Escorts Staff Available • Minimum to Maximum Range Available. Our escort service •BJ (Blowjob) •FK (French kissing) •Kissing with tongue •O-Level (Oral sex) •Long Silky Brown Hair •69 (69 sex) •A-Level (5 start Escort) •Dating 03-May(Ast)

Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...

chennailover

"Call Girls Indore VIP Service.. Booking Open Now We Are Providing Safe & Secure High Class girl women sucking men Services Affordable Rate 100% Satisfaction, Unlimited Enjoyment. Any Time for Model/ women seeking men in royal call girl High class luxury and premium call girl agency. ✔️High class luxury and premium escorts agency We Provide Well Educated, Royal Class Female, High-class Escorts agency offering a top high class escort service in the royal Escorts ✔️ Get High Profile queens , Well Educated , Good Looking , Full Cooperative Model Services. you can see me at my comfortable Hotels or I can visit you in hotel Our Service Available IN All Services 3/5/7 Star Hotels, In call /Out call Service 24/7.. ✔️ All Meetings We Provide Hottest Female With Me Are Safe And Consensual With Most Limits Respected Complete Satisfaction Guaranteed...Service Available In:- 24/7 3 * 5 *7 *Star Hotel Service In. In Call Out call service Avilable also. ✔️ I guarantee you to have an unforgettable experience with me A curvy body, long hair and silky smooth skin. She is an independent royal Escorts/Women Seeking Men model will give you more pleasure & Full satisfaction. ✔️ I am very sensual and flirtatious with charming personality! I love to laugh and my bright smile is ever Present. ,Hotel & Home Services CALL PLZZ ✔️Available Near All 3* 4* 5* 7* Hotels Of I Want Only Hotel Name , Guest Name , Room No. Only For Confirmation.✔️ Nandani... agency...⭐⭐⭐⭐⭐ VIP...Service ✣ ✤ ✥ ✦ TIME WASTERS AND BARGAINERS ARE PLEASE EXCUSE, WE RESPECT YOUR SAFETY AND PRIVACY AND EXPECT TH WHATSAPP CALL ME "

Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...

mahaiklolahd

💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lonely Housewife In Top Rated Hotel WhatsApp Chat : +91-9257276172 Get More Information About Jaipur Escorts Service Jaipur Escorts offer their services to their clients at any time of day or night - including sex, travel and tours. Contact them via telephone or the internet. Hire an escort as your movie partner, date or party companion - they're sure to exceed all your expectations. Girls available 24/7 make for great companions who offer sensual body massages and drinks/food service during your time together. Find one who fits with your personality or budget - these girls have you covered.

💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...

khalifaescort01

Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Rajasthan Booking Details Are here 05-May-2024( Mj) Click On WhatsApp Chat +91-9521753030 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...

khalifaescort01

🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In Hyderabad Escorts Service Escorts Service Available Whatsapp Chaya ☎️ : [+91-9352852248 ] Escorts Service Hyderabad are always ready to make their clients happy. Their exotic looks and sexy personalities are sure to turn heads. You can enjoy with them, including massages and erotic encounters.#P12Our area Escorts are young and sexy, so you can expect to have an exotic time with them. They are trained to satiate your naughty nerves and they can handle anything that you want. They are also intelligent, so they know how to make you feel comfortable and relaxed SERVICE ✅ ❣️ ⭐➡️HOT & SEXY MODELS // COLLEGE GIRLS HOUSE WIFE RUSSIAN , AIR HOSTES ,VIP MODELS . AVAILABLE FOR COMPLETE ENJOYMENT WITH HIGH PROFILE INDIAN MODEL AVAILABLE HOTEL & HOME ★ SAFE AND SECURE HIGH CLASS SERVICE AFFORDABLE RATE ★ SATISFACTION,UNLIMITED ENJOYMENT. ★ All Meetings are confidential and no information is provided to any one at any cost. ★ EXCLUSIVE PROFILes Are Safe and Consensual with Most Limits Respected ★ Service Available In: - HOME & HOTEL Star Hotel Service .In Call & Out call SeRvIcEs : ★ A-Level (star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)Receive advanced sexual techniques in different mode make their life more pleasurable. ★ Spending time in hotel rooms ★ BJ (Blowjob Without a Condom) ★ Completion (Oral to completion) ★ Covered (Covered blowjob Without condom ★ANAL SERVICES.

🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...

Call Girls In Delhi Whatsup 9873940964 Enjoy Unlimited Pleasure

Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Service Available Call Mrs Leela Ji +91-8005736733 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Kolkata Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In Kolkata C010524HD Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 8005736733 !! Thank you for Visiting.

Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...

Namrata Singh

Recently uploaded (20)