1. 28/2/2023
Surgeon : Mr Gan
MO : Nabilah, Kamal
PREOP MEETING

2. NO NAME DIAGNOSIS OPERATION
1 Anisah binti Arif
SB01226854
Symptomatic
cholelithiasis
Laparoscopic
cholecystectomy
2 Tan Beng Wah
SB01200991
Left ingunal hernia Left open hernioplasty
3 Perumal A/L Kathan
SB00819853
Left inguinoscrotal
hernia
Left open hernioplasty
4 Wong Kok Mun
SB00006413
Left ingunak hernia Left open hernioplasty

3. 1. Anisah binti Arif, SB01226854
● Anisah, 42 year old lady
U/L HTN on amlodipine 5 mg OD
● Diagnosis: Symptomatic cholelithiasis
● Operation: Laparoscopic cholecystectomy
● Presented with abdominal cramping x 1/12
intermittent pain
no vomiting
no jaundice
no obstructive jaundice sx
● Went to Klinik adham private – Done USG abdomen
Gall bladder : Multiple large gall bladder stone with
posterior shadowing
No evidence of emphysematous gall bladder
Liver with fatty infiltration
CBD not dilated
Globular uterus
imp : Cholelithiasis
● OE: alert pink walk in
abd soft non tender , no mass palpable
not in pain
● USG HBS 16/12/22
● The liver shows mild increase in echogenicity. Its edges
are sharp and margins smooth. No focal liver lesion.
The gallbladder is distended with multiple stones within,
largest measures 1.6cm in diameter. No gallbladder wall
thickening or pericholecystic fluid.
No dilated intrahepatic or extrahepatic biliary ducts.
The portal vein is patent and normal in calibre.
The visualised pancreas and spleen appears normal.
The kidneys are of normal size and echogenicity. No
calculi or hydronephrosis bilaterally.
The right kidney BPL/PT: 9.6cm/1.5cm.
The left kidney BPL/PT: 9.5cm/1.4cm.
The urinary bladder is partially distended. No stone
within.
The uterus is bulky with multiple isoechoic lesions within,
largest measures 2.5 x 3.3 x 3.7cm (AP x W x CC).
Impression:
1. Mild fatty liver.
2. Cholelithiasis.
3. Multiple heterogenous isooechoic uterine lesions, likely
uterine fibroids. Suggest gynaecological evaluation.
● LFT (29/12/22): ALT 9, AST 14, total bilirubin 17, Total
prot Albumin 41
● LFT (14/2/23): ALT 8, AST 11, ALP 95, total bilirubin 19,
Total protein 76, Albumin 42

4. PAC (20/2/23)
● Comfortable
no failure symptoms
denies heat intolerance / palpitations / diarrhea / chest pain
no more abdominal pain
BP: 137/87
PR: 116 ( patient claims to be white coat anxiousness )
● plan: <D/W Dr Zezy >
to send TFT to rule out hyperthyroidism
for op as planned under GA
anaes to rv 1/7 prior op
to serve T. Midazolam 7.5mg ON 1/7 prior op and upon OT call
covid rtk (72 hours validity )
● TFT: T4 15.6, TSH 2.04

5. 2. Tan Beng Wah, SB01200991
● Tan Beng Wah
67 year old/ male
● Diagnosis: Left inguinal hernia
● Op planned: Left open hernioplasty
● Issue under surgical:
● BPH
Ix at private centre: PSA: 2.54
● Currently on T. Tamsulosin 0.4mg OD
since March 2022
● Upon review in SOPD
no more urinary issues
left inguinal hernia manually reducible
(since March 2022)
● PSA (28/7/22): 0.98
● ULTRASOUND KUB ON 10.01.23.
Indication:
66 years old, chinese, male, came with
prostatomegaly symptoms, and LUTS
symptoms.
Findings:
Both kidneys are normal in size and
echogenicity.
BPL RK/LK: 9.2cm / 9.5cm.
Parenchymal thickness RK/LK: 1.5cm/
1.7cm.
No focal renal lesion.
No stone or hydronephrosis bilaterall
Urinary bladder is well distended. No
bladder wall thickening. No calculi seen
within.
Prostate is not enlarged with volume of
13mls.
Impression:
No significant abnormality.

6. PAC (9/2/23)
● Plan:
Aim for op under SAB
If need to convert to GA, to prepare for possible difficult intubation
anaes team to review patient again in ward 1 day prior to op

7. 3. Perumal A/L Kathan, SB00819853
● 75 year old gentleman
● Diagnosis: Left inguinoscrotal hernia
● Operation: left open hernioplasty
● U/L LV clot started on t. warfarin since april 2022
- previously planned for op for left hernia repair in
Hospital Selayang noted ECG changes during pre op
assessment
● Echo (20/04/2022) noted apical clot seen over LV
measuring 4.3cm2
EF estimate : 25-30%
- cont T.warfarin possible lifelong
● Repeated Echo on (21/10/2022)
LV THROMBUS 2.2CM X 1.8CM at
LV APICAL SEPTAL
LV THINING
mild MR
DYSTOLIC Function GRADE 1
RV SYSTOLIC Function TYPEC, 1.8 CM
IVC 1.5CM MORE THAN 50% CONTRACTIBILITY INDEX
NO VEGETATION
● History of left inguinal swelling for past 10 years
exacerbated with cough and heavy lifting and
prolonged standing
worsening of symptoms recently
associated with occasional pain
BO and PU normal
● Risk factor: previously work as oil palm estate,
history of carying weight
Currently
keeping well
claim the swelling is reducible spontaneously
BO an PU normal
no abdominal pain
● Examination:
Noted Left inguinal-scrotal swelling measuring
6x5cm, completely reducible,cough impulse +ve,
no pain, bilateral testes palpable

8. PAC (27/1/23)
● Plans:
- to admit pt to ward at
least 5 days earlier for
bridging therapy
- for primary team to refer
back to medical for GA
cardiac assessment and
bridging therapy prior to op
- if proceed, op is to be
done under GA
- for high risk consent
- for icu back up
- to repeat fbc, rp, trop-i
and coag on admission
- anaest to review in ward
prior to op
● Review in SOPD:
● PLAN (d/w Mr Ashok)
proceed op as planned on
28/2/23
to admit 5 days prior on
23/2/23
to refer medical in ward
for bridging therapy

9. 4. Wong Kok Mun, SB00006413
● 54 year old gentleman
● Underlying :
1. RVD
-latest CD4 > 500
- VL<20 many years
● Diagnosis: Left inguinal hernia
● Operation: Left open hernioplasty
● On and off will have left sided inguinal
hernia for the past 1 year
Left dragging pain
No obstructive symptoms
● On examination: Left sided inguinoscrotal
hernia 4cm x 4cm
Reducible
Cough impulse present
Skin over swelling healthy
● PAC (22/2/23)
● Plan :
Proceed op as planned on 28/2/2023
For anaest to review and take anaest
consent in ward
To take RTK covid prior op
Repeat full bloods investigations and
ECG prior op