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Ravikumar G., Manoharan R., Jenifer P.
Published: 27 October 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174680

Abstract:
Background: Agriculture remains the most important occupation in India and upper limb injuries occur frequently in agricultural accidents. Agriculture related injuries are important causes of mortality and morbidity in all age groups. These injuries result in major physical and psychological impacts as well as economical burdens. Objectives of the study was to study the pattern and epidemiological basis of agricultural hand injuries, to analyse the prognosis and recovery pattern of agricultural hand injuries in terms of return to work following treatment and to suggest measures for prevention of agricultural hand injuries.Methods: The study was a descriptive study conducted in the department of plastic and reconstructive surgery, Thanjavur medical college from October 2012 to April 2017. About 220 patients admitted with agricultural upper limb injuries were evaluated. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated.Results: Agricultural upper limb injuries constituted about 11.25% of total upper extremity trauma. Males were more commonly affected than females. Majority of the patients were in the age group 21-50. Most of the patients were right handed individuals. Hand injuries were more common (73%).Conclusions: We can reduce agricultural upper limb injuries by shielding the rotating components of farming machinery that cause injuries, informing and educating farming families, forbidding the entrance of children to areas with agricultural machines, providing information about agricultural accidents and their prevention methods, and adjusting the working hours of farming personnel, especially in the hottest months of the year.
Ali Hussein Abid, Ehab Jasim Mohammad, Alaa Abdulqader Abdulrazaq
Published: 27 October 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174681

Abstract:
Background: Incidental carcinoma of the prostate is very important is one of the major life-threatening condition for men at all ages. The incidence was found to increase with age. The aim of this study was to evaluate prostatic autopsy samples from Iraqi men over 50 years of age.Methods: 100 autopsy samples of whole prostate were collected from the Institute of Forensic Medicine in Baghdad. All the autopsy cases over 50 years of age died from causes unrelated to prostatic disease.Results: Age ranges from 50-80 years and the mean age was 59.3 years. Benign prostatic hyperplasia was the common pathological finding (92%). Forty-eight cases of benign prostatic hyperplasia were associated with chronic non-specific prostatitis (CNP), 6 cases were associated with low grade prostatic intraepithelial neoplasia and 2 cases with infarction and 6 cases of low grade prostatic intraepithelial neoplasia. Prostatic adenocarcinoma was detected in 6% of the cases. The mean weight was 39.9gm. The mean ellipsoid volume was 34.9cm3. The mean spheroid volume was 36.1cm3. The majority of benign prostatic hyperplasia cases were found in the 6th decade.Conclusions: From the present study, we can conclude that the majority of cases were in the 6th decade, benign prostatic hyperplasia was the most common finding, the most common association with benign prostatic hyperplasia was chronic nonspecific prostatitis, a low frequency of prostatic carcinoma and it was not associated with benign prostatic hyperplasia.
Navjot Singh Brar, Rajbir Singh Bajwa
Published: 27 October 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174676

Abstract:
Background: Hernia may be generally defined as a protrusion of viscus or part of a viscus though an abnormal opening in the walls of its containing cavity. The Greek word ‘hernia’ means an offshoot, a budding or bulge. But the Latin word ‘hernia’ means a rupture or tear. The most important principle in reconstruction surgery is to avoid tension when restoring the muscular or elastic structures. The modern biologically based concept for repair of groin hernia, acquired during adult life, is application of a patch, avoidance of tension and use of local, spinal or epidermal anaesthesia.Methods: Present study is a Prospective study conducted in the Department of General Surgery in Sri Guru Ramdas Medical College and Hospital. Patients admitted in wards with inguinal hernia from General Surgery out-patient Department were selected for study. The study consisted of 60 patients between 15 to 74 years; The study period is from April 2015 to September 2016. The main aim and objective of any hernia repair is to avoid any recurrence and also acceptability to the patient in terms of pain, discomfort, other complications during follow up and obviously in terms of cost- effectiveness of repair.Results: The present study comprises 60 cases of inguinal hernia who were admitted in the wards of Department of General Surgery in the Sri Guru Ramdas Institute of Medical sciences and research. The study was carried out during span of 1½ years. All of these cases were studied prospectively and results were analysed from various angles. Among total 60 cases in this study, maximum cases belonged to age group 35-44 years ;15 (25%) and minimum to age group 65-74 years 5 (8.3%). Case distribution as per type of hernia, it was observed that among total 60 cases 34 (56.67%)had inguinal hernia and rest 26 (43.3%) had inguino scrotal hernia. Most 0f the cases had right sided hernia 35 (58.33%), left sided hernia was seen only in 23 cases (38.33%) whereas bilateral hernia was present in 2 (3.33%).Conclusions: From our results of observations in the study we can conclude that-The methods of Lichtenstein’s tension free inguinal hernioplasty under local anaesthesia is safe, simple, effective, economical, and without any side effects such as hypotension, nausea, vomiting, urinary retention, and spinal headache.
Himabindu Bangaru, Alluru Sarath Chandra, Varun Vijay Gaiki
Published: 27 October 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174658

Abstract:
Background: With increased awareness about breast cancer, many women with breast lumps are attending clinics. Though benign breast lumps are most common, they may be associated with morbidity and have become cause for concern to patients. Triple assessment by clinical, radiological and pathological examination is a standard approach in the evaluation of breast lumps. Even in cases of benign breast diseases, multimodality tests are being preferred to give reassurance to patients. This study was aimed to study distribution of various benign breast lumps in relation to age at presentation, to identify sensitivity and specificity of clinical breast examination, Ultrasonography (USG) and Fine needle aspiration cytology (FNAC) methods in the evaluation of benign breast lumps and to compare with final histopathological diagnosis.Methods: A retrospective study was conducted in department of general surgery at Malla Reddy institute of medical sciences, Hyderabad from August 2013 to July 2017. 202 females with benign breast lumps were evaluated by clinical breast examination, ultrasonography (USG) and Fine needle aspiration cytology (FNAC) methods. All patients underwent excision biopsy of lump. Final histopathological report was taken as reference standard.Results: Fibroadenoma was most common in 2nd decade. Clinical breast examination and USG showed good sensitivity but less specificity than FNAC. FNAC showed both good sensitivity and specificity. There was very good degree of agreement between FNAC and histopathological diagnosis (Kappa=0.911).Conclusions: Good clinical examination can give accurate preoperative diagnosis of benign breast lumps. Triple assessment by clinical breast examination, USG and FNAC can be useful in the evaluation of benign breast lumps.
, T. P. Karthikeyan, K. Balaji Singh, T. Arulappan
Published: 27 October 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174654

Abstract:
Background: Parotid gland is the largest of the salivary glands present in the body. Neoplastic lesions in parotid gland always causes difficulty in tissue diagnosis due to their diversified histology. Lesion in the superficial lobe of parotid is more amenable for clinical diagnosis but deep lobe lesion requires imaging to confirm the diagnosis. Managing parotid swelling seems like a mystery due to these issues.Methods: There were 30 patients who presented with complaints of swelling in the parotid region. For all these patients detailed history was taken and clinical examination was done and findings noted. Contract enhanced computed tomography (CECT) of the parotid region was done followed by fine needle aspiration cytology (FNAC) and the management was planned accordingly.Results: All the 30 patients were within the age group of 25 years to 65 years. All the patients presented with swelling in the parotid region. Among the 30 patients, 10 patients had complaints of associated pain in the parotid region. On clinical examination, all the patients had lesion in the superficial lobe of parotid and 2 patients had deep lobe involvement. 1 patient had features of facial nerve palsy. Contrast enhanced computed tomography (CECT) and Fine needle aspiration cytology (FNAC) was done. For all the patients’ surgical management was planned accordingly.Conclusions: Routinely submitting all parotid swelling patients to Fine needle aspiration cytology and computed tomography helps to solve the mystery of diversified histology and presentation.
Ganni Bhaskara Rao, Samir Ranjan Nayak, Sepuri Bala Ravi Teja, Reshma Palacharla
Published: 27 October 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174636

Abstract:
Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.
Emad Gomaa, Magdy Khalil Abdel Mageed
Published: 27 October 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174637

Abstract:
Background: In some hematological diseases, the spleen may become enlarged, inflamed and causes destruction of normal blood elements. Laparoscopic splenectomy (LS) was first prescribed in 1991 by Delaitre et al and since that date, it gained a steadily increasing worldwide agreement as an option for splenectomy in patients with hematological diseases. It was reported that this can be performed safely and effectively, with lower incidence of morbidity and mortality. The objective of the study was to compare laparoscopic with open splenectomy as regard its benefits and hazards in haematological diseases.Methods: This prospective study had been conducted in General Surgery Department, Sohag Faculty of Medicine. The study included patients with haematological diseases indicated for elective splenectomy, during the period from January 2015 to June 2017. Twenty patients were included for open surgery (OS) and 20 cases were included for laparoscopic splenectomy (LS).Results: Surgical time was significantly longer in LS than OS group. There was significant correlation between surgical time and splenic size in both groups. Most of the LS patients had been operated upon using the anterior approach (65%). Hospital stay after operation in the LS group was much less than the OS group. Return of off-bed activities, bowel movements, oral intake and drain removal were longer but not significantly different compared to LS figures.Conclusions: Laparoscopic splenectomy for haematological indications can be done safely for the properly selected patients with less blood loss and hospital stay but it requires more operative time as compared to conventional splenectomy.
Bopaiah K. S., Shreykumar P. Shah
Published: 27 October 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174638

Abstract:
Post traumatic Sinus/cerebral venous thrombosis is a rare entity. A high index of suspicion is required as the prognosis is poor in this clinical setting, in view of the effects of the head injury. We report 2 cases of the patient worsening acutely after initial recovery from trauma. The etiology and pathogenesis in such cases are varied and hypothetical with no definite underlying cause identified. Cerebral venous thrombosis (CVT) as an etiology of headache is not always easy to diagnose unless suspected, and in any patient with head injury and delayed deterioration after initial recovery, post traumatic Cerebral venous thrombosis should be kept as a differential diagnosis.
Reshma S., Vijai R., Chakarvarthy N.
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174530

Abstract:
Poland’s syndrome is a rare congenital condition. It is classically characterized by absence of unilateral chest wall muscles and sometimes ipsilateral symbrachydactyly (abnormally short and webbed fingers). The condition typically presents with unilateral absence of the sternal or breast bone portion of the pectoralis major muscle which may or may not be associated with the absence of nearby musculoskeletal structures. We report a 25-year-old male patient with typical features of Poland’s syndrome. To the best of our knowledge, this is the first documented case of a patient with Poland’s syndrome reported from Chennai.
Ramalingam Aishwin Saravana Kumar, Selvaraj Vishnuvarthan
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3347-3349; https://doi.org/10.18203/2349-2902.isj20174493

Abstract:
Background: Lateral internal sphincterotomy is the only choice in the treatment of the fissure in ano. Complete and partial sphincterotomy was followed in variable individuals. But post-operative complication like incontinence, early mobilization and early recovery is to be made into account for best results among these patients.Methods: This study is made in 2015-2016 period among 52 patients with chronic fissure in ano, partial sphincterotomy i.e., division of internal sphincter below the dentate line was performed. Post-operative follows up and symptoms were recorded, in such cases treated adequately. The period of revisit was decided according to patient compliance 1 month, 3months, 6 months. The data was collected prospectively and recorded in view of change in the treatment.Results: 47 of the patients were pain free within first 5 days of surgery. Remaining 5 patients required further division for pain relief due to persistent pain after 3 weeks. The associated post-operative complication among these patients was itching due to burning sensation in and around the anus which resolved later. None among these patients developed fecal incontinence.Conclusions: Among all age group of the patients included in this study were subjected to same type of the procedure and results were recorded to give better prognosis with lowest degree of recurrence for which repeat of the same procedure gave the complete relief. Lateral internal partial sphincterotomy is an effective technique for complete relief of pain in chronic fissure in ano.
Senthil Kumar A. C., Rajesh S.
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174517

Abstract:
Background: Historically surgery for nodes in carcinoma penis was done as staged procedure due to fear of higher morbidity and longer hospital stay. However, in view of the established safety of the simultaneous procedure, very few centres do simultaneous surgery for nodes and primary in cancer penis.Methods: A retrospective analysis of all the simultaneous surgeries for nodes and primary for carcinoma penis done at our hospital, during the period April 2015 to March 2017 were done and various parameters were calculated and compared with historical standards of various series.Results: The various parameters namely wound morbidity, hospital stay and complications were analysed and compared with historical standards. A total of 15 patients during the above mentioned were found to be suitable for the analysis after having excluded patients who had previous therapy and inoperable tumours. The mean follows up period was 12 months (ranging from 8 to 20 months). The mean hospital stay was 15 days (range from 12 days to 25 days). The skin margin necrosis rate was 6.67%, wound infection rate was 6.67% and there were no perioperative deaths. The same was compared with historical standards.Conclusions: Simultaneous surgery for primary and nodes in carcinoma penis is safe and the standard results are reproducible in a rural tertiary medical centre like ours.
Shruthikamal V., Reshma S., Rajesh S.
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3546-3547; https://doi.org/10.18203/2349-2902.isj20174536

Abstract:
Adenoid Cystic carcinoma of the breast is a rare neoplasm accounting for 0.1% of breast carcinomas, and presenting most commonly as a painful breast lump. In contrast to the aggressive nature of adenoid cystic carcinoma at other sites, adenoid cystic carcinoma of the breast has a favourable prognosis, lymph node involvement or distant metastases seldom occur. Treatment is basically of modified radical mastectomy. Chemotherapy, radio therapy and hormonal treatment have been infrequently used. We report a case of 60 years old woman with adenoid cystic carcinoma of the right breast managed with MRM.
Devendra K. Prajapati, Salil Mahajan
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174535

Abstract:
Lipoma is universal and abundantly located benign soft tissue tumor, which is composed of fat cells. These tumors often develop where adipose tissue is predominant. Lipomas are soft to firm/cystic, usually movable, and painless. They grow very slowly, and have rarely found to be cancerous. However, these are rarely localized in the plantar aspect of the foot. Here we find out a large benign tumor located in the planter surface of foot, finally diagnosed by histopathological examination.
Prabhat Nichkaode, Shusrut Bhukte, Aakash Bandhe
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174500

Abstract:
Background: Varieties of pancreatic pathologies, needs resection of pancreatic tissue. Adenocarcinoma of the pancreatic duct is the most common malignancy presenting with early metastasis and seen as resistant to alternative treatment regimens currently available. Management and handling of such tumors is a complex and challenging task for a surgeon. Surgical resection offers an improved prognosis, with a median survival after resection of 14-20 months and up to 25% 5-year survival rates. Present study is aimed at presenting data of 62 pancreatic resections for various malignant pancreatic lesions.Methods: This is an ongoing longitudinal study which started in 2009 at teaching institute in central India. Though we had 109 patients for pancreatic resection, only 62 patients were considered suitable for the study. All patients after admission were thoroughly investigated and then considered for surgery. 48 patients were male and 14 patients were female. Age group was ranging from 33 to 65 years with mean age between 45 to 55 years. Spectrum of various malignancies and different types of pancreatic resections were done and results are presented here.Results: Pancreatic adenocarcinoma is an aggressive malignancy responds to surgical treatment better than other alternative modalities. In the present series out of 62 patients 27 patients with pancreatic head cancer, 22 patients with periampullary cancer, 2 patients with duodenal cancer, 6 patients with distal cholangio carcinoma, 1 patient with mucinous cystadenocarcinoma. 4 patients with body and tail of pancreas cancer. Average age 38 to 65 years, 47 males and 15 females. Commonest procedure was Whipple’s operation, and distal pancreatectomy. Survival in present series was 18 -24 months and 5-year survival was 12 % that is seen mainly with Periampullary cancer.Conclusions: Surgery is the only chance of cure or long-term survival in pancreatic cancer. Chemo radiation as a primary therapy is ineffective. But some reports suggest the improved quality of life with palliative chemotherapy. Biology of the disease is the king and dictates the survival, the type of surgical procedure had no impact on survival, nor on morbidity and mortality.
Siripong Sirikurnpiboon, Chotirot Angkurawaranon, Ratchamon Pinyoteppratarn, Kasidin Vitoopinyoparb, Bunlung Muyphuag, Suchart Chantawibul, Thawee Ratanachu-Ek
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174489

Abstract:
Background: Ligation at the root of the inferior mesenteric artery (IMA) or ‘high-tie’ is widely accepted during oncologic resection of sigmoid colon cancer surgery. However, IMA ligation may compromise the anastomotic blood supply and risk injury to autonomic nerve plexus. The preservation of IMA or ‘low-tie’ may lead to increase blood flow and decrease postoperative bowel complications, nevertheless require longer operative time and technical difficulties. This study aims to compare the results between laparoscopic sigmoidectomy with selective sigmoidal artery ligation (group A) and low-ligation IMA (group B).Methods: A 1:2 case-matched comparative study and retrospective review of 27 patients with sigmoid cancer (19 female and 8 male) who underwent laparoscopic sigmoidectomy between January 2012 to December 2015. There were 9 patients in group A and 18 patients in group B. Perioperative results were collected and follow-up was recorded at 6 and 12 months after surgery.Results: There were no difference in the mean operative time {group A 194.44 (+28.77), group B 178.89 (+55.52), p=0.349}, blood loss {group A 94.44 (+52.71), group B 79.44 (+58.15), p=0.51}, and mean numbers of harvested lymph nodes {group A 14.56 (+3.74), group B 17.56 (+7.64), p=0.183}. Three patients in group B experienced a short period of stool frequency (2-4 weeks postoperative) and one with constipation. No leakage, bleeding, or tumor recurrence occurred in both groups during the 1 year follow up.Conclusions: Laparoscopic sigmoidectomy with selective sigmoidal artery ligation and lymph node dissection allows equivalent short-term oncologic results to low-ligation IMA technique.
Tushar Goel, Sameer Bhate
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174537

Abstract:
Impalement thoracic injuries are rare of great importance due to severity and high chances of mortality. It is essential to prevent possible vascular injury by the object avoiding major haemorrhage. This study’s primary objective is to discuss 22-year-old male patient admitted in emergency with impaling thoracic trauma by metallic sharp object post battery blast at home. X-ray reveals linear foreign body: penetrating thorax and lung. CT Chest was done and assessment was made for further management with cardiothoracic department. Patient details were collected by patient’s IPD file. Complete detailed history, patient vitals, hemogram, ABO, ABG, CXR along with USG chest and abdomen and CECT chest was done. Post op daily chest X-ray and hemogram along with chest physiotherapy and spirometry was done. Treatment diagnosis was impaled linear foreign body penetrating thorax and lung, patient was shifted to OT, under GA sternotomy was performed. Foreign object passing just lateral to subclavian penetrating upper pole of lung was identified and under specific vision pulled out carefully through entry wound keeping in mind vascular trauma. Necrosed lung part was stapled and wedge resected, on POD 8 patient was discharged with satisfactory condition. Impalement thoracic traumas are rare and have high mortality. Selection of line of treatment is necessary. Indication of surgery under high risk is performed for further trauma. In our case sternotomy was planned and under specific vision impaled object which was passing just by subclavian penetrating through lung was removed safely and patient went home in good condition.
Manish Bansal, Sameer Gupta, Kanika Goel, Sulbha Mittal
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3564-3566; https://doi.org/10.18203/2349-2902.isj20174541

Abstract:
Gastrointestinal stromal tumours (GISTs) are mesenchymal tumors arising in the gastrointestinal tract (GIT). In GIT, the most common site of presentation is stomach followed by small intestine, colon, rectum and oesophagus. Here we report a rare case of intraluminal jejunal GIST with history of pain abdomen, occasional vomiting and GI bleed. Patient was taken up for exploratory laparotomy. Intraoperative findings revealed a hard-nodular growth in antimesenteric border of jejunum, 5 cm distal to duodenojejunal flexure (DJ) partially obstructing the lumen. Anastomosis was quite difficult due to presence of growth near DJ flexure and chances of leak were high. The patient had an uneventful postoperative course and doing well after 1 year of follow up with no recurrence.
, Ihsan Dogan, Onur Ozgural, , Suha Beton, Agahan Unlu
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3519-3522; https://doi.org/10.18203/2349-2902.isj20174528

Abstract:
Subdural empyema is a rare complication that causes high morbidity and mortality following sinusitis. Cranial complications should be considered in patients who develop neurological symptoms. These patients need surgery that should be performed by neurological and ear-nose-throat surgeons working together. A 14-year-old girl developed aphasia and hemiparesis from retrograde thrombophlebitis following sinusitis and we planned a two-stage surgery for the patient. In the first step, we drained the empyema by a craniotomy and functional endoscopic sinus surgery. In the second step, we drained a mature abscess. The purpose of this paper is to review the surgical and clinical management of intracranial complications from sinonasal infections.
, Ankur Bansal, Anil Baliyan
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174522

Abstract:
Background: An appendectomy is the surgical removal of the appendix. Appendectomy may be performed laparoscopically or as an open operation. Laparoscopy is now often used as patient resumed normal activity within a shorter period than had been experienced with open appendectomy. Patients had a superior cosmetic result and experienced significantly less postoperative discomfort. In this study, we attempted to determine the predictors for difficult appendectomy using history and clinical examinations, preoperative laboratory data, ultrasonography findings and intraoperative finding.Methods: The study was conducted in Sarojini Naidu Medical College, Agra. All patients who underwent laparoscopic appendectomy from 1st January 2016 to 30th June 2017 were included in the study. A detailed performa was developed to record information regarding patient history, physical examination, laboratory parameters, ultrasonography (USG) findings and intra-operative details. Laparoscopic appendectomy done in more than 120 minutes, converted into open due to difficulty in surgery and not due to complications, severe adhesions were considered to be a case of difficult appendectomy.Results: We found that the difficult laparoscopic appendectomy can be predicted preoperatively based on age >60 years, history of previous lower abdominal surgery, time of onset to surgery >24 hours, acute appendicitis and peri appendicular collection.Conclusions: There are very few reports to determine the predictors of difficult appendectomy and more research is required to establish it.
Kuldeep Sharma, , Ashish Ashokrao Hatkar
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174521

Abstract:
Background: Trauma is recognized as a serious public health problem. In fact, it is the leading cause of death and disability in the first four decades of life and is the third most common cause of death overall. Trauma may lead to short or long-term disability. Objective was to study the pattern of chest injuries with resultant underlying damage, in rural set up.Methods: The present study was carried out among 500 cases of age group 15 to 75 years, all religions and both sexes. All patients received in the Emergency Room (ER/Casualty) were immediately attended and history, primary survey and resuscitation were done simultaneously. X ray chest-erect position was taken and subsequent management either operative or non-operative was done according to clinic-radiological findings. After discharge, patients were followed on OPD basis till the time they return to the normal activity.Results: Majority of patients (31%) were from 55 to 65 years of age group and were male (64.2%). Vehicular accident was the commonest (56.8 %) cause of injury. Vehicular accidents were the most common cause of chest injuries. In vehicular accidents two-wheeler riders were the common victims (55.28%). Assault was 2nd most common mode of injury. Among those patients who sustained chest trauma had average VAS 6 (49.2%) followed by 4 (45%). Majority of patient were treated conservatively (93.6%).Conclusions: The most active age group and males were affected with commonly vehicular accidents. They mainly suffered chest injuries.
Atish Kumar, Dharani Priya, Jayesh S., Kamal Kataria
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174532

Abstract:
Lipoma, though one of the most common benign mesenchymal neoplasms, its presentation in hand is very rare. It can be located in various planes. Intramuscular lipomas are uncommon and usually occur in the proximal muscles of the extremities. Intramuscular lipoma of hand is extremely rare and only very few cases have been reported in the literature. Lipomas of hand may present with neurovascular deficit due to compression. We present here an unusual case of intramuscular lipoma of thenar region with no neurovascular deficit which was surgically excised under local anaesthesia with good cosmetic and functional outcome.
Vinay G., Balasubrahmanya K. S.
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3392-3396; https://doi.org/10.18203/2349-2902.isj20174502

Abstract:
Background: Any skin closure technique aims at opposing the skin edges precisely without tension for sufficient time to allow healing to take place. The ease and speed with which the skin closure is completed, the level of patient discomfort, the complication rate, and the final cosmetic result are the factors which has to be considered in making a comparison of different types of wound closure. This study aims at comparing steristrips and subcuticular sutures for wound closure after thyroid surgery based on assessment of post-operative pain, neck mobility and cosmetic appearance.Methods: A comparative study was carried out among 90 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 10 months. Subjects of either sex undergoing thyroidectomy will be randomized to had their wounds closed by steristrips or subcuticular sutures using a simple randomization table. Patients who underwent previous neck irradiations, secondary neck surgeries, and patients with poor compliance were excluded from the study. Descriptive statistics, unpaired t-test and chi-square test were used to analyse the results.Results: The mean age group of the study subjects was 48.6 (range 24-76) years. The gender distribution showed a higher number of females (82) as compared to males (8). 70 patients were diagnosed with multinodular goitre, 16 patients were of thyroid neoplasms and 4 were of inflammatory thyroid conditions. 12 patients underwent subtotal thyroidectomy and 78 patients underwent total thyroidectomy. Wound closure by steristrips had less post-operative pain, acceptable neck mobility and excellent scar appearance as compared to subcuticular sutures.Conclusions: The choice of materials for wound closure will depend on the surgeon's preference. However, this study does show that steristrips sutures can be removed more quickly and is more acceptable method of wound closure as compared to subcuticular sutures after thyroid surgery.
M. Madhusudana Naik, N. Nagaprasad, Varun Vishwanath
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3363-3370; https://doi.org/10.18203/2349-2902.isj20174497

Abstract:
Background:The clinical study of incidence and role of co-morbid conditions in management and outcome of burns patients. The objective of this study was to determine the role of comorbid conditions in burns patient management and to understand the outcome the morbidity and mortality in burns patients with comorbid conditions.Methods: One hundred patients suffering burn injury with associated comorbid conditions had been selected randomly (every third burns patient with associated comorbidity). Co-morbidities associated were noted from history given by the patients. It is a prospective observational clinical study of 2 years of duration. Patients admitted in the department of burns and reconstructive surgery from the 2104 October up to twenty-four months were included in this prospective study.Results: It is a clinical observational prospective study. Study involve 100 burns patients with comorbidities: alcoholics (53%), smokers (15%), diabetic (12%), obesity (7%), psychiatric illness (6%), epilepsy (5%), bronchial asthma (2%). It was observed that morbidity and mortality were more in alcoholic (49%) and diabetic patients (33%) when compared to other co-morbid conditions. Wound infections and delayed wound healing was found more in diabetic patients. Incidence of higher percentage of burns was found in alcoholic patients.Conclusions: This study concluded that comorbid conditions increased the duration of hospital which also affected mortality, with longest stay of 102 days and average duration of stay of patients with co-morbid conditions was 45-65 days.
, Shrinivas S. Chavan, Vitthal D. Kale, Amol Hekare, Archana Sylendran, Abishek Khond
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174543

Abstract:
Internal jugular venous (IJV) Phlebectasia are rare disorders. It is generally diagnosed at an early age, usually unidentified or misdiagnosed or ignored because of the scarcity of the knowledge on the disorder. We encountered a case of 7-year-old child with a right sided intermittent neck swelling which mimicked as an external laryngocele. But, the diagnosis of IJV Phlebectasia was made on “dynamic” ultrasound (USG) doppler study. Cervical adenopathy, mediastinal masses, tuberculosis and certain syndromes of connective tissue disorders were ruled out. The child was managed conservatively with parents and the child being educated about disorder.
, Nagendra Yadav, Firoz Alam, Akhil Khandarpa
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174539

Abstract:
We report four cases who were referred to Dr. D. Y. Patil Medical Hospital, Pune suffering from abdominal pain and gastrointestinal manifestations. The patients' history was unremarkable, except that they had contact with dogs and live in rural communities. Laboratory findings showed peripheral blood eosinophilia, leukocytosis, and elevated liver enzymes. Ultrasonography showed well-circumscribed cystic masses in the liver. Diagnosis of hydatid cysts was confirmed by computed tomography (CT). Surgical treatment was performed and all patients recovered well. The results of these cases support the nation that CT scan can led to increased clarity, regarding surgical management, because of discordance between radiographic and laboratory findings.
Trupti Tonape, , Iresh Shetty, Bhoomi Raval, Sree Kumar Balasubramanian
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174504

Abstract:
Background: The neck swelling is often surrounded by mystique in arriving at a diagnosis as well as in its management. There are many good approaches to a patient with a swelling in the neck.Methods: This study was done in Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune. In this study, we have taken 30 cases in study group. Only posterior triangle neck swellings were considered during the study. Clinico-pathological co-relation was done during the study.Results: In the present study group of 30 patients we found 10 patients to be having Lymphadenitis which includes both tuberculous and non-tuberculous, 8 patients to be having lipoma, 4 patients to be having neck secondaries, 2 patients of cystic hygroma and 6 nonspecific causes like cavernous haemangioma, madelung disease, Kikuchi Fujimoto disease. Further histological co-relation was done.Conclusions: Incidence of different types of neck swellings were found and rare diseases like Madelung’s disease and Kikuchi fujimoto’s disease.
Turki Abdullah S. Al-Ajmi, Abdullah Salah Al-Hussain, Mohammed Fuad Al-Abdulqader
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174490

Abstract:
Background: Trauma resuscitations are complicated, high-risk, and time-sensitive actions that need the coordination of different specialists arriving from multiple areas in the hospital. This systematic review aimed to understand the main key challenges of trauma resuscitations using a broad search in various database.Methods: A systematic review of published articles between the years 2000 and 2016 was conducted using different electronic databases such as PubMed, Medline and Embase to identify studies evaluating trauma resuscitations challenges. Different keywords were used in this study to recognize relevant articles. The titles of all articles were scanned in the first stage. Irrelevant articles were omitted and the abstracts of the rest articles were reviewed in the second stage. Finally, the full text of all articles which met the inclusion and exclusion criteria were reviewed and a data extraction sheet was made to summarize all the articles. Data were analyzed descriptively.Results: Twenty studies were reviewed including; RCT (3 studies), QRCT (5 studies), and descriptive study (12 studies). The results showed that there are four main trauma resuscitation challenges including pre-hospital challenges, error-related challenges, equipment and technical challenges, and finally general challenges.Conclusions: Trauma resuscitation is one of the most critical aspects of emergency care. It is necessary to promote resuscitation care and focus on patient outcomes in terms of mortality and more importantly, functional outcomes. Considering these main factors affecting trauma resuscitation will improve patients’ outcomes and help those who are engaged in providing services.
Mohanapriya Thyagarajan, Mahin Nallasivam, Balaji Singh
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3344-3346; https://doi.org/10.18203/2349-2902.isj20174492

Abstract:
Background: Breast tuberculosis is uncommon even in countries where the incidence of pulmonary and extra pulmonary tuberculosis is high. The incidence of breast tuberculosis is less than 1% of the total breast pathologies in the world.Methods: This is a prospective study wherein all cases of breast tuberculosis with age above 18 years with only primary breast tuberculosis in both sexes. A total of 40 patients were diagnosed with breast tuberculosis. Most of the patients were treated as outpatient. All the patients were subjected to Imaging (Ultrasonagram or Mammogram) and fine needle aspiration cytology (FNAC). When FNAC was in conclusive, core needle biopsy was done. When none of the investigations were contributive, patient was subjected to excision biopsy. The tissue was sent for histopatho logical examination, gene xpert, AFB culture and sensitivity.Results: Diagnosis of breast tuberculosis was confirmed in all the 40 patients either with fine needle aspiration cytology or biopsy. All patients were with anti-tuberculous treatment as per the Revised National Tuberculosis Control Program of India (RNTCP). All patients responded well and had complete recovery. Overall prognosis of breast tuberculosis was good.Conclusions: Breast tuberculosis is often mistaken for carcinoma breast. Clinical examination often fails to differentiate carcinoma breast from tuberculosis and a high index of suspicion is necessary. Mammography is not of much help as the findings in carcinoma in advanced stage are similar to that of tubercular lesion.
Jawahar Krishnaswamy, Khalilur Rahaman, Reshma S.
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174506

Abstract:
Background: Cervical lymphadenopathy is one of the commonest presentations in inflammatory and neoplastic disorders. Fine needle aspiration cytology (FNAC) is a well-established diagnostic method used to sample swellings at various sites in the body. It is a simple, quick, inexpensive and minimally invasive OPD technique used for establishing the etiology of cervical lymphadenopathy. Aim of this study was to evaluate the diagnostic accuracy of Fine needle aspiration cytology (FNAC) in cervical lymphadenopathy.Methods: This study included 50 patients presenting to the surgery outpatient department with cervical lymphadenopathy. Detailed history and physical examination was done followed by FNAC in all the patients. The diagnosis was then compared with the gold standard excisional biopsy and histopathological examination by standard statistical methods.Results: Among the 50 patients studied 31 were male and 19 were female. According to histopathologic diagnoses in 50 cases, the patients were diagnosed to have benign lesion in 28 cases (56%), and malignant lesion in 22 cases (44%). Among the benign etiologies, tuberculosis was the most frequent (40%) followed by reactive nonspecific inflammation (16%). Among the malignant etiologies, metastatic deposits constituted 30 % followed by lymphoma constituting 14%. FNAC results supported a benign lesion in 27 cases and were compatible with a malignant lesion in 19 cases. Comparing FNAC results with histopathological diagnoses revealed that, in 46 cases the FNAC results were compatible with histopathology, a total accuracy of 92%. In one case, benign lesion was over diagnosed as malignant and in 3 cases malignant lesions were underdiagnosed as benign lesions. It was found that, in diagnosing benign and malignant lesions, FNAC had a sensitivity of 96.42% and a specificity of 86.36%. Positive predictive value was 90% and negative predictive value was 95%. Out of the 50 patients studied, 20 patients (40%) were confirmed to have tuberculous lymphadenitis by histopathological examination. FNAC supported a tuberculous etiology in 14 cases and 6 cases were underdiagnosed by FNAC. The sensitivity of FNAC in diagnosing tuberculous etiology was found to be 70%, specificity was 100%, positive predictive value was 100%, negative predictive value was 85.71%. Overall the sensitivity of FNAC in diagnosing a pathological cervical lymph node was found to be 92.85%, specificity was 87.5%, positive predictive value was 97.5%, negative predictive value of 70%.Conclusions: The utility of fine needle aspiration cytology in the evaluation of cervical lymphadenopathy has been well established by this study. It is a reliable and convenient method with minimal complications in the management of patients presenting with cervical lymphadenopathy. The various causes of cervical lymphadenopathy were found to be tuberculosis, secondary metastasis, primary malignancy of the lymph nodes and nonspecific reactive lymphadenitis. This study also supports the fact that tuberculosis is still a common cause of cervical lymphadenopathy in India.
Shahaji Chavan, Shubhi P. Bhatnagar, Mahendra Bendre, Anuradha Dnyanmote, Vinayak Kshirsagar, Nilesh Sinha, Amrithraj Thiyagarajan
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3552-3556; https://doi.org/10.18203/2349-2902.isj20174538

Abstract:
Malignant peripheral nerve sheath tumour (MPNST) is an extremely rare soft tissue sarcoma which usually arises from peripheral nerves or somatic soft tissue with an incidence of 0.001%. It’s most common anatomical sites are the proximal portions of the upper and lower extremities and the trunk and it’s extremely rare for such a tumour to occur elsewhere in the body. We report a rare case of such a tumour over the left posterior aspect of neck in a 28-year-old female patient. We have reviewed this case in terms of clinical presentation, investigations, surgical treatment and adjuvant therapy and have shortly described our experience. MRI and CT neck supported the diagnosis of this tumour. Fine needle aspiration cytology taken from the swelling revealed a low-grade spindle cell tumour with a possibility of MPNST. Excision of the tumour was done and the excised specimen was sent for histopathological examination which revealed MPNST. Adjuvant radiotherapy was given postoperatively. At a 6-month follow-up, patient is doing well with no evidence of recurrence. Suspicion of this tumour should be raised in a rapidly growing painless tumour in and around a nerve tissue. Diagnosis is made by assessing a combination of clinical, pathological and immunohistochemistry features. Complete surgical removal should be the goal of treatment with definitive histological diagnosis. A regular follow up is recommended to confirm any recurrence or metastasis.
, Ravi Batra, Kamal Sharma
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174529

Abstract:
Hemorrhage is a well-known complication of partial nephrectomy. The bleeding is usually suspected when a patient presents with haematuria or bloody drain discharge following the procedure. This study’s primary objective is to discuss case of 63-year-old-man incidentally diagnosed with left lower pole kidney mass. USG abdomen was done and a suspicious mass in lower pole of kidney is noticed. CT-urography was done and assessment was made for further management. Patient details were collected by patient’s IPD file. Complete detailed history, patient vitals, hemogram, ABO, with USG abdomen and CT urography was done. Post op CT angiogram was done to evaluate for drain leak. Treatment diagnosis was left lower pole malignant mass. Pre-operative left ureteric catheter placement was done. 11th rib cutting incision was given. The tumour was resected with 1 cm margin. The renal defect was closed with interrupted sutures to the parenchyma. Gerota’s fascia was closed. A Robinson drain was placed and the abdominal wall closed. The case was managed without vessel clamping and hypothermia for clear renal cell carcinoma with post op bleed, successfully identified and managed conservatively, giving another potential management option in non-torrential haemorrhage.
Julius Gbenga Olaogun, , , Olakunle Muyiwa Odesanmi, Oladapo Atolagbe Adesua
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3211-3217; https://doi.org/10.18203/2349-2902.isj20174491

Abstract:
Background: Early diagnosis has been shown to improve the prognosis of breast cancer, hence breast self-examination (BSE) as a screening method may have its benefits. The aim of the present study is to determine the prevalence of BSE practice, the correctness of the practice steps and the knowledge of breast cancer disease among women attending secondary health facility.Methods: The study was a descriptive study among women attending antenatal care and immunization clinics at State Specialist Hospital, Ikere-Ekiti between October and December 2015. A total of 238 women seen during the period and who consented to participate in the study were included. Structured self-administered questionnaire was used and data obtained was analyzed using SPSS version 20. Level of significance was set at P
Chandrasekhar S. Neeralagi, Yogesh Kumar, Surag K. R., Lakkanna Suggaiah, Preetham Raj
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174496

Abstract:
Background: Haemorrhoids are the most common benign anorectal problems worldwide. Treatments of third and fourth degree hemorrhoids include surgical haemorrhoidectomy. Milligan Morgan haemorrhoidectomy (MMH) as described in 1937 has remained the most popular among many techniques proposed. In order to avoid the postoperative drawbacks of Milligan Morgan haemorrhoidectomy, a new surgical treatment for prolapsing haemorrhoids has been described by Longo in 1995, procedure called stapled haemorrhoidopexy which is associated with less postoperative pain and a quicker recovery. The objective of this study was to compare the short-term outcome between stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy.Methods: Prospective randomized study of 120 patients with grade 3 and grade 4 haemorrhoids requiring surgical treatment either MMH or SH, 60 in each group for the period of 18 months from June 2014 to November 2015. Post-operative pain, duration of surgery, duration of hospital stays, post-operative complications and time taken to return to work were compared with mean follow up period of 6 months.Results: Duration of surgery is significantly low in stapled group with P <0.001, duration of hospital stay is significantly low in stapled group with P <0.001, post-operative pain low in staple group with P <0.05, time taken to return to work is significantly early in stapled group with P <0.001. Post-operative complications incontinence not found in the present study but recurrence of two cases in each group noted.Conclusion: Stapled hemorrhoidopexy is associated with less postoperative pain, shorter duration of surgery and hospital stay, earlier return to work as compared with Milligan-Morgan open hemorrhoidectomy. The procedure is not associated with major post-operative complications.
Navjot Brar, Amanjot Singh, Rajbir Bajwa
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174519

Abstract:
Background: Inguinal hernia may be generally defined as a protrusion of viscus or part of a viscus though inguinal canal. The only way recommended to treat inguinal hernias now a day is to perform tension free Lichenstein repair. In this study, we have done a prospective study on clinical outcomes of lichtenstein tension free inguinal hernioplasty under local anaesthesia in Department of General Surgery, Sri Guru Ram Dass Hospital and Research, Sri Amritsar from 15 August 2014 to 15 February 2017, a period of 2 and half years.Methods: A prospective study was conducted in patients admitted in wards with inguinal hernia from General Surgery Outpatient Department. The series consisted of 60 patients between 15 to 74 years.Results: It is found that no recurrence has yet occurred in 2½ years follow up and it is well accepted specially in older age group (55 -74 years).Conclusion: The methods of Lichtenstein’s tension free inguinal hernioplasty under local anaesthesia is safe, simple, effective, economical, and without any side effects such as hypotension, nausea, vomiting, urinary retention, and spinal headache.
Venkatarami Reddy Vutukuru, Sivaramakrishna Gavini, Chandramaliteeswaran Chandrakasan, Brahmeshwara Rao Musunuru,
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174507

Abstract:
Background: Morbidity following Pancreaticoduodenectomy still remains high. Few studies have shown decrease in morbidity with the addition of Braun Enteroenterostomy (BEE). Aim of the present study was to determine any possible benefit with addition of BE to the standard reconstruction after pancreaticoduodenectomy.Methods: In this prospective randomized controlled study, all patients who underwent Pancreaticoduodenectomy from June 2012 to July 2016 were included. They were randomized to undergo either standard reconstruction (Group A) or with addition of Braun Enteroenterostomy to standard reconstruction (Group B). Outcomes were compared between 2 groups and the results were analyzed. P value of <0.05 was considered significant.Results: 104 patients were included in the study. Group A included 56 patients who underwent standard reconstruction and Group B had 48 patients who had addition of BEE to standard reconstruction. The demographic profile, tumour characteristics, and biochemical profile were similar in 2 groups. Mean operating time and Intra operative blood loss were similar. The incidence of pancreatic fistula (POPF) did not differ significantly in 2 groups (14/56, 25% in group A versus 8/48, 16.6% in group B; p = 0.42). The incidence of Delayed Gastric Emptying (DGE) was not statistically different in 2 groups (20/56, 35.7% in group A versus 12/48, 25% in group B; p=0.77). Infection rates were similar in two groups. Mean hospital stay was similar in both groups (11.2 days versus 10.7 days; p=0.68).Conclusions: The outcomes of patients after pancreaticoduodenectomy were not altered by addition of Braun Enteroenterostomy to standard reconstruction.
, Boniface Adegah
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174526

Abstract:
Though uncommon, cases of traumatic hip dislocation have been reported in children worldwide. Averagely, it is recommended that the acceptable duration for reduction after such dislocations is about 6 hours. Even with that there is about 5% documented chance of developing avascular necrosis of the head of the femur. The incidence of avascular necrosis increases with delayed relocation of the femoral head. We report a case involving a 6-year-old girl with a 2-week delayed diagnosis of a left posterior hip dislocation that was reduced and followed up for 6 years.
SibaPrashad Pattanayak, , Bipin Kishore Bara, Manoj Kumar Behera
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174518

Abstract:
Background: Human rabies continues to be endemic in India and according to recent estimate 20,000 persons die of this disease every year. Hence this study was conducted to know the prevalence and pattern of animal bites during last one year and to determine the rate of admission in Department of Surgery.Methods: This study was conducted in the casualty, Department of Community Medicine, Department of Surgery at M. K. C. G. Medical College, Odisha, India between 1st April 2016 - March 31st, 2017. It was a cross sectional study, where convenient sampling method was used. The sample size was 6242 subjects, above 1year age group selected randomly within last 1 year. The socio demographic characteristics, epidemiological and rate of admission in surgery department were studied.Results: It was found that during last one year, out of 6242 animal bite cases, majority of them were bitten by dogs 4785 (76.66%). It was found that 5617 (90%) are category III bite, 548 (8.78%) are category II bites, 77 (1.23%) are category I bite. Parts of body bitten by animals were limbs 5828 (93.37%), face 312 (5%), back 52 (0.83%). Out of 6242 cases, 348 (5.5%) cases were admitted in General Surgery Department.Conclusions: The prevalence of dog bite was found to be more and was of category III in nature and part of body affected were mostly limbs. Prevalence of bite was nearly equal among male and female. Around 5% of the total animal bite cases required admission in Department of Surgery.
Binni John, Bipin P. Mathew, Vipin Chandran C.
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3350-3353; https://doi.org/10.18203/2349-2902.isj20174494

Abstract:
Background: Helicobacter pylori have an important role in the pathogenesis of peptic ulcer disease. The aim of the present study was to observe the prevalence of H. pylori in peptic ulcer perforation cases and the rationale of H. pylori eradication therapy post operatively and to investigate factors associated with peptic ulcer.Methods: This cross-sectional study was conducted at the Department of general surgery, Government Medical College, Kottayam for a period 20 months from March 2012 to October 2013 after getting approval from institutional ethics committee. A total of 113 patients were participated in the study after meeting inclusion criteria. After getting written consent from the patients with perforated peptic ulcer, resuscitation and laparotomy was performed in the emergency department. H. pyloriinfection was confirmed by histopathological examination by Giemsa staining. Based on the histopathological report, the prevalence of H. pylori infection in the patients was assessed and was given appropriate H. pylori eradication regimen.Results: The mean age of presentation of the patients was 52.81±14.5 years. Male to female ratio was 4.14:1. Out of 113 cases, 67 cases (59.3%) had duodenal ulcer perforation while 46 cases (40.7%) had gastric ulcer perforation. Of them 53(46.9%) cases were positive H. pylori positive. No significant association was found between the incidence of H. pylori infection in peptic ulcers with smoking, hypertension, diet intake, NSAIDS intake. In our study association between H. pylori and diabetes mellitus (p=0.02) found to be significant which can be further investigated.Conclusion: According to our study the prevalence of H. pylori infection in perforated peptic ulcer disease is 47% which must be considered as significant. Hence all the patients undergoing laparotomy for peptic ulcer perforation should be investigated for H. pylori infection and if positive we must start the anti H. pylori regimen for them, which is more cost effective.
Ashish K. Khetan, Meenakshi Yeola
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174501

Abstract:
Background: Laparoscopic cholecystectomy (LC) has become gold standard for the surgical treatment of gallbladder disease. 2% to 15% of patients require conversion to open surgery for various reasons. Pre-operative prediction of “difficult laparoscopic cholecystectomy” may not only improve patient safety but also be useful in reducing the overall cost of therapy. The aim of this study is to study the factors determining the preoperative predictability of difficult laparoscopic cholecystectomy.Method: 30 cases of laparoscopic cholecystectomy operated by a single experienced surgeon. There are total 15 score from history, clinical and sonological findings. They were evaluated and scored on the basis of scoring system of Randhawa and Pujahari. Score up to 5 is defined as easy, 6-10 as difficult and 11-15 as very difficult.Result: Previous history of hospitalization for cholecystitis and increased gall bladder wall thickness were found statistically significant in predicting difficult LC.Conclusion: The scoring system had a positive prediction value for easy prediction of 81.9% and for difficult prediction of 75%.
Monika Anant, Amrita Singh
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174544

Abstract:
Osseous endometrium is a rare clinical entity with the presence of bone in the endometrium. Almost all cases in literature have been reported as presenting with secondary infertility often having a prior history of a 1st or 2nd trimester abortion. This interesting case was 38 years age, presented with menorrhagia for few months only, had her last child birth 12 years ago by caeasarean delivery, her menstrual problem subsided with successful hysteroscopic removal of the bony chips. Although rare, the diagnosis is suspected on ultrasonography and can be managed easily with hysteroscopy which can visualize and simultaneously remove the bony spicules.
Sunil Vitthalrao Jagtap, Pranita Warhate, Neerav Saini, P. G. Chougule
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174520

Abstract:
Background: A significant number of oral cancer cases present initially with precursor lesions. If detected earlier in disease course it will reduce the morbidity and mortality. The objective of this study was to evaluate the clinical presentation and various histopathological types of premalignant lesions.Methods: This is descriptive, observational, analytical type of study of five-year duration. The detail clinical presentation, relevant investigation and histopathological study on biopsy tissue stain with H and E was done and the data is analysed.Results: During study period, 173 cases having oral lesions were observed. Among these 38 cases showed oral premalignant lesions. The most common age group affected was in between 50 to 59 years. The male predominance was noted. Male to female ratio was 1.9:1. The location of the lesions were buccal mucosa (55.26%), tongue (26.31%), gingiva (7.90%), alveolus (5.26%), lip (2.6%), retromolar area (2.63%) was noted. The common etiological factor observed was tobacco chewing. On histopathological features, cases were of leukoplakia 68.41%, oral lichen planus 13.16%, oral submucous fibrosis 7.90%, actinic cheilitis-7.9%, and oral erythroplakia 2.6%.Conclusions: In this study, various oral premalignant lesions were observed. Their clinical and histopathological evaluation was done. Oral leukoplakia was most common lesion in the present study. Buccal mucosa was the most common site. Tobacco chewing habit was the common risk factor observed. Early detection of premalignant oral lesion is of utmost importance to prevent further morbidity as these lesions further progress to oral cancer.
Ashwin Porwal, Paresh Gandhi, Deepak Kulkarni
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174516

Abstract:
Background: Pelvic floor dyssynergia (PFD) is one of the commonest subtypes of constipation and treated conservatively but is often unsatisfactory. Biofeedback Pelvic Floor Exercise Therapy (BFT) has been introduced as an alternative treatment. Method: A prospective study was conducted at Healing Hands Clinic, Pune. Total 35 patients diagnosed as having pelvic floor dyssynergia confirmed by MR defecography (MRD) enrolled in to the study. All patients trained for pelvic floor muscle exercise. Patient performed exercise 20 minutes per day for 12 weeks. Data have been collected using a standardized questionnaire (Longo's obstructed defecation syndrome (ODS) score, Patient Assessment of Constipation Quality of Life (PAC-QOL) and Bristol stool score and performed anal manomentry test (3-D HDAM) at every 4 weeks. Result: Study result demonstrated a statistically significant improvement in the mean resting pressure, maximum squeezing pressure and average of 10 seconds hold (from 69.83±6.40 to 39.87±5.51, 98.67±17.23 to 128.67±26.92, 78.70±15.41 to 109.00±22.23, P = 0.005 at week 12). The mean total ODS decreased significantly (p<0.0005) from baseline to 22.92±4.03 to 11.46±6.76 at week 12. Also, individuals ODS score items were significantly improved at week 8 and week 12. Bristol stool score significantly improved from 2.12±1.14 to 4.04±0.96 at 12 weeks (p<0.0005). Significant improvements were recorded in all four individual score domains (physical discomfort, psychosocial discomfort, worries and concerns, satisfaction) and total score of PAC-QOL at week 12. Conclusion: Biofeedback therapy provides improvement in bowel symptoms, anorectal function and reduces use of aperients in constipated subjects with pelvic floor dyssynergia
, Balaji Singh, Arulappan Thangasamy, Shobana Rajasekar
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174495

Abstract:
Background: Gall stone disease is a common disease affecting human beings. Over the past two decades, laparoscopic cholecystectomy has become gold standard for the surgical treatment of gallbladder disease. The advantages of laparoscopic cholecystectomy over open surgery are a shorter hospital stay, less postoperative pain, faster recovery, better cosmoses. This study was planned to identify the circumstances and the risk factors influencing the conversion of laparoscopic cholecystectomy to open procedure.Methods: This is a Prospective study conducted over a period of 24 months. A total of 50/500 patients who were electively posted for laparoscopic cholecystectomy and got converted into open cholecyctectomy were included in the study. The Factors recorded and analysed were Age and Sex of the patient, presence of diabetes mellitus, previous episode of Acute Cholecystitis, Body Mass Index, presence of abdominal scar, total count, Ultrasonagram Abdomen findings of Gallbladder wall thickness and presence of pericholecystic fluid.Results: In our study, it has been observed that Patient Related Factors - Age >50yrs, Male gender, Presence of Diabetes Mellitus, Obesity, previous Abdominal surgeries and Disease Related Factors - previous episode of Acute Cholecystitis, presence of Acute Cholecystitis, Gallbladder wall thickness >4mm, presence of Pericholecystic fluid were found to be significant risk factors in conversion of laparoscopic to open cholecystectomy.Conclusions: These risk factors help to predict the difficulty of the procedure and this would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174515

Abstract:
Background: Esophageal atresia (EA) with or without Tracheoesophageal fistula (TEF) has been described as the epitome of pediatric surgery and the management of these neonates require high degree of skill, manpower and tertiary care. This clinical study was undertaken to identify the EA and TEF cases along with the pattern of associated anomalies causing mortality in Varanasi .Methods: This prospective study included 53 patients of EA with TEF who underwent primary esophageal anastomosis. Their clinical profile, time of presentation, various associated anomalies, sex distribution, and their effect on mortality and morbidity were observed.Results: Mortality was high (41.64%) among patients who reached the tertiary centre late i.e. >24 hours. The incidence of low birth weight babies is approximately 75% and mortality rate increased with low birth weight. Almost 2/3 of patients had clinical or radiological evidence of pneumonia. The mortality was very high in severe pneumonia 66.7% as compared to 15% patients without pneumonia. Septicaemia and leak were most common complications. The mortality in septicemic patients is high (77.8%). The overall incidence of associated anomalies was 47%. Early surgical intervention improved the survival of EA with TEF with major GIT associated anomalies. The overall survival rate was 60.37% and mortality was 39.67%.Conclusions: Although we have improved a lot in managing these cases of EA with TEF, but we have to do much more to achieve our goal of near 100% survival.
, Ihsan Dogan, Elif Ozyurek, Onur Ozgural, , Melih Bozkurt
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174525

Abstract:
The central nervous system, as a metastatic focus, has an extreme predisposition to retinoblastoma and has been indicated as the most common site for this disease. Herein, we report a 4-year-old girl presenting with multiple cranial metastases of retinoblastoma. To our knowledge, this presented case is valuable and significant in terms of being reported as the first cerebellar metastasis of retinoblastoma in the literature and removing this lesion together with supratentorial focus in a single operation with a single skin incision.
Navjot Brar, Jatinder Singh Dhaliwal, Amanjot Singh, Rajbir Bajwa
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174523

Abstract:
Background: Necrotizing fasciitis including Fournier’s gangrene is an uncommon, critically serious infection of the subcutaneous tissue and fascia with relative sparing of the skin and muscle. Despite modern supportive measures, the reported mortality rate still is high and this is due to part to the aggressive nature of the infection. The present study was performed upon 50 patients to study clinicopathology of necrotizing fasciitis with special reference to Fournier’s gangrene. Methods: This cross-sectional study was conducted in Surgery ward of SGRD Hospital, for a period of 1 year (1st January 2015 to 31st December 2015). The performa filled for patients with necrotizing fasciitis was designed on the basis of NICE guidelines and details like history, examination, general survey, local examination, systemic examination and investigations, statistical analysis of data done. Results: Necrotizing fasciitis, though it is found at any age but is a disease of middle and old aged adults in this part of the world, being commonest in the 4th, 5th, 6th decades of life and is more common in males. The disease is more common in people with low socio-economic groups with poor personal hygiene, diabetes mellitus and history of drug addiction. Trauma is the most common predisposing factor for the necrotizing fasciitis as a whole whereas idiopathic cause is the most common cause in cases of Fournier’s gangrene. Polymicrobial infection is the most common variety, where in E. coli, Streptococcus, Bacteroids are most commonly isolated. Regarding monobacterial infection streptococcus being the most common. Conclusion: Current study showed increased frequency of necrotizing fasciitis in people aged above 40 years. Diabetes mellitus and other premorbid conditions increase the risk of mortality. Polymicrobial infection in combination of Escherichia coli, Streptococcus, Pseudomonas, Bacteroids and Staphylococcus were the most commonly found. Early debridement, parenteral combined antibiotic and supportive measure formed the basis of treatment. Septicemia was a common complication which was often cause death.
, A. John, V. A. Kumar
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174524

Abstract:
Background: Secondary peritonitis carries high mortality and morbidity. Many scoring systems have been designed to assess its severity. This study was undertaken to compare the Mannheim peritonitis index (MPI) and revised multiple organ failure score (Revised MOFS) in predicting the mortality and morbidity.Methods: A prospective observational study was undertaken in adults operated for gastrointestinal perforation. Clinical and biochemical parameters as required for MPI and Revised MOFS were recorded. Each of the scores were divided under four categories; MPI 29; Revised MOFS 0, 1, 2 and >2. Data was compared for predicting mortality and morbidity. P-value, ROC curve and 95% CI were used as statistical tools.Results: Two thirds of 120 patients studied presented after 48 hours. MPI score of 29 had mortality of 0%, 2.2%, 27.2% and 50% respectively. ROC curve showed highest sensitivity and specificity of 79% and 70% respectively at MPI of 25. Significant value for mortality was obtained with MPI >25 (p= 0.000012) and with Revised MOFS >1 (p< 0.001); for morbidity with MPI >21 (p= 0.010) and with Revised MOFS >1 (p< 0.001). 20% patients with Revised MOFS zero were also morbid.Conclusions: Both MPI and Revised MOFS systems are good in predicting the mortality, but MPI is easy scoring system and a better option for predicting morbidity. MPI score >25 for mortality and >21 for morbidity are significant.
, R. K. Hanumanth Naik
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174512

Abstract:
Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Often, it is difficult to reach a proper diagnosis. There may not be classical symptoms and signs of appendicitis. Accurate diagnosis can be aided by additional testing or expectant management or both. These might delay interventions and lead to appendiceal perforation with increased morbidity, mortality and hospital stay. Studies have shown that simple appendicitis has got mortality of 0.3% and perforated appendicitis 6%. Hyperbilirubinemia is a new diagnostic tool for predicting perforation of appendix. The aim of the study is to establish the role of hyperbilirubinemia as a new diagnostic tool to predict perforated appendicitis.Methods: This is a prospective study conducted on 100 consecutive cases of acute appendicitis admitted to the emergency ward. These were subjected to investigations to support the diagnosis. These cases were also subjected to liver function tests and clinical diagnosis was confirmed pre-operative investigations and post-operatively by histopathological examination. Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using either chi square test or fisher's exact test. The level of significance was set at P <0.05.Results: Total serum bilirubin including both direct and indirect was found to be significantly increased in case of acute suppurative appendicitis. Serum bilirubin was much higher (P <0.000) in cases of gangrenous/perforated appendicitis.Conclusions: Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis.
Manal M. Khan,
Published: 27 September 2017
International Surgery Journal, Volume 4, pp 3567-3569; https://doi.org/10.18203/2349-2902.isj20174542

Abstract:
We report a case of 35 years old male who presented with a huge, gradually progressing swelling of right side of chest and abdomen for 5 years. Dimensions of swelling were 40cmx30cm. Radiological findings suggested characteristic appearance of a chondrosarcoma which was arising from right lower ribs. Lesion has involved whole liver, gall bladder, right half of colon and right kidney. On histopathology, we found low grade chondrosarcoma. Though low-grade chondrosarcoma is a potentially curable neoplasm in its early stages, the present patient reported very late. As famous dictum said “the ignorant are ignorant of their ignorance “, this is a classic example of patient's ignorance which converted a curable disease into incurable.
Virendra S. Athavale, Shivmurti N. Khandalkar, Megha Mahawar, Iresh Shetty, Aditya Lad
Published: 27 September 2017
International Surgery Journal, Volume 4; https://doi.org/10.18203/2349-2902.isj20174510

Abstract:
Background: The aim of this study was to evaluate the effectiveness and rate of healing of Aloe vera gel in treatment of chronic wounds, to compare the effectiveness of Aloe vera gel with conventional dressing (normal saline and povidone iodine) and to assess the percentage reduction of wound healing with Aloe vera gel dressing.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital, DPU University, for a period of 2 months (from January 2017 to March 2017) and is a prospective and comparative randomized type of study using 50 cases (Group A and Group B, 25 each). The study was approved by the Institute’s Ethics Committee.Results: Data analysis showed that at the end of 4 weeks, mean surface area in Group A is reduced to 4.58 cm2 from 9.79 cm2 which is higher than that in the control group. Also, the average rate of healing in Aloe vera gel is more than control group. Percentage reduction in ulcer surface area was calculated to be much more in Group A as compared to Group B.Conclusions: The study concluded that Aloe vera gel is highly effective in treatment of chronic ulcers and stimulates the growth of wound healing. Thus, reducing the hospital stay. Apart from being efficacious in wound healing, Aloe vera gel is safe product. No allergic reactions/infections were associated with Aloe vera gel. Aloe vera gel not only heals faster but is also cost effective.
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