Journal of Surgery and Research

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EISSN : 2640-1002
Published by: Fortune Journals (10.26502)
Total articles ≅ 163
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Journal of Surgery and Research, Volume 4, pp 4-13; https://doi.org/10.26502/jsr.100200104

Abstract:
Introduction: Stapled hemorrhoidectomy has been considered as a novel technique in the surgical treatment of prolapsed hemorrhoids. Although it involves substantial added cost, it resulted in shorter period of convalescence in comparison with Open hemorrhoidectomy. Aim: To investigate and compare the outcome and post-operative complications in patients with grade III and IV hemorrhoids who underwent hemorrhoidectomy with either Stapler hemorrhoidectomy or Milligan Morgan hemorrhoidectomy. Methods: A total of 80 patients between the age group 28 to 40 years who were diagnosed with grade III and IV hemorrhoids, were divided into two groups equally. Group- 1 contains 40 Patients undergoing Stapler hemorrhoidectomy and Group- 2 contains 40 Patients undergoing Open hemorrhoidectomy/Milligan Morgan. Post-operatively patients of both the groups were assessed for bleeding, pain against pre-operative symptom profile, development of recurrence and long-term complications. Comparative analysis between the two groups were done based on student’s T test using SPSS software version. The level of significance was set at 5% (p < 0.05). Results: Stapler hemorrhoidectomy technique was quicker to perform in comparison with Open hemorrhoidectomy (p value < 0.001). Hospitalization and duration of resumption to daily activity was less in Stapler hemorrhoidectomy group as compared to Open hemorrhoidectomy/Milligan Morgan group (p value < 0.001). Conclusion: Both methods were effective in the treatment of hemorrhoidectomy, however the advantages of Stapler hemorrhoidectomy in terms of lesser operative time and intra and post-operative bleeding and lower incidence of various post-operative complications was observed.
Fjolla Hyseni, Guri Hyseni, Valon Vokshi, Loran Rakovica, Ali Guy, Breta Kotorri, Ina Kola, Masum Rahman, Anisa Cobo, Juna Musa
Journal of Surgery and Research, Volume 04, pp 172-178; https://doi.org/10.26502/jsr.100200122

Abstract:
Congenital anomalies are not uncommon. Urogenital disorders can be isolated or associated with other malformations, but they are usually misdiagnosed at birth and found in physical examination or as urologic signs at adolescence. This case report presents a rare case of a 3-year-old female patient with multiple malformations including ectopic anus, crossed fused ectopic kidney, vaginal duplication, bladder duplication, and multiple organ malformations. Prenatal diagnosis, a detailed physical examination and early surgical treatment are particularly important for prevention of further complications. In this case report, the surgical approach was performed using the cutback technique for rectovaginal separation among other surgical procedures in order to achieve functionality.
Jean Paul Engbang, Christian Beugheum Chasim, Franck Moise Abenelang, Marcelin Ngowe Ngowe
Journal of Surgery and Research, Volume 04, pp 167-181; https://doi.org/10.26502/jsr.10020121

Abstract:
Introduction: Pancreatic cancer is a public health problem because of its poor prognosis. Most of the factors related to the prognosis of this cancer are negative and pessimistic. Therefore, our work is to estimate the overall survival of our patients and to establish the prognostic factors associated to survival. Materials and Methods: This was a cohort study with retrospective data collection method, carried out from January 1, 2010 to December 31, 2019 i.e. a period of 10 years. The research took place in General hospitals of Yaounde and Douala; at Yaounde University Teaching Hospital and at Laquintinie. We obtained ethical clearance from the Institutional Review Board of the University of Douala. We included records of patients with pancreatic cancer of at least 12 months follow-up after diagnosis. Results: We had a total of 94 cases of pancreatic cancer during our study. Mean age at diagnosis was 56.5 ±12.3 years, the most represented age group was 50-59 years (48.9%), with sex ratio of 1.6 in favor of men. Median consultation time was 6 months. The most common stage of diagnosis was stage IV of the TNM classification. Conclusion: At the end of our study, it appeared that survival associated to pancreatic cancer remains low, in fact the median overall survival was 25 months. All prognostic factors found in our study were factors of poor prognosis which were: consultation time >3 months; high serum creatinine level and the occurrence of metastases.
Abdullah AlDaihani, Salem AlDouseri, Mohammad AlDaihani
Journal of Surgery and Research, Volume 04, pp 182-186; https://doi.org/10.26502/jsr.10020124

Abstract:
Paradoxical vocal fold motion (PVFM) can occur at any stage of amyotrophic lateral sclerosis (ALS). PVFM results in glottic narrowing or complete blockage of airway in ALS patients, which eventually leads to respiratory insufficiency and sudden death. ALS typically presents initially with weakness of hands and bulbar musculature. Rarely, hoarseness is the initial symptom in ALS. This is a case report of how PVFM presents initially with hoarseness as a first symptom of ALS.
Ana Lopez-Marco, Stuart W Grant, Saifullah Mohamed, Chiara Proli, Dheeraj Mehta, Aprim Youhana, Ragheb Hasan, Yasir Abu-Omar, Nicolas Nikolaidis
Journal of Surgery and Research, Volume 04, pp 187-196; https://doi.org/10.26502/jsr.10020125

Abstract:
Objective: Use of mechanical valves requires long-term anticoagulation, which carries additional risks of bleeding and thrombosis. The aim of the study was to investigate the impact of anticoagulation on length of postoperative stay and the incidence of anticoagulation-related complications. Methods: A multicentre study of prospectively collected data, including all patients below 65 years of age undergoing aortic valve replacement (± concomitant non-valvular procedures) was performed. Exclusion criteria included preoperative atrial fibrillation and other indications for anticoagulation, previous cardiac surgery, emergency operations and infective endocarditis. Primary end-points were length of hospital stay and anticoagulation-related complications within 6 weeks of discharge. Results: A total of 1973 patients were included over a 5-year period from 5 centres in the UK. Mean patient age was 59 years (range 17-65 years). Mechanical valves were implanted in 52% of patients. The use of mechanical prostheses was associated with significantly prolonged postoperative stay (median of 7 vs. 6 days with bioprosthesis, p < 0.001) being an independent predictor of prolonged postoperative stay (> 8 days; OR 1.55, 95% CI 1.27-1.90, p < 0.001). On subanalysis, 1.4% of patients with mechanical prosthesis required readmission for anticoagulation-related complications within 6 weeks of discharge (including late tamponade). An additional 2% required repeated hospital attendance for INR stabilisation. Conclusion: Use of mechanical valves in patients below 65 years of age is associated with both increased hospital stay and anticoagulation-related complications compared to bioprosthesis. The clinical and health economic implications of prosthesis choice should be considered by both the heart team and patient.
Henry Liao, Steve Lau, Henry Drysdale, Glenn Guest
Journal of Surgery and Research, Volume 04, pp 152-157; https://doi.org/10.26502/jsr.10020119

Abstract:
Introduction: Clostridium Difficile infection (CDI) following restoration of intestinal continuity is uncommon and may progress to fulminant colitis. Fulminant CDI is associated with significant morbidity and mortality. In an unwell patient without clear evidence of an anastomotic leak, surgeons should be aware of the possibility of CDI and institute appropriate management. Presentation of Case: We report the case of a 71- year-old man, who presented for an elective loop ileostomy reversal after an ultra-low anterior resection for a low rectal cancer eight months prior. The patient deteriorated clinically on post-operative day (POD) 4 and by POD 5 was in septic shock with multi-organ failure. A relook laparotomy confirmed no anastomotic leak and a flexible sigmoidoscopy revealed typical appearance of pseudomembranous colitis. The patient continued to deteriorate in the intensive care unit despite oral and rectal Vancomycin. An abdominal computed tomography (CT)1 on POD 9 demonstrated severe pancolitis and enteritis necessitating surgical intervention. He underwent an emergency subtotal colectomy with an end ileostomy after failing medical management. Discussion: Many factors have been shown to increase the incidence of Clostridium difficile colonization in the colon including recent hospitalization, antibiotic use, and length of defunctioning beyond six months. The presence of risk factors associated with an increase in CDI such as proton pump inhibitor use, steroid use or immunosuppression and advanced age may allow surgeons to predict high risk patients. Conclusion: Although rare, fulminant CDI following reversal of ileostomy is a potentially fatal condition. Surgeons should be aware of the risk factors predisposing patients to CDI particularly in a patient with an acute abdomen without clear evidence of an anastomotic leak.
Dongyi Peng, Amanda B. Reed-Maldonado, Lia Banie, Guifang Wang, Guiting Lin, Guiting Lin And Tom F. Lue
Journal of Surgery and Research, Volume 04, pp 128-141; https://doi.org/10.26502/jsr.10020117

Abstract:
Background: Carboxymethylcellulose (CMC) is an inexpensive biomaterial that has been used for wound dressings and as an excipient for drug therapy. CMC in combination with adipose-derived stem cells has been reported to enhance tissue healing. The mechanisms underlying this effect are poorly understood. Objective: To investigate the effects of CMC and BloodSTOP iX (BSiX) on porcine dermal cells (PDCs) and porcine adipose-derived stem cells (PADSCs) to define the mechanisms of CMC in activating PDCs and PADSCs. Methods: A young pig was used to isolate PDCs and PADSCs. PDCs were treated with different concentrations of CMC, BloodSTOP (BS), and BSiX. Expression of phosphorylated histone 3 (H3P) and cell proliferation were then assessed. To explore the mechanisms of CMC in activating PDCs and PADSCs, the cells were treated with different concentrations of CMC (0,10,100,1000μg/ml), and Western blot was used to measure the proteins of the Wnt/β-catenin pathway. Results: CMC and BSiX had significant effects in promoting PDC cell growth, while the effect of BS was minor. Both CMC and BSiX promoted PDCs mitosis in vitro; BSiX at a concentration of 100μg/ml had the best effect. Both CMC and BSiX promoted PDC proliferation in a dose-dependent manner, but the effect from BSiX was much greater than that of CMC. CMC activated AMPK in both PDCs and PADSCs. AMPK by crosstalking with Wnt/β-catenin, activated AMPK promotes the expression of its downstream genes, such as H3P and Cyclin D1. Conclusion: We successfully isolated and cultured PDCs and PADSCs. We found that both CMC and BSiX promoted PDC mitosis and proliferation in a dose-dependent manner. In both PDC and PADSC, CMC activated Wnt/β-catenin signaling pathway through AMPK. This could be the underlying mechanism by which CMC activates stem cells and dermal cells to promote wound healing.
Abdul Rehman, Muhammad Fahd Shah, Muhammad Toqeer Zahid, Hamza Shahid, Verda Baig, Masood Ur Rehman, Shahid Khattak, Aamir Ali Syed
Journal of Surgery and Research, Volume 04, pp 263-269; https://doi.org/10.26502/jsr.10020133

Abstract:
Objective: To study the outcomes of patients who underwent surgery for malignancies during the COVID 19 Pandemic. Method: Patients who underwent oncological surgery from March to July 2020 were studied. COVID-PCR was done in all patients preoperatively. Those who tested positive were postponed for 2 weeks. Patients were followed for type of surgery, need of ICU admission, presence of COVID symptoms post operatively and development of complications. Total length of hospital stay was also recorded. Results: A total of 1105 patients were operated from March to July 2020 for GI, HBP, Head & Neck, Urology, Gynaecological, Orthopaedics, Neurosurgical, Plastic Surgery and Cardio-thoracic cancers. Of these 339 patients were operated without any COVID testing. From April 2020, new hospital policies came into effect and every patient was required to undergo testing 48 hours before surgery. 766 patients underwent testing for COVID. 666 patients were negative and proceeded with surgery. 92 patients tested positive on routine screening and had their operation delayed for a period of 2 weeks. 8 patients who were operated in emergency had COVID infection but surgery was not delayed due to emergent nature of the procedure. When analysing the hospital stay of these 100 patients who tested positive there were only 10 patients who were admitted to COVID facility and there were only 3 mortalities that were attributable to COVID. Conclusions: Operating on patients who are COVID positive didn’t lead to any additional morbidity and mortality. We recommend that all hospitals should resume their elective surgical lists.
Tofayel Hossain, Razib Ahmed, Maftun Ahmed, Nitya Ranjan Balo, Nurul Alam Siddique
Journal of Surgery and Research, Volume 04, pp 248-254; https://doi.org/10.26502/jsr.10020131

Abstract:
Introduction: Total Hip Replacement is one of the most successful orthopaedic procedures performed now-a-days. A British orthopaedic surgeon named Charnley first introduced with this treatment. A noncemented joint prosthesis, sometimes called a press-fit prosthesis, is specially textured to allow the bone to grow onto it and adhere to it over time. Aim of the study: The study aims to determine the results and the complications associated with non-cemented total hip replacement (THR). Methods: This cross-sectional study was conducted in the Department of Orthopaedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh during the period from February 2016 to February 2018. Sample size was 35. Statistical analysis of the results was done by computer software devised in the statistical packages for social scientist (SPSS-25) and MS excel-16. Results: In total 35 patients in this cross-sectional study from the total of 35 patients we found most of the patients were male 29(82.86%) and female 6(17.14%). Most of the patients found in 31-40 age group 14(40.00%), then 41-50 and that was 11(31.43%) respectively 5(14.29%) found in 21-30, 11(31.43%) in 41-50 and 4(11.43%) in >61. So most of them found excellent on the score of 90-100, 20(57.14%), then 11(31.4%) was 80-89 score as good, 3(8.6%) found in 70-79 score fair and below <70 score found 1(2.9%) as poor. Conclusion: There is many reasons that may have caused surgeons in the past to move away from the use of cemented implants have been found to be unwarranted and the evidence does not support the increasing using of noncemented implants. In particular, the risk of mortality in cemented THA has not been found to be higher than noncemented THA.
Samrat Ray, Subhashish Das, Vivek Mangla, Amitabh Yadav, Parul Chugh, Naimish N Mehta, Samiran Nundy
Journal of Surgery and Research, Volume 04, pp 229-240; https://doi.org/10.26502/jsr.10020129

Abstract:
Background: Despite the high morbidity following Whipple’s pancreatoduodenectomy operations, there is still a lack of an objective pre-operative tool, based only on clinical and biochemical parameters to predict the outcome following the procedure that might be implemented. Materials and Methods: Using a multivariate regression model, the significant predictors of post-operative outcome were identified in a set of retrospective database of patients (2006-2017), and a risk score developed by binary logistic regression method. This was validated in a set of prospective patients (2017-2020). The model’s predictive accuracy and discriminative ability were assessed using the receiver operating characteristics (ROC) analysis. Results: On multivariate analysis in the retrospective cohort (n=442), the significant predictors of post-operative outcome were identified as peak bilirubin levels, pre-operative stenting and nature of the disease (Benign/Malignant). A risk score was derived and validated on the prospective cohort (n=182). The mean risk for an unfavourable outcome was 24% for a score of /=15. This was further tested on the validation cohort for individual risk scores (AUC=0.793). There was no significant difference between observed and expected risk of major complications (p=0.31). Conclusion: The risk score showed a fair accuracy in predicting post-operative morbidity in the prospective cohort. Therefore, we propose this to be used as a quick aid to predict the operative outcome in patients posted for pancreatoduodenectomy on an outpatient basis using simple pre-operative clinical and laboratory variables.
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