International Surgery Journal

Journal Information
ISSN / EISSN: 23493305 / 23492902
Published by: Medip Academy
Total articles ≅ 5,296

Latest articles in this journal

Divya Sharma, Ranjit Chaudhary
Published: 1 October 2022
International Surgery Journal; https://doi.org/10.18203/2349-2902.isj20222612

Abstract:
Background: Ureterovaginal fistulae are a rare but extremely serious complication of gynaecologic surgery. The objective of this study is to evaluate the feasibility and outcome of endourology in the management of ureterovaginal fistulae. Methods: Retrospective study from August 2018 to April 2022 comprising 18 consecutive cases. Patients ranged from 25-45 years, most common preceding gynaecological intervention was total abdominal hysterectomy, most common presenting complaint was urinary leak. All patients in which the imaging studies showed the ureter communicating with the urinary bladder were taken up for primary stenting. Rest of the cases were subjected to a urinary diversion by percutaneous nephrostomy. Results: 12 cases had fistula on right and 6 on left side. Imaging studies showed communication in 12 cases in which primary retrograde stenting was attempted. We were successful in 8 cases. In remaining 10 cases percutaneous nephrostomy was done. In the 10 cases of urinary diversion, antegrade stenting could be done in 3 cases. 2 out of these did not show any ureteric communication in the initial imaging studies. Overall, 11/18 cases (61.1%) could be stented, rest 7 cases were managed by ureteric reimplantation. Conclusions: Primary retrograde stenting should be considered the primary mode of intervention in all cases of ureterovaginal fistula where imaging studies show a ureteric communication with the bladder. When it is not possible or when imaging studies fail to demonstrate a communication, achieve a urinary diversion by nephrostomy and reassess after 2 weeks. All cases managed by endoscopic approach must be followed up after stent removal.
Abinaya Preethi, Surya Rao Rao Venkata Mahipathy, Narayanamurthy Sundaramurthy, Alagar Raja Durairaj, Anand Prasath Jayachandiran, Suresh Rajendran
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1742-1744; https://doi.org/10.18203/2349-2902.isj20222599

Abstract:
The bilobed flap is a local flap used for the reconstruction of small to moderate cutaneous nasal defects. It was first described by Esser in 1918 for use in nasal tip reconstruction. It is a double transposition flap where the first flap serves to fill the primary defect, and a second smaller fills the secondary defect. This approach seeks to distribute tension across a wider area. It is a random pattern flap with no specified blood supply. This study was done at the department of plastic and reconstructive surgery, Saveetha medical college and hospital, from January 2018 to December 2018. Five patients (four female and one male) underwent bilobed flap to reconstruct the cutaneous nasal defects out of which three patients had naevus while two patients had basal cell carcinoma nose. Their ages ranged from 35-68 years with a mean age of 52 years. The procedures were done under local anaesthesia. Post-operatively, all sutures were removed on the 5th day. This technique was performed in 5 cases with defect size ranging from 0.9×1.1 to 1.3×1.8 cm. All defects were closed under minimal wound tension, all scars were inconspicuous, no obvious complications occurred, and the aesthetic outcomes were considered favorable. The bilobed flap is a versatile, easy to perform and reliable flap for closure of small nasal cutaneous defects with good aesthetic outcomes, reduced morbidity and less scarring.
Anubhav Goel, Ankur Bansal, Karan Rawat
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1706-1709; https://doi.org/10.18203/2349-2902.isj20222593

Abstract:
Background: Head injury is a significant reason for high dreariness and mortality, especially in youthful and useful age bunch patients. As per the World Health Organization report on street security, road traffic accidents (RTAs) would be the fifth driving reason for death worldwide constantly 2030. Larger part of the head wounds are ramifications of street auto collisions (RTAs), falls, attacks, or wounds, happening either in the work environment, during sport, and so forth. Present study was aimed to study patients with head injury coming to our tertiary care center. Methods: Present study was a prospective, observational type, conducted in patients with head injury who were admitted under the department of surgery during study period.Results: After applying inclusion and exclusion criteria, total 230 patients were considered for present study. 57% patients were from 21-50 years age group. Male to female ratio was 2.6:1. RTAs (63%) was most common cause of head injury in present study followed by assaults (20%) and fall from height (10%). 63% patients had mild head injury, while 21% and 16% patients had moderate and severe head injury respectively. Total 17% deaths were noted in present study. Outcome worsens with worsening of severity of head injury. Conclusions: Trauma remains leading cause of head injury in present study. Necessary preventive measures and vigorous training of all medico and para-medico staff for early management of head injury can definitively reduce mortality and morbidity due to head injury.
Oyibo Ugbede Emmanuel, Abubakar Sadiq Muhammad, Ngwobia Peter Agwu, Abdullahi Abdulwahab-Ahmed, Mungadi Ismaila Arzika
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1681-1688; https://doi.org/10.18203/2349-2902.isj20222591

Abstract:
Background: Bladder cancer is the ninth commonest cancer and the 13th most common cause of mortality worldwide. Its early diagnosis poses a great challenge therefore the need to identify biomarkers which may improve the current diagnostic practice. Methods: This is a prospective study of patients managed for bladder cancer at the urology unit, department of surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria between April 2019 to June 2020. Urine cytology, urine nuclear matrix protein 22 (NMP22) quantitative test and histology of the bladder biopsy specimens were done at the Histopathology and Chemical Pathology laboratory respectively of the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Data was collected using a structured proforma and analyzed using statistical package for social sciences (SPSS) version 20.0. Results: Eighty-three patients enrolled in the study however 46 of them with features of bladder carcinoma participating in the study group and 37 in the control group. The study and control groups' mean age and age range are (49.70±11.45,18-69) and (51.84±13.75,18-78) years, respectively. The sensitivity, specificity, PPV, NPV and AUC of urine NMP22 and urine cytology in the study were (78.3% vs. 58.7%), (32.4% vs. 100.0%), (59.0% vs. 100.0%), (54.6% vs. 66.1%), (0.207 vs. 0.538) respectively for the diagnosis of bladder cancer. Conclusions: Urine NMP22 quantitative test shows high sensitivity, low specificity and a low AUC compared to urine cytology and thus of poor clinical value in the diagnosis of bladder cancer in our region.
Ravi Kumar Sabu M., Kannan R., Joyce Prabakar
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1745-1749; https://doi.org/10.18203/2349-2902.isj20222600

Abstract:
Diverticular disease of the colon is commonly prevalent in developed countries, especially in the western population. This is mainly attributed towards their food habits which include less dietary fibre which is the primordial cause of diverticular disease. Its incidence is gradually increasing in developing countries, especially in southern parts of India due to rapid change in food habits which are moving towards western culture. Majority of the patients with diverticular disease may remain asymptomatic. Diverticular disease presents to the hospital with a wide variety of symptoms such as lower abdominal pain, fever, malaise, bleeding per rectum which manifests because of its complications. Hence the early presentations of diverticular disease should not be missed and proper evaluation should be carried out in suspicious cases to prevent complications which can be deadly. Here we present a series of cases that are received in our emergency department as a complication of diverticular disease. This is a case series in which we study the emergency presentations of diverticular diseases admitted in Rajiv Gandhi government general hospital. Here diverticular disease is proven by a series of investigations that include evaluation of acute abdomen such as x ray abdomen erect, ultrasound abdomen, contrast enhanced computed tomography and histopathological examination with appropriate management.
Debangshu Kumar, Bishal Kundu
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1731-1736; https://doi.org/10.18203/2349-2902.isj20222598

Abstract:
Background: Post operative bracing following ACL reconstruction has been traditionally used in post operative period to reduce pain limit knee range of motion to protect against valgus and varus stress. There is a lack of consensus in published literature regarding knee immobilization. The aim of this study is to compare the functional outcome and pain control in patients using knee immobilizer with those not using them in immediate post operative period. Methods: A total of 60 patients admitted with ACL tear who were admitted from January 2020 to August 2021 were enrolled in this study and randomised into two groups, given knee immobilizer or no immobilizer following arthroscopic ACL reconstruction. Patients were assessed for pain, knee range of motion and functional outcome with 6-month follow-up. Results: VAS score for pain was significantly lower for knee brace users (p=0.24) on post-op day2 but there was no significant difference on subsequent measurements. Also, the IKDC Score, arc of motion of knee joint and complication rate did not show significant difference between the two groups. Conclusions: Based on this study, the use of a knee brace for improving short term outcome following ACL reconstruction is not justified and adds to the cost of treatment. A short cylindrical back slab for 2-3days can serve the same purpose of controlling pain and soft tissue protection.
Aditya Singh Baghel, Krishnanand Anand, Saumya Gupta
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1720-1725; https://doi.org/10.18203/2349-2902.isj20222596

Abstract:
Background: Outcome of laparoscopic cholecystectomy is determined by an array of factors including patient & gallstone-related variables. Number of gallstones influences pathophysiology of disease thereby influencing outcome of surgery. This study was aimed at investigating clinical, haematological, radiological features and surgical outcomes among patients having single and multiple gallstones. Methods: Single centre, hospital-based, prospective, observational study involving 60 patients undergoing LC. Data pertaining to clinical, hematological, radiological variables and surgical outcomes were collected and analysed. Results: Mean duration of symptoms (m/c- pain) was significantly shorter among participants having multiple gallstones (p=0.034). There was no statistically significant difference among participants having single and multiple stones regarding any of clinical signs and symptoms (p>0.05). Mean GB wall thickness among patients having single and multiple gallstones was 3.27 mm and 4.18 mm (p=0.038). Difference in proportion of patients having pericholecystic collections was statistically significant (p=0.019). Mean duration of surgery among participants with single and multiple stones was 57 minutes and 71 minutes, respectively (p=0.012). On intraoperative examination, adhesion was noted in 20% of participants with single stone and 35% of participants in multiple stones group (p=0.029). Conversion rate to OC was 12% in multiple stones group and only 3.4% of participants with single stone (p=0.028). Adjusted odds ratio for conversion to OC was 3.39 (95% CI 1.98-7.89) for patients having multiple gallstones. Conclusions: Although patients having single and multiple gallstones have similar clinical features, findings of ultrasonography and surgical outcomes may differ significantly.
Digvijoy Sharma, Saikat Mallik, Hitesh Kalita
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1710-1714; https://doi.org/10.18203/2349-2902.isj20222594

Abstract:
Background: Pancreatico-enteric anastomoses after Whipple’s pancreaticoduodenectomy (PD) has truly remained Achilles' heel in this technically challenging and complex surgery. Many techniques have been developed over decades to reduce the rate of postoperative pancreatic fistula (POPF), which is still the major cause of morbidity and mortality even in the current era. Methods: A retrospective review of all patients who underwent Whipple’s PD by the same surgical team from August 2019 to February 2022 was performed.Results: A total of 41 patients underwent classical Whipple’s PD with the new technique of PJ during the study period. No patient developed clinically significant PF. Delayed gastric emptying was seen in three patients and surgical site infection occurred in three patients. The rate of overall morbidity was 14.3%. Conclusions: This simple and innovative technique significantly reduces the risk of POPF irrespective of pancreatic texture and duct diameter. It is easily reproducible without adversely affecting the operative time.
Harshit Kamal, Malika Singh, Mohammad Riyaz, Rohith Mudadla, Murugesan S. Devakumar, Jeswanth Satyanesan
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1750-1754; https://doi.org/10.18203/2349-2902.isj20222601

Abstract:
Intrahepatic cholangiocarcinoma (ICC), which is ordinarily a very invasive tumor and often takes a rapid and fatal course, sometimes shows macroscopic intra bile duct extension. We present a case of a 45-year-old Indian gentleman who presented with jaundice. Further evaluation with contrast enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) abdomen revealed mass lesion in segment 4 of liver with extension into the bile duct. A formal left hepatectomy with gall bladder and bile duct tumour thrombus extraction with bile duct excision followed by a Roux-en-Y hepaticojejunostomy was performed. Intra bile duct growth of ICC may reflect indolent biological behavior and thus warrants an aggressive surgical approach, which appears to give a good prognosis.
Bhupesh Harish Tirpude, Ashwini Annamwar, Raj Gajbhiye, Gayatri Deshpande
Published: 28 September 2022
International Surgery Journal, Volume 9, pp 1715-1719; https://doi.org/10.18203/2349-2902.isj20222595

Abstract:
Background: Chronic granulomatous mastitis is a rare benign breast condition that can mimic breast cancer. The present study was undertaken to assess the demographics, clinical presentation, etiology, diagnostic tools and management of patients with CGM. Methods: This descriptive observational study was conducted in total 83 women who presented with breast lump with tenderness associated with fever for more than 4 weeks of duration in the Department of General Surgery at Tertiary Care Centre from June 2018 to December 2020. Results: In all cases breast lump was chief complaint, of maximum (38.5%) had this illness since last 1 to 4 months. 48 patients had past history of tuberculosis. Axillary lymph node was enlarged in 24.1% and body temperature was raised in 57.8% of cases. Skins over the lump were presented with indurated with multiple pus discharging sinuses (50.6%) and palpable mass with erythema and ulcerative skin lesion (49.4%). On biopsy all the patients presented with granulomatous mastitis and on USG, hypoechoic mass was presents in all cases. Patients were managed medically by IV antibiotic and AKT (57.8%) and IV antibiotic with oral corticosteroid (42.2%). Incision and drainage were done in 74 cases while 8 required wide local excision and in 1 patient mastectomy was done. Conclusions: The histopathology remains the optimal diagnostic tool. Corticosteroid therapy has been shown to be efficacious for CGM, but in the existence of many complications, surgical treatment has been first method of choice. We consider that wide local excision is the better treatment choice if possible.
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