International Surgery Journal

Lung isolation and one-lung ventilation in a tracheostomised patient undergoing minimally invasive direct coronary artery bypass surgery: a case report

2026-03-27T08:25:06+0530

MIDCAB being a safe and effective procedure may be considered ideal for non-diffuse multivessel occlusions, adequate left ventricular function and for those who prefer to return to their normal life without sternotomy wound care. In such patients, the use of bronchial blockers as an adjunct via elective tracheostomy prior to the cardiac surgery facilitates prolonged ventilation for an extended period. Moreover, this technique expands the scope of MIDCAB to be applied in a diverse spectrum of patients with minimal risk. This is a rare case of insertion of bronchial blockers along with pre-operative tracheostomy for airway management prior to MIDCAB surgery.

Anterior aesthetic rehabilitation with adhesively cemented lithium disilicate ceramic veneers: a case report

2026-03-08T08:09:30+0530

Contemporary restorative dentistry prioritizes biomimetic principles and preservation of sound enamel to optimize adhesion, marginal stability, and long-term performance. This clinical case report describes anterior esthetic rehabilitation using adhesively cemented lithium disilicate ceramic veneers within a minimally invasive restorative approach. A 32-year-old systemically healthy female patient presented with esthetic dissatisfaction related to dental giroversion, discoloration, and incisal wear in the maxillary anterior region. After comprehensive clinical evaluation and diagnostic planning, treatment with four lithium disilicate veneers (IPS e.max®, Ivoclar) was indicated for teeth 11, 12, 21, and 22. A diagnostic wax-up and mock-up were performed to validate esthetic and functional parameters prior to conservative preparation, primarily within enamel. Impressions were obtained using addition silicone, and provisional restorations were placed. At the definitive appointment, veneers were conditioned following glass-ceramic protocols, and enamel surfaces were treated using a strict adhesive protocol. Cementation was performed individually with light-cured resin cement under rubber dam isolation. Occlusal adjustment, finishing, and polishing ensured functional stability and esthetic integration. The final outcome demonstrated satisfactory morphological, chromatic, and functional integration. Longitudinal evidence supports high survival rates for lithium disilicate veneers when adhesion is predominantly enamel-based and protocols are rigorously executed. Within minimally invasive restorative options, lithium disilicate veneers remain a predictable and evidence-supported solution for cases with high esthetic demand and long-term color stability requirements.

Left sided gallbladder: a rare case report and approaches to surgical management

2026-03-20T08:34:28+0530

Left-sided gallbladder (LSGB) is a rare anatomical anomaly defined by its location to the left of the round ligament. With a reported incidence of 0.7-1.2%, LSGB is clinically significant due to association with the biliary tree and vascular abnormalities, which can increase technical difficulty and risk of intra-operative injury during laparoscopic cholecystectomy. We describe the case of a female patient in her 30s who presented with sudden onset epigastric pain in the context of recurrent gallstone pancreatitis. Pre-operative imaging, including ultrasound, CT and MRCP showed non-obstructive cholelithiasis with no obvious anatomical abnormalities. A gallbladder located to the left of the falciform ligament, in keeping with a true LSGB, was identified during her laparoscopic cholecystectomy. To obtain optimal retraction and exposure, an additional left upper quadrant port was inserted. Intra-operative cholangiogram demonstrated conventional biliary anatomy with the cystic duct draining to the right of the hepatic duct. The patient had an uncomplicated post-operative recovery. LSGB is often diagnosed intra-operatively and carries an increased risk of biliary and vascular injury. Early recognition and modification of surgical technique, including adjustment of port placement and use of intra-operative cholangiography may be helpful to achieve critical view of safety and minimise operative complications.

Multimodal surgical approach to complex arteriovenous malformation of the scalp

2026-03-27T08:24:59+0530

Arteriovenous malformations are vascular anomalies characterized by abnormal connections between arteries and veins, originating from genetic mutations that alter vessel formation. Their management presents a challenge due to their unique behavior in each patient and the high rate ofmorbidityand recurrence. The case of a 21-year-old female with an arteriovenous malformation in the region is described parietotemporooccipital. The left side of the body had been previously treated with a series of embolizations. Upon evaluation, a pulsatile, progressively growing tumor was found in the aforementioned region. A coordinated approach between endovascular therapy and plastic surgery was implemented, achieving selective embolization prior to definitive surgical resection. A wide resection was performed with partial-thickness skin grafting. Postoperative recovery was favorable, with adequate graft integration and a satisfactory functional outcome. The management of arteriovenous malformations requires an individualized strategy based on a comprehensive evaluation. The combination of embolization and resection remains the most effective option for lesion control and complication reduction, especially in complex or recurrent cases.

Managing emergent irreducible rectal prolapse: pros and pitfalls of Altemeier procedure and review of perineal strategies

2026-03-27T08:21:51+0530

Rectal prolapse is a debilitating condition predominantly affecting older adults and may be exacerbated by chronic constipation, frailty, or psychiatric comorbidities. Perineal approaches, including the Altemeier procedure, offer an effective treatment option for selected patients, particularly when abdominal surgery carries elevated risk. We report the case of a 62-year-old woman with schizophrenia, hemorrhoidal disease, and chronic constipation who presented with a large, irreducible full-thickness rectal prolapse of several years’ duration and underwent emergency perineal rectosigmoidectomy. A 23-cm rectosigmoid segment was resected and a hand-sewn coloanal anastomosis performed. Histopathological examination showed mucosal hemorrhage, ulceration, and vascular congestion without dysplasia or malignancy. Postoperative recovery was uneventful, with restoration of bowel function by postoperative day 8 and discharge on day 9. Transient flatus incontinence resolved spontaneously. At two-year follow-up, the patient remained asymptomatic, without recurrence, constipation, or significant incontinence. However, recurrence of rectal prolapse was documented five years after surgery and additional post-recurrence evaluation will be performed.
Rectal prolapse is an uncommon but debilitating condition, particularly in patients with comorbidities such as chronic constipation or psychiatric disorders. Incarcerated prolapse requires prompt surgical intervention; in this case, the Altemeier procedure was chosen due to irreducibility, chronicity, and patient frailty. Postoperative recovery was uneventful, with restoration of bowel function and good two-year functional outcomes. Although recurrence remains a concern—especially with large or long-standing prolapses—the procedure is a pragmatic and reproducible option for high-risk patients. The Altemeier procedure is an effective option for irreducible rectal prolapse, offering good functional outcomes in high-risk patients. Long-term recurrence remains possible, highlighting the need for individualized management and ongoing postoperative follow-up.

Bouveret syndrome secondary to a cholecystoduodenal fistula in a patient with locally advanced cholangiocarcinoma

2026-03-27T08:21:03+0530

Bouveret syndrome is a rare form of gallstone ileus characterized by gastric outlet obstruction caused by the impaction of a large gallstone that migrates through a biliary-enteric fistula. Its occurrence in patients with active biliary malignancy is exceptionally uncommon and poses significant diagnostic and therapeutic challenges. We report the case of a 63-year-old woman with locally advanced, unresectable cholangiocarcinoma who presented with acute abdominal pain, hemodynamic instability, and severe metabolic derangement during first-line systemic therapy. Computed tomography revealed a contained gallbladder perforation with a cholecystoduodenal fistula and a large gallstone impacted in the duodenal bulb, causing secondary gastric dilatation consistent with Bouveret syndrome. Due to clinical deterioration and unfavorable local inflammatory conditions, surgical management was selected. Exploratory laparotomy was performed, and the stone was mobilized retrogradely into the stomach, followed by anterior gastrotomy and successful extraction. The management of Bouveret syndrome remains controversial, particularly in patients with advanced malignancy, as endoscopic treatment has limited success in cases involving large stones or severe inflammation. In this patient, stone size, local anatomy, and oncologic status justified a palliative surgical approach focused on symptom relief and damage control. Bouveret syndrome in the setting of advanced cholangiocarcinoma is rare and associated with poor prognosis; however, individualized, multidisciplinary decision-making is essential, and surgical intervention remains a valid option in unstable patients or when endoscopic management is not feasible.

Acute duodenal diverticulitis with contained perforation causing biliary obstruction and ascending cholangitis: a case report

2026-03-07T06:39:24+0530

Periampullary duodenal diverticula (PAD) are common in older adults but rarely cause biliary obstruction and cholangitis. Distinguishing diverticulitis with contained perforation from other periampullary pathology can be challenging, and endoscopic visualisation may be limited by scope choice. An 83-year-old woman presented with two weeks of right upper-quadrant pain, associated with fever, jaundice and cholestatic derangement. CT and MRCP showed periampullary diverticulitis with contained perforation, causing common bile duct (CBD) obstruction; several small non‑obstructive CBD stones were also present. She met accepted criteria for definite acute cholangitis. In view of suspected diverticular perforation and anticipated technical challenges with endoscopic retrograde cholangiopancreatography (ERCP), she was managed conservatively with intravenous antibiotics and supportive care, with clinical and biochemical resolution. Follow-up CT intravenous cholangiogram showed normal calibre ducts and no filling defects. Forward-viewing gastroscopy later did not visualise diverticulum. PAD can present with diverticulitis and peridiverticular collection causing biliary obstruction and cholangitis, even when small non‑occlusive CBD stones coexist. Conservative management may be effective in selected stable patients when ERCP carries high risk and side‑viewing duodenoscopy should be considered when endoscopic visualisation is required.

Transpositional and skin grafting following release of axillary contracture due to burn injury: a rare case report

2026-03-27T08:21:36+0530

Burn injuries are among the most common causes of disability and mortality in children. One of the most frequent complications is post-burn contracture, which significantly impairs functional mobility and quality of life. Axillary contracture, in particular, poses a surgical challenge due to its impact on upper limb movement, making activities of daily living difficult for affected individuals. A 22-year-old male patient presented with a 15-year history of scald burn scar on his left axillary following a scald injury in childhood. The patient experienced restricted shoulder mobility, limiting his daily activities. Physical examination revealed a contracture involving the left axilla, lateral, and posterior thorax. Surgical release of the contracture was performed under general anesthesia using appropriate reconstructive techniques tailored to the defect. The procedure was successfully completed, and the patient was discharged in stable condition. Postoperative follow-up showed satisfactory wound healing and a marked improvement in shoulder mobility. Post-burn axillary contracture remains a major challenge, not only from a surgical standpoint but also because of its profound impact on a patient’s independence and quality of life. Surgical release continues to be the cornerstone of treatment, offering a path toward restoring function and dignity that years of scarring may have taken away. From our experience, timely and well-planned reconstructive surgery can safely and effectively correct even severe contractures with both anterior and posterior involvement, including cases where definitive management has been delayed for many years.

Ruptured popliteal artery aneurysm presenting with cardiac arrest and requiring lifesaving amputation: a case report

2026-03-27T08:21:34+0530

Rupture of a popliteal artery aneurysm (PAA) is a rare but potentially fatal event, often presenting with haemorrhagic shock, limb loss and high mortality. Early diagnosis and prompt surgical management are critical for survival. A 50-year-old previously healthy man was found collapsed, agitated, and complaining of right leg pain. During prehospital transport, he became progressively unresponsive. On arrival at the emergency department, he experienced cardiac arrest with pulseless electrical activity. Advanced cardiovascular life support was initiated, achieving return of spontaneous circulation after three cycles of cardiopulmonary resuscitation. Despite aggressive resuscitation, persistent haemodynamic instability required vasopressor support and massive transfusion. Physical examination revealed a tense haematoma extending from the right thigh to the leg, with absent distal pulses. CT angiography demonstrated active haemorrhage from the right popliteal artery with a large intramuscular haematoma, consistent with ruptured PAA. As vascular surgery was unavailable locally, teleconsultation with a regional centre recommended emergency transfemoral amputation for life-saving haemorrhage control. The amputation was performed without complications. After 14 days in intensive care for pulmonary infection, the patient recovered and was discharged on postoperative day 18. Follow-up showed complete stump healing and successful prosthetic rehabilitation. Ruptured PAA is an extremely rare yet life-threatening condition. In hospitals without vascular surgery, rapid recognition and decisive intervention, including emergency amputation, may be the only viable life-saving option.

A biliary dilemma resolved by endoscopy: Lemmel syndrome as a cause of non-lithiasic acute obstructive cholangitis

2026-03-27T08:20:58+0530

Acute cholangitis is commonly caused by choledocholithiasis. A diagnostic and surgical dilemma arises when no stones are found. Lemmel syndrome—biliary obstruction secondary to a periampullary duodenal diverticulum—is a rare but crucial etiology to consider. This report describes its presentation, diagnosis, and endoscopic management. We present the case of a 73-year-old female with severe acute obstructive cholangitis without evidence of lithiasis. Evaluation included clinical history, physical examination, laboratory tests, ultrasound, and magnetic resonance cholangiopancreatography. The definitive diagnosis was established via endoscopic retrograde cholangiopancreatography (ERCP). Clinical and biochemical findings were consistent with cholangitis, but imaging studies revealed no choledocholithiasis. ERCP demonstrated a 30 mm periampullary duodenal diverticulum containing the major papilla, which was covered with food residue, confirming Lemmel syndrome. Management involved diverticular cleansing and endoscopic sphincterotomy, which successfully resolved the obstruction. This case highlights the importance of including Lemmel syndrome in the differential diagnosis of non-lithiasic acute cholangitis. Detailed endoscopic evaluation is essential to identify this anatomical alteration and avoid unnecessary surgical interventions. Targeted endoscopic treatment represents an effective and minimally invasive strategy.

Colonic intussusception caused by a giant colonic lipoma: case report and literature review

2026-03-27T08:21:11+0530

Colonic lipomas are rare benign tumours that frequently remain asymptomatic. However, when large in size, they may cause serious complications such as intussusception and bowel obstruction, challenging differentiation from malignant neoplasms. This paper reports the case of a 54-year-old male patient admitted to the emergency department with intermittent abdominal pain and progressive constipation over two months. Computed tomography revealed colo-colonic intussusception involving the descending and sigmoid colon with a 4.2 cm endoluminal lesion suggestive of neoplasia. Colonoscopy confirmed a pedunculated stenotic mass, enabling intussusception reduction, but diagnostic biopsy was not feasible. Due to persistent obstructive symptoms, inability to exclude malignancy, and risk of recurrent intussusception, left colectomy via laparotomy was performed. Pathological examination confirmed a benign submucosal lipoma measuring 4.2×3.5×3.5 cm without signs of malignancy. Postoperative course was uneventful with progressive bowel recovery and hospital discharge in good clinical condition. This report emphasizes the importance of accurate differential diagnosis of colonic lipomas, judicious indication for surgical resection in complicated giant lipomas, and minimally invasive techniques available for management of this condition.

Propofol-induced anaphylaxis with severe angioedema during colonoscopy: a case report

2026-03-27T08:20:55+0530

Propofol is widely used for procedural sedation and anesthesia due to its rapid onset and recovery. Although regarded as safe, it can rarely provoke severe allergic reactions, including anaphylaxis. Because these events are infrequent, recognition may be delayed, particularly when clinical features are atypical. We described a case of propofol-induced anaphylaxis during outpatient colonoscopy in a 66-year-old man with no known allergies. The patient developed sudden desaturation, hypotension, and progressive facial and cervical angioedema, initially misinterpreted as bowel perforation due to associated abdominal distention. Multiple intubation attempts failed, necessitating an emergent tracheostomy. This case emphasizes the need for early suspicion of anaphylaxis in unexplained perioperative collapse, prompt administration of epinephrine, airway preparedness, and post-event allergy evaluation to confirm the diagnosis and prevent re-exposure.

Extranodal marginal zone lymphoma of mucosa associated lymphoid tissue: a rare cause of acute abdomen

2026-03-27T08:20:53+0530

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is a low-grade B-cell lymphoproliferative disorder that most commonly involves the stomach. Involvement of the small intestine is rare, accounting for a small proportion of gastrointestinal cases, and clinical presentation is often nonspecific. Acute abdomen resulting from intestinal perforation is an exceptional manifestation. Case presentation: We report the case of a 33-year-old male with no significant past medical history who presented with a two-week history of progressive diffuse abdominal pain, fever, and anorexia. Physical examination revealed signs of peritonitis and a palpable inflammatory mass in the right lower quadrant. Given the clinical diagnosis of acute abdomen, an emergency exploratory laparotomy was performed, revealing a small bowel inflammatory mass with intestinal perforation and purulent peritonitis, located approximately 50 cm from the ileocecal valve. Segmental small bowel resection with primary anastomosis and appendectomy were performed. Histopathological and immunohistochemical analysis of the resected specimen confirmed extranodal marginal zone lymphoma of MALT type. The postoperative course was uneventful, and the patient was discharged without complications. Small intestinal extranodal marginal zone lymphoma is a rare entity with an indolent course and nonspecific clinical manifestations, which may delay diagnosis. In exceptional cases, it may present as an acute abdomen due to complications such as intestinal perforation, requiring urgent surgical intervention. This case underscores the importance of maintaining a high index of suspicion and highlights the role of a multidisciplinary approach in diagnosis and management.

Successful management of gastric fistulas with endoluminal vacuum therapy after a type IV hiatal hernia repair: a case report

2026-03-27T08:20:34+0530

Endoluminal vacuum therapy (Endo-Vac) is currently part of the first line in the endoscopic management of gastrointestinal fistulas or perforations, due to its high success rates and low percentage of adverse events. We present the case of a 48-year-old man who presented with two gastric fistulas after the correction of a type IV hiatal hernia and anti-reflux surgery, which was successfully managed with endoluminal vacuum therapy without complications. Endo-Vac therapy is currently a safe and effective technique for the treatment of transmural defects in the digestive tract. However, it is necessary to develop an algorithm based on the location, size of the defect, associated stenosis, infection, and available experience to reduce complications and possible adverse events, always in conjunction with a multidisciplinary team.

A case of recanalised umbilical vein thrombosis

2026-03-17T07:50:53+0530

A case of a 55 year old woman with recanalised umbilical vein thrombosis in a patient with gastritis who does not have liver cirrhosis or portal hypertension. This patient had presented with mild nausea and acute onset of epigastric pain. CT abdomen and pelvis had demonstrated this finding of a recanalised umbilical vein with thrombus formation, along with some thickening of the gastric antrum with mild surrounding fat stranding suggestive of gastritis. The patient underwent an inpatient gastroscopy to rule out malignancy in context of these findings, which only demonstrated some healed gastric ulcers. Histopathology report described chronic gastritis and intestinal metaplasia, no evidence of established malignancy. This is an unusual case that highlights that recanalisation of the umbilical vein could occur without portal hypertension. This may have been a spontaneous event or could have been caused by local inflammation such as gastritis.

Abdominal gunshot wound: a case report

2026-03-20T08:34:33+0530

Firearm injuries pose an escalating health concern worldwide and contribute significantly to trauma-related mortality and disability. We hereby report one such case of firearm injury where a 20-year-old male came to the trauma care centre with a penetrating abdominal injury, and the bullet was trapped in the pelvic bone. The associated bowel injuries were with intraoperative findings of jejunal perforations, colonic mesenteric injury and retroperitoneal haematoma that was managed by exploratory laparotomy with repair of associated injuries. The bullet, however, was not removed. The report aims to highlight the management of firearm injury and emphasise that bullet removal may not be necessary in all cases, depending on the site and structure of retention in relation to associated patient factors.

Flood syndrome: a leaky umbilical hernia

2026-03-27T08:21:44+0530

Flood syndrome is a rare but serious complication of advanced liver disease, defined by spontaneous rupture of an umbilical hernia with sudden leakage of ascitic fluid. Chronic ascites increases intra-abdominal pressure, weakening the abdominal wall and predisposing to hernia formation. Skin ulceration or necrosis over the hernia sac may indicate impending rupture. We present a case of a 53-year-old man with decompensated chronic liver disease and ascites who presented with abdominal distension, umbilical swelling, and continuous ascitic fluid leakage. He had discontinued medical therapy two months earlier. Examination revealed a distended abdomen with a necrotic umbilical hernia and significant fluid loss. Following prompt fluid resuscitation, emergency surgical repair with excision of necrotic tissue was performed. Postoperatively, ascites management was reinstated, and recovery was uneventful. Flood syndrome carries high morbidity and mortality. Early recognition, hemodynamic stabilization, infection control, and effective ascites management are crucial for successful surgical repair and improved outcomes.

Nigam’s hybrid intraperitoneal onlay mesh repair of large incisional hernia

2026-03-27T08:21:31+0530

Incisional hernia repair is done by laparoscopic and open technique. A mesh is placed inside the abdominal cavity over the hernia defect through laparoscopy, it is called as IPOM (Intraperitoneal Onlay mesh repair). The mesh is fixed with tacks or sutures. The IPOM-plus technique is the repair process where the hernia defect is closed before placing the mesh. Hybrid IPOM is a method of repair where a combination of open and laparoscopic procedures is used. Nigam’s hybrid-IPOM (NH-IPOM) is a new technique combining laparotomy and laparoscopic IPOM in large incisional hernias specially in obese individuals where the redundant abdominal wall of hanging large hernia is excised and wound is closed.

Gallbladder carcinoma presenting as hemobilia and overt gastrointestinal bleeding: a rare case report

2026-03-27T08:21:30+0530

Gallbladder carcinoma (GBC) rarely presents as hemobilia or hemocholecyst. Intraluminal hemorrhage as the initial manifestation of gallbladder cancer is extremely uncommon, reported in nearly 1% of cases, with only a handful of cases described in the literature over the last three decades. A 54-year-old female presented with recurrent abdominal pain, melena, jaundice, and severe anemia requiring multiple blood transfusions. Repeated upper gastrointestinal endoscopies, colonoscopies, and contrast-enhanced computed tomography scans failed to identify the bleeding source initially. A subsequent upper gastrointestinal endoscopy demonstrated active blood ooze in the second part of the duodenum, raising suspicion of hemobilia. Further imaging revealed a gallbladder mass with common bile duct involvement. Exploratory surgery identified a gallbladder tumor with intraluminal blood clots extending into the common bile duct. The patient underwent radical cholecystectomy with liver wedge resection and en bloc excision of the common bile duct followed by Roux-en-Y hepaticojejunostomy. Histopathology confirmed grade 1 mucinous adenocarcinoma of the gallbladder (pT2a pN0). Postoperative recovery was uneventful, with no further episodes of gastrointestinal bleeding. This case highlights the diagnostic challenges of hemobilia in the absence of prior biliary intervention or trauma and emphasizes the importance of persistent evaluation and high clinical suspicion for early diagnosis of gallbladder malignancy presenting with obscure gastrointestinal bleeding.

Gas under the diaphragm due to perforation of a gangrenous uterus in a postmenopausal nulliparous woman: a diagnostic and surgical dilemma

2026-03-27T08:21:15+0530

Pneumoperitoneum is most commonly associated with hollow viscus perforation. Rare gynecological causes may mimic gastrointestinal pathology, leading to diagnostic dilemmas. Chances of uterine perforation presenting as gas under the diaphragm (pneumoperitoneum) are extremely low, as it's a very rare complication, usually from a perforated pyometra (pus in the uterus), often misdiagnosed as a GI perforation. We report to you a 54-year-old postmenopausal woman presented with acute abdomen and radiological pneumoperitoneum. Emergency exploratory laparotomy revealed pyoperitoneum, a gangrenous perforated uterus, and gangrenous small bowel loops. Subtotal hysterectomy with bowel resection and stoma formation was performed. Intraoperative pus culture grew Escherichia coli. Despite aggressive management, the patient succumbed on postoperative day one.

Isolated ileal tuberculosis presenting as massive lower gastrointestinal bleeding: rare case report

2026-03-27T08:21:08+0530

Intestinal tuberculosis (TB) is a common form of extrapulmonary (EPTB) in developing countries. It usually presents with obstruction, perforation, or malabsorption. Presentation as massive lower gastrointestinal (LGI) bleeding is extremely rare. A 65-year-old male, presented with sudden onset of massive bleeding per rectum associated with haemorrhagic shock. He required multiple Blood products transfusion. Contrast-enhanced CT abdomen showed distal ileal wall thickening with intraluminal contrast extravasation, suggestive of a vascular malformation. Laparotomy showed multiple areas of congestion and ulceration noted in distal ileum with active bleed intraluminally, associated enlarged mesenteric lymph nodes present. Limited ileocecal resection was performed. Histopathological examination revealed granulomatous lesion-Koch’s etiology. Isolated lleal TB, rarely presents as massive lower GI bleeding. Early surgical intervention plays a vital role in both diagnosis and management, especially when the patient presents with hemodynamic instability

Spontaneous intramural hemorrhage of the terminal ileum leading to bowel gangrene in a healthy 37-year-old female: a comprehensive case report

2026-03-27T08:20:47+0530

Spontaneous intramural intestinal hemorrhage (SIIH) is a very unusual presentation. It is only associated with anticoagulant drug therapy, trauma, or coagulopathies. Terminal ileal involvement in a patient without any predisposing factors is an extremely rare presentation, and progression to bowel gangrene is even rarer. We report a 37-year-old woman with no known comorbidities, medications, or surgical history who presented to us with acute abdominal pain and vomiting. Contrast-enhanced computed tomography (CECT) revealed hypo-enhancing distal ileal loop with free air foci, few loculated collections and enhancing peritoneum in right iliac fossa with features of subacute intestinal obstruction. Clinical deterioration ensued despite conservative management. Exploratory laparotomy, revealed a 15 cm gangrenous terminal ileal segment. Resection with end ileostomy was performed. Although SIIH usually resolves with conservative management, deterioration may lead to ischemia of the bowel segment associated with obstruction and needs timely surgical intervention. Prompt recognition and timely decision-making are critical for preventing mortality.

Laparoscopic repair of eventration of the left dome of the diaphragm: case report with review of literature

2026-03-27T08:20:40+0530

Diaphragmatic eventration (DE) is characterized by an abnormal elevation of one or both hemi diaphragms without any actual disruption or discontinuity in the diaphragmatic musculature. This condition results in a structurally intact but functionally impaired diaphragm. The etiology may be either congenital or acquired, thereby allowing for its occurrence across a wide age spectrum-from neonates to elderly individuals. Its diagnosis is usually made and confirmed on imaging. Symptomatic patients of DE require surgery for its repair (open/ laparoscopic/ thoracoscopic/robotic). The authors, herein, present the case of a 51 years old male patient who had symptomatic left sided DE. He underwent a laparoscopic repair and had an uneventful recovery.

Unusual penetrating cervicothoracic injury with retained iron rod

2026-03-27T08:20:37+0530

Penetrating cervicothoracic injuries are exceedingly rare and have a complicated mechanism of injury. The emergency team faces substantial challenges in diagnosing and treating these kinds of injuries. Evaluation and management are still contentious, and there isn't a single, widely recognized management strategy. We report an unusual accident in a young male who presented with iron rod penetrating left side of neck and coming out of left scapula. The iron rod was removed under general anaesthesia and patient made an uneventful and smooth recovery.

Transanal minimally invasive surgery for complex rectal adenomas in a regional colorectal unit: early outcomes within a collaborative tertiary network

2026-03-08T08:09:31+0530

Transanal minimally invasive surgery (TAMIS) is an established technique for local excision of complex rectal adenomas, predominantly performed in tertiary colorectal centres. Access in regional hospitals remains limited. We report our early experience of introducing TAMIS within a regional colorectal unit through structured collaboration with tertiary colorectal services, through a case series of three consecutive patients undergoing TAMIS for complex rectal adenomas in a regional general surgery unit between August and November 2025. One patient underwent staged diagnostic and definitive excision. Lesion size ranged from 25-40 mm and were located in the low to mid rectum. All procedures were completed successfully without conversion. Final histopathology demonstrated tubulovillous adenoma with low-grade dysplasia in all cases. One patient experienced a Clavien-Dindo grade II complication. There were no reoperations or 30-day readmissions. Thus, TAMIS can be safely introduced in selected patients within a regional setting with appropriate multidisciplinary governance and collaborative support. This model enables delivery of organ-preserving surgery closer to home while maintaining safety and appropriate escalation pathways.

Octreotate avid intrapancreatic lesions-intrapancreatic splenunculi masquerading as pancreatic neuroendocrine tumours

2026-03-11T08:38:05+0530

Splenunculi (heterotopic spleens or accessory splenic tissue), are relatively common (occurring in ~10-30% of the population) and can occur in a variety of locations, including within solid organs such as the pancreas, kidney and the liver. The majority of intrapancreatic splenunculi (IPS) are located within or adjacent to the tail of the pancreas. Differentiating IPS from other pancreatic lesions, specifically those with malignant potential such as pancreatic neuroendocrine tumours (pNETs) can be challenging based solely on radiological appearance. Both IPS and pNETs have similar characteristics on contrast enhanced CT and octreotate-PET imaging. IPS are benign and largely asymptomatic. They require no surgical intervention or follow-up. pNET’s are relatively rare neoplasms which require active surveillance or surgical resection depending on their size and other patient factors. Current international guidelines do not routinely recommend definitive tissue diagnosis prior to proceeding with surgical resection of presumed pNET lesions. Here, we present a case series of four patients with tail of pancreas (ToP) lesions, initially suspected to be pNETs based on CT and octreotate PET imaging, who subsequently underwent further, more sensitive investigations (denatured red cell scan or endoscopic ultrasound (EUS) guided fine needle aspirate (FNA) and were confirmed to have IPS. Accurate diagnosis with further investigations such as EUS guided biopsy, is valuable in guiding surgical management of octreotate avid ToP lesions and avoiding potentially harmful and unnecessary surgical intervention.

Syringe-based closed negative suction drainage for small surgical wounds: a case series and review of low-cost surgical innovation

2026-03-27T08:20:32+0530

Postoperative fluid accumulation within surgical wounds can lead to complications such as hematoma, seroma, surgical site infection, and delayed wound healing. Closed suction drainage systems are commonly used to prevent these complications by eliminating dead space and facilitating continuous evacuation of fluid collections; however, commercially available systems may not always be accessible in resource-limited settings. This prospective observational case series was conducted at B. D. Pandey District Hospital, Nainital, India, from January 2024 to June 2025, including 24 patients undergoing minor surgical procedures with anticipated dead space formation. A syringe-based closed suction drainage system was assembled using a disposable syringe and infant feeding tube to generate negative pressure drainage. The mean age of patients was 28 years, with 16 males and 8 females. Indications included excision of soft tissue swellings, minor reconstructive procedures, and closure of wounds with potential dead space. Mean drainage volume was 25 ml on postoperative day 1, 12 ml on day 2, and 4 ml on day 3, with a mean drain duration of 3 days. No hematoma or seroma formation was observed, while two patients developed superficial surgical site infection managed conservatively. Syringe-based closed negative suction drainage is a simple, safe, and cost-effective alternative for small surgical wounds, particularly useful in low-resource healthcare settings.

Association of serum zinc, selenium, nickel, cobalt and prostate-specific antigen levels with prostate cancer: a case-control study

2026-03-27T08:21:48+0530

Background: Prostate cancer (PCa) is a leading cause of cancer morbidity and mortality in men, with growing incidence in Nigeria. While prostate-specific antigen (PSA) remains the primary screening tool, its limited specificity necessitates exploration. Zinc (Zn), selenium (Se), nickel (Ni) and cobalt (Co) have been implicated in carcinogenesis, but their roles in PCa among Nigerian men remain under researched. To evaluate the association between serum Zn, Se, Ni, Co and prostate-specific antigen (PSA) levels in histologically confirmed PCa.

Methods: This was a prospective case-control study conducted among 81 men presenting with bladder outlet obstruction in two Nigerian hospitals. Forty-one patients with histologically confirmed PCa and 40 with benign prostatic disease (controls). Serum Zn, Se, Ni and Co levels were measured using atomic absorption spectrophotometry and PSA was determined via standard immunoassay. Demographic and biochemical data were analyzed.

Results: PSA was significantly elevated in PCa patients (18±5 ng/ml) versus controls (2±1 ng/ml, p<0.001). PCa patients had lower Zn (0.34±0.66 vs. 0.79±0.42 µg/ml, p<0.001) and Co (0.015±0.010 vs. 0.20±0.36 µg/ml, p<0.001), while Ni was higher (0.52±0.42 vs. 0.30±0.08 µg/ml) but not statistically significant (p=0.600). Se levels were slightly lower in PCa (0.14±0.07 µg/ml) compared to controls (0.17±0.07 µg/ml), without statistical significance (p=0.073).

Conclusions: PCa in Nigerian men is associated with PSA elevation, reduced serum Zn and Co and a trend toward higher Ni and lower Se. Zn depletion aligns with established literature, whereas reduced Co represents a novel observation warranting further study. Trace element profiling, alongside PSA, may enhance detection of PCa.

Comparative effectiveness of open versus endoscopic hernioplasty techniques in inguinal hernia repair: a retrospective study

2026-03-27T08:21:41+0530

Background: The optimal surgical approach for inguinal hernia repair remains debated. This study compared open (mesh and non-mesh) and endoscopic hernioplasty techniques, focusing on operative duration, postoperative pain, recovery and early complications.

Methods: A retrospective cohort study was conducted on 334 patients who underwent inguinal hernioplasty at a single university clinic (2022-2024). Five techniques were evaluated: Bassini repair (n=32), Kimbarovsky repair (n=34), Lichtenstein tension-free repair (n=178), transabdominal preperitoneal repair (TAPP; n=71) and extended totally extraperitoneal repair (eTEP, n=19). Outcomes assessed included operative duration, postoperative pain intensity (Visual Analog Scale-VAS), pain duration and hospital stay, narcotic analgesic requirements and early complications.

Results: Endoscopic techniques (TAPP and eTEP) demonstrated superior perioperative outcomes compared with open repairs. Patients undergoing TAPP/eTEP reported lower VAS scores (p<0.001) and a shorter duration of pain, with no narcotic analgesic use, versus 7.3% (Lichtenstein) and 34.8% (Bassini/Kimbarovsky). Median hospital stay was shorter after endoscopic repair (4 days) than following Lichtenstein repair (6–7 days). However, endoscopic procedures required longer operative times than open techniques. Early complication rates were low across all groups; seromas occurred more frequently after TAPP/eTEP repair (3.3%) than after Lichtenstein repair (0.5%), while hematomas were not observed in endoscopic cases.

Conclusions: Endoscopic inguinal hernioplasty is associated with reduced postoperative pain, minimal narcotic requirement and shorter hospital stay, but longer operative duration. These techniques should be considered preferentially when adequate surgical expertise and resources are available and rapid recovery is prioritised. Lichtenstein repair remains a reliable open alternative, while non-mesh techniques demonstrated less favourable outcomes.

The correlation between elevated procalcitonin levels and poor short-term clinical outcomes in patients with resectable colorectal cancer

2026-03-27T08:21:38+0530

Background: Elevated procalcitonin (PCT) levels reflect systemic inflammation, a common condition in colorectal cancer (CRC) that is associated with unfavorable prognosis. Inflammatory responses may negatively affect postoperative recovery and quality of life. This study aimed to evaluate the correlation between increased PCT levels and short-term clinical outcomes in patients with resectable CRC.

Methods: A prospective observational study was conducted at Dr. Moewardi General Hospital, Surakarta, from November 2022 to November 2023. Fifty patients with resectable CRC who underwent pre-operative PCT testing were included. Short-term clinical outcome was assessed using the SF-36 questionnaire, categorizing patients into good (score >50) and poor (score≤50) quality of life groups. The relationship between PCT levels and clinical outcomes was analyzed using the Spearman rank correlation test.

Results: The mean PCT level was 0.54±1.15 ng/ml, with a median of 0.09 ng/ml. Patients with poor quality of life had significantly higher mean PCT levels (1.61±2.55 ng/ml) compared to those with good quality of life (0.08±0.05 ng/ml). A strong and statistically significant correlation was found between elevated PCT levels and poor short-term clinical outcomes (r=0.795; p=0.001). Higher PCT levels were also significantly associated with all eight SF-36 domains, including physical functioning, role limitations, bodily pain, and general health.

Conclusions: Increased PCT levels are strongly correlated with poorer short-term clinical outcomes in patients with resectable CRC. PCT may serve as a useful biomarker for monitoring inflammation and predicting postoperative quality of life.

Cardiac injury and mortality after blunt chest trauma: a prospective observational cohort study

2026-03-27T08:21:26+0530

Background: Cardiac trauma is a serious injury that can occur after blunt chest trauma, posing a high risk of rapid deterioration and mortality. This study aims to evaluate cardiac injuries and mortality after blunt chest trauma.

Methods: This observational cohort study included 303 patients with blunt chest trauma, comprising 248 males (81.85%) and 55 females (18.15%), resulting in a male-to-female ratio of 4:1. The mean age was 39.26±19.89 years, with a range of 2 to 81 years. All patients underwent a clinical assessment, an injury severity evaluation using the injury severity score (ISS) and received various diagnostic tests.

Results: The overall mortality rate was 14.2% (43 out of 303 patients). Logistic regression analysis identified independent mortality predictors, including the mode of trauma, need for mechanical ventilation, ISS, and blunt cardiac injury (BCI). Our patients were divided into two groups; group I had 91 patients (30.03%) with BCI, showing a mortality rate of 27.5% (25 patients), significantly higher than the 8.5% (18 patients) in group II, without BCI.

Conclusions: BCI is an important independent predictor of mortality in cases of blunt chest trauma. Therefore, physicians need to prioritize early diagnosis and management of this condition.

Correlation between tumor size and site with axillary lymph node metastasis in breast cancer

2026-03-27T08:20:43+0530

Background: Breast cancer remains significant health concern across the world and the leading cause of cancer related mortality and morbidity among females. Various trials have been performed to evaluate the chances of less extensive surgery in both breast and axilla, even omission of axillary surgery. So, it is paramount to identify the prognostic and predictive factors that may fulfill the goal in the future.

Methods: This was a cross-sectional observational study which took place in the Department of Surgical Oncology, National Institute of Cancer Research and Hospital (NICRH), Mohakhali, Dhaka from January 2023 to December 2023 over a period of 12 months. A p<0.05 was considered statistically significant.

Results: A total number of 76 patients were enrolled in the current study after fulfilling the inclusion and exclusion criteria. Mean age of the study population was 42.37±9.87 years. There is statistically significant relationship between tumor size and ALNM (p<0.05) where majority of the patients (n=47) presented with T2 lesion (61.84%). Results of the study also showed involved site of breast by cancer was significantly related to axillary lymph node metastasis (ALNM). The number of patients presented with upper and outer quadrant, Upper and Inner quadrant and lower and inner quadrant were 48 (63.2%), 13 (17.1%) and 6 (7.9%) respectively. Lower and outer quadrant was involved by 8 (10.5%) patients which was not significantly related with ALNM (p>0.05).

Conclusions: The current study demonstrated quadrant involvement can emerge as a clinically useful prognostic factor in breast cancer as there is a higher incidence of lymph node positivity with increasing size of the breast tumor and for tumors located at the outer quadrants of the breast. So, the site of primary tumor and size may be an important characteristic finding affecting the prognosis and treatment of patients with breast cancer.

Early outcome of open wound dressing with tincture of benzoin compound versus closed wound dressing in clean wounds

2026-03-27T08:20:36+0530

Background: Wound is disruption in the continuity of epithelial lining of skin or mucusa resulting from damage. The Aim of this study was to assess the effectiveness of open wound dressing with tincture of benzoin compound versus close wound dressing with gauze and plaster for post-surgery and other wounds less than 20 cm in length

Methods: The study adopted a form of quasi-experimental approach where the effects of the different wound dressing protocols were assessed. Informed consent was obtained from the patients before enrolling into the study. The patients for this research work were randomly divided into two groups; one group was dressed with gauze and plasters after the routine cleaning with antiseptic, while the other group after same routine cleaning had tincture of Benzoin compound applied to the skin and left open. The acceptability and comfort of the dressing used was ascertained from the patient using questionnaire. Data was analysed and a p value less than or equal to <0.05 was considered statistically significant.

Results: Open wound dressing with tincture of benzoin compound had better wound healing outcome, there was 65% wound healing requiring no further dressing, while closed wound dressing with gauze and plaster had 55%. Ninety-six percent prefer benzoin compound dressing while 74% prefer gauze and plaster. The 26% said if given another opportunity, they would not like to have gauze and plaster dressing compared to 4% that will use it.

Conclusions: Open wound dressing with tincture of benzoin compound is effective and has a comparable advantage over close wound dressing.

The clinico-epidemiological profile and safety and effectiveness of polygeline in Indian patients presenting with hypovolemia: results from a prospective, multicentre, single-arm and open-label post-marketing observational study

2026-03-07T06:39:23+0530

Background: Severe trauma and acute fluid loss are major causes of hypovolemia, linked to high morbidity and mortality if untreated. Intravenous fluid resuscitation, including plasma volume expanders (PVEs), is essential for restoring intravascular volume and perfusion. Polygeline, a gelatine-based colloid, is widely used; however, Indian real-world safety and effectiveness data remain limited. Objectives were to describe the demographic and clinico-epidemiological profile of Indian patients with hypovolemia and to evaluate the effectiveness and safety of Polygeline 3.5% intravenous infusion in routine clinical practice.

Methods: This prospective, multicentre, open-label, post-marketing observational study enrolled 154 patients aged 18-65 years who received polygeline 3.5% IV infusion. Demographic and clinical characteristics were documented. Effectiveness was assessed by changes in hemodynamic parameters, urine output, respiratory rate, metabolic markers, pallor, and skin condition over 24 hours. Safety and tolerability were monitored throughout the study.

Results: Hypovolemia was equally attributed to traumatic and non-traumatic causes. Among traumatic cases, 46% were classified as class II hypovolemia and 4.7% as class III, while non-traumatic cases showed fewer moderate to severe presentations. Over 24 hours, significant improvements were observed in hemodynamic parameters: mean systolic blood pressure increased from 99.99 to 119.11 mmHg, diastolic pressure from 61.68 to 74.43 mmHg, pulse rate declined from 104.60 to 85.53 bpm, respiratory rate from 21.57 to 18.82 breaths/min, and urine output increased from 21.08 to 218.90 mL (p<0.0001). One non-serious adverse drug reaction (0.6%) was reported and resolved without intervention.

Conclusions: Polygeline 3.5% IV infusion demonstrated effective hemodynamic stabilization with a favourable safety profile in patients with hypovolemia of traumatic and non-traumatic origin.

Challenging conventional belief: total extraperitoneal repair with reduced operative time versus Lichtenstein in Central India

2026-03-27T08:25:10+0530

Background: Inguinal hernia is a common surgical condition, and repair techniques significantly impact patient outcomes. This study aimed to compare total extraperitoneal (TEP) laparoscopic repair with Lichtenstein tension-free open mesh repair in terms of operative outcomes, post-operative pain, complications, and hospital stay among patients in Central India.

Methods: A comparative study was conducted at a tertiary care centre from June 2022 to August 2024. A total of 100 patients with uncomplicated inguinal hernia were enrolled and randomly assigned into two equal groups: 50 patients underwent laparoscopic TEP repair, and 50 underwent Lichtenstein repair. Patients were evaluated for operative time, blood loss, post-operative pain (using visual analogue scale), complications, hospital stay, and follow-up outcomes over a minimum period of two months.

Results: The TEP group had a shorter average operative time (78 min) compared to Lichtenstein (90 min, p<0.001) and lower intraoperative blood loss (20 ml vs 35 ml, p<0.001). Post-operative pain was significantly less in TEP, with 94% of patients experiencing pain for only one day versus prolonged pain in the Lichtenstein group (p<0.001). Complications such as cord edema and wound infection were lower in the TEP group (0% and 2%, respectively) compared to Lichtenstein (10% and 12%, p<0.001). The average hospital stay was shorter for TEP (3 days) compared to Lichtenstein (5 days, p<0.001). No recurrences were observed in either group during follow-up.

Conclusions: TEP repair provides advantages of shorter operative time, reduced blood loss, less post-operative pain, fewer complications, and shorter hospital stay while maintaining comparable safety and effectiveness to Lichtenstein repair. However, it requires advanced surgical skills and specialized equipment, whereas Lichtenstein remains a safe and practical option in settings lacking laparoscopic facilities.

Effect of body mass index and obesity on lymph node harvest in colorectal cancer resections

2026-03-27T08:25:08+0530

Background: Body mass is generally perceived by surgeons as a factor increasing technical difficulty in most surgical procedures. This is a retrospective observational study on colorectal cancer resections considering obesity, to see how patient body mass index (BMI) affects lymph node harvest in colorectal cancer.

Methods: This was a retrospective observational study between October 2021 and November 2023 at a district general hospital in England. Ethical approval was not sought as this was an observational anonymised study without any patient identifiable information. Data was collected consecutively from MDT lists and grouped by procedure and subgroups with BMI and node harvest was checked in each subgroup and group.

Results: We had 171 patients and a statistically significant effect on node harvest was only seen in abdominoperineal resections with BMI over 30

Conclusions: Obesity did not influence lymph node harvest in colorectal resections other than in abdominoperineal resections in BMI over 30.

Comparative analysis of Lord’s plication and Jaboulay’s eversion in the surgical management of primary vaginal hydrocele

2026-03-27T08:25:01+0530

Background: Hydrocele, a common benign cause of scrotal swelling, frequently requires surgical correction. Among available techniques, Lord’s plication and Jaboulay’s eversion are widely used, yet evidence comparing their outcomes remains inconclusive, particularly in the Indian context. Aim was to compare postoperative outcomes of Lord’s plication and Jaboulay’s eversion in adult males with primary vaginal hydrocele.

Methods: A prospective comparative observational study was conducted at a tertiary care centre between January 2024 and December 2025, enrolling 100 adult male patients with primary vaginal hydrocele. Based on sac wall thickness and size, 71 patients underwent Jaboulay’s eversion and 29 underwent Lord’s plication. Primary outcome was the rate of postoperative complications; secondary outcomes included pain on postoperative day (POD) 3 and 7, hospital stay duration, suture removal day, and recurrence at 6 months. Data followed STROBE guidelines; statistical analysis employed Fisher’s exact and Kruskal-Wallis tests, with p<0.05 considered significant.

Results: Postoperative complications occurred in 33% of patients, significantly lower in the Jaboulay group (17%) compared to Lord’s (72%) (p=0.002). Mean hospital stay was shorter following Jaboulay’s eversion (7.08±1.6 days) versus Lord’s plication (8.0±1.75 days; p<0.001). Suture removal occurred earlier after Jaboulay’s (5.9±0.7 days vs 7.2±1.1 days; p=0.002). No recurrence was observed in either group at 6 months.

Conclusions: Both procedures effectively treat primary hydrocele; however, Jaboulay’s eversion offers significantly fewer complications, less postoperative pain, and faster recovery. It should be preferred, particularly for large or thick-walled hydroceles.

State of the art in burn care: principles and advances in surgical management

2026-03-04T08:06:00+0530

Burn injuries remain a major global health challenge, associated with high morbidity, mortality, and long-term disability, particularly in low- and middle-income countries. Over the past decades, burn care has evolved into a multidisciplinary field that integrates early resuscitation, surgical intervention, intensive care, rehabilitation, and long-term reconstruction. Accurate assessment of burn depth and total body surface area, prompt fluid resuscitation, infection prevention, and timely surgical decision-making are fundamental to improving outcomes. Early excision and wound closure, most commonly achieved through split-thickness skin grafting, remain the cornerstone of surgical management for deep burns, while alternative strategies such as dermal substitutes, temporary biological dressings, and bioengineered skin have expanded options for patients with extensive injuries or limited donor sites. Long-term care focuses on the prevention and treatment of scarring and contractures through staged reconstruction and structured rehabilitation. This state-of-the-art review summarizes current principles and advances in burn surgical management, emphasizing individualized, multidisciplinary, and resource-sensitive approaches.

Inguinal hernia and diverticulosis in octogenarians: the role of connective tissue and aging: a short narrative review

2026-03-04T08:05:59+0530

Inguinal hernia and diverticulosis are highly prevalent conditions in older adults that significantly affect health expenditures and complications. Increasing evidence suggests that both diseases may share common age-related pathophysiological mechanisms, particularly alterations in connective tissue and collagen metabolism. These associations appear especially relevant in octogenarians. A narrative literature review was conducted using PubMed to identify studies addressing inguinal hernia, diverticulosis, diverticulitis, connective tissue alterations, collagen metabolism, and aging, with a focus on patients aged 80 years and older. Relevant epidemiological, clinical, registry-based, and experimental studies were synthesized. The study reveals that diverticulosis affects roughly 70% of individuals aged 80 and older, with a concerning 20% recurrence rate of diverticulitis leading to high complication and mortality rates following surgery. As age increases, the risk for inguinal hernia also rises, especially for emergency repairs. Evidence suggests a common underlying connective tissue disorder linking the two conditions, with patients undergoing colectomy for diverticulitis at higher risk for incisional hernia. This calls for personalized management strategies, particularly preoperative assessments for patients with diverticulosis. Inguinal hernia and diverticulosis present significant challenges for octogenarians, necessitating informed, tailored management approaches. The study emphasizes the link between age-related connective tissue changes and adverse health outcomes, advocating for individualized care strategies. Ongoing research is essential to refine management pathways and improve outcomes for aging patients.

Emerging methods in wound care: an update

2026-03-07T06:39:25+0530

Chronic wounds [diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), pressure injuries] and complex acute wounds impose substantial morbidity, reduced quality of life and high health-care costs. Many wounds fail to heal because of impaired angiogenesis, persistent inflammation, hypoxia, senescent cells, dysfunctional extracellular matrix (ECM) and biofilm-laden microbiomes. Recent innovations target these pathophysiologic drivers. This narrative review synthesizes contemporary advances in wound care across biologic or regenerative therapies, advanced biomaterials, antimicrobial or anti-biofilm strategies, device-based physical modalities, smart dressings, digital integration and 3D printing or bioprinting. The mechanisms, representative technologies, clinical indications, evidence strength, practical considerations and safety or regulatory challenges are summarized. Biologic approaches include cellular therapies [autologous or allogeneic keratinocytes, fibroblasts, mesenchymal stromal or stem cells (MSCs)], platelet-derived products, engineered skin substitutes and emerging gene or RNA therapies offering targeted modulation of inflammation, angiogenesis and matrix repair. However, they all require rigorous wound bed preparation and patient optimization. Advanced dressings (hydrogels, protease-modulating matrices, electrospun scaffolds, antimicrobial-integrated and oxygen-releasing materials) improve local milieu and enable controlled therapeutic delivery. Antimicrobial strategies addressing biofilms include enzymatic dispersal agents, bacteriophage therapy and local antibiotic delivery systems. However, multimodal use with debridement is superior to single interventions. Device-based modalities [Negative pressure wound therapy (NPWT) and NPWTi, electrical stimulation (ES), photobiomodulation, photodynamic therapy (PDT), oxygen therapies, ultrasound or shockwave] show utility in specific contexts with strongest evidence for NPWT. Smart sensors, closed-loop dressings and AI-enabled digital assessment promise earlier detection and personalized interventions but need outcome validation. 3D printing and bioprinting enable patient-specific scaffolds and tissue constructs but face vascularization and regulatory barriers. Multimodal, evidence-guided, patient-personalized approaches built on optimized systemic care and meticulous wound bed preparation are most likely to improve outcomes. Key needs include standardized endpoints, larger pragmatic trials, cost-effectiveness data and implementation frameworks to ensure safety, regulatory compliance and equitable access.

Difficult cholecystectomy: a systematic review of predictive factors, surgical approaches and outcomes

2026-03-27T08:21:01+0530

Laparoscopic cholecystectomy is the standard surgical treatment for benign gallbladder disease; however, a substantial proportion of procedures are classified as difficult due to anatomical distortion, inflammation, or technical factors, resulting in increased operative complexity and higher complication rates. This literature review aims to synthesize current evidence regarding predictive factors, classification systems, surgical strategies, and clinical outcomes associated with difficult cholecystectomy. A systematic search was conducted in PubMed (Medline), Scopus, Web of Science, SciELO, and Google Scholar for studies published from 2010 and 2025 in English or Spanish addressing difficult cholecystectomy, predictive factors, classification systems, surgical approaches, and outcomes. The literature consistently identifies advanced age, male sex, obesity, comorbidities, previous abdominal surgery, acute cholecystitis, elevated inflammatory markers, and ultrasonographic findings such as gallbladder wall thickening and impacted stones as key predictors of difficult cholecystectomy. Classification systems including the Tokyo Guidelines, Nassar scale, Parkland grading, and G10 scoring system demonstrate high predictive value for operative difficulty, conversion, and complications. Bailout strategies such as subtotal laparoscopic cholecystectomy, fundus-first technique, and timely conversion to open surgery are associated with improved safety in complex cases. Early identification of predictive factors and systematic use of validated classification systems are essential to optimize surgical planning, reduce complications, and improve patient outcomes in difficult cholecystectomy.