International Surgery Journal

Hand and wrist reconstruction with a posterior interosseus artery flap: case report and literature review

2026-07-08T06:52:14+0530

The posterior interosseous artery flap (PIAF) is an invaluable tool in reconstructive hand surgery, providing a versatile and reliable option for soft tissue defects while maintaining the major vascular axes of the upper limb. We provide a comprehensive review of the PIAF, describe the relevant vascular anatomy, including the origin and course of the posterior interosseous artery (PIOA), and discuss the many advantages of this flap, such as excellent tissue match and the avoidance of major artery sacrifice. Also, discussed are the surgical technique and possible complications, particularly venous congestion, and their management. Finally, we address the disadvantages of the procedure, including the challenging dissection near the posterior interosseous nerve and the limitations in flap width, to provide a balanced perspective for the reconstructive surgeon.

Osseous metaplasia in adrenal myelolipoma; second documented case in human literature

2026-07-29T09:31:09+0530

Adrenal myelolipomas are rare benign tumors composed of mature adipose and hematopoietic tissue. The prevalence of adrenal myelolipoma on autopsy is 0.08-0.4%. Osseous metaplasia within myelolipoma is an extremely rare pathology, with few cases reported in the literature. This study aims to report a case of adrenal myelolipoma with osseous metaplasia, a pathology only reported once in human studies, and to evaluate its clinical and pathological characteristics. A 75-year-old female with a history of hypertension, diabetes, and hyperlipidemia presented with left flank pain. An MRI of the abdomen revealed a left adrenal mass (7x6x5 cm). Preoperative hormonal evaluation, including serum cortisol and plasma metanephrines, were unremarkable and ruled out a functional adrenal tumor. An uneventful robotic assisted adrenalectomy was performed. The resected specimen was an encapsulated adrenal and mass measuring 5.8x5.1x4.8 cm and weighed 78 g. There were areas of hemorrhagic and fatty tissue. Findings were consistent with a left adrenal myelolipoma with osseous metaplasia, calcification, and fibrosis. She had an uncomplicated postoperative course and was discharged on post operative day two. Adrenal myelolipomas are a rare pathology, accounting for only 2-4% of adrenal tumors. Though the etiology remains unclear, the most widely accepted theories are adrenocortical cell metaplasia of the reticuloendothelial blood capillaries or bone marrow cells embolism and hypertrophic reticulum cells. While adrenal myelolipomas are most commonly found incidentally, CT scan is the most sensitive in detecting fat, and therefore detecting these tumors. Most patients are asymptomatic, but larger tumors have been shown to be associated with flank, abdominal and back pain. Most tumors are hormonally inactive, but 10% are hormonally active tumors. Metaplasia can occur due to many conditions including vitamin A deficiency, neoplasia, stress, and chronic inflammation. It was discovered in the adrenal cortex of the two-toed sloth that showed erythroid and myeloid elements. To the best of our knowledge there is only one reported similar case in the human study literature, which documented a patient with hypertension, diabetes, and Cushing syndrome with an adrenal mass. The resected specimen pathology was consistent with mature adipose tissue and areas of osseous metaplasia. Adrenal myelolipoma with osseous metaplasia is an extremely rare pathology, To the best of our knowledge and literature review there is only one case documented in humans. Further evaluation is needed to determine the prognostic factors and sociodemographic associations associated with adrenal myelolipomas exhibiting these specific pathologic characteristics.

Vascular surgery in rural areas: abdominal aortic aneurysm surgery with prosthesis in a tertiary hospital in Haiti: a case report

2026-07-29T09:30:37+0530

Open surgery was replaced in the 1990s by endovascular repair (EVAR), a less invasive method that benefits many patients. However, he remains inaccessible in resource-limited countries, where surgery faces many obstacles. This article explores a case of aorto-iliac aneurysm in a young adult treated in a rural area with limited resources, highlighting the challenges and possibilities of surgical interventions performed under restrictive conditions. A 43-year-old hypertensive man with a 5-year history of abdominal mass presented with abdominal pain and mass. Examination revealed a left-sided pulsatile abdominal mass with thrill. Ultrasound showed a 71.8 mm infrarenal aorto-iliac aneurysm with 39 mm common iliac artery diameter. He underwent successful open repair with a bifurcated prosthesis after stabilization and optimization. CT angiography is the gold standard for diagnosing abdominal aortic aneurysm, allowing accurate assessment and planning. In our context, planning was based on Doppler ultrasound due to limited access to CT angiography. Preparing for open repair of abdominal aortic aneurysms (AAA) also involves optimizing comorbidities, a functional blood bank, and invasive monitoring. In this case, limitations included a lack of CT scanning, minimal blood resources, no invasive intraoperative hemodynamic monitoring and reports indicated that a Doppler ultrasound confirmed the success of the graft. These shortcomings theoretically increase surgical risk, reflecting realities in resource-limited hospitals. This case shows open AAA surgery is feasible in constrained environments with good preparation and adaptation. Although EVAR is effective, open surgery remains crucial in certain situations.

Transverse colon adenocarcinoma mimicking complicated diverticulitis with abscess: a case report and review of literature

2026-07-29T09:26:27+0530

Colorectal cancer (CRC) is one of the most common cancers leading to death and illness globally. In cases of complicated diverticulitis with abscess, the usual course of action is to manage the condition with antibiotics and drainage. However, Inflammatory diverticular disease may have a similar clinical and imaging presentation to CRC, leading to a diagnostic dilemma. This study presents a case of a 68-year-old male with acute abdominal pain and a non-contrast computed tomography (CT) scan showed distal transverse colon diverticulitis with a 6.1×6.5 cm abscess. He was treated with IV antibiotics and IR-guided percutaneous drainage, but developed a persistent purulent discharge at the drain site, followed by hematochezia. A contrast-enhanced CT scan showed persistent thickening of the colonic wall and a track from the collection to the skin. A subtotal colectomy with loop ileostomy was done. The histopathology showed a perforated, moderately differentiated transverse colon adenocarcinoma (pT4aN0M0; stage IIB). To conclude, the lack of improvement after drainage or the development of a tract/fistula should trigger an urgent reassessment for an occult malignancy and control of the source.

Redefining the spectrum of fistula-associated malignancy in Crohn’s disease: a rare case of colonic adenocarcinoma arising from a perianal fistula

2026-07-29T09:26:26+0530

Crohn’s disease (CD) is a chronic, relapsing, and progressive disease characterised by transmural inflammation affecting any segment of the gastrointestinal tract. Perianal fistulising CD (PFCD) affects approximately 20% of CD patients and is associated with a more aggressive disease course and reduced quality of life than those without fistulising disease. While the association between luminal colorectal cancer and CD has been well-established, PFCD-associated fistula cancers is a rarer entity. Existing literature is comprised mostly of case reports and case series, thus guidelines for detection and management of these cancers are scarce. Current diagnostic techniques display major shortfalls, necessitating the adoption of a multimodal, multidisciplinary approach. Further research is needed into its true incidence, pathophysiology and demographics, as well as the efficacy of and enhancing current diagnostic techniques. We present a case of a young female who developed an adenocarcinoma within a chronic perianal fistula.

When benign mimics malignancy: giant hypervascular focal nodular hyperplasia requiring left hemi-hepatectomy

2026-07-29T09:26:15+0530

Focal nodular hyperplasia of the liver (FNHL) is a benign, non-invasive, and common liver cell tumor with a habitually lazy course of action. The probability of FNHL transforming into malignancy is very unlikely. The prevalence of FNHL globally is reported as 0.4-3% in the general population and the risk of acquiring FNHL increases with age. A 29-year-old woman presented to the hepatobiliary department of the Grodno University Clinic with complaints of intermittent epigastric pain, early satiety and abdominal bloating. No associated fever, jaundice, weight loss, or gastrointestinal bleeding was present. The patient’s medical history was not significant, and she had no family history of cancer. A large, well-circumscribed heterogeneous lesion occupying the left lobe of the liver was demonstrated on the abdominal ultrasound scan. Contrast enhanced computed tomography (CT) revealed a giant hypervascular mass with intense arterial phase enhancement and partial washout during the portal venous phase. Furthermore, magnetic resonance imaging further confirmed a hypervascular lesion arising predominantly from segments II, III, and IV of the liver. This case report illustrates the diagnostic challenges aroused by giant hypervascular focal nodular hyperplasia (FNH), a benign liver lesion that can precisely replicate the characteristic features of malignant tumors, both clinically and radiologically.

Extensor tendon injuries in zone VI – surgical repair and functional outcomes: a case report

2026-07-29T09:26:25+0530

Extensor tendon injuries in Zone VI of the hand are common and generally offer favorable conditions for primary repair because of the larger tendon caliber and lower anatomical complexity. Optimal functional recovery depends on appropriate surgical technique, suture selection, and postoperative rehabilitation. We report the case of a 35-year-old man with complete laceration of the extensor digitorum communis tendons of the third, fourth, and fifth digits following a sharp traumatic injury. Primary repair was performed using a modified Kessler technique with a 3-0 nylon core suture and a continuous 4-0 nylon epitendinous suture. A review of the recent literature on Zone VI extensor tendon injuries, including technical and biomechanical considerations, was also conducted. This case supports current evidence that combining core and epitendinous sutures, together with a thorough understanding of tendon anatomy and biomechanics and the implementation of early rehabilitation protocols, provides reliable restoration of extensor function and favorable clinical outcomes in Zone VI tendon injuries.

Penile trauma in the field: a case of power take-off injury managed without hospitalization

2026-07-29T09:26:24+0530

Power take – off injury (PTO) is the commonest mode for male genital injury. PTO injury occurs when a power electrical / mechanical heavy machine pulls victims loose outfit when entangled and rips off with a de-gloving injury of the male genitalia. In this report we have discussed a case of 42-year-old man, working in a paper factory, who came to our clinic with a de-gloving injury of the penis with PTO model and with reported significant blood loss. He was solely managed in our clinic due to financial constraints and non-availability of a valid health insurance. The patient took one month for whole recovery, with preserved sexual and urinary functions.

Adult presentation of congenital Bochdalek hernia: a rare case report

2026-07-29T09:32:16+0530

Bochdalek hernia is a congenital posterolateral diaphragmatic defect that typically presents in neonates with respiratory distress. Adult presentation is extremely rare and often diagnosed incidentally or when complications occur. We report a case of a 68-year-old male who presented with acute abdominal pain and vomiting. Imaging revealed a left posterolateral diaphragmatic defect with herniation of stomach, spleen and transverse colon into the thoracic cavity. The patient underwent successful surgical repair with reduction of herniated viscera including spleen for which splenectomy done with closure of the diaphragmatic defect. This case highlights the importance of considering congenital diaphragmatic hernia in adults presenting with unexplained thoraco-abdominal symptoms.

Giant pedunculated neurofibroma of the thigh with apical ulceration in a patient with neurofibromatosis type 1: a case report and review of operative management

2026-07-29T09:32:16+0530

Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder arising from mutations in the NF1 tumour-suppressor gene on chromosome 17q11.2. It is characterised by café-au-lait macules, axillary freckling, Lisch nodules, and the development of multiple cutaneous and plexiform neurofibromas. Giant solitary pedunculated neurofibromas are a rare and functionally disabling manifestation, particularly when complicated by secondary ulceration, which carries a risk of infection and raises concern regarding malignant transformation. A 56-year-old woman with NF1 presented to the outpatient surgical clinic with a large, pedunculated soft-tissue mass over the upper lateral left thigh that had progressively enlarged over many years and had recently developed an ulcer at its apex with intermittent serous discharge. Following thorough pre-operative workup-including magnetic resonance imaging (MRI) of the thigh, ultrasound-guided fine-needle aspiration cytology (FNAC), and cardiorespiratory assessment-the patient underwent elective surgical excision under general anaesthesia. Histopathological examination confirmed a benign peripheral nerve sheath tumour consistent with neurofibroma. Surgical excision remains the definitive treatment for large, symptomatic or ulcerated neurofibromas. Careful pre-operative imaging and meticulous dissection are essential to achieve complete resection whilst avoiding neurovascular injury. Lifelong multidisciplinary surveillance is mandatory given the systemic nature of NF1 and the risk of malignant peripheral nerve sheath tumour (MPNST) transformation.

Synchronous gastrointestinal stromal tumour and neuroendocrine tumour in a patient with neurofibromatosis type 1: a rare clinical association

2026-07-29T09:32:13+0530

Type 1 Neurofibromatosis (NF1) is an autosomal dominant disorder caused by germline mutation of the NF1 gene. While it typically manifests as multiple cutaneous neurofibromas and café-au-lait macules, patients also have an inherent predisposition to neoplasms arising from neural crest–derived tissues and the gastrointestinal tract. GISTs are relatively well-recognized in NF1, whereas neuroendocrine tumours (NET) are uncommon. The synchronous occurrence of both NET and GIST in an NF1 patient is exceedingly rare. We present a 53-year-old female with known NF1 who developed synchronous small-bowel GIST and pancreatic NET. The patient presented with intermittent jaundice. Imaging suggestive of periampullary carcinoma. During Whipple’s procedure, lesions suggestive of periampullary carcinoma and small bowel GIST were identified. Both tumours were resected. Histopathology confirmed high grade spindle-cell GIST and well-differentiated NET. The postoperative course was uneventful. NF1-associated GISTs are not uncommon, but coexistent NETs are rare and easily overlooked. This case underscores the need for heightened vigilance and a broadened differential diagnosis in NF1 patients presenting with gastrointestinal symptoms, as synchronous multifocal tumours may be missed without careful evaluation.

Recurrent plantar eumycetoma in a young soldier managed with wide local excision and vacuum assisted closure: a rare case report

2026-07-29T09:32:12+0530

Mycetoma was first reported in the year 1843 in Madurai, India by Dr. John Gill, and was then called “Madura foot”. The disease is caused by true fungi (Eumycetoma) or bacteria (Actinomycetoma). Commonly, affecting farmers in the tropical and sub-tropical regions, in contact with contaminated soil. The organism gets inoculated into the skin and soft tissue after minor trauma. It causes chronic progressive granulomatous inflammation, leading to destruction of skin and soft tissue characterised by classical triad of painless soft tissue swelling, multiple sinuses and discharge of grains. The treatment consists of early recognition, histopathological confirmation of causative organism, systemic antifungal therapy and surgical excision if not responding to medication. In this article, we present a rare case of recurrent Eumycetoma in a 34-year-old male. He had a history of Eumycetoma in 2018 affecting right foot, treated with systemic antifungals. A recurrent lesion occurred after approximately five years, affecting deeper muscle layers. MRI revealed no bony involvement. He was treated with oral Voriconazole, surgical excision and Vacuum-assisted closure of defect, with a favourable outcome. No recurrence noted upto one year of follow-up. Aim was to emphasize on diagnosis and management of Mycetoma, in cases presenting with classical triad of painless soft tissue swelling, multiple sinuses and discharge of grains, especially in young adults with history of minor trauma while in contact with soil. Early recognition, systemic antifungals with wide local excision leaving behind a healthy margin, followed by vacuum-assisted closure, a high protein diet and physiotherapy, can provide favourable outcome in treatment of Eumycetoma. Reconstructive surgical options can be explored for larger defects. Case report providing level IV evidence.

“Abdominal cocoon” small bowel obstruction: a diagnostic challenge in adolescent female

2026-07-29T09:32:09+0530

Primary sclerosing encapsulating peritonitis (SEP), also referred to as abdominal cocoon syndrome (ACS), is an exceedingly unusual etiology of intestinal obstruction. Morphologically, defined by the entire or partial encasement of the small intestine within a dense fibrocollagenous membrane. Historically it was prevalent among adolescent females in tropical regions. Latest evidence indicates its global distribution, with a higher incidence in males than females. ACS poses a significant diagnostic problem due to its non-specific clinical presentation. We report the case of a 15-year-old female presenting with acute on chronic intestinal obstruction with a history of recurrent similar episodes of abdominal distention with progressive constipation. Preoperative imaging (CECT abdomen) suggested small bowel obstruction with a transition point at the distal jejunum/proximal ileum, without pinpointing on the presence of cocooning. Exploratory laparotomy revealed that the ileal loops were entirely encased in a dense, avascular fibrous peritoneal sac, presenting a classic "cocoon" appearance. Adhesiolysis and excision of the thickened membrane were performed. Histopathology confirmed sclerosing peritonitis with chronic inflammatory infiltrate without evidence of granulomas or tuberculosis affirming that the disease is idiopathic (primary). This case highlights the importance of considering ACS in the differential diagnosis of intestinal obstruction in adolescent females, particularly in tropical regions and demonstrates the curative potential of surgical membrane excision.

Small break, big threat: a rare case presentation of J-pouch ileal perforation

2026-07-29T09:33:00+0530

The ileal J pouch anal anastomosis (IPAA) is a common surgical option for patients undergoing restorative proctocolectomy for ulcerative colitis (UC). Perforation of the J pouch reservoir is a rare but serious complication. It can present with acute peritonitis and needs urgent surgical treatment. We report the case of a 30-year-old male with a history of UC who had previously undergone subtotal colectomy with IPAA along with diversion ileostomy and later ileostomy reversal. He came to the emergency department with sudden abdominal pain. On examination, he had generalised peritonitis and imaging showed pneumoperitoneum. An emergency exploratory laparotomy was performed. It showed a 1×1 cm perforation at the blind end of the J pouch loop along with one litre of toxic peritoneal fluid. Thorough peritoneal lavage done. The perforation was closed primarily and a proximal loop ileostomy was created. The patient recovered well after surgery and was discharged on postoperative day 12. This case shows the importance of early diagnosis and prompt surgical management of J pouch perforation in patients with a history of IPAA.

Primary breast diffuse large B-cell lymphoma presenting as a breast lump: a case report of a rare mimicker of breast carcinoma

2026-07-29T09:30:39+0530

Primary breast lymphoma (PBL) is a rare extranodal form of non-Hodgkin lymphoma that accounts for a small proportion of breast malignancies. It often mimics primary breast carcinoma clinically and radiologically, making diagnosis challenging. A 70-year-old female presented with a painless lump in the right breast of one-week duration. Clinical examination revealed a firm, non-tender mass in the lower outer quadrant of the right breast, along with cervical lymphadenopathy. Ultrasonography demonstrated a suspicious BIRADS 4 lesion. PET-CT showed a hypermetabolic lesion in the right breast with ipsilateral axillary lymph node involvement. Tru-cut biopsy initially suggested an undifferentiated malignant neoplasm. Immunohistochemistry revealed CD10 and BCL6 positivity with MUM1 negativity, confirming diffuse large B-cell lymphoma (DLBCL), germinal center B-cell (GCB) subtype. The patient was treated with R-CHOP chemotherapy. The patient responded well to treatment and remains clinically stable with no complications during a six-month follow-up period. PBL should be considered in the differential diagnosis of breast masses, especially when imaging findings are inconclusive. Histopathology with immunohistochemistry is essential for diagnosis. Early initiation of chemotherapy can result in favourable outcomes, avoiding unnecessary surgical intervention.

Nigam's hybrid intraperitoneal onlay mesh technique: an ideal procedure for big ventral hernia in an obese patient with hanging abdominal wall – a case report

2026-07-29T09:26:28+0530

Nigam’s hybrid intraperitoneal onlay mesh technique (NH-IPOM) for big ventral hernia in an obese patient is the ideal surgical procedure. NH-IPOM is ideal for large incisional hernias specially in obese individuals where the redundant abdominal wall is hanging down. Incisional hernia repair is a common but troublesome problem develops after laparotomy for various reasons. Repair of incisional hernia is difficult as well as complicated specially in large hernia. It is operated by laparoscopic and open technique. Common methods of laparoscopic repair of incisional hernia are IPOM, IPOM-plus and hybrid-IPOM. Hybrid-IPOM is a combination of open and laparoscopic methods. We have developed our hybrid-IPOM technique, called NH-IPOM technique which is a combination of laparoscopic and open surgery. NH-IPOM is ideal for large incisional hernias specially in obese individuals where the redundant abdominal wall is hanging large hernia is excised and wound is closed. NH-IPOM is ideal procedure for such hernias due to low rate of complications including recurrence. NH-IPOM technique is easy and curative, but requires more studies.

Asymptomatic Sturge-Weber syndrome patient with extradural-intradural Ewing sarcoma

2026-07-29T09:26:28+0530

Sturge Weber syndrome (SWS), also called as encephalotrigeminal angiomatosis is an uncommon congenital neurological disorder and frequent among the neurocutaneous syndromes specifically with vascular predominance. Symptoms and signs depend on the extent and location of the venous dysplasia. In its complete trisymptomatic form, SWS is physically characterized by port-wine stains (PWS) over the trigeminal area, leptomeningeal angiomas usually over the parieto-occipital region, and eye abnormalities. We report a case of 19 year old gentleman asymptomatic Roach type II SWS patient with Ewing sarcoma presenting as extradural-intradural spinal tumour.

Post traumatic persistent broncho-pleural fistula managed with autologous blood patch pleurodesis: a rare case report

2026-07-29T09:26:14+0530

Persistent air leak (PAL) and bronchopleural fistula (BPF) following penetrating thoracic trauma are uncommon and pose significant therapeutic challenges. Surgical repair and endoscopic interventions may not always be feasible, particularly in peripheral fistulas or in hemodynamically fragile patients. We report a rare case of post-traumatic persistent BPF following a close-range firearm injury to the chest in a 26-year-old male. Despite initial stabilization and intercostal drainage, the patient developed recurrent pneumothorax with massive air leak after chest tube removal. Imaging confirmed a BPF. Autologous blood patch pleurodesis (ABPP) was performed via the intercostal drain using 100 mL of autologous blood. A repeat instillation was required after 24 hours due to PAL, following which complete resolution was achieved. The lung remained fully expanded, and the chest tube was successfully removed without complications. This case highlights ABPP as a simple, safe, cost-effective, and minimally invasive option for managing refractory post-traumatic PAL when conventional measures fail.

Giant neurofibroma around the knee in a 34-year-old male: a case report

2026-07-29T09:28:58+0530

Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder characterized by multiple neurofibromas, café-au-lait macules, and skeletal abnormalities. Plexiform neurofibromas can attain large sizes, causing functional impairment and cosmetic deformity. Surgical excision remains the primary treatment for symptomatic lesions. A 34-year-old male with a known history of NF1 presented to the General Surgery OPD with a progressively enlarging mass around the left knee and multiple swellings over the body for 15 years. The swelling around left knee was associated with discomfort during walking and restriction of knee movements. Physical examination revealed a large, soft-to-firm, non-tender mass measuring approximately 10×12 cm involving the anterior aspect of the knee. Magnetic resonance imaging (MRI) of left knee suggested a large soft tissue mass consistent with neurofibroma without intra-articular extension. CECT Chest suggested few apical bullas and multiple cutaneous fibromas. The patient underwent complete surgical excision of the mass under general anaesthesia. Histopathological examination confirmed the diagnosis of neurofibroma. The postoperative period was uneventful, and the patient showed significant functional improvement during follow-up. Giant neurofibromas around the knee are uncommon and can significantly impair mobility. Early diagnosis and complete surgical excision can provide symptomatic relief, improve function, and prevent further complications.

The tale of twice left behind: laparoscopic excision of dual symptomatic ureteric stumps

2026-07-29T09:26:23+0530

Ureteric stump syndrome is a rare complication post-nephrectomy characterized by persistent urinary symptoms, often secondary to reflux or infection of the residual ureteric tissue. The presence of dual symptomatic ureteric stumps is an extraordinarily rare phenomenon. We report a case of successful laparoscopic management of dual refluxing ureteric stumps in an adult female with complex urogenital anatomy, including an ectopic ureter. A 31-year-old woman with a history of left ureteric reimplantation for an ectopic ureter opening into the bladder neck and vagina underwent laparoscopic nephrectomy for a poorly functioning kidney. She developed recurrent urinary tract infections (UTIs) and persistent symptoms despite nephrectomy. Imaging revealed dilated ureteric stump on non-contrast computed tomography (CT). During laparoscopic surgery, two dilated ureteric stumps were identified and excised completely. Postoperative recovery was uneventful with complete symptom resolution. This case highlights the diagnostic and surgical challenges posed by dual ureteric stumps and supports laparoscopic completion ureterectomy as a safe and effective treatment for refractory ureteric stump syndrome.

Giant frontoparietal scalp lipoma presenting as a massive cranial swelling: clinicoradiological, cytological and histopathological correlation

2026-07-29T09:26:20+0530

Lipomas are the most common benign mesenchymal tumors composed of mature adipocytes. While frequently encountered in the trunk and extremities, giant lipomas of the scalp are rare owing to limited subcutaneous tissue and cosmetic concerns prompting early treatment. A 59-year-old male presented with a gradually progressive swelling over the left frontoparietal scalp for 14 years in OPD of Department of General Surgery of Saraswathi Institute of Medical Sciences, Hapur, U.P., India. Examination revealed a painless, well-circumscribed, soft-to-firm swelling measuring approximately 11×8 cm with normal overlying skin. Ultrasonography demonstrated a well-defined heterogeneous hyperechoic lesion measuring 11.1×8.6 cm in the subcutaneous plane without internal vascularity, suggestive of lipoma. Fine-needle aspiration cytology showed mature adipocytes without atypia, favoring a lipomatous lesion. The patient underwent complete surgical excision under appropriate anesthesia. Intraoperatively, a large encapsulated adipocytic mass was identified and excised en bloc. Histopathological examination confirmed lipoma. Postoperative recovery was uneventful. Giant scalp lipomas are uncommon and may attain considerable size before presentation. Imaging, cytology, and histopathology are useful for diagnosis. Complete surgical excision remains curative with excellent cosmetic and functional outcomes.

Foreign body induced vesical stone

2026-07-29T09:26:19+0530

Urinary bladder stone formation due to foreign body is not well understood. But insertion of foreign body in urethra for sexual gratification is increasing and most commonly encountered in psychiatric patient. Various types of foreign body has been reported for self-insertion into urinary bladder.in this study fishing threads were used for insertion into the urinary bladder that leads to stone formation for which open cystolithotomy was performed.

The relationship between KRAS gene mutations in colorectal cancer patients and the response to chemotherapy with a 5-fluorouracil and oxaliplatin regimen at Dr. Moewardi General Hospital

2026-07-29T09:32:19+0530

Background: Colorectal cancer remains a significant cause of mortality worldwide. While KRAS gene mutations are established predictors of resistance to anti-EGFR targeted therapy, their impact on response to conventional chemotherapy involving 5-fluorouracil (5-FU) and oxaliplatin remains inconsistent. This study aimed to evaluate the relationship between KRAS mutation status and the clinical response to 5-FU and oxaliplatin-based chemotherapy in colorectal cancer patients at Dr. Moewardi General Hospital.

Methods: This was an observational analytic study utilizing a retrospective cohort design. The sample included 48 colorectal cancer patients who underwent 5-FU and oxaliplatin chemotherapy with documented KRAS mutation status. Data were extracted from medical records, encompassing demographics, mutation status, chemotherapy response, TNM stage, metastasis, and mortality. Bivariate analysis was performed using the Fisher Freeman–Halton exact test, and multivariate analysis was conducted via binary logistic regression.

Results: Most patients were aged 50–59 years (33.3%) and were female (62.5%). KRAS mutations were found in 66.7% of patients. Chemotherapy response was predominantly progressive disease (75%). Among KRAS-positive patients, 78.1% experienced progressive disease. Bivariate analysis showed no significant association between KRAS mutation status and chemotherapy response (p=0.679). Logistic regression analysis also did not identify any factors that significantly affected mortality.

Conclusions: There was no statistically significant association between KRAS gene mutation status and the response to 5-FU and oxaliplatin chemotherapy in colorectal cancer patients within this study population.

Chronic postoperative inguinal pain after open inguinal hernioplasty: prevalence and clinical characteristics in a Mexican secondary care hospital

2026-07-29T09:32:15+0530

Background: Chronic postoperative inguinal pain, also known as inguinodynia, is one of the most clinically relevant complications following open inguinal hernia repair and may significantly impair quality of life. This study aimed to determine the prevalence and clinical characteristics of chronic postoperative inguinal pain in patients undergoing open inguinal hernioplasty at a secondary care hospital in Mexico.

Methods: A prospective, descriptive, cross-sectional, single-center study was conducted in adult patients who underwent open inguinal hernioplasty at Hospital General de Zona No. 20, Puebla, Mexico, between 2024 and 2025. A total of 94 patients were included through simple random probabilistic sampling. Data were obtained from clinical records and follow-up interviews performed either by telephone or in person using a standardized questionnaire. Variables included age, sex, body mass index, presence and intensity of inguinal pain and use of non-steroidal anti-inflammatory drugs.

Results: The prevalence of chronic postoperative inguinal pain was 17% (16/94), corresponding to approximately one in six patients. Most symptomatic patients were male and between 35 and 54 years of age. Pain intensity was predominantly mild to moderate; however, a small subgroup reported severe to very severe pain. Compared with previously published data, our prevalence was slightly lower than the 24.8% reported in open repair cohorts.

Conclusions: Inguinodynia remains a frequent complication after open inguinal hernioplasty. Although most patients presented mild to moderate symptoms, severe pain requiring specialized management was identified in a minority. Standardized postoperative surveillance protocols may improve early recognition and treatment.

Outcome of dorsal metatarsal artery perforator flap for coverage of soft tissue defect of dorsal distal foot and toes

2026-07-29T09:32:12+0530

Background: Resurfacing soft tissue defects in the distal foot remains challenging. Traditional options include amputation, cross-leg flaps, free tissue transfer, and skin grafts, each with limitations. The dorsal metatarsal artery perforator flap offers a safe, reliable alternative with minimal donor site morbidity, particularly suited for small to moderate defects. The aim of the study was to evaluate outcomes of the dorsal metatarsal artery perforator flap for reconstruction of distal dorsal foot and toe defects.

Methods: This prospective observational study was conducted in the Department of Plastic Surgery, Dhaka Medical College Hospital, involving 30 patients selected by purposive sampling. All patients were followed for 30 days postoperatively.

Results: Mean defect dimensions were 3.52±0.95 cm (length) and 2.52±0.56 cm (width), with a mean area of 9.07±3.83 cm². Mean flap dimensions were 5.6±1.33 cm (length) and 3.15±0.56 cm (width), mean area 17.89±6.07 cm². The first dorsal metatarsal artery perforator was used in 73.3% of patients, the second and third in 13.3% each. Marginal flap necrosis occurred in 46.7%, significant flap loss in 13.3%, and no necrosis in 20%. Venous congestion was seen in 53.3% and wound infection in 23.3%. No donor site morbidity was observed in 83.3%. Outcomes were satisfactory in 63.3%, good in 16.7%, and poor in 20% of cases.

Conclusions: The dorsal metatarsal artery perforator flap provides satisfactory, durable coverage for soft tissue defects of the distal dorsal foot and toes with low donor site morbidity.

Effect of ethanolic propolis extract on TNF-α, caspase-3 expression and histopathological findings in hypoxic skin flaps: an experimental study in rats

2026-07-29T09:29:15+0530

Background: Hypoxia remains a major cause of skin flap failure due to excessive production of reactive oxygen species (ROS), which triggers inflammation and apoptosis through increased expression of tumor necrosis factor-alpha (TNF-α) and caspase-3. Propolis contains bioactive compounds with antioxidant and anti-inflammatory properties that may improve skin flap survival under hypoxic conditions. This study aimed to evaluate the effect of ethanolic propolis extract on TNF-α expression, caspase-3 expression, and histopathological changes in a hypoxic skin flap model.

Methods: An experimental post-test only control group study was conducted using 24 male Rattus norvegicus divided into four groups (n=6/group): control, P1, P2, and P3. Different flap dimensions (1/3, 1/2, and 2/3) were used to induce varying degrees of hypoxia. Ethanolic extract of Gunung Lawu propolis was administered orally at a dose of 800 mg/kg bw/day for seven days. TNF-α and caspase-3 levels were measured using enzyme-linked immunosorbent assay (ELISA). Histopathological evaluation included necrosis, acute inflammation, and re-epithelialization. Statistical analysis was performed using one-way ANOVA followed by post hoc tests and Kruskal–Wallis analysis.

Results: Propolis administration significantly reduced TNF-α levels in all treatment groups compared with controls (p<0.001), with the greatest reduction observed in the P3 group (55.5%). Caspase-3 expression was also significantly decreased (p<0.001), with the highest reduction found in the P3 group (79.5%). Histopathological assessment demonstrated lower necrosis and acute inflammation scores and higher re-epithelialization scores in treatment groups; however, these differences were not statistically significant (p>0.05).

Conclusions: Ethanolic propolis extract effectively attenuated inflammatory and apoptotic responses in hypoxic skin flaps by reducing TNF-α and caspase-3 expression. Although histopathological improvements were observed, they did not reach statistical significance. Propolis may serve as a promising adjunctive therapy to enhance skin flap viability.

Splenectomy indications and outcomes among children: a retrospective study from a tertiary care center in Saudi Arabia

2026-07-29T09:31:08+0530

Background: Splenectomy is a surgical procedure frequently performed on children and adolescents for several hematological indications. It is recognized as a safe and feasible procedure. However, post-splenectomy complications are recognized well in some cases. Experienced surgeons play a vital role in managing intra-operative and postoperative complications. Evaluate indications, outcomes and complications of splenectomy among children and to find out the indications for open splenectomy in the era of minimally invasive surgery in a tertiary care center.

Methods: A retrospective study was conducted among 71 children (0-14) years old who underwent a splenectomy at King Faisal Specialist hospital and Research Center (KFSHRC) in Riyadh, Saudi Arabia, from 2010-2019. The study is based on electronic medical records. Data analysis was carried out using the Excel analysis tool.

Results: In total, 71 pediatric participants were included in this study. 60 (84.5 %) of them underwent laparoscopic splenectomy (LS) and 11 (15%) open splenectomy (OS). For LS (35 males, 25 females), while in OS (Seven males, four females). The median age was seven years among the LS group and six among the OS group. The average hours of surgery were 2:13 Hours (LS) while 2:23 Hours (OS). The median hospital stay among LS was four and a half days and the OS group was six days. The most common immediate postoperative complication was fever.

Conclusions: Laparoscopic Splenectomy has become the standard of care. LS has advantages over OS, like earlier recovery and shorter hospital stay.

Dexmedetomidine versus dexamethasone as intrathecal adjuvants for tibiofibular fracture fixation under spinal anaesthesia: a prospective randomised double-blind study

2026-07-29T09:26:23+0530

Background: Postoperative pain following tibiofibular fracture fixation may outlast the analgesic duration of hyperbaric bupivacaine used for spinal anaesthesia. Intrathecal adjuvants such as dexmedetomidine and dexamethasone have been used to improve block characteristics and prolong postoperative analgesia. To compare the analgesic efficacy and safety of intrathecal dexmedetomidine and dexamethasone as adjuvants to hyperbaric bupivacaine in adults undergoing spinal anaesthesia for tibiofibular fracture fixation.

Methods: In this prospective randomised double-blind trial, 68 ASA I–II patients scheduled for unilateral tibiofibular fracture fixation were randomised to receive 15 mg hyperbaric bupivacaine with either 5 μg dexmedetomidine (BDM, n=34) or 4 mg dexamethasone (BDA, n=34). The primary outcome was duration of analgesia, defined as the interval between onset of sensory block and a Numerical Rating Scale pain score >3. Secondary outcomes included onset of sensory and motor block, postoperative pain scores, adverse events, and patient satisfaction.

Results: Baseline characteristics were comparable between groups. Compared with dexamethasone, dexmedetomidine produced a faster onset of sensory block (3.0±0.82 vs 3.8±0.9 min; p=0.001) and motor block (4.1±0.9 vs 5.0±1.1 min; p=0.001), and significantly prolonged analgesia (328.6±28.1 vs 263.0±26.1 min; p<0.001). Pain scores at 4 hours were lower and patient satisfaction was higher in the dexmedetomidine group (both p<0.001). However, hypotension occurred more frequently with dexmedetomidine (29.4% vs 2.9%; p=0.003).

Conclusion: Intrathecal dexmedetomidine provided superior block characteristics, longer postoperative analgesia, lower pain scores, and greater patient satisfaction than intrathecal dexamethasone, although these benefits were accompanied by an increased incidence of intraoperative hypotension.

Predictors of primary biliary patency loss following biliary-enteric reconstruction for iatrogenic bile duct injury: a retrospective cohort study from a tertiary referral center in Mexico

2026-07-29T09:28:38+0530

Background: Iatrogenic bile duct injury is one of the most serious complications associated with cholecystectomy. Although its incidence is low, its clinical impact is substantial due to the associated morbidity and mortality, the need for complex reconstructive procedures, and the significant deterioration in patients’ quality of life.

Methods: A retrospective cohort study was conducted. Patients who underwent biliary-enteric reconstruction for iatrogenic bile duct injury at a tertiary care center from 2018 to 2022. The primary outcome was loss of primary biliary patency during follow-up. Univariate analysis was performed to identify factors associated with this outcome, using statistical package for the social sciences (SPSS) 25.

Results: A total of 73 patients were included. Primary biliary patency was achieved in 49 patients (67.1%), whereas 24 patients (32.9%) developed loss of primary biliary patency. Postoperative bile leak occurred in 22 patients (30.1%). On univariate analysis, postoperative bile leak was significantly associated with loss of primary biliary patency (OR 14.33; 95% CI 4.30–47.78; p<0.001). SG3 classification showed a trend toward association with loss of primary biliary patency, although statistical significance was not reached (OR 2.27; 95% CI 0.83–6.19; p=0.110). According to the Cho classification, 52 patients (71.2%) achieved favorable outcomes (grades A–B).

Conclusions: Postoperative bile leak was significantly associated with loss of primary biliary patency following biliary-enteric reconstruction for iatrogenic bile duct injury. Early identification of this complication may allow closer surveillance strategies and timely detection of reconstructive failure.

A study on the prognostic value of the strong ion gap in acute pancreatitis

2026-07-02T06:40:06+0530

Background: Severe acute pancreatitis (SAP) may range up to 20-30%. So, it is important to assess the disease severity in a timely and accurate manner to provide comprehensive treatment to Acute pancreatitis (AP) patients, which will allow the clinician to consider more aggressive interventions to prevent adverse outcomes and decrease the high mortality of SAP.

Methods: This is a prospective cohort study of 61 patients admitted to the KIMS, Hubli from December 2016 to June 2018 with Acute pancreatitis (AP). Blood gas and biochemical analysis for each patient was performed on admission and multiple metrics was calculated according to the Stewart’s acid-base theory and their accuracy was used as predictors of AP severity and mortality. A p value of <0.05 was considered statistically significant.

Results: Of the 61 patients presenting with AP, 6 developed severe AP and 5 died during hospitalization. Patients with severe AP had significantly higher median strong ion gap (SIG) than patients with mild or moderate AP respectively with p<0.001 making SIG strong predictor of severity, mortality and good prognostic indicator.

Conclusions: SIG is a strong independent predictor of severity and mortality. It helps in better triaging, risk stratification, management and prognosis of such patients in the future.

Evaluation of management of diabetic foot ulcers according to Wagner’s classification in a tertiary care hospital in Northern India

2026-07-09T07:50:55+0530

Background: Diabetic foot ulcer (DFU) is among the most severe and disabling complications of diabetes mellitus and represents a major cause of hospitalization, morbidity, lower limb amputation, and mortality worldwide. The incidence of diabetic foot complications is increasing rapidly in developing countries such as India due to rising diabetes prevalence, poor glycemic control, delayed healthcare access, and lack of foot care awareness. Wagner’s classification remains one of the most practical and widely accepted systems for evaluating diabetic foot ulcers and guiding treatment strategies. Early diagnosis and stage-appropriate intervention are essential for reducing complications and improving limb salvage rates.

Methods: This prospective observational study was conducted among 70 patients with diabetic foot ulcers admitted to the Department of General Surgery in a tertiary care hospital in Northern India over a period of 18 months. Detailed demographic data, duration of diabetes, associated comorbidities, glycaemic status, ulcer characteristics, microbiological profile, and radiological findings were recorded. Ulcers were graded according to Wagner’s classification system. Patients received medical and surgical management including glycaemic control, antibiotics, debridement, incision and drainage, skin grafting, and amputations where indicated. Outcomes were evaluated in terms of ulcer healing, duration of hospital stay, and amputation rates.

Results: The majority of patients were males (68.6%) with a mean age of 56.8±10.4 years. Wagner Grade II ulcers were most common (34.3%), followed by Grade III ulcers (28.6%). Peripheral neuropathy was observed in 71.4% of patients and poor glycemic control in 74.3%. Surgical intervention was required in 61.4% cases, with debridement being the most commonly performed procedure. Major amputations were more common in Wagner Grade IV and V ulcers. Increasing Wagner grade showed significant association with prolonged hospitalization and increased amputation rates (p<0.05).

Conclusions: Wagner’s classification is an effective and reliable tool for assessing severity and guiding management of diabetic foot ulcers. Early diagnosis, strict glycemic control, aggressive infection management, regular wound care, and timely surgical intervention are essential to improve outcomes and reduce limb loss.

Role of esmolol in non-healing chronic wounds

2026-07-29T09:34:32+0530

Background: Diabetic foot ulcers (DFUs) exhibit delayed healing due to persistent inflammation, oxidative stress, microvascular dysfunction, and impaired cellular responses. Topical esmolol hydrochloride has demonstrated wound‑healing potential through inhibition of aldose reductase, reduction of advanced glycation end products, and promotion of epithelial and endothelial migration.

Methods: This observational cohort study included 30 patients with chronic, non‑infected foot or lower‑leg ulcers of more than three weeks’ duration, including diabetic (Wagner class 1A/1B) and non‑diabetic traumatic wounds. Patients received topical esmolol hydrochloride 14% once daily in addition to standard wound care. Wounds were assessed weekly for nine weeks using the Bates–Jensen wound assessment tool (BWAT). Complete healing was defined as full epithelialization without discharge.

Results: Mean BWAT score improved from 28 at baseline to 3 at week 9, representing an 89.3% reduction. Complete healing within 9 weeks was achieved in 24 patients (80%). Healing was significantly higher in non‑anemic patients compared with anemic patients (p<0.05). Patients with normal serum albumin showed better outcomes, while glycemic control showed a positive but non‑significant association.

Conclusions: Topical esmolol hydrochloride appears to be a safe and effective adjunct to standard wound care for diabetic and traumatic foot ulcers. Correction of systemic factors such as anemia and malnutrition further enhances outcomes. Larger randomized studies are required to confirm efficacy.

A novel method of extracting gallbladder specimen in acute cholecystitis: cutting the gallbladder into strips

2026-07-29T09:34:00+0530

Background: Acute cholecystitis is a common surgical condition. Laparoscopic cholecystectomy is the standard treatment, but the optimal method for specimen retrieval remains debated. This study evaluates the safety and efficacy of a novel technique involving cutting the gallbladder into strips compared to conventional endobag retrieval.

Methods: A retrospective study was conducted at Citizens Specialty Hospital, Hyderabad, from February 2025 to December 2025. A total of 100 patients with acute cholecystitis undergoing laparoscopic cholecystectomy were included. The gallbladder specimen was extracted by cutting it into strips. Data were analyzed using SPSS version 25.0. Patients were followed for two months.

Results: No intraoperative or postoperative complications were observed. There were no cases of port-site infection, bile leak, or intra-abdominal abscess. The mean hospital stay was 1.3±0.5 days. Patients reported good postoperative comfort.

Conclusions: The technique of cutting the gallbladder into strips is a safe, effective, and cost-efficient alternative to conventional endobag retrieval in laparoscopic cholecystectomy.

Conversion rate and complications in laparoscopic cholecystectomy in acute versus chronic cholecystitis: a prospective cohort study

2026-07-29T09:34:31+0530

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstone disease. However, acute cholecystitis (AC) is traditionally considered more challenging than chronic cholecystitis (CC) due to edema, adhesions, and distorted anatomy in Calot’s triangle. These factors may increase operative time, conversion rates, and complication risks. With modern safety strategies such as the critical view of safety (CVS), outcomes may be comparable between the two conditions.

Methods: A prospective cohort study was conducted including 70 patients undergoing LC, divided into two groups: 35 patients with AC and 35 with CC. Operative time, intraoperative difficulty, conversion to open surgery, postoperative complications, and hospital stay were compared.

Results: The conversion rate was 5.7% in both groups. Operative time was marginally longer in AC but without statistical significance. Intraoperative bleeding, bile leak, wound infection, and subhepatic collection were slightly more frequent in the acute group; however, no statistically significant difference was observed. No major bile duct injury occurred in either group.

Conclusions: LC in AC is safe and feasible when performed with adherence to standard safety principles. Conversion and complication rates are comparable to CC in experienced hands.

Gastrointestinal tract at high altitude of Ladakh: a surgeon’s perspective

2026-07-29T09:34:00+0530

Background: High altitude environment with its hypoxic rarefied, cold, dry and high wind velocity affect almost all aspect of human physiology. However, attitude sickness is generally equated with HACE and HAPE. At high altitude, cellular hypoxia is found to have profound effect on the Gastrointestinal Tract (GI), which otherwise is mostly ignored. It is estimated that 80% of people who have acute mountain sickness have GI symptoms. The spectrum of GI dysfunctions which occur at high altitude are wide and varied but still not commonly talked about unlike HACE and HAPE.

Methods: The present study is a post-facto, retrospective in nature where observations and data are collected during April 2023 to April 2024, at SNM Hospital, Leh in Ladakh (UT) of India (the only government hospital in Leh), located at an altitude of 3000 meter AMSL. Data collected is based on the patients who had reported to emergency and OPD of SNM hospital with gastrointestinal ailments which are conventionally attributed to short and long term stay at high altitude. In addition, some unique conditions which has been managed by the author at different time frame are also reported in this study, because of they being rare, unique and challenging for a clinician and to further substantiate this study.

Results: This study unveiled some unique observations found in high altitude Ladakh region in gastrointestinal context, and some of which were: peptic ulcer perforation was more common than GI bleed. Of the 29 cases of peptic ulcer perforation operated, 19 were lowlanders (65.5%); GI bleed due to peptic ulcer was never seen in both the lowlanders and locals unlike the study from Tibet; carcinoma stomach is the most common malignancy in Ladakh, the figure of 54 number of patients in a year (2023) against the 1.3 Lakh total population of Leh district is comparable to the high incidence rate reported in Mizoram, the state with highest incidence of carcinoma stomach. This rate is definitely higher than the national average; four cases of mesenteric ischemia is reported which otherwise due to venous thrombosis is a rare occurrence and no report of high altitude induced mesenteric venous ischemia is available in literature. Similarly splenic abscess was also seen in some of the tourist visiting Ladakh.

Conclusions: High altitude related conditions are needed to be seen and understood through a wider lens and not just HACE and HAPE. Understanding and sharing of experience of high-altitude related condition is essential for further understanding of the topic under discussion. Keeping in view the wide spectrum of gastrointestinal dysfunction occurring in both local and visitor there is need to talk about it on equal footing like HACE and HAPE.

Minimally invasive thyroidectomy versus conventional thyroidectomy in a tertiary care centre

2026-07-29T09:33:59+0530

Background: Since the advent of minimally invasive surgery, it has been applied for various intra-abdominal, retroperitoneal and even surgeries of the limbs. Thyroidectomy is one of the most performed endocrine surgeries. The first minimally invasive neck surgery was performed in 1997 following which, different approaches have been developed to reach the neck. Conventional open thyroidectomy remains the gold standard, while minimally invasive and endoscopic approaches are gaining popularity for their cosmetic and recovery advantages. To compare outcomes between conventional thyroidectomy and minimally invasive thyroidectomy in terms of operative time, postoperative pain, hospital stay, complications, cosmetic satisfaction and the feasibility of this new modality in a tertiary care centre.

Methods: A prospective comparative study was conducted at the Department of General Surgery, Mysore Medical College and Research Institute from November 2021 to August 2025, including 15 patients undergoing thyroidectomy. Patients were divided into two groups–Group A (Conventional Thyroidectomy) and Group B (Minimally invasive thyroidectomy).

Results: Minimally invasive thyroidectomy showed a longer operative time compared to conventional surgery, but had less postoperative pain, reduced hospital stay and superior cosmetic satisfaction. All patients were assessed postoperatively for complications and followed up for 3 months for cosmetic outcome. Minimally invasive thyroidectomy offers great benefits in terms of cosmetic outcome.

Conclusions: Minimally invasive thyroidectomy is a safe and effective alternative to conventional thyroidectomy with better cosmetic outcomes and faster recovery, although requiring longer operative time and advanced surgical expertise.

Changing paradigms in management of acute calculous cholecystitis

2026-07-29T09:32:20+0530

Background: The term “acute calculous cholecystitis” indicates inflammation of the gall bladder caused by gallbladder stones. Usually the patients diagnosed with acute cholecystitis are advised to undergo laparoscopic cholecystectomy within 72 hours of onset of symptoms or electively after 6 to 12 weeks.

Methods: This is a retrospective study carried out at Department of Minimal Access and General Surgery, Max Hospital, Gurugram, India aimed at evaluating the ideal timing for undertaking surgery for managing acute calculous cholecystitis. This study of 1004 patients was carried out from July 2022 to August 2025 after having obtained due approval from the institutional authorities. For purposes of this study we included all patients presenting to our department for management of calculous cholecystitis during the period of this study. Out of these 1004 patients, a total of 491 were diagnosed as acute calculous cholecystitis and their clinical data was analyzed deploying standard statistical tools for purposes of this research.

Results: Out of the 1004 patients who underwent laparoscopic cholecystectomy from a period of July 2022 to August 2025, 491 patients were diagnosed as having acute cholecystitis. 223 patients were taken up for surgery with prior written consent within 0-3 days after getting diagnosed with symptomatic calculous cholecystitis (early surgery group). Operation for the remaining 268 patients had to be delayed for a variety of reasons which included co-morbid medical conditions besides personal preferences (delayed surgery group).

Conclusions: Acute calculous cholecystitis continues to be a common surgical condition with evolving management strategies. The findings of the present study demonstrate that early laparoscopic cholecystectomy within 72 hours of the onset and also as soon as technically possible is both a safe and advantageous approach in the management of these patients.

Incidence and comparison of patient-related and technical factors for gallbladder content spillage during laparoscopic cholecystectomy

2026-07-29T09:32:17+0530

Background: Gallbladder perforation with spillage of bile or stones is frequently encountered during laparoscopic cholecystectomy. Although usually considered a minor intraoperative event, it may contribute to postoperative infectious complications. The relative contribution of patient-related and technical factors remains unclear. Aim of the study was to determine the incidence of gallbladder content spillage and evaluate the contribution of patient-related versus technical factors during laparoscopic cholecystectomy.

Methods: A prospective observational study was conducted on 120 consecutive adult patients undergoing laparoscopic cholecystectomy at ESIC Medical College and Hospital, Basaidarapur, New Delhi between March 2024 and July 2025. Demographic variables, body mass index, ultrasonographic findings, intraoperative characteristics, and operative steps were analysed. Gallbladder content spillage was defined as intraoperative perforation with release of bile, stones, pus, mucus, or sludge. Statistical analysis was performed using Chi-square or Fisher’s exact test, with p<0.05 considered significant.

Results: Gallbladder content spillage occurred in 34 patients (28.3%). The majority were females (74.2%), and 45.8% were obese. No significant association was observed between spillage and age, gender, BMI, ultrasonographic findings, or intraoperative stone characteristics. Technical factors accounted for 67.7% of spillage events compared with 32.3% attributed to patient-related factors (p=0.003). Excessive traction at the gallbladder fundus and dissection from the gallbladder fossa were the most common operative steps associated with spillage.

Conclusions: Gallbladder content spillage during laparoscopic cholecystectomy occurs frequently and appears predominantly related to operative technique rather than patient characteristics. Attention to critical operative steps may reduce its incidence.

Restoring the gate: laparoscopic Nissen fundoplication significantly elevates lower esophageal sphincter pressure and alleviates GERD symptoms

2026-07-29T09:32:10+0530

Background: Gastroesophageal reflux disease (GERD) is a highly prevalent condition with significant quality-of-life implications. Laparoscopic fundoplication is the established surgical standard of care, yet quantitative manometric data from Indian tertiary care centers remain sparse. To compare preoperative and postoperative lower esophageal sphincter (LES) pressure in patients undergoing laparoscopic Nissen fundoplication and to correlate manometric changes with symptomatic improvement.

Methods: An observational study of 45 adults who underwent laparoscopic Nissen fundoplication (January–December 2023) at a tertiary care center. High-resolution esophageal manometry (HRM) was performed within one month preoperatively and within three months postoperatively. Symptom severity was assessed using the validated GERD-Q questionnaire. Statistical analysis employed the Wilcoxon Signed-Rank Test (p≤0.05 considered significant).

Results: Mean LES pressure increased significantly from 10.80±1.78 mmHg preoperatively to 16.77±3.77 mmHg postoperatively (median: 10.11 → 15.80 mmHg, p<0.05). The GERD-Q score improved from 9.96±2.35 to 6.76±1.37 (p<0.05). Of 45 patients, 43 (95.6%) demonstrated LES pressure augmentation and 42 (93.3%) reported symptomatic improvement. The overall complication rate was 11.1%, all managed conservatively.

Conclusions: Laparoscopic Nissen fundoplication produces a statistically significant and clinically meaningful increase in LES resting pressure alongside significant symptomatic relief. These findings from an Indian tertiary care centre corroborate international data and support fundoplication as a safe, effective intervention for GERD refractory to medical therapy.

Incidence of fistula-in-ano after drainage of perianal abscess: a retrospective comparison of drainage alone versus drainage with primary fistula treatment

2026-07-29T09:31:07+0530

Background: Perianal abscess is a common anorectal surgical emergency, most often resulting from cryptoglandular infection. While incision and drainage (I&D) is the standard treatment, persistence of the underlying septic focus may lead to recurrent abscess or fistula-in-ano. The benefit of performing fistulotomy or fistulectomy at the time of abscess drainage remains debated because of concerns regarding sphincter injury and functional outcomes.

Methods: This retrospective comparative study included adult patients who underwent surgery for perianal or ischiorectal abscess between June 2018 and April 2023 at Sagar Hospital and Shanthi Hospital and Research Centre, Bengaluru. Patients were treated with either I&D alone (Group A) or I&D with concomitant fistulotomy/fistulectomy (Group B). Outcomes were assessed after a minimum follow-up of one year using a structured telephonic questionnaire and review of available clinical records.

Results: Of 136 patients treated during the study period, 15 were lost to follow-up. The final analysis included 121 patients: 49 in Group A and 72 in Group B. Abscess recurrence occurred in 20.4% of Group A patients compared with 4.2% in Group B (p=0.0065; RR 4.9, 95% CI 1.4–17.0). Fistula-in-ano developed in 6.1% and 2.7% of patients, respectively, with no statistically significant difference (p=0.394; RR 2.2, 95% CI 0.4–12.5).

Conclusions: Concomitant fistulotomy or fistulectomy at the time of abscess drainage was associated with significantly lower abscess recurrence. A selective approach to definitive fistula treatment during the index procedure may be beneficial in carefully selected patients with identifiable fistulous pathology.

Effect of energy-based devices on skin retraction in gynaecomastia in comparison to conventional techniques: a prospective observational study

2026-07-29T09:30:39+0530

Background: Gynecomastia is a common benign condition in males that often requires surgical correction to achieve satisfactory aesthetic outcomes. Power-assisted liposuction (PAL) is widely used; however, optimal skin retraction remains challenging.

Methods: This prospective cohort study evaluated whether the addition of radiofrequency-assisted liposuction (RFAL) to PAL results in superior skin retraction compared with PAL alone in patients undergoing gynecomastia surgery.

Results: A total of 32 patients were equally divided into PAL alone and RFAL+PAL groups. Baseline demographic characteristics and Simon’s grading were comparable between the groups. Both techniques resulted in progressive improvement in nipple–areola complex size and positioning over 6 months; however, the RFAL+PAL group demonstrated significantly greater reduction in NAC horizontal diameter and improved positioning (p<0.001).

Conclusions: The addition of RFAL to PAL significantly enhances skin retraction and aesthetic outcomes in gynecomastia surgery, providing superior NAC reduction, improved alignment and sustained contour refinement compared with PAL alone.

Epidemiology, risk factors and microbiological profile of surgical site infections in emergency surgeries

2026-07-29T09:29:26+0530

Background: Surgical site infections (SSIs) remain a major cause of postoperative morbidity, prolonged hospitalization, and increased healthcare expenditure. Identification of risk factors and local microbial patterns is essential for effective prevention and management. The objectives of this study are to evaluate the incidence of surgical site infections (SSI) in emergency surgical patients, identify associated risk factors, and analyze the bacteriological profile and antimicrobial susceptibility patterns of the isolated organisms.

Methods: A prospective observational study was conducted in the Department of General Surgery, Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana. A total of 150 adult patients who underwent emergency surgery and subsequently developed wound-related complications were included. Patients were followed for 30 days postoperatively. Clinical, demographic, and perioperative variables were recorded. Wound swabs were subjected to microbiological culture and antibiotic susceptibility testing. Statistical analysis was performed using SPSS version 21.0.

Results: The mean age of patients was 41.46±17.93 years, with males constituting 72.7% of cases. Culture positivity was observed in 67 patients, of whom 76% yielded Gram-negative organisms and 24% Gram-positive organisms. Escherichia coli (14.7%) was the most common isolate, followed by Klebsiella spp. (12.7%). Gram-negative isolates demonstrated high resistance to fluoroquinolones and third-generation cephalosporins, while piperacillin-tazobactam and meropenem showed the best susceptibility profiles. Significant associations with SSI were observed for prolonged duration of surgery (p=0.003), blood transfusion requirement (p=0.024), and higher Southampton wound scores (p<0.001). Age, sex, comorbidities, body mass index, anemia, previous surgery, and type of surgery were not significantly associated with SSI.

Conclusions: Prolonged operative duration, blood transfusion, and higher Southampton scores were significant predictors of SSI. The predominance of multidrug-resistant Gram-negative organisms highlights the importance of institution-specific antibiograms and antimicrobial stewardship programs to optimize patient outcomes.

A comparative study of appendicitis inflammatory response score and Tzanakis score for diagnosing patients with acute appendicitis

2026-07-29T09:26:26+0530

Background: Accurate diagnosis of acute appendicitis remains challenging, and negative appendectomy rates remain significant when decision-making is based on clinical suspicion alone. Clinical scoring systems combine symptoms, signs, laboratory parameters and imaging to improve diagnostic accuracy. This study aimed to compare the diagnostic performance of the Appendicitis Inflammatory Response (AIR) score and the Tzanakis score in suspected acute appendicitis.

Methods: This prospective comparative study was conducted in the Department of General Surgery, Mamata General Hospital, Khammam, for 2 years. 94 patients above 16 years of age with clinically suspected acute appendicitis were included. All patients were evaluated using both AIR and Tzanakis scoring systems. Histopathological examination (HPE) of the resected appendix was considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for both scoring systems.

Results: The mean age was 33.2±14.87 years; males constituted 55.3% (M:F=1.2:1). On histopathological examination, out of 94 patients 80(85.1%) had acute appendicitis, 4 (4.3%) had follicular hyperplasia, and 10 (10.6%) had normal appendix. With cutoff >8, Tzanakis score showed sensitivity 98.8%, specificity 78.6%, PPV 96.3%, NPV 91.7%, and diagnostic accuracy 95.7%. With cutoff >8, AIR score showed sensitivity 67.5%, specificity 71.4%, PPV 93.1%, NPV 27.8%, and diagnostic accuracy 68.1%.

Conclusions: The Tzanakis score demonstrated higher diagnostic accuracy than the AIR score. The inclusion of ultrasonography improves reliability, making it a practical and effective tool for clinical decision-making, particularly in resource-limited settings.

The role of hematological parameters in predicting tumor grade and stage in renal cell carcinoma patients undergoing nephrectomy

2026-07-29T09:26:12+0530

Background: The aim of this study is to evaluate the role of hematological parameters in predicting Fuhrman grade and tumor stage in renal cell carcinoma patients undergoing nephrectomy.

Methods: All patients newly admitted in the Department of Genitourinary Surgery in Kozhikode Medical College with a diagnosis of renal cell carcinoma from 01 August 2020 to 31 July 2021 were included after taking informed consent and considering the inclusion and exclusion criteria.

Results: Hematological parameters such as red blood cell distribution width (RDW), haemoglobin to platelet ratio (HPR), procalcitonin (PCT) and platelet to lymphocyte ratio (PLR) when correlated with the grade of cases, RDW and PLR were seen increased in high grade tumours. RDW and PLR showed statistically significant correlation with a p value of <0.001 for RDW and 0.02 for PLR. An RDW above 14.2 and PLR more than 140.69 is likely to be predictive of high Fuhrman grade. ROC curve was plotted and the mean RDW, PLR, PCT cut-off values of the patients for FG and T stage were 12.8%, 130.7, 0.24% and 13.8%, 166.01, 0.19% respectively. RDW, PLR, PCT, HPR were analyzed for any correlation for predicting whether the tumor be limited to kidney or extending outside kidney. Only RDW showed a statistically significant result with p value 0.02 and it suggests that RDW above 14.52 is suggestive of a tumor limited to kidney.

Conclusions: We conclude that when hematological parameters such as RDW and PLR were correlated with grade of the tumor and RDW with the stage of the tumor. HPR and PCT didn’t show significant relation with grade of tumor.

Comparison of loop ligation and clip ligation of the cystic duct during laparoscopic cholecystectomy: a prospective study

2026-07-29T09:26:22+0530

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and cholecystitis. Cystic duct stump leakage remains an important and potentially preventable cause of postoperative bile leak. This study compared loop ligature closure and clip closure of the cystic duct with respect to postoperative bile leak following laparoscopic cholecystectomy.

Methods: A prospective comparative study was conducted at Stanley Medical College Hospital, Chennai, between August 2023 and September 2025. One hundred patients with symptomatic cholelithiasis or acute cholecystitis undergoing elective laparoscopic cholecystectomy were enrolled. Patients were allocated to either Group A (loop ligature closure) or Group B (clip closure) of the cystic duct. Postoperative monitoring for bile leak was performed through clinical assessment and biochemical evaluation. Patients were followed up at 1 and 3 months.

Results: Three patients required conversion to open cholecystectomy and were excluded from the analysis. Among the remaining 97 patients, bile leak occurred in 1 of 47 patients (2.1%) in the loop closure group and 2 of 49 patients (4.1%) in the clip closure group, with no statistically significant difference between the groups. Both techniques provided effective cystic duct occlusion. Loop ligature closure was associated with lower material cost compared with metallic clips. No late complications were observed during follow-up.

Conclusion: Loop ligature closure and clip closure are both safe and effective methods for cystic duct occlusion during laparoscopic cholecystectomy. Loop ligature closure represents a practical and cost-effective alternative to metallic clips without increasing the risk of postoperative bile leak.

Double strip fascial reinforcement of inguinal hernia: optimized tissue repair technique

2026-07-29T09:26:18+0530

Background: Inguinal hernia repair has evolved from tissue-based techniques to mesh repair, the current standard of care. However, mesh-related complications have renewed interest in tissue-based repairs. This study evaluates the outcomes of tissue-based inguinal hernia repair and its effectiveness as an alternative to mesh repair.

Methods: This prospective study conducted at Department of Surgery, Seethalakshmi Hospital, Tamil Nadu, from January 2015 to July 2018. Total of 208 patients with primary inguinal hernia underwent optimized tissue repair (OTR). Outcomes assessed included postop pain, ambulation time, hospital stay, seroma formation and recurrence.

Results: A total of 208 patients with inguinal hernia were analysed, including 132 (63.47%) indirect, 52 (25.0%) direct, and 24 (11.53%) combined hernias. The mean age was 51.1 years (range: 18-70 years), with a male predominance (181; 87.02%). Early ambulation within 6-9 hours was achieved in 198 (95.19%) patients. On postoperative day one, 200 (96.15%) patients reported mild pain, while 8 (3.85%) had moderate pain; by day two, all patients had only mild pain. Most patients required only oral analgesics (196; 94.23%) and resumed oral intake within 6 hours (185; 88.94%). Early discharge was achieved in 202 (97.11%) patients on postoperative day one, with a mean hospital stay of 1 day. Postoperative complications were minimal, with seroma in 11 (5.28%), superficial surgical site infection in 4 (1.92%), and hematoma in 2 (0.96%) patients, all managed conservatively. No intraoperative complications or chronic postoperative groin pain were observed. During the 7-year follow-up period, two patients developed clinical recurrence and subsequently underwent mesh repair.

Conclusions: OTR appears to be a safe and effective tissue-based option for primary inguinal hernia repair, with favorable short- and long-term outcomes.

Intraoperative irrigation in contaminated appendectomy: balancing antimicrobial efficacy and tissue viability from a reconstructive surgery perspective

2026-07-29T09:32:14+0530

Background: Surgical site infection (SSI) remains a major determinant of postoperative morbidity. Traditional preventive strategies focus on antimicrobial control; however, emerging surgical paradigms emphasize tissue viability and wound biology. To evaluate the impact of intraoperative irrigation (povidone-iodine vs saline) on SSI following appendectomy, integrating perioperative variables within a reconstructive framework.

Methods: Retrospective comparative study including patients aged 18–60 years undergoing appendectomy for stage II–IV appendicitis. Variables included irrigation type, SSI occurrence, operative time, incision type, antibiotic regimen and duration and timing of infection onset. SSI was defined according to CDC criteria. Statistical analyses included Fisher’s exact test and exploratory Firth logistic regression.

Results: Thirty-one patients were included (saline n=22, povidone-iodine n=9). SSI occurred in 9.7% (3/31), with no cases observed in the povidone-iodine group (13.6% vs 0%, p=0.54). All SSI cases occurred in patients with complicated appendicitis and midline incisions. Median antibiotic duration was significantly longer in SSI patients (16 vs 10 days, p=0.016). SSI onset occurred on postoperative days 7 and 20. No significant association was observed between operative time and SSI.

Conclusions: SSI following appendectomy is a multifactorial outcome. Strategies balancing antimicrobial control with preservation of tissue viability may optimize postoperative outcomes.

Laparoscopic cholecystectomy in patients with situs inversus totalis: surgical challenges and technical adaptations

2026-07-29T09:32:18+0530

Gallstone disease is one of the most common gastrointestinal disorders worldwide, and laparoscopic cholecystectomy has become the gold standard treatment for symptomatic cholelithiasis and acute cholecystitis. Situs inversus totalis (SIT) is a rare congenital condition characterized by mirror-image transposition of thoracic and abdominal organs, which may complicate both the clinical diagnosis and surgical management of biliary disease due to altered anatomical orientation. A targeted systematic review of the literature was conducted using the PubMed/Medline database to identify studies reporting laparoscopic cholecystectomy in patients with SIT. The search included publications from January 2010 to March 2026 using a combination of Medical Subject Headings (MeSH) and free-text terms related to situs inversus and laparoscopic cholecystectomy. Titles and abstracts were screened for relevance, followed by full-text review of eligible studies. Case reports and case series describing operative techniques, clinical presentation, and surgical outcomes were included. Data were extracted and synthesized narratively due to the heterogeneity of the available evidence. The literature search identified seven relevant studies, consisting primarily of case reports and small case series from multiple geographic regions. Most patients presented with symptomatic cholelithiasis or acute cholecystitis, often characterized by atypical left-sided abdominal pain due to mirror-image anatomy. Across the included studies, laparoscopic cholecystectomy was successfully performed with technical modifications such as mirrored trocar placement, adjusted surgeon positioning, and ergonomic adaptations during dissection. Postoperative outcomes were generally favorable, with most patients experiencing uneventful recovery and no significant intraoperative or postoperative complications. Laparoscopic cholecystectomy can be safely and effectively performed in patients with SIT when appropriate preoperative recognition and intraoperative technical adaptations are applied. Awareness of the reversed anatomical orientation, careful operative planning, and strict adherence to established principles of safe laparoscopic surgery are essential to minimize operative risk. Further multicenter studies are needed to better define standardized surgical strategies and outcomes in this rare clinical scenario.

High-grade renal trauma: conservative management experiences in Morocco

2026-07-29T09:32:18+0530

Renal trauma accounts for 1-5% of abdominal injuries and is mostly caused by blunt mechanisms such as road traffic accidents. Non-operative management (NOM) is now the standard of care for hemodynamically stable patients, even with high-grade injuries. This retrospective case series included twelve patients with CT-confirmed renal trauma managed in Casablanca between March 2024 and March 2025. The median age was 35 years, and all patients were male. High-grade injuries predominated (AAST IV: 7; V: 5). Conservative management was performed in 91.7% of cases; five patients required double-J stenting for urinoma, and one unstable gunshot case underwent nephrectomy. Early complications occurred in five patients, mainly urinomas. At six-month follow-up, renal function was preserved in all cases. Conservative management proved safe and effective for high-grade renal trauma, even without embolization access, with excellent short- and mid-term outcomes.

Clinical and biochemical outcomes of laparoscopic adrenalectomy in patients with Conn’s syndrome: experience from a tertiary referral center in Mexico

2026-07-29T09:28:17+0530

Unilateral primary aldosteronism, also known as Conn's syndrome, is a potentially curable cause of secondary arterial hypertension. Laparoscopic adrenalectomy represents the treatment of choice in selected patients, there are few national reports regarding its clinical and perioperative outcomes. A retrospective, observational, single-center case series was conducted on patients diagnosed with unilateral primary aldosteronism who underwent laparoscopic adrenalectomy at the Department of General Surgery of the High Specialty Medical Unit No. 25, Northeast National Medical Center, Mexican Social Security Institute (IMSS), Monterrey, Nuevo León, Mexico, between January 2020 and December 2024. The mean age was 46.3 years, and 58.3% of the patients were male. Preoperative hypokalemia was present in 91.7% of cases, and the mean number of antihypertensive medications was 3. Postoperatively, complete success was observed in 75% and partial success in 25%, with no cases of biochemical or clinical persistence. Resolution of hypokalemia was documented in 100% of patients, along with a significant decrease in serum aldosterone levels and the aldosterone-renin ratio, as well as a substantial reduction in antihypertensive requirements. There were no conversions to open surgery or perioperative complications, with a mean hospital stay of 24 hours. The predominant histopathological diagnosis was adrenal adenoma 91.7%. In this cases series study, laparoscopic adrenalectomy demonstrated a high rate of clinical and biochemical success, an excellent perioperative safety profile, and adequate resolution of the metabolic alterations associated with Conn's syndrome. These findings support its role as the treatment of choice for patients with unilateral primary aldosteronism.

Real-world case series evaluating trypsin–chymotrypsin for postoperative recovery in general surgery patients

2026-07-29T09:32:13+0530

Postoperative inflammation plays a pivotal role in recovery, contributing to pain, oedema, and delayed wound healing, and impacting overall patient comfort. Proteolytic enzymes, particularly the oral combination of trypsin–chymotrypsin, exhibit well-documented anti-inflammatory, anti-oedematous, and fibrinolytic effects that support postoperative recovery. This retrospective case series reports real-world clinical outcomes of seven patients treated across diverse surgical conditions in India, highlighting the clinical utility of this enzyme therapy. Across all cases, adjunctive trypsin–chymotrypsin was associated with marked reductions in erythema, oedema, induration, tenderness, and pain severity, alongside improved wound healing and patient comfort during follow-up. Notably, these benefits were observed across major abdominal procedures, recurrent hernia repair, fasciotomy for cellulitis, axillary soft-tissue excision, and complex oral cavity reconstruction with flap coverage, reflecting its versatility in managing postoperative inflammation. These observations suggest that trypsin–chymotrypsin may have a favourable effect on reducing postoperative inflammatory signs and improving patient comfort across the varied surgical scenarios.

Surgical management and outcomes of self-inflicted zone V wrist injuries: a narrative review

2026-07-29T09:33:01+0530

Self-inflicted wrist injuries involving flexor tendon zone V represent a complex subset of hand trauma with important surgical, functional, and psychosocial implications. These injuries frequently involve simultaneous damage to tendons, nerves, and vascular structures, often resulting in substantial long-term disability. Despite their clinical relevance, the available literature remains fragmented, with no universally accepted definition of “spaghetti wrist” and no standardized management framework. This narrative review synthesizes current evidence on epidemiology, injury patterns, classification systems, clinical assessment, operative management, rehabilitation, complications, and prognosis in self-inflicted zone V wrist injuries. A structured literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar for studies published between January 2005 and January 2025 in English or Spanish. Eligible publications included retrospective and prospective cohort studies, case series, case reports, and review articles addressing self-inflicted wrist injuries involving zone V. Extracted data included epidemiological characteristics, mechanisms of injury, classification systems, assessment tools, surgical and non-surgical management strategies, rehabilitation protocols, and functional outcomes. Findings were synthesized qualitatively, with emphasis on recurring themes, areas of consensus, and persistent gaps in knowledge. Available evidence indicates that these injuries predominantly affect young adults, frequently men, and are commonly associated with psychiatric comorbidity. Injury patterns typically involve the dominant hand inflicting damage on the non-dominant wrist and are characterized by multistructural involvement. Flexor tendons are almost universally affected, while neurovascular injury varies in severity and consistently emerges as the strongest predictor of long-term functional impairment. Outcome heterogeneity remains substantial, reflecting differences in injury definitions, operative techniques, rehabilitation protocols, and outcome measures. Psychiatric factors further influence recurrence risk, adherence to therapy, and return-to-work outcomes. Self-inflicted zone V wrist injuries remain a challenging and heterogeneous clinical entity. Although advances in microsurgical reconstruction and rehabilitation have improved recovery, prognosis remains guarded, particularly in patients with nerve or combined neurovascular injury. Standardized definitions, consistent outcome reporting, and integration of surgical, rehabilitative, and psychiatric care are essential to improve comparability across studies and optimize patient outcomes.

Indocyanine green fluorescence angiography in reconstructive surgery: does better visualization translate into better outcomes?

2026-07-29T09:32:09+0530

Indocyanine green fluorescence angiography (ICG-FA) is an intraoperative imaging adjunct used to assess tissue perfusion in real time across multiple surgical specialties. It enables dynamic visualization of microvascular blood flow and has been proposed to reduce ischemia-related complications such as anastomotic leakage and flap necrosis. Despite increasing adoption, its definitive clinical benefit remains debated. Evidence from randomized trials and meta-analyses suggests potential reduction in complications in selected settings, particularly colorectal surgery, although results are heterogeneous in reconstructive procedures. This review evaluates physiological basis, clinical applications, limitations, and emerging developments, highlighting a gap between improved intraoperative decision-making and consistent patient-centered outcomes. A narrative review of PubMed, Scopus, and major surgical journals was performed, prioritizing systematic reviews, meta-analyses, randomized controlled trials, and high-impact observational studies. ICG-FA reliably visualizes perfusion and frequently alters intraoperative decisions. In colorectal surgery, meta-analyses show reduced anastomotic leakage. In reconstructive surgery, including breast and microsurgical flaps, it helps identify poorly perfused tissue and optimize flap design, though evidence for consistent reduction in complications remains variable. Limitations include lack of standardized quantitative thresholds, interobserver variability, limited tissue penetration, and inconsistent methodologies. Emerging technologies such as quantitative fluorescence analysis and artificial intelligence may improve reproducibility. Overall, ICG-FA is a valuable adjunct but its impact on long-term outcomes remains uncertain. Future research should focus on standardized protocols and prospective trials to better define its role in modern reconstructive and gastrointestinal surgery and to establish evidence-based guidelines for routine clinical implementation across diverse surgical specialties worldwide in high-risk patient populations particularly settings.

Standardization of the endoscopic approach in early bariatric leaks: an evidence-based clinical algorithm

2026-07-29T09:30:38+0530

Gastrointestinal leaks remain a critical complication following bariatric surgery, associated with significant morbidity and mortality. Success in management has shifted toward a multidisciplinary approach where therapeutic endoscopy plays a central role. This study aims to standardize the endoscopic management of early leaks (postoperative days 3-7) through a clinical-technical algorithm based on current evidence. A comprehensive review of current literature (2020-2025) was conducted, analyzing 16 key studies focused on endoscopic interventions for leaks following laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB). The analysis included clinical success rates for primary closure (clips/suturing), diversion (stents), and internal drainage (pigtails/vacuum therapy). The evidence suggests a "window of opportunity" between days 3 and 7. For defects <10 mm in healthy tissue, primary closure with over-the-scope clips or endoscopic suturing is preferred. Larger defects (>10 mm) or those involving ischemic tissue require derivative therapy with mega-stents or vacuum-assisted closure (EVT). In RYGB, endoscopic suturing is the gold standard for anastomotic leaks, while in LSG, internal drainage via the EDEN protocol allows early enteral nutrition and reduces stent-related intolerance. Standardizing the endoscopic approach based on defect size and tissue biology is essential to optimize outcomes. Hemodynamically stable patients benefit from early endoscopic intervention, which reduces hospital stays and prevents the progression to chronic fistulas. The proposed algorithm provides a structured decision-making tool for the surgical team.

The discontinuation of halothane production and its implications for anaesthesia practice in resource-limited countries: a Nigerian perspective

2026-07-29T09:26:25+0530

Halothane has long been a cornerstone of anaesthesia in low- and middle-income countries, (LMICs) including Nigeria, owing to its low cost, effectiveness, and compatibility with basic delivery systems such as draw-over apparatus. However, its declining global production, driven by commercial decisions in high-income markets, threatens the sustainability of anaesthesia in resource-limited settings. This review examines the implications of reduced availability of halothane for Nigerian anaesthesia practice and explores strategies to maintain safe perioperative care. A narrative review of the literature from PubMed, Google Scholar, and SciSpace was conducted, focused on halothane use, volatile agents, workforce capacity, and service delivery in Nigerian and LMICs healthcare contexts. The diminishing supply of halothane poses major challenges for rural and under-resourced facilities that rely on it for routine surgery, reflecting deeper systemic problems including inadequate healthcare funding, infrastructure gaps, workforce shortages, and reliance on imported medical supplies. Transitioning to alternatives such as isoflurane or sevoflurane offers safety advantages but entails higher costs, greater equipment requirements, increased training needs, and the potential widening existing disparities in access to safe anaesthesia. The cessation of halothane production poses both a challenge and an opportunity for anaesthesia practice in Nigeria. Strategic investments in workforce training, infrastructure, affordable alternative techniques, and supportive national policies are essential to ensure a sustainable transition and to preserve equitable, high-quality perioperative care.

Post-mastectomy breast reconstruction in sub-Saharan Africa: a scoping review of availability, uptake, techniques, outcomes and barriers

2026-07-29T09:26:21+0530

Breast cancer survival in sub-Saharan Africa (SSA) is low, mastectomy predominates, and breast loss without reconstruction carries a documented quality-of-life cost. Post-mastectomy breast reconstruction may improve quality of life and the acceptability of surgery; however, its availability, uptake, and outcomes across SSA are poorly characterized. We aimed to map the existing evidence on this topic. Following the PRISMA extension for Scoping Reviews and the Arksey and O’Malley framework as refined by Levac and colleagues and the Joanna Briggs Institute, we searched PubMed/MEDLINE, Embase, Scopus, Web of Science, CINAHL and African Journals Online, with grey-literature and reference-list searching, for sources addressing post-mastectomy breast reconstruction in women treated for breast cancer in SSA. Sources were screened in Rayyan and charted across five domains: availability, uptake and techniques, patient perspectives, outcomes, and barriers and facilitators. The evidence was sparse, concentrated in a few countries, and dominated by qualitative studies and service surveys rather than by reconstruction outcome series. Reconstruction was often described as scarce and centralized, available at very few facilities, within mastectomy-dominated and largely out-of-pocket care pathways. Patient-level evidence concerned perceptions and acceptability, shaped by life stage, culture, and religion, rather than experience of reconstruction. No source reported oncological or standardized aesthetic outcomes after reconstruction; the only robust outcome evidence concerned the quality-of-life harm of mastectomy alone. Barriers include a scarcity of services, workforce shortages, costs, and cultural factors. Post-mastectomy breast reconstruction in SSA is a largely unmapped field characterized by minimal availability and an almost complete absence of outcome data in the literature. Registries, prospective outcome studies, and resource-stratified service planning are needed to support equitable, patient-centered breast cancer care.

Artificial intelligence in jejunal diverticulosis: emerging applications in imaging recognition, risk stratification and surgical decision support

2026-07-29T09:26:12+0530

Jejunal diverticulosis is a rare small-bowel disorder that is frequently under-recognized and may present with severe complications including diverticulitis, perforation, haemorrhage, and intestinal obstruction. Diagnosis relies primarily on cross-sectional imaging, particularly computed tomography (CT) and CT enterography, yet diverticula are often overlooked due to their subtle appearance and the rarity of the disease. In parallel, artificial intelligence (AI) has rapidly advanced across gastrointestinal imaging and clinical decision support, offering new opportunities for automated lesion detection, imaging phenotyping, and risk prediction. Aim of the study was to review current and emerging applications of artificial intelligence relevant to jejunal diverticulosis, with emphasis on imaging recognition, complication risk stratification, and surgical decision support. A structured narrative review was conducted using a literature search informed by the PRISMA framework. Electronic databases including PubMed/MEDLINE, Scopus, and Google Scholar were searched for studies published between January 2000 and February 2026. Search terms included combinations of “jejunal diverticulosis,” “small bowel diverticula,” “artificial intelligence,” “machine learning,” “deep learning,” “capsule endoscopy,” “CT enterography,” and “diverticulitis.” Studies describing AI applications in capsule endoscopy, cross-sectional small-bowel imaging, diverticular disease, and surgical decision support were included. Findings were synthesized narratively due to heterogeneity in study design and methodologies. AI has demonstrated high diagnostic accuracy in gastrointestinal imaging, particularly in capsule endoscopy where convolutional neural networks can detect small-bowel lesions, including diverticula, with very high sensitivity and specificity. In cross-sectional imaging, machine-learning and radiomics models applied to CT enterography can identify and quantify small-bowel pathology and predict clinically relevant outcomes. AI applications in colonic diverticulitis and acute abdominal CT have shown promising performance in differentiating disease entities, predicting complications, and guiding clinical triage. These advances provide a methodological foundation for applying AI to jejunal diverticulosis. Potential applications include automated detection of jejunal diverticula on CT or CT enterography, multimodal risk stratification models integrating clinical and imaging data, and AI-assisted decision support for conservative versus surgical management. Although AI models specifically targeting jejunal diverticulosis have not yet been reported, advances in gastrointestinal imaging analytics and clinical prediction models suggest substantial potential for future development. Multi-institutional data sharing, standardized imaging annotation, and prospective validation studies will be essential to develop reliable AI tools capable of improving early detection, risk assessment, and surgical decision-making in this rare but clinically significant condition.

Hepatocellular carcinoma in the context of chronic hepatitis C infection: pathogenesis, diagnosis and therapeutic advances

2026-07-29T09:26:21+0530

Hepatocellular carcinoma is one of the most formidable cancers worldwide, and chronic infection with hepatitis C virus (HCV) plays a crucial role in its development. Even though the advent of direct-acting antivirals has greatly improved the rate of viral eradication, the lingering effects of long-term HCV—characterized by ongoing inflammation, advancing fibrosis, and intricate genetic alterations—continue to drive the formation of cancer. Based on my own clinical observations as well as recent scientific findings, this chapter delves deeply into the process by which HCC arises in an HCV-affected liver. I describe the sequential molecular events set off by persistent infection, assess modern imaging and diagnostic techniques (including both tissue-based assessments and liquid biopsy approaches), and review a range of treatment strategies from surgical removal to cutting-edge systemic therapies. In addition, I discuss future possibilities, particularly the potential benefits of precision medicine and the integration of multi-omics data. This review is designed to serve as both a practical resource for healthcare professionals and a catalyst for further research.