International Surgery Journal

Surgical management of the complete atrioventricular septal defect: literature review and case report

2026-09-25T09:29:18+0530

Complete atrioventricular septal defect is a complex congenital cardiac defect caused by failure of septal separation, frequently associated with Down syndrome. It is considered a significant challenge in terms of diagnostic and therapeutic management. Our work aims to provide an update on the clinical and therapeutic aspects of the complete AVSD managed by our team at University Hospital Ibn Sina of Rabat, highlighting the importance of developing pediatric cardiac surgery in our Moroccan healthcare system. A retrospective descriptive study involved 20 patients who underwent surgery for complete AVSD between January 2020 and December 2023. Medical records were used to collect clinical, echocardiographic, surgical, and follow-up data. The median age at surgery was 7.5 months, and 90% of the patients had Down syndrome. Among the 20 included patients, 19 survived the intervention, yielding a survival rate of 95%. Postoperative complications included transient severe pulmonary hypertension in 4 patients (20%), moderate residual mitral insufficiency in 6 patients (30%), and rare complications such as septic shock and chylothorax. The single-patch repair technique was employed in 95% of cases. Complete CAV requires a multidisciplinary approach. This study highlights the importance of early diagnosis and timely surgical intervention in improving clinical outcomes and reducing morbidity and mortality.

A case series of giant fibroadenoma presenting as an axillary mass: a rare presentation

2026-09-25T09:30:29+0530

Fibroadenoma of breast is the most common benign tumour of breast but fibroadenoma of axillary breast tissue is rare, and giant fibroadenoma of axillary breast tissue is even rarer. This article is case series of three patients presented with axillary mass, who underwent surgery through an axillary incision, later found to be giant fibroadenomas in two cases and normal fibrofatty tissues of axilla in one case. Seroma formation and arm odema are common complications.

Spectrum of presentation and management of retrocaval ureter: a 10-year single centre experience

2026-09-25T09:30:28+0530

Retrocaval ureter is a rare congenital abnormality with an incidence of 0.06-0.17%. With the frequent use of radiological imaging in modern practice, there has been an increase in the identification as well as evolution in the management options for these cases. We present a series of 18 cases of retrocaval ureter managed at our institute from August 2015 to May 2025. The initial evaluation included routine blood investigations and ultrasound KUB followed by CT scan, IVU and RGP for confirmation. This case series aims to highlight the spectrum of presentation of retrocaval ureter that we encountered and the management option chosen. In our study, there were 17 cases of Type 1 retrocaval ureter and one case of Type 2 retrocaval ureter. 14 cases presented with flank pain, 3 cases with urinary tract infection and 1 case were an incidental finding. One patient had an associated renal pelvic calculus and 1 patient had a poorly functioning right kidney. One patient presented with a broken forgotten DJ stent in situ placed initially in view of recurrent urinary infections. In our study, 1 patient had left renal agenesis and 1 patient was a known case of ventricular septal defect. Retrocaval ureter, being a rare entity, has been reported sporadically over decades. The existing case series report a few numbers of cases or dwell on the traditional management done with the increasing trend towards minimal invasive approach. In our study, we aim to highlight the varied presentations of retrocaval ureter that we encountered in our institute, along with the management tailored accordingly. Retrocaval ureter is a rare clinical entity. With modern diagnostic tools, there is an increasing chance of early diagnosis, thus enabling us to safeguard the renal function with prompt intervention.

Troublesome gallbladder fossa bleeding during laparoscopic cholecystectomy: case series with review of literature

2026-09-25T09:26:41+0530

Gall bladder fossa bleeding is an uncommon but significant complication of laparoscopic cholecystectomy (LC). Effective laparoscopic control of such bleeding is essential to avoid conversion to open surgery. This retrospective case series was conducted in the Department of General Surgery and Advanced Laparoscopic Surgery, Dr. L. H. Hiranandani Hospital, Powai, Mumbai, Maharashtra, India. The study included patients who developed gall bladder fossa bleeding not controlled by conventional measures, during LC between 2013 and 2023. Hospital electronic medical records (EMR) and operative notes were reviewed to identify eligible cases. A total of three patients were included in the study. Data were extracted using a structured case record proforma and included patient’s age, sex, diagnosis, intraoperative occurrence of gall bladder fossa bleeding, and the surgical technique used for hemostasis. All patients were managed with laparoscopic gall bladder fossa suturing for control of bleeding. The effectiveness of the technique was assessed based on achievement of hemostasis, need for conversion to open surgery, and intraoperative outcome as documented in operative records. A total of three patients who developed gall bladder fossa bleeding during LC between 2013 and 2023 were included in this case series. The mean age of the patients was 47.3 years (range: 39-57 years). Two patients (66.7%) were male and one patient (33.3%) was female. All cases were diagnosed intraoperatively and were managed successfully with laparoscopic gall bladder fossa suturing. Hemostasis was achieved in all patients (100%) without the need for conversion to open surgery. No intraoperative complications related to the suturing technique were reported in any of the cases. Laparoscopic gall bladder fossa suturing proved to be an effective and safe technique for achieving hemostasis in all patients, with no need for conversion to open surgery and no associated complications. This method may serve as a useful option for controlling persistent gallbladder (GB) bed bleeding when conventional hemostatic measures are ineffective.

A case of heparin induced thrombocytopenia requiring an open arterial thrombectomy

2026-09-25T09:29:11+0530

Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin exposure characterized by thrombocytopenia and a paradoxical prothrombotic state. Although venous thrombosis is more common, arterial thrombosis can result in severe limb-threatening ischemia. A 69-year-old man admitted with new-onset atrial fibrillation and acute systolic heart failure received unfractionated heparin followed by enoxaparin. He subsequently developed a marked decline in platelet count and acute bilateral lower-extremity ischemia. Computed tomography angiography demonstrated extensive thrombi involving the abdominal aorta and bilateral iliac arteries, while venous duplex demonstrated no venous thrombosis. HIT was confirmed by positive anti-PF4 antibodies and serotonin release assay. All heparin products were discontinued and argatroban was initiated. Progressive limb ischemia required catheter-directed EKOS thrombolysis followed by open right common femoral artery thrombectomy, resulting in restoration of lower-extremity perfusion and avoidance of amputation. This presentation was particularly challenging because of concomitant atrial fibrillation and peripheral arterial disease, which provided an alternative explanation for the arterial thrombosis. HIT should be considered in patients with recent heparin exposure who develop thrombocytopenia and unexplained arterial thrombosis, even in the absence of venous thrombosis. Prompt heparin cessation, alternative anticoagulation, and multidisciplinary endovascular and surgical intervention can achieve successful limb salvage.

The hernia’s hidden passenger: strangulated epiploic appendages within a left inguinal hernia sac – a case report

2026-09-25T09:25:17+0530

Epiploic appendagitis is a rare, self-limiting inflammatory condition involving fat-filled appendages attached to the colon. Its presentation can mimic other causes of acute abdomen, making diagnosis challenging. A 38-year-old man presented with a painful, irreducible left groin swelling clinically and ultrasonographically suggestive of an incarcerated inguinal hernia. Diagnostic laparoscopy revealed two sigmoid epiploic appendages within the hernia sac, one of which was necrotic; laparoscopic reduction, TAPP mesh repair, and appendage excision were performed successfully, with an uneventful recovery and no recurrence or mesh-related complications. Although conservative treatment is often sufficient for epiploic appendagitis, the use of mesh in cases associated with strangulated inguinal hernia remains debatable. Laparoscopic approaches provide effective management with favorable outcomes, but further research is required to establish standardized treatment protocols.

Acute appendicitis coexisting with caecal perforation caused by Ascaris lumbricoides: a surgical enigma

2026-09-25T09:25:21+0530

Ascaris lumbricoides infestation is one of the most common helminthic infections worldwide, particularly in low- and middle-income countries with poor sanitation. Although it has been implicated in several abdominal surgical emergencies, the concurrent occurrence of acute appendicitis and caecal perforation caused by Ascaris lumbricoides is exceedingly rare and has been infrequently reported in literature. We report the case of a 21-year-old female undergraduate who presented with a five-day history of migratory right lower abdominal pain, vomiting, and low-grade fever. Clinical evaluation was suggestive of acute appendicitis, and she underwent emergency open appendicectomy. Intraoperatively, copious peritoneal fluid, an inflamed vermiform appendix, and a pinhole caecal perforation approximately 5 mm from the appendiceal base were identified. An adult Ascaris lumbricoides worm was found protruding through the perforation. Appendicectomy, primary repair of the caecal perforation after freshening of the edges, and peritoneal lavage were performed. Histopathological examination confirmed acute inflammation of both the appendix and caecal tissue. The patient received postoperative antibiotics and albendazole, had an uneventful recovery, and was discharged on the fifth postoperative day. The coexistence of acute appendicitis and Ascaris lumbricoides-induced caecal perforation is an exceptionally rare surgical entity that may be diagnosed only at operation. In regions where helminthic infestations are endemic, surgeons should maintain a high index of suspicion for concomitant bowel pathologies and routinely inspect the caecum and terminal ileum during appendicectomy to avoid missed diagnoses and improve patient outcomes.

Cytomegalovirus enteritis causing multifocal ileal perforation in a patient with chronic lymphocytic leukaemia: a case report

2026-09-25T09:26:42+0530

Cytomegalovirus (CMV) infection of the gastrointestinal tract occurs predominantly in immunocompromised patients and most commonly affects the stomach and colon, while clinically significant small bowel disease and perforation are rare. We report a case of a 79-year-old man with chronic lymphocytic leukaemia (CLL), developing a superimposed CMV infection leading to hollow viscus perforation. CMV inclusions were confined to ulcerated mucosa overlying areas of neoplastic infiltration and were absent in intervening macroscopically normal bowel, supporting a synergistic clinicopathological mechanism rather than incidental co-infection. This case highlights that in immunocompromised patients with multifocal bowel thickening and perforation, CMV enteritis should be considered even when preoperative imaging suggests an alternative source.

Perforated Meckel’s diverticulum with congenital diaphragmatic hernia

2026-09-25T09:30:29+0530

Congenital diaphragmatic hernia (CDH) is a congenital anomaly in which there is herniation of abdominal contents into the thoracic cavity, this leads to pulmonary hypertension and pulmonary hypoplasia to a varying degree. Association of CDH with various extra-diaphragmatic malformations is known. We present a case of a CDH, in which the patient developed perforation of Meckel’s diverticulum (MD) post-operatively. This is the first reported case of a patient with CDH developing perforation of a MD.

Leukemic infiltration mimicking an infected anal fissure in primary refractory acute myeloid leukaemia: challenging the role of surgery in neutropenic patients

2026-09-25T09:26:33+0530

The management of persistent anorectal disease in neutropenic patients with acute myeloid leukaemia (AML) remains controversial because operative intervention has traditionally been discouraged owing to concerns regarding bleeding, impaired wound healing, and septic complications. Although conservative management is recommended as the initial treatment strategy, the optimal approach for patients with persistent symptoms remains uncertain. We report the case of a 20-year-old woman with primary refractory AML who developed severe anorectal pain during prolonged febrile neutropenia despite broad-spectrum antimicrobial therapy and comprehensive conservative management. Pelvic magnetic resonance imaging demonstrated an active sinus tract without a drainable abscess. Following multidisciplinary assessment, examination under anaesthesia with fissurectomy was performed. Histopathological examination confirmed leukemic infiltration of the anal fissure, with blast cells positive for myeloperoxidase and CD68, establishing the definitive diagnosis. The patient experienced marked postoperative improvement in anorectal pain. This case supports an individualised multidisciplinary approach in which failure of optimised conservative management should prompt careful reassessment with appropriate imaging rather than automatic exclusion of surgery. In carefully selected patients, operative intervention may provide both definitive diagnosis and meaningful symptomatic benefit.

Recurrent breast abscess with isolation of Fusobacterium nucleatum: a case report and review of oncogenic potential

2026-09-25T09:26:39+0530

Breast abscesses are uncommon in non-lactating adolescents and are typically caused by common skin flora. Fusobacterium nucleatum, an anaerobic gram-negative bacterium primarily associated with periodontal disease, has recently been implicated in colorectal and breast tumorigenesis but is rarely identified in breast infections. We report the case of a 14-year-old previously healthy female who presented with a right breast abscess requiring incision and drainage (I&D). Initial cultures yielded anaerobic gram-positive organisms; however, following recurrence one month later with a larger abscess, operative cultures isolated Fusobacterium nucleatum. She was successfully treated with targeted intravenous antibiotics followed by a four-week oral course. This case highlights the importance of considering atypical anaerobic pathogens in persistent or recurrent pediatric breast infections. The identification of F. nucleatum in breast tissue raises questions regarding microbial dysbiosis and its potential long-term implications, underscoring the need for appropriate antimicrobial management and close clinical follow-up.

Extrauterine migration of an intrauterine device to the right iliac fossa: a rare case report

2026-09-25T09:26:31+0530

Intrauterine devices (IUDs) are highly effective, reversible methods of contraception, but uterine perforation and extrauterine migration are uncommon complications. We report the case of a 32-year-old multiparous woman who presented by self-referral from another healthcare facility with a two-week history of right iliac fossa pain and a history of IUD insertion. Abdominal ultrasonography was unremarkable but demonstrated an empty uterine cavity despite the absence of a history of IUD expulsion. A plain abdominal radiograph was subsequently obtained, which demonstrated the IUD in the right iliac fossa. She underwent open exploratory laparotomy, which revealed the IUD lying freely in the right iliac fossa close to the fimbrial end of the right fallopian tube. There was no identifiable uterine perforation, scar, or defect. However, the right fallopian tube was oedematous, raising the possibility of an unusual route of migration through the right uterine ostium, along the fallopian tube and through the fimbrial end into the peritoneal cavity. The IUD was removed, and bilateral tubal ligation was performed at the patient's request because she had completed her desired family size and declined other contraceptive methods. Her postoperative recovery was uneventful, and subsequent follow-up was satisfactory. This case highlights the importance of careful history taking, appropriate evaluation of a missing IUD, and prompt management, particularly in low-resource settings where advanced imaging and minimally invasive surgery may not be readily available.

Intraneural ganglion of the intermediate dorsal cutaneous nerve of the foot: a Pollyannaish diagnostic challenge

2026-09-06T08:14:47+0530

Intraneural ganglion cysts are rare, benign mucinous lesions that develop within the epineurium or perineurium of peripheral nerves, most commonly in proximity to synovial joints. Their occurrence in the intermediate dorsal cutaneous nerve of the foot is exceptionally uncommon. Owing to their rarity and nonspecific clinical presentation, these lesions are frequently misdiagnosed, resulting in delays in appropriate management. This report presents a case of an intraneural ganglion cyst arising from the intermediate dorsal cutaneous nerve on the dorsum of the foot. The purpose of this study is to highlight the diagnostic challenges associated with this unusual entity and to emphasize the importance of considering nerve-related pathologies in patients presenting with persistent dorsal foot masses. Initially, the lesion was presumed to be a benign and innocuous condition-a “Pollyannaish diagnosis” - which contributed to delayed recognition of the underlying neural origin. A comprehensive diagnostic approach, including detailed clinical evaluation and imaging studies, was employed to establish the diagnosis. Surgical exploration and excision were subsequently performed with careful preservation of the involved nerve and assessment of potential joint connections. This case underscores the importance of maintaining a high index of suspicion for intraneural ganglion cysts in atypical locations, utilizing appropriate imaging modalities for accurate diagnosis, and undertaking meticulous surgical management. Early recognition and treatment can improve outcomes and reduce the risk of recurrence or neurological complications.

From challenge to change – reduction mammoplasty for a young female with benign breast growth

2026-09-25T09:29:11+0530

Benign papillary lesions of the breast, such as intraductal papillomas, are generally non-cancerous but can pose diagnostic and therapeutic challenges due to their atypical presentations and potential for coexistence with ductal hyperplasia. This case report describes a 20-year-old female presenting with an unusually large, progressively growing right breast mass over eight years. Clinical and histopathological evaluation confirmed a benign papillary lesion without malignancy. Given the size and associated complications, a wise-pattern reduction mammoplasty with a superomedial pedicle was performed. The patient had a smooth postoperative recovery with satisfactory aesthetic and functional outcomes. This case underscores the importance of individualized management strategies for benign breast lesions and demonstrates the efficacy of reduction mammoplasty in young patients with significant breast hypertrophy. Awareness of such rare, extensive benign presentations is crucial for timely intervention and optimal patient care.

Solitary fibrous tumor of the mesentery: a rare presentation

2026-09-25T09:31:08+0530

Solitary fibrous tumors (SFTs) are uncommon mesenchymal neoplasms that most frequently arise from the pleura but may occur at extrapleural sites, including the abdomen. Mesenteric SFTs are exceedingly rare and often present as slow-growing abdominal masses. We report a case of a large mesenteric SFT with intermediate-risk features, managed successfully by complete surgical excision. Diagnosis was confirmed by characteristic histopathological and immunohistochemical findings, including diffuse STAT6 and CD34 expression.

Missed intraoperative localisation of an accidentally ingested razor blade in a child with subsequent spontaneous passage: a case report

2026-09-25T09:29:08+0530

Accidental ingestion of sharp foreign bodies in children is a pediatric surgical emergency that carries a significant risk of gastrointestinal perforation, hemorrhage, and obstruction. Although the majority of ingested foreign bodies pass spontaneously, sharp metallic objects such as razor blade fragments represent a particularly high-risk category. Failure to localize such objects intraoperatively is a rare and challenging scenario with few published reports. A 13-year-old boy presented to the emergency department following accidental ingestion of half of a new double-edged shaving razor blade. He was entirely asymptomatic on presentation, with no abdominal pain, hematemesis, melena, or signs of peritoneal irritation. Vital parameters were within normal limits. Serial plain radiographs of the abdomen confirmed progressive distal migration of the metallic fragment. Given concerns about perforation risk from the sharp-edged object, exploratory laparotomy was undertaken after 24 hours of observation. A pre-operative radiograph suggested the blade had reached the distal ileum. Intraoperative examination of the entire small bowel conducted under bright illumination and with the aid of a sterilized magnet failed to locate the fragment. The abdomen was closed after thorough exploration. The postoperative course was uneventful; the patient passed flatus on postoperative day one, and the intact razor blade fragment was identified in the patient's stool on postoperative day two following mild laxative administration. This case illustrates that intraoperative failure to localize an ingested sharp metallic foreign body does not preclude spontaneous passage. It underscores the diagnostic limitations of intraoperative localization techniques and suggests that conservative post-exploration management with laxatives and stool surveillance may be appropriate when no adverse intraoperative findings are encountered. Pre-operative and real-time intraoperative fluoroscopy may enhance localization in future cases.

Rapid healing of a delayed post amputation wound secondary to femoral artery thrombosis

2026-09-25T09:31:07+0530

Post-amputation wound complications are a known problem for people with peripheral arterial disease. The risk is much higher for people who have immunosuppression or metabolic problems. When femoral artery thrombosis affects tissue perfusion, the body's natural processes for healing wounds are greatly weakened, making patients more likely to get a secondary infection and have long-lasting health problems. We present the case of a 56-year-old man with a constellation of systemic comorbidities type 2 diabetes mellitus, HIV infection, hypertension, and malnutrition who underwent right below-knee amputation following CT angiography-confirmed femoral artery thrombosis. Despite standard wound care and systemic antibiotics, the postoperative wound demonstrated persistent delayed healing, characterized by slough formation, active infection, moderate-to-high exudate levels, and significant pain. A structured collagen-based wound care protocol was introduced, utilizing a combination of QuoroGel®, QuoroFiber, and QuoroHeal as primary dressing agents, applied at three-day intervals over a 15-day treatment course. No adjunctive interventions such as offloading, compression therapy, or advanced supportive modalities were employed.

Clinically meaningful improvement was evident after the very first dressing application. Progressive development of healthy granulation tissue was noted by the second and third dressings, with epithelialization becoming apparent after the fourth. The wound responded well in terms of infection control and pain relief, with no treatment-related adverse events recorded throughout the observation period. In this patient with increased risk factors and impaired wound healing because of immunosuppression and malnutrition, it has been shown that collagen dressing can help to accelerate wound healing. It is possible that the benefit provided by collagen dressing could be proven through further controlled studies.

Dermoid cyst in the suprasternal notch: a rare case

2026-09-25T09:29:06+0530

A mass in the suprasternal notch could have various probabilities, where in a dermoid cyst can be one of them but not one of the most common causes. With various clinical and pathological examinations and also with the help of imaging modalities, we can reach the diagnosis. In this case, the investigations such as ultrasonography, FNAC and CT neck were heavily skewed in the direction of a dermoid cyst. Here, we present a case of a 13-year-old female child who presented with a swelling in the suprasternal notch. She has undergone an excision biopsy after confirming the diagnosis with USG neck, FNAC and CT neck.

Reconstruction of the upper eyelid ciliary margin using an eyebrow hair-bearing Fricke flap in a young patient: a case report

2026-09-25T09:25:20+0530

Traumatic loss of upper eyelid tissue presents a dual challenge—restoring the delicate mechanics of eyelid function while recreating the subtle aesthetic harmony of the periocular region. We report the reconstruction of a lateral upper eyelid defect in an 18-year-old male following traumatic avulsion, approached with an emphasis on both protection and appearance. A temporally based forehead (Fricke) flap was thoughtfully designed to incorporate a linear array of eyebrow hair follicles, allowing not only resurfacing of the defect but also recreation of a natural-appearing lash line. This was complemented by meticulous posterior lamellar repair and lateral canthal stabilization for structural integrity. This reconstruction achieved stable eyelid position, complete and comfortable eye closure, and pleasing aesthetic contour with restoration of the lash margin. This case highlights the versatility of the Fricke flap, demonstrating how, when adapted with aesthetic intent, it can seamlessly unite function with form in selected traumatic eyelid defects.

Laparoscopic excision of a giant retroperitoneal benign mesenteric cyst encasing the left ureter and iliac vessels: a rare case report and literature review

2026-09-25T09:25:17+0530

Retroperitoneal mesenteric cysts are exceedingly rare benign intra-abdominal tumors that pose significant diagnostic and therapeutic challenges due to their silent progression, large potential size, and proximity to major retroperitoneal neurovascular and urinary structures. We present the case of a 59-year-old postmenopausal female presenting with chronic, intermittent left-sided abdominal pain for three years and progressive urinary hesitancy for one year. Advanced imaging delineated a giant, thin-walled, unilocular retroperitoneal cystic lesion measuring approximately 12.6 × 11.4 × 10.9 cm, causing severe extrinsic compression, displacement, and complete encasement of the left ureter and left common iliac artery, resulting in moderate hydronephrosis. Despite the immense size and complex anatomic adherence, the patient successfully underwent a minimally invasive Laparoscopic Excision of the giant cyst with meticulous dissection and preservation of the encased ureter and iliac vessels. Following complete isolation, controlled aspiration was safely executed without spillage to downsize the specimen for extraction, avoiding open conversion. Histopathological evaluation confirmed a benign mesenteric cyst of retroperitoneal origin. The patient experienced an uneventful postoperative recovery with immediate resolution of urinary and painful symptoms. This case underscores that with advanced laparoscopic expertise and precise anatomical navigation, giant adherent retroperitoneal cysts can be safely managed via minimally invasive pathways, avoiding the morbidity of open conversion.

Indocyanine green fluorescence-guided laparoscopic liver resection for hepatocellular carcinoma: a case report

2026-09-25T09:26:32+0530

Indocyanine green (ICG) fluorescence imaging has emerged as a useful adjunct in laparoscopic liver surgery, providing real-time visualization of hepatocellular carcinoma (HCC) and assisting in tumor localization and determination of the parenchymal transection plane. Its role is particularly relevant in achieving adequate oncological clearance while preserving uninvolved liver parenchyma. A 60-year-old man with hepatitis B infection on treatment presented with abdominal pain and loss of appetite. Contrast-enhanced computed tomography demonstrated a solitary 5.1×5.8×5.7 cm segment 3 lesion with arterial-phase enhancement and venous-phase washout, consistent with HCC. Liver function was preserved, with no evidence of portal hypertension. ICG was administered intravenously at a dose of 0.5 mg/kg, 48 hours before surgery. During laparoscopy, near-infrared fluorescence imaging clearly identified the tumor and delineated its boundaries from the surrounding liver parenchyma. The fluorescence was used to guide parenchymal transection, and a laparoscopic left lateral sectionectomy was performed. Histopathological examination demonstrated a 6×5.5×4.8 cm well-differentiated HCC, with a tumor-free resection margin and pathological stage pT1b. ICG fluorescence imaging provides real-time intraoperative guidance during laparoscopic liver resection. In selected patients with HCC, its use may facilitate accurate tumor localization and margin-oriented parenchymal transection while preserving uninvolved liver parenchyma. Further prospective studies are required to establish whether routine use of ICG fluorescence translates into improved long-term oncological outcomes.

Comorbidity-modified biomarker prediction of postoperative atrial fibrillation after cardiac surgery: a scoping review

2026-09-25T09:26:43+0530

Postoperative atrial fibrillation (POAF) complicates 20–50% of cardiac surgical procedures and is associated with increased stroke risk, prolonged hospitalisation, and mortality. Numerous circulating and clinical biomarkers have been proposed for POAF risk stratification; however, diabetes, chronic kidney disease (CKD), and obesity are typically entered as adjustment covariates rather than assessed as effect modifiers of biomarker performance. This scoping review mapped the extent to which the POAF biomarker literature evaluates comorbidities as modifiers of predictive performance. Following the Arksey and O’Malley framework and PRISMA-ScR reporting guidance, PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception, without date or language restriction, alongside backward and forward citation chasing of the included sources. Two reviewers independently screened the records and extracted the data; disagreements were resolved by discussion or by a third reviewer. Data were descriptively synthesised. Out of 1,409 records identified, 887 remained after de-duplication, and 845 were excluded at title/abstract screening, leaving 42 reports for full-text retrieval (one could not be retrieved). Of the 41 reports assessed in full text, 23 studies met the inclusion criteria, and 18 were excluded for documented reasons. Diabetes was the most frequently assessed comorbidity, reported in 21 of 23 studies, almost always as an adjustment covariate or unstratified baseline characteristic rather than a formally tested interaction term. Only two studies performed explicit statistical interaction testing between comorbidities and candidate predictors for POAF, and both found no significant interactions. Chronic kidney disease and obesity were assessed less frequently and with limited methodological rigor. Comorbidities are rarely evaluated as genuine effect modifiers of biomarker performance in POAF prediction research. Although diabetes has been formally tested, it does not appear to modify predictor performance, although the evidence base is too sparse to draw firm conclusions. Future POAF biomarker studies should pre-specify and report comorbidity-stratified or interaction analyses to clarify whether comorbidity-tailored risk models are warranted.

Resecting the rigid and reconstructing the rest: a comprehensive review of chest wall sarcoma management

2026-09-25T09:25:19+0530

Primary chest wall sarcomas are rare malignancies, representing approximately 0.04% of new cancer diagnoses and requiring a complex multidisciplinary management strategy. A comprehensive Boolean search was conducted using PubMed/Medline, Google Scholar, Embase and Scopus to identify studies based on their relevance to the multidisciplinary management of adult patients with primary or secondary chest wall sarcomas. This review explores the clinical landscape of these heterogeneous tumors, differentiating between bone-derived and soft-tissue sarcomas. Diagnosis necessitates advanced imaging, including CT, MRI, and PET/CT, and precise biopsy techniques to facilitate accurate histopathological classification and surgical planning. Wide en bloc surgical resection achieving negative (R0) margins remains the primary curative modality, significantly impacting local control and overall survival. The integration of neoadjuvant and adjuvant systemic therapies and radiation is highly subtype-dependent, with chemosensitive tumors like Ewing sarcoma benefiting most from multimodality approaches. Furthermore, we detail the evolving science of chest wall reconstruction, where rigid prosthetic systems and advanced soft-tissue coverage are utilized to restore skeletal stability and respiratory function. Finally, this review highlights the emerging roles of targeted therapies and 3D intraoperative navigation. Ultimately, a coordinated multidisciplinary paradigm is essential to optimize oncological outcomes and preserve the quality of life for patients with these challenging thoracic neoplasms.

Management of strangulated inguinal hernias: a comparison of the Désarda versus Bassini procedure

2026-09-25T09:29:06+0530

Background: The unsatisfactory results of suture repair (high incidence of recurrence and chronic postoperative pain) mean that practitioners are constantly seeking techniques that offer the best outcomes. Consequently, the Désarda technique warrants testing in the management of strangulated inguinal hernias. The aim of this study was to compare the Désarda technique with tissue raphia (Bassini) in the treatment of strangulated inguinal hernias

Methods: This was a prospective, randomised, single-centre, controlled study conducted from December 2013 to December 2019 at the La Renaissance University Hospital Centre in N’Djamena.

Results: A total of 133 patients were recruited, comprising 109 men and 24 women, with a mean age of 29.5 years±5 years and a range of 18 to 61 years. There were no intraoperative or early postoperative complications in either group. Nor were there any deaths. The 7-year recurrence rate was significantly lower in the Désarda group (1.8% vs 12.2%; the odds ratio was 0.07 with a 95% confidence interval ranging from 0.01 to 0.55), p=0.02. The result is statistically significant because p<0.05. The risk of developing chronic post-operative pain was one-tenth as high in the Desarda group compared with the Raphie group. The odds ratio was 0.1 with a 95% confidence interval ranging from (0.01 to 0.8). The Desarda procedure statistically significantly reduces the rate of dissatisfaction among patients who have undergone surgery. The odds ratio was 0.07, with a 95% confidence interval ranging from 0.01 to 0.55; this association was statistically significant.

Conclusions: The Desarda technique is a safe and effective method as it reduces the incidence of recurrence and postoperative pain. The majority of patients who underwent surgery were satisfied.

Efficacy and safety of abdominal cavity cleansing with chlorhexidine for reducing surgical site infection in patients undergoing appendectomy

2026-09-25T09:25:22+0530

Background: Surgical site infection (SSI) remains a relevant postoperative complication after appendectomy. Intraoperative abdominal cavity cleansing is used in clinical practice, but the evidence supporting antiseptic solutions remains heterogeneous.

Methods: A prospective case-control study was conducted in adults undergoing appendectomy for acute appendicitis at a tertiary hospital in Puebla, Mexico. Patients received intraoperative abdominal cavity cleansing with either chlorhexidine or saline. The primary outcome was surgical site infection within 30 days. Patients were followed at 15 and 30 days postoperatively. Demographic, clinical, microbiological, and adverse-event data were collected. Associations were analyzed using odds ratios with 95% confidence intervals and Fisher’s exact test, with p<0.05 considered statistically significant.

Results: The median age was 37 years (IQR 26-51); 217 patients (55.5%) were women and 174 (44.5%) were men. Uncomplicated and complicated appendicitis occurred in 198 (50.6%) and 193 (49.4%) patients, respectively. Postoperative complications occurred in 97/192 (50.5%) patients in the chlorhexidine group and 58/108 (53.7%) in the saline group. Chlorhexidine showed a non-significant trend toward fewer complications (OR 0.88, 95% CI 0.55-1.41; p=0.63). Mean time to infection was 16.3±8.4 days. The most frequent positive isolate was Escherichia coli. No increase in adverse events was observed with chlorhexidine.

Conclusions: Abdominal cavity cleansing with chlorhexidine was clinically safe and showed a non-significant trend toward fewer postoperative complications compared with saline. These findings support further adequately powered randomized studies to define its role in SSI prevention after appendectomy.

TP53 overexpression and three-year survival in stage III and IV colorectal cancer: a retrospective cohort study

2026-09-25T09:26:33+0530

Background: TP53 mutations are among the most common molecular alterations in colorectal cancer (CRC) and are frequently associated with tumor aggressiveness and poor prognosis. This study evaluated the influence of TP53 overexpression on three-year overall survival in patients with stage III and IV CRC.

Methods: A retrospective cohort study was conducted on 46 patients with stage III–IV CRC treated at Dr. Moewardi General Hospital, Surakarta, Indonesia, between 2020 and 2023. TP53 expression was assessed using immunohistochemistry and categorized as overexpression or non-overexpression. Survival outcomes were analyzed using Chi-square and Kaplan–Meier methods with log-rank testing.

Results: Seventeen patients (36.9%) demonstrated TP53 overexpression, whereas 29 (63.1%) showed non-overexpression. Mortality before three years was significantly higher in the overexpression group (82.4%) than in the non-overexpression group (31.0%). TP53 overexpression was significantly associated with reduced three-year survival (p=0.001; Cramer’s V=0.495). Kaplan–Meier analysis demonstrated significantly shorter survival among patients with TP53 overexpression (log-rank p=0.002). Metastatic status and lymphovascular invasion were also associated with poorer survival.

Conclusions: TP53 overexpression is significantly associated with decreased three-year survival in advanced CRC and may serve as a useful prognostic biomarker for risk stratification and treatment planning.

Surgical site infections in emergency vs elective surgery: a cross-sectional comparison

2026-09-25T09:29:07+0530

Background: Surgical site infections (SSI) are among the most common postoperative complications, leading to increased morbidity, prolonged hospitalization, and higher healthcare costs. Emergency surgical procedures are particularly associated with higher infection rates because of limited preoperative preparation and a greater likelihood of contaminated wounds. This study compared the incidence of SSI between emergency and elective surgeries and evaluated associated risk factors and postoperative outcomes.

Methods: This cross-sectional comparative study was conducted in the Department of Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh, from January 2025 to December 2025. A total of 104 patients were enrolled using purposive sampling, including 52 undergoing emergency surgery and 52 undergoing elective surgery. Data were analyzed using SPSS version 26.0.

Results: The overall SSI rate was 19.2%. SSI occurred significantly more often in emergency surgeries (28.8%) than in elective surgeries (9.6%). Emergency procedures were more frequently associated with prolonged operative duration and contaminated or dirty wounds. Significant risk factors for SSI included diabetes mellitus, smoking, prolonged surgery (>2 hours), and wound contamination. Patients who developed SSI experienced significantly longer hospital stays, higher reoperation rates, and increased 30-day readmission rates compared with those without infection.

Conclusion: Surgical site infections are significantly more common following emergency surgery than elective procedures. The higher SSI rate in emergency operations is largely attributable to greater wound contamination, longer operative times, and limited opportunities for preoperative patient optimisation.

Perioperative adverse events in neurosurgery – incidence, pattern and associated factors in a Nigerian tertiary hospital

2026-09-25T09:25:16+0530

Background: Perioperative adverse events remain important causes of morbidity and mortality after neurosurgery, particularly in resource-constrained settings. This study evaluated their frequency, pattern and associated factors at a Nigerian tertiary hospital.

Methods: A retrospective observational study was conducted among patients undergoing cranial or spinal neurosurgical procedures at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, from January 2022 to December 2024. Demographic, clinical, operative and outcome data were extracted from hospital records. Associations were assessed using chi-square or Fisher's exact tests, followed by multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

Results: Of 126 identified cases, 103 met eligibility criteria. Mean age was 46.9±18.3 years and 65.0% were male. Cranial procedures accounted for 68.9% and emergency procedures for 57.3%. Thirty-four patients (33.0%) experienced at least one perioperative adverse event. The most frequent events were intraoperative hypotension, electrolyte disturbances, excessive blood loss, surgical site infection and reoperation. Neurological improvement occurred in 67.0%, while mortality was 8.7%. Emergency surgery (AOR 2.63, 95% CI 1.10–6.31), ASA III–IV (AOR 2.41, 95% CI 1.01–5.72), blood loss >500 ml (AOR 3.78, 95% CI 1.48–9.67), surgery >4 hours (AOR 2.92, 95% CI 1.19–7.15) and incomplete checklist completion (AOR 3.46, 95% CI 1.01–11.88) were independently associated with adverse events.

Conclusions: Perioperative adverse events were common. Strengthened risk assessment, haemostatic management, operative efficiency and complete checklist implementation may support safer neurosurgical care.

Effect of ethanolic propolis extract on hypoxia-induced skin flap survival in white rats (Rattus norvegicus) – an experimental study

2026-09-25T09:25:15+0530

Background: Hypoxia in skin flaps promotes oxidative stress and inflammation, which may impair angiogenesis and tissue survival. Propolis contains flavonoids and polyphenols with antioxidant, anti-inflammatory, and angiogenic properties. This study evaluated the effect of ethanolic propolis extract on malondialdehyde (MDA), vascular endothelial growth factor (VEGF), necrosis, and acute inflammation in a rat skin-flap model.

Methods: This experimental pre-test and post-test control-group study included 24 male white rats (Rattus norvegicus) allocated to four groups: control (K) and three treatment groups receiving ethanolic propolis extract 800 mg/kg body weight/day with different flap proportions (P1, P2, and P3). Blood MDA and VEGF levels were measured before and after treatment, and skin-flap specimens were assessed histopathologically. MDA and VEGF were analyzed using one-way ANOVA with post hoc testing, while necrosis and acute inflammation were analyzed using the Kruskal-Wallis test.

Results: MDA decreased least in K (-3.89±0.47) and most in P3 (-6.81±0.53), with a significant between-group difference (p<0.001). VEGF increased least in K (6.30±1.10) and most in P3 (11.55±1.19), also with a significant between-group difference (p<0.001). Between-group differences were not significant for necrosis (p=0.256) or acute inflammation (p=0.513).

Conclusions: Propolis administration significantly increased skin flap survival, as indicated by a decrease in MDA and an increase in VEGF levels. At the histopathological level, propolis administration reduced the degree of necrosis and acute inflammation in the skin flap, although this reduction was not statistically significant.

Performance dynamics and learning curve in basic laparoscopic simulation – analysis of 489 participants in a structured training program

2026-09-25T09:25:14+0530

Background: Laparoscopic surgery requires complex psychomotor skills, including bimanual coordination, adaptation to the fulcrum effect, depth perception, and fine instrument control. Dry-lab simulation enables the development of these skills in a safe, reproducible environment without risk to patients.

Methods: A retrospective, cross-sectional study with convenience sampling was conducted from March 2024 to January 2026 at the Centro de Formación de Mínima Invasión in Mexico City, Mexico, conducted among residents and attending physicians enrolled in a diploma course on advanced laparoscopy and robotic techniques at a minimally invasive surgery training center in Mexico City. Nonparametric tests included Wilcoxon, Friedman, Kruskal-Wallis, and Mann-Whitney U tests, as well as Spearman correlation, with statistical significance set at p<0.05, using statistical package for the social sciences (SPSS) program.

Results: Of 523 initial records, 489 participants were included. Mean age was 30.7±3.7 years; 70.6% were male and 29.4% were female. Most participants belonged to General Surgery (91.0%), followed by Urology (7.0%) and Gynecology (2.0%). Significant improvement was observed in object transfer (35.8%; p<0.001), extracorporeal knot tying (43.5%), and intracorporeal suturing (22.6%; p<0.001). Precision cutting did not show significant improvement: delta +1 second, percentage improvement -0.4%, and p=0.788. Comparisons among tasks demonstrated significant differences (p<0.001).

Conclusions: Structured laparoscopic simulation was associated with significant improvement in three basic tasks. The magnitude of improvement varied according to task type and was greatest for extracorporeal knot tying. Precision cutting requires complementary assessment metrics focused on accuracy and technical quality.

Initial outcomes of a surgical ambulatory pathway for right upper quadrant pain

2026-09-25T09:26:40+0530

Background: Right upper quadrant (RUQ) abdominal pain is a common emergency presentation. Ambulatory care pathways (ACP) are described as management strategies to reduce hospital bed pressure. ACP allows well patients presenting out of hours to be discharged from the emergency department, with a plan for re-presentation for further management. The aim of this study is to demonstrate that select patients with RUQ pain can be managed via ACP to achieve shorter inpatient length of stay (LOS) without higher morbidity or mortality.

Methods: Prospective data on eligible patients treated via ACP for RUQ pain between June 2021 and 2022 were compared with a retrospectively collected matched cohort of inpatient care pathway (ICP) patients from June 2019 to June 2020. Data collected included patient demographics, diagnosis, LOS, complications, and readmissions within 30 days.

Results: Patients on the ACP had significantly shorter LOS (p<0.001) with a median LOS of 1.0 (IQR 0.0-1.30) compared to patients on the ICP with a median of 2.0 (IQR 1.25-2.75). There were no significant differences in patient demographics, theatre access, surgical complications, or readmissions within 30 days.

Conclusions: Patients who presented out of hours with RUQ pain treated through the ACP had a shorter LOS without increased morbidity or mortality. ACP management of RUQ pain appears safe for patients who meet strict criteria.

Impact of non-English primary language on adequacy of bowel preparation for elective colonoscopy: a retrospective audit of a high-volume, culturally diverse endoscopy unit

2026-09-17T07:05:07+0530

Background: Non-English primary language (non-EPL) is a recognized risk factor for inadequate bowel preparation for colonoscopy, which can lead to delayed procedures, repeat colonoscopies, and increased healthcare costs. New South Wales has the highest proportion of non-EPL residents of any Australian state, and endoscopy units serving these communities must implement effective multilingual strategies to maintain care standards. Auburn Hospital has adopted a proactive approach using professional interpreter services, translated preparation resources, and language-specific patient education clinics. This study aimed to assess the effectiveness of these interventions by comparing bowel preparation quality and the rate of inadequate colonoscopy preparation between non-EPL and English primary language (EPL) patients.

Methods: A retrospective review of elective colonoscopies performed from January to June 2025 was conducted at a high-volume, culturally diverse metropolitan Sydney hospital. The primary outcome was the rate of inadequate bowel preparation, defined as a Boston bowel preparation score (BBPS) below 6. Secondary outcomes included median BBPS and rates of deferred or repeated colonoscopies. Outcomes were compared between EPL and non-EPL cohorts using Fisher’s exact test for categorical variables and the Mann–Whitney U test for BBPS score distributions.

Results: A total of 720 elective colonoscopies were analysed (non-EPL: n=324, 45%; EPL: n=396, 55%). Twenty-nine patients (4%) had inadequate preparation (BBPS <6); of these, 55% were EPL (n=16) and 45% were non-EPL (n=13), corresponding to inadequate preparation rates of 4.0% in both groups. There was no statistically significant difference in preparation quality, with both groups achieving a median BBPS of 8 (IQR 7–9; non-EPL mean 7.83 [SD 1.16]; EPL mean 7.96 [SD 1.04]).

Conclusions: Contrary to prior studies, non-EPL status was not associated with poorer bowel preparation at this institution. The overall inadequate preparation rate of 4% meets the GESA benchmark of less than 10% and is consistent with high-performing endoscopy centres, likely reflecting the effectiveness of the multilingual communication strategies in place.

Beyond the scalpel: post-operative outcomes of radial diode laser ablation in sacrococcygeal pilonidal sinus disease

2026-09-20T09:13:32+0530

Background: Conventional excisional surgery for sacrococcygeal pilonidal sinus disease repays cure with weeks of open wound care. This study evaluated post-operative outcomes of 1470-nm radial diode laser ablation and the factors governing healing.

Methods: Fifty consecutive patients underwent curettage and 1470-nm radial diode laser ablation at 10 W in a prospective observational study in Kanpur, India, between October 2024 and February 2026. Age, sex, body mass index, family history, morphological stage, occupational sitting duration, gluteal hair density and hair shaft thickness were tested against healing time, delayed healing beyond 30 days and six-month recurrence, univariably and by multivariable linear regression.

Results: Mean age was 25.0±5.3 years and 42 patients (84.0%) were men. Mean operating time was 26.1±8.7 minutes, hospital stay 1.3±0.5 days and day-7 pain 1.2±0.8. Mean healing time was 28.5±10.2 days; 46 patients (92.0%) had no complication and three (6.0%) recurred. Healing time rose with stage (20.1 to 43.5 days; F=22.19, p<0.001), sitting duration (F=5.37, p=0.008), body mass index (r=0.344, p=0.014) and hair density (F=3.61, p=0.035). Delayed healing was associated with advanced stage (76.5% versus 3.0%), overweight (77.8% versus 17.1%), sitting beyond six hours daily (54.5% versus 7.1%) and dense gluteal hair (53.3% versus 17.1%; all p≤0.016). Hair shaft thickness predicted nothing. On multivariable regression only stage remained independent (B=5.60 days per stage, p<0.001; R²=0.737). No factor predicted recurrence.

Conclusions: Laser ablation achieved day-care surgery with minimal pain and 6.0% recurrence. Morphological stage governed healing; body mass index, sedentary work and hair density acted through it.

Comparison of two preoperative scoring systems in predicting difficult laparoscopic cholecystectomy

2026-09-25T09:29:18+0530

Background: Gallstones are a prevalent condition in India, with laparoscopic cholecystectomy being the gold standard treatment. Accurate preoperative prediction of surgical difficulty is essential to improve outcomes and reduce complications.

Methods: This prospective observational study, conducted among 77 patients at a tertiary care center, compared two scoring systems: Randhawa and Pujahari, Acharya and Adhikari. Preoperative scores were assessed using clinical, laboratory, and imaging parameters. These scores were compared to intraoperative outcomes such as surgery duration, complications, and conversion to open cholecystectomy.

Results: Both scoring systems showed reliable accuracy in predicting surgical difficulty. Randhawa and Pujahari demonstrated higher specificity and better performance in ruling out difficult cases, while Acharya and Adhikari showed higher sensitivity and negative predictive value. Most surgeries were categorized as easy (66.2%), with a smaller proportion being difficult (31.2%) or very difficult (2.6%).

Conclusions: Preoperative scoring systems are valuable tools for predicting the complexity of laparoscopic cholecystectomy. While both systems performed well, Randhawa and Pujahari had slightly better accuracy, whereas Acharya and Adhikari showed superior sensitivity.

A comparative study on early versus conventional feeding in patients under going small bowel anastomosis

2026-09-25T09:30:30+0530

Background: Postoperative nutritional management plays a critical role in surgical recovery, particularly following gastrointestinal procedures such as small bowel anastomosis. Traditional practice delays enteral nutrition until bowel sounds or flatus return; however, recent evidence suggests that early enteral feeding (EEN) may improve outcomes without increasing complications. Aim was to compare patient compliance, tolerance, and clinical outcomes between early enteral feeding and conventional feeding methods in patients undergoing elective small bowel anastomosis.

Methods: This prospective comparative study was conducted at a tertiary care center over a two-year period. A total of 100 patients undergoing elective small bowel anastomosis were randomly divided into two groups: Group A (Early feeding, n=50): Initiated enteral feeding via nasogastric tube on postoperative day (POD) 2. Group B (Conventional feeding, n=50): Began oral feeding after return of bowel sounds, typically POD 5-7. Parameters assessed included vomiting, abdominal distension, return of bowel function, nasogastric tube removal, infection, anastomotic leak, length of hospital stay, and patient compliance. Data were analyzed using standard statistical tests; a p<0.05 was considered significant.

Results: Early return of bowel function: Flatus passed significantly earlier in group A (mean 2.4±0.6 days) vs. group B (3.6±0.7 days), p<0.001. Shorter hospital stay: Group A had a significantly shorter stay (6.1±1.3 days) than group B (9.4±1.6 days), p<0.001. Lower abdominal distension: Group A (10%) vs Group B (26%), p=0.04. Similar complication rates: anastomotic leak was rare and not significantly different (2% vs. 4%, p=0.56). High compliance: 92% in Group A tolerated early feeding; 100% in Group B adhered to conventional feeding.

Conclusions: Early enteral feeding following small bowel anastomosis is better tolerated and enhances postoperative recovery of the patients, faster bowel function recovery and reduced hospital stay without increasing the risk of complications. Following Early enteral feeding in routine practice is aligned with Enhanced Recovery After Surgery protocol (ERAS).

Comparative evaluation of retrograde intrarenal surgery versus percutaneous nephrolithotomy for 1-2 cm renal calculi: a retrospective comparative study

2026-09-25T09:29:10+0530

Background: Renal calculi measuring 1-2 cm presents a therapeutic dilemma between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL). The present study aimed to compare clinical outcomes, complications and stone clearance rates between these two modalities.

Methods: This retrospective comparative study was conducted in the Department of Urology and Renal Transplant, JNU Medical College, Jaipur, from January 2025 to January 2026. A total of 250 patients were included, of whom 80 underwent RIRS and 170 underwent PCNL. Demographic variables, stone characteristics, operative outcomes and postoperative complications were analysed.

Results: The stone-free rate was 95.0% in the RIRS group and 98.2% in the PCNL group. Mean operative time was 1.8 hours in the RIRS group compared to 1.3 hours in the PCNL group. Bleeding complications were more common in the PCNL group (28.8%) whereas fever and sepsis were more frequent following RIRS. Hospital stay was similar in both groups.

Conclusions: Both RIRS and PCNL are effective treatment options for intermediate-sized renal calculi. RIRS offers a minimally invasive alternative, whereas PCNL provides superior stone clearance in selected patients.

Comparison of efficacy of open hemorrhoidectomy versus stapled haemorrhodopexy in grade 3 and above internal haemorrhoid patients

2026-09-25T09:29:09+0530

Background: Haemorrhoidal disease is a common anorectal condition, with Grade III and IV haemorrhoids often requiring surgical intervention. Open haemorrhoidectomy (Milligan-Morgan technique) has long been the standard procedure but is associated with significant postoperative pain and prolonged recovery. Stapled haemorrhoidopexy has emerged as a minimally invasive alternative with the potential for improved postoperative outcomes. This study aimed to compare the efficacy and postoperative outcomes of open haemorrhoidectomy and stapled haemorrhoidopexy in patients with advanced haemorrhoids.

Methods: This prospective observational study was conducted at a tertiary care center over a period of one year (July 2023 to July 2024). A total of 84 patients with Grade III and IV internal haemorrhoids were included and equally divided into two groups: open haemorrhoidectomy (n=42) and stapled haemorrhoidopexy (n=42). Outcomes assessed included postoperative pain using the Visual Analogue Scale (VAS) at 12, 24, and 48 hours, postoperative bleeding, duration of hospital stay, and time to return to work. Statistical analysis was performed using appropriate tests, with p <0.05 considered significant.

Results: Stapled haemorrhoidopexy demonstrated significantly lower postoperative pain scores at all time intervals compared to open haemorrhoidectomy (p<0.001). The stapled group experienced minimal postoperative bleeding (mean 0.36 days vs 3.14 days), shorter hospital stays (mean 0.74 vs 2.55 days), and earlier return to work (mean 3.33 vs 7.43 days). In contrast, open haemorrhoidectomy was associated with higher pain intensity, prolonged bleeding, and delayed recovery.

Conclusions: Stapled haemorrhoidopexy is superior to open haemorrhoidectomy in terms of reduced postoperative pain, minimal bleeding, shorter hospital stay, and faster return to normal activities. It can be considered a preferred surgical option for the management of Grade III and IV haemorrhoids, provided adequate surgical expertise is available.

Early mesh-related complications following hernia repair: a prospective observational study from a tertiary care centre

2026-09-25T09:31:06+0530

Background: Mesh-based hernia repair is the standard of care; however, early postoperative complications remain a concern.

Methods: A prospective observational study was conducted on 266 patients undergoing elective mesh hernia repair between January 2025 and January 2026. Patients were followed for 30 days. Data on demographics, comorbidities, surgical variables, and complications were collected and analyzed using SPSS v22. A p- value <0.05 was considered statistically significant.

Results: The overall incidence of early complications was 12%. The most common complications were seroma (4.1%), scrotal edema (3.4%), surgical site infection (2.6%), and hematoma (2.3%). Mesh infection occurred in 1.9% of cases. Patients with comorbidities had significantly higher complication rates (33.3% vs 9.6%, p<0.001). Incisional and umbilical hernias showed higher complication rates compared to inguinal hernias (p=0.01). Multivariate analysis identified comorbidity (OR=4.2) and prolonged hospital stay (OR=3.8) as independent predictors.

Conclusions: Early mesh-related complications are relatively infrequent and mostly manageable. Patient-related factors, particularly comorbidities, play a significant role in determining outcomes.

Association between preoperative serum albumin and serum cholesterol with surgical site infection: a prospective observational study

2026-09-25T09:30:27+0530

Background: Surgical site infection (SSI) is one of the most common healthcare-associated infections and a major cause of postoperative morbidity, prolonged hospital stays, and increased healthcare costs. While obesity and hypoalbuminemia are established risk factors for SSI, the roles of serum cholesterol and serum albumin remain controversial. This prospective observational study was conducted to evaluate the association of preoperative serum albumin and serum cholesterol with the incidence of SSI among patients undergoing elective clean-contaminated general surgical procedures at Heritage Institute of Medical Sciences, Varanasi.

Methods: This prospective observational study was conducted over two years at Heritage Institute of Medical Sciences, Varanasi. A total of 150 patients aged 18–65 years undergoing elective clean-contaminated general surgical procedures were enrolled. Demographic characteristics, comorbidities, and preoperative serum albumin and cholesterol levels were recorded. SSI was diagnosed according to Centre for Disease Control (CDC) criteria. Data were analyzed using SPSS version 26.0, and associations between variables were assessed using the Chi-square test, with p<0.05 considered statistically significant.

Results: SSI occurred in 51 (34.0%) of 150 patients. Hypoalbuminemia and abnormal serum cholesterol levels were significantly associated with SSI (p=0.026 and p=0.030, respectively), and postoperative hospital stay was significantly longer among patients with SSI.

Conclusions: Preoperative serum albumin and serum cholesterol are important predictors of surgical site infection following elective clean-contaminated general surgery. Their preoperative assessment and optimization may help reduce postoperative infectious complications and improve surgical outcomes.

A study of the learning curve of total extraperitoneal repair of inguinal hernia among young laparoscopic surgeons in a tertiary care centre in an urban city

2026-09-25T09:26:43+0530

Background: Totally extraperitoneal (TEP) repair of inguinal hernia is a technically demanding laparoscopic procedure with a well-recognized steep learning curve. Limited data exist from teaching institutions in developing countries regarding the progression of surgical competence among young laparoscopic surgeons.

Methods: A prospective observational study was conducted over two years in the Department of General Surgery at a tertiary care teaching hospital. Twenty-five young laparoscopic surgeons with 1–5 years of laparoscopic experience were enrolled. Data on operative time, intraoperative complications, need for senior assistance, mesh fixation method, and surgeon confidence were collected sequentially for each TEP procedure performed. Surgeons were categorized into early (≤10 cases) and late (>10 cases) learning phases. Statistical analysis was performed using Student's t-test, Mann–Whitney U test, Chi-square, and Fisher's exact test as appropriate.

Results: The majority of surgeons were aged 30–35 years (44%), with 36% having 1–2 years of laparoscopic experience. Mean operative time decreased significantly from 142±28 minutes in the early phase to 78±18 minutes in the late phase (p<0.001). Requirement for senior assistance decreased from 68% to 22% (p=0.002), and mean confidence score improved from 2.8±0.9 to 4.1±0.7 (p<0.001). A statistically significant association was found between number of TEP procedures performed and operative time reduction (p=0.003). Creation of the space of Bogros (24%) and dissection of Cooper's ligament (16%) were identified as the most time-consuming and assistance-requiring steps.

Conclusions: TEP repair has a clearly defined and significant learning curve. Proficiency is progressively achieved with increasing case volume, with substantial improvement observable beyond 10 cases in this cohort. Structured mentorship, targeted training on critical dissection steps, and adequate case exposure are essential for safe and efficient skill acquisition.

Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy for grade III and IV hemorrhoids – a prospective randomized comparative study

2026-09-25T09:25:22+0530

Background: Surgical management of grade III and IV hemorrhoids is associated with postoperative pain and delayed recovery. Stapled hemorrhoidopexy offers a tissue-preserving alternative to conventional excisional hemorrhoidectomy. This study compared perioperative and early postoperative outcomes of stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy.

Methods: This prospective randomized comparative study was conducted over two years at a tertiary care centre. One hundred and twenty patients aged 18-80 years with symptomatic grade III or IV hemorrhoids were randomized equally into two groups: open Milligan-Morgan hemorrhoidectomy (n=60) and stapled hemorrhoidopexy (n=60). Operative time, intraoperative blood loss, postoperative pain assessed using the visual analogue scale (VAS), hospital stay, and early postoperative complications were evaluated. A p value <0.05 was considered statistically significant.

Results: Stapled hemorrhoidopexy demonstrated significantly shorter operative time than Milligan-Morgan hemorrhoidectomy (26.41±7.25 versus 37.51±8.16 min; p<0.0001) and lower intraoperative blood loss (10.56±2.89 versus 38.80±8.48 ml; p<0.0001). Postoperative VAS pain scores were significantly lower in the stapled group at 6, 12, 24 and 48 hours and on postoperative day 7 (p<0.0001). Hospital stay was also significantly shorter (1.60±0.73 versus 2.29±0.93 days; p<0.0001). Postoperative bleeding occurred significantly less frequently after stapled hemorrhoidopexy (21.7% versus 53.3%; p=0.0004). Urinary retention was observed in 5.0% versus 15.0%, while anal discharge occurred in 3.3% versus 13.3% of patients in the stapled and open groups, respectively.

Conclusions: Stapled hemorrhoidopexy provides significant short-term advantages over Milligan-Morgan hemorrhoidectomy, with reduced operative time, blood loss, postoperative pain, hospital stay, and early morbidity. It represents an effective option for appropriately selected patients with grade III and IV hemorrhoids; however, longer-term studies are required to determine recurrence, functional outcomes, quality of life, and cost-effectiveness.

A comparative study of video-assisted thoracoscopic surgery and open thoracotomy in the surgical management of thoracic empyema

2026-09-25T09:26:41+0530

Background: Thoracic empyema represents a challenging clinical condition, particularly in advanced stages requiring surgical intervention. While open thoracotomy has traditionally been the standard approach, video-assisted thoracoscopic surgery (VATS) has emerged as a minimally invasive alternative with potential benefits. To compare postoperative outcomes, safety, and cosmetic results between VATS and open thoracotomy in patients undergoing surgical management for thoracic empyema.

Methods: This comparative study included 50 patients diagnosed with advanced thoracic empyema who underwent surgical management. Patients were equally divided into two groups: VATS (n=25) and open thoracotomy (n=25). Demographic characteristics, postoperative pain scores, duration of hospital stay, cosmetic outcomes, and postoperative complications were assessed and compared.

Results: Both groups were demographically comparable. Patients in the VATS group experienced significantly lower postoperative pain, shorter hospital stay, fewer postoperative complications, and superior cosmetic outcomes compared to those undergoing open thoracotomy. The overall safety profile of VATS was favorable, with no increase in perioperative risk.

Conclusion: VATS is a safe and effective surgical approach that offers clear advantages over open thoracotomy in the management of thoracic empyema, supporting its use as the preferred initial surgical modality in appropriately selected patients.

Safety, complications and predictors of outcomes in extended totally extraperitoneal inguinal hernia repair: a prospective observational study

2026-09-25T09:25:19+0530

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. The extended totally extraperitoneal (eTEP) approach has gained increasing acceptance because of its improved visualization, enhanced ergonomics, and reduced postoperative morbidity. However, prospective data regarding its safety profile, postoperative complications, recurrence, and factors influencing surgical outcomes remain limited.

Methods: A prospective observational study was conducted among 60 adult patients undergoing eTEP inguinal hernia repair at a tertiary care center. Demographic characteristics, operative details, intraoperative events, postoperative complications, and recurrence were prospectively recorded. Patients were followed at 1, 3, and 6 months after surgery. Data were analyzed using descriptive and inferential statistics, with a p-value <0.05 considered statistically significant.

Results: The mean age of the study population was 52 ± 10 years, and 75% of patients were male. The mean operative time was 75 ± 15 minutes. Intraoperative complications were uncommon, with 95% of patients experiencing no adverse events. Postoperative complications occurred in 15% of patients, with seroma being the most frequent (8.3%), followed by hematoma (3.3%), surgical site infection (1.7%), and foreign body sensation (1.7%). Recurrence was observed in 3.3% of patients at 3 months and 5.0% at 6 months. Patients aged ≥50 years, those with higher body mass index, and those with bilateral hernias had significantly longer operative times, higher postoperative pain scores, and longer hospital stays (p <0.05).

Conclusions: The eTEP technique is a safe and effective minimally invasive approach for inguinal hernia repair, demonstrating low intraoperative and postoperative complication rates with minimal early recurrence. Advanced age, higher body mass index, and bilateral hernia are associated with less favorable perioperative outcomes and should be considered during preoperative assessment and surgical planning.

A retrospective study to assess temporal trends in mortality for colon cancer and non-infective enteritis and colitis among U.S. adults, 1999-2020

2026-09-25T09:25:18+0530

Background: Colon cancer and non-infective enteritis and colitis continue to be major causes of gastrointestinal deaths in the United States, despite improvements in screening, diagnosis, and treatment. This study to evaluate long-term mortality trends and demographic differences in colon cancer and non-infective enteritis and colitis among U.S. adults aged 25 years and older, between 1999 and 2020.

Methods: In this retrospective, STROBE-compliant study, data was obtained from the CDC Multiple Cause of Death database (1999-2020). Deaths were categorised by colon cancer (C18) as the underlying cause and non-infective enteritis and colitis (K50-K52) as a contributing cause. Age-adjusted mortality rates (per 1,000,000 population) and temporal trends were assessed using Joinpoint regression. Associations with sex, race, urbanization, and place of death were also evaluated.

Results: A total of 2,885 deaths were analyzed. Of these, 53.2% were males and 46.8% females; 92.1% were White and 6.4% Black; 80.9% lived in metropolitan areas, including 27.5% in large central areas. 47.6% of deaths occurred in medical facilities, 28.4% at home, and 13.1% in nursing homes. Mortality rates were higher among males and residents of metropolitan areas. Joinpoint regression revealed significant temporal changes in mortality over the study period.

Conclusions: Mortality from colon cancer and non-infective enteritis/colitis showed changes over time from 1999 to 2020, with overall declines but with higher mortality rates among males and those in metropolitan areas. These findings highlight the importance of improving screening, early detection, and targeted interventions to reduce disparities and improve outcomes in high-risk populations.

Evaluation of trauma outcomes using the trauma and injury severity score at a tertiary care centre: a prospective observational study

2026-09-25T09:27:08+0530

Background: Trauma is a leading cause of death among young, economically active people. The trauma and injury severity score (TRISS) combines anatomical injury, physiological status and age to estimate probability of survival (Ps). We assessed its ability to predict in-hospital mortality at a tertiary care centre.

Methods: In this prospective study, 180 adults (≥18 years) with trauma admitted and treated for at least 24 hours over 18 months were evaluated. Glasgow coma scale (GCS), revised trauma score (RTS), injury severity score (ISS) and TRISS Ps were calculated using standard Boyd coefficients and compared with observed outcomes. Discrimination was assessed using the area under the receiver-operating-characteristic curve (AUROC).

Results: The cohort was predominantly young and male (85.6%), with road traffic accidents (60.5%) and blunt trauma (88.9%) predominating. Overall survival was 91.1% and mortality 8.9%. Non-survivors had lower GCS (7.88±3.28 versus 14.52±0.76), higher ISS (35.19±13.24 versus 12.98±7.61), lower RTS (4.60±1.40 versus 7.64±0.46) and lower TRISS Ps (48.1±28.9% versus 98.0±4.0%; all p<0.001). TRISS showed excellent discrimination (AUROC 0.994), with 56.3% sensitivity, 100% specificity, 100% positive predictive value, 95.9% negative predictive value and 96.1% accuracy.

Conclusions: TRISS demonstrated excellent discrimination for in-hospital mortality and may be useful for trauma outcome assessment and audit. Its modest sensitivity suggests potential limitations in identifying some patients at risk of death and supports local validation and recalibration.

Study on evaluation of P-POSSUM scoring system in patients undergoing exploratory laparotomy

2026-09-25T09:26:31+0530

Background: Emergency exploratory laparotomy carries substantially higher morbidity and mortality than elective surgery, and accurate risk stratification is essential for perioperative decision-making, patient counselling and surgical audit. The Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) is widely used for this purpose, but its performance in Indian tertiary surgical units requires local validation. This study aimed to evaluate the validity of P-POSSUM in predicting 30-day postoperative mortality and to characterize the complication profile in patients undergoing emergency exploratory laparotomy.

Methods: This prospective observational study was conducted over two years (November 2023 to October 2025) in the Department of Surgery of a tertiary teaching hospital in Northern Maharashtra. A total of 134 patients aged 13 years or older undergoing emergency exploratory laparotomy were enrolled by convenience sampling. Preoperative physiological and intraoperative operative severity variables were recorded and P-POSSUM scores calculated using the standard logistic regression equation. Observed 30-day mortality was compared with P-POSSUM-predicted mortality, and observed-to-expected (O:E) ratios were calculated. Associations between clinical parameters and mortality were assessed using the chi-square test.

Results: The mean age was 56.25±15.04 years, with a male predominance (53.7%). Perforation peritonitis (41.79%) was the commonest diagnosis, followed by acute intestinal obstruction (29.10%) and appendicular perforation (20.90%). The mean physiological score was 12.05±5.06, operative score 9.31±3.36, and mean predicted mortality was 33.72±24.39%. Overall observed mortality was 23.88% (32/134) compared with an expected mortality of 33.72%, giving an O:E ratio of approximately 0.71, indicating that P-POSSUM overestimated mortality in this surgical cohort. Physiological score >18, higher operative severity, greater blood loss, degree of peritoneal soiling and presence of malignancy were significantly associated with mortality (p<0.05). Postoperative complications occurred in 59.7% of patients, most commonly sepsis (20.90%) and renal failure (19.40%); 63.43% required ICU admission and 40.30% required ventilatory support.

Conclusions: P-POSSUM remains a clinically useful risk-stratification tool for patients undergoing emergency exploratory laparotomy in an Indian tertiary surgical unit, but it systematically overestimates mortality, indicating a need for population-specific recalibration to improve its predictive accuracy and surgical audit utility.

From oxygen biology to surgical outcomes: translating hyperbaric oxygen therapy mechanisms into tissue salvage

2026-09-25T09:29:09+0530

Hyperbaric oxygen therapy (HBOT) has emerged as a valuable adjunct in the management of ischemic and complex surgical wounds; however, its clinical application remains heterogeneous and often empirically driven. Despite growing evidence supporting its efficacy, a critical gap persists between the mechanistic understanding of HBOT and its integration into surgical decision-making. This systematic review aimed to synthesize current evidence on the biological mechanisms underlying HBOT and translate these mechanisms into clinically relevant outcomes. A structured search of PubMed/MEDLINE, Scopus, and Web of Science identified 312 records, of which 30 studies were included in the final qualitative synthesis. The evidence identified enhanced oxygen diffusion, angiogenesis and neovascularization, inflammatory modulation, antimicrobial activity, and cellular regeneration as interconnected mechanisms underlying the therapeutic effects of HBOT. Across surgical contexts, these mechanisms were associated with improved wound healing, enhanced tissue viability, infection control, reduced tissue necrosis, and lower amputation risk in selected clinical settings. Considerable heterogeneity was identified in treatment timing, pressure, session duration, frequency, and total number of sessions, with therapeutic responsiveness appearing to depend on the underlying pathophysiology, stage of tissue injury, and residual tissue viability. Based on these findings, a translational framework linking tissue hypoxia, ischemia, inflammation, infection, and impaired regeneration with specific HBOT-mediated mechanisms and expected clinical outcomes is proposed. Collectively, the findings support conceptualizing HBOT as a targeted adjunctive therapy rather than a universally applicable intervention, emphasizing mechanism-driven patient selection, appropriate treatment timing, and individualized therapeutic strategies to optimize its role in surgical tissue salvage and wound healing.