International Surgery Journal

Decellularized extracellular matrix scaffolds and biological constructs as a paradigm shift in orchestrating recapitulative tissue regeneration for complex hand reconstruction

José E. H. Jaramillo — Wed, 28 Jan 2026 00:00:00 +0530

The inherent limited regenerative capacity of composite tissues in the human hand, frequently compromised by trauma, oncological resection, or degenerative pathologies, presents a formidable challenge in restorative surgery. Conventional autografts are constrained by donor site morbidity, finite availability, and suboptimal structural integration, while synthetic implants often fail to provide the requisite biological cues for true histogenesis. This has precipitated a translational pivot towards bioengineered strategies leveraging decellularized extracellular matrix (dECM) scaffolds. These biological frameworks, derived from allogeneic or xenogeneic tissues, are meticulously processed to remove immunogenic cellular antigens while preserving the intricate ultrastructural architecture and native bioactive signaling molecules, including glycosaminoglycans, proteoglycans, and conserved growth factors. Upon implantation, these biomimetic scaffolds act as instructive three-dimensional blueprints, facilitating host cell recruitment, proliferation, and spatially organized differentiation—a process known as guided tissue regeneration. Critical applications in hand surgery include the use of dECM nerve conduits for bridging digital nerve gaps, chondrogenic scaffolds for articular cartilage restoration in the metacarpophalangeal and interphalangeal joints, and tendon augmentation grafts. Furthermore, the advent of bioprinting and organoid culture technologies enables the pre-seeding of these scaffolds with autologous progenitor cells, such as mesenchymal stem cells or tenocytes, creating advanced tissue-engineered constructs. The overarching objective is to transcend mere mechanical repair and achieve true biological integration and functional restitution, thereby restoring the intricate biomechanics and sensorimotor repertoire of the human hand. This manuscript will elucidate the foundational science of dECM scaffolds, delineate their current clinical applications in hand surgery, and discuss the translational hurdles and future trajectories of this burgeoning field.

Shifting stones: a review on rising tide of pediatric cholelithiasis in the modern age

Tanya Chopra, Suresh Kalyanasundar, Ashok K. Gupta, Gaurav Sharma — Wed, 28 Jan 2026 00:00:00 +0530

Once deemed a clinical rarity, paediatric cholelithiasis has now emerged as a common hepatobiliary disorder among children. The rising incidence is closely linked with the global propulsion in pediatric obesity, dietary transitions, sedentary behaviour, and improved imaging modalities, facilitating rapid and frequent diagnosis. This comprehensive literature review delineates the shifting epidemiology, explores pathophysiological mechanisms, and critically appraises diagnostic and management algorithms in the pediatric population.

Ciliated hepatic foregut cyst: a rare diagnosis behind a hepatic cyst

Tue, 13 Jan 2026 00:00:00 +0530

Ciliated hepatic foregut cysts (CHFC) are rare and typically benign lesions of the liver derived from an embryonic remnant of foregut epithelium. Patients are almost always asymptomatic and mostly incidentally found on radiologic studies. Radiographic imaging is usually insufficient for diagnosis and definitive diagnosis is made through histology. It is important to consider this condition in the differential diagnosis of liver lesions, particularly those located in the subcapsular region of the segment 4. Usual diagnostic uncertainty and a malignant potential that cannot be totally excluded, surgical excision should be considered. We describe a case of a 76-year-old male with an atypical cystic mass in segment 4 of the liver who underwent a laparoscopic resection. Histology revealed a ciliated hepatic foregut cyst.

Subtotal reconstructive laparoscopic cholecystectomy with rendezvous approach as treatment for cholecystocholedocholithiasis, Mirizzi syndrome type IV, and duodenal diverticulum

Fri, 16 Jan 2026 00:00:00 +0530

This case report describes the successful management of complex biliary pathology in a 49-year-old female patient with Mirizzi syndrome type IV, cholecystocholedocholithiasis, and a duodenal diverticulum. A minimally invasive approach was employed, combining subtotal reconstructive laparoscopic cholecystectomy with a rendezvous procedure to facilitate stone clearance and biliary reconstruction. The case highlights the feasibility and safety of this combined technique in challenging scenarios, emphasizing the importance of individualized, multidisciplinary management. Further research is necessary to establish standardized protocols and evaluate long-term outcomes in similar complex cases.

Case report: acute appendicitis in a Spigelian hernia

Jessica S. Centeno, Jorge U. Mendez — Wed, 28 Jan 2026 00:00:00 +0530

Spiegel's hernia is a rare condition, accounting for 0.12% to 2% of abdominal hernias. Spiegel's hernias are defined as a protrusion through a defect in the Spiegel fascia, which is located along the semilunar line. This line marks the transition zone between the lateral border of the rectus abdominis muscle and the aponeurotic insertions of the lateral abdominal muscles. A 70-year-old female patient presented with localized lower right abdominal pain lasting for 7 days, accompanied by a palpable mass within a defect in the abdominal wall. During surgical intervention, a Spiegel's hernia with acute appendicitis (complicated acute appendicitis) was identified inside the hernial sac. An appendectomy was performed, along with primary closure of the hernial defect. Spiegel's hernia is infrequently encountered, and the presence of acute appendicitis within the hernial sac is even more uncommon. Therefore, clinical findings should be correlated with imaging and laboratory studies to establish an accurate diagnosis.

Perforated gallbladder secondary to gallbladder tuberculosis: a case study

Dalit Blumenthal, Olivia Currie — Wed, 28 Jan 2026 00:00:00 +0530

Gallbladder tuberculosis is a rare form of abdominal tuberculosis accounting for 1% in all abdominal cases. The non-specific nature of clinical symptoms as well as radiological findings make gallbladder tuberculosis difficult to diagnose. Rare complications include gallbladder perforation which is explored further in our case summary, emphasises the importance of a thorough examination and the importance of clinical suspicion when in the presence of constitutional symptoms and right upper quadrant pain.

Correction of malocclusion and functional impairment following failed maxillofacial gunshot reconstruction: a case report

Morshed Rakan Morshed — Wed, 28 Jan 2026 00:00:00 +0530

Gunshot injuries to the face represent one of the most complex forms of maxillofacial trauma, frequently resulting in extensive bone comminution, soft-tissue damage, and functional impairment. This report describes a 31-year-old male who sustained a high-velocity facial gunshot injury that was initially managed elsewhere with unsatisfactory outcomes. The patient presented with severe malocclusion, restricted mouth opening, and facial asymmetry. Secondary corrective surgery was undertaken to restore skeletal alignment, occlusion, and function. Postoperative recovery was favorable, with restoration of neurosensory function, stable occlusion, and satisfactory esthetic and functional outcomes following implant-supported rehabilitation.

Surgical management of intestinal obstruction due to a Mazuji III adhesion in a geriatric patient: dilemma in the management of an incidental Meckel's diverticulum

Wed, 28 Jan 2026 00:00:00 +0530

The management of an incidentally discovered Meckel's diverticulum (MD) during emergency surgery poses a significant dilemma in unstable geriatric patients. We report the case of a 77-year-old critically ill female with multiple comorbidities who underwent emergency laparotomy for an intestinal obstruction caused by a Mazuji type III band adhesion. An uncomplicated MD was found incidentally. Given the patient's hemodynamic instability and severe metabolic acidosis, and adhering to damage control surgery principles, the decision was made not to resect the MD to avoid prolonging operative stress. This case highlights the conflict between classic teaching advocating for prophylactic resection and a conservative, individualized approach in high-risk patients. We discuss the literature, which suggests a low long-term risk of complication from incidental MD in adults, potentially even lower in the elderly, and argue that in such scenarios, the immediate surgical risk outweighs the potential future benefit. This report reinforces the principle of "first, do no harm" and underscores the necessity of tailored surgical decision-making that prioritizes physiological stabilization in complex emergency settings.

When diverticulitis of the appendix mimics appendicitis: a case report

Wed, 28 Jan 2026 00:00:00 +0530

Appendiceal diverticulosis is a rare and often incidental finding, with significant clinical relevance due to its association with increased risk of perforation and malignancy. It is frequently misdiagnosed as conventional appendicitis due to overlapping clinical presentations. A patient presented to the Emergency Department with a 3-day history of progressively worsening abdominal pain, localized to the right iliac fossa. The patient had a recent history of hospitalization for acute appendicitis with formation of an appendiceal mass (plastron), which was managed conservatively with antibiotic therapy. Elective surgical intervention was planned following resolution of the acute phase. The patient subsequently underwent a laparoscopic appendectomy without intraoperative complications. Histopathological examination of the surgical specimen revealed a vermiform appendix with multiple diverticula, without evidence of acute inflammation. Subserosal haemorrhage was noted. No signs of neoplasia were identified. The patient had an uneventful postoperative recovery and was discharged on postoperative day one. This case highlights the importance of considering appendiceal diverticulosis in the differential diagnosis of acute appendicitis. Awareness of this entity can aid in better risk stratification and postoperative management.

Palliation can be an option for giant splenic artery aneurysm: a case report and review of literature

Wed, 28 Jan 2026 00:00:00 +0530

Giant splenic artery aneurysm (SAA) is a rare vascular pathology, though it remains the third most common intra-abdominal visceral artery aneurysm which is rarely goes above >3 cm in size. Only a few cases larger than 10 cm have been reported, with a rupture risk of 28% and 40% mortality when rupture occurs. A 78-year-old male with a history of vascular dementia, ischemic heart disease, diabetes, and a previously embolized 4 cm SAA (2008) is reported, who presented in March 2025 with COVID-19 infection and non-specific upper abdominal pain. Imaging revealed a 17.3 cm thrombosed splenic artery aneurysm—the largest reported to date. An attempt at endovascular embolization was unsuccessful due to distorted anatomy and multiple non-cannulable collaterals. Given his comorbidities, poor functional status, and the complexity of open surgery, the multidisciplinary team opted for conservative management with palliative intent. At 8-month follow-up, he remained stable and asymptomatic with no aneurysm growth. While endovascular or open surgical repair remains the treatment of choice for splenic artery aneurysms, palliation may be an appropriate option in selected patients where intervention poses disproportionate risk. Multidisciplinary discussion and individualized decision-making are essential in such rare and high-risk cases.

Atypical presentation of thyroglossal cyst

C. Arun Socratese — Wed, 28 Jan 2026 00:00:00 +0530

A thyroglossal duct cyst is a congenital anomaly that traditionally presents with a swelling in the anterior part of the neck with a tract extending behind the hyoid bone, which moves with tongue protrusion. But here we received a patient with atypical features, confusing whether it’s a dermoid cyst or a lymphatic cyst, as radiological features suggested no tract was found.

Painful and rare tumor of the pediatric hand – calcifying aponeurotic fibroma

Shifa Raheel, Mohammed Nadir — Wed, 28 Jan 2026 00:00:00 +0530

Pediatric hand tumors are rare and the commonest include ganglion cysts and giant cell tumors. Calcifying aponeurotic fibroma (CAF) is a rare, locally aggressive, benign fibroblastic tumor occurring usually in the palms of the hands and soles of the feet in young and adolescents under 20 years of age. Clinically, it presents as a painless palpable mass. Pathologically, it is characterized by fibroblast proliferation with an indistinct border and calcification. This soft tissue tumor typically infiltrates into the surrounding fascia or muscle and has a predilection for local recurrence after surgical excision of around 50%. Only 4 cases of pediatric CAF have been reported from India till date and all of them were painless swellings, at a site other than the hand. We present the first case of painful pediatric CAF of the hand in an 8 year old male patient. Clinical findings and imaging features (X-ray, USG, MRI) are presented. Patient underwent excision biopsy with complete removal of tumor and histopathological features were consistent with CAF. Patient was followed up for a period of 1 year post-resection and showed good function and no recurrence.

Mucinous cystic neoplasm of the spleen with ovarian like stroma: a rare entity

Wed, 28 Jan 2026 00:00:00 +0530

Mucinous cystic neoplasms (MCNs) of the spleen are very rare, with a few reported cases in the literature. They are often confused with more common benign or parasitic splenic cysts due to very similar imaging features. We report a case of a 52-year-old woman with a giant multicystic lesion in the spleen, initially thought to be a hydatid cyst. Contrast-enhanced CT revealed a giant, cystic lesion. Surgical splenectomy was performed, and histopathology confirmed a mucinous cystadenoma with an ovarian-like stroma. Immunohistochemistry revealed estrogen and progesterone receptor positivity, confirming MCN. This case demonstrates the importance of considering MCN in the differential diagnosis of large, complex splenic cysts, even without pancreatic involvement. The presence of septations, wall calcifications, mass effect and absence of daughter cysts on imaging should raise suspicion for MCN. Histopathological evaluation remains gold standard, since preoperative imaging cannot reliably distinguish these rare neoplasms. Complete surgical resection is curative and essential due to the potential risk of malignant change. Awareness of splenic MCN is important for accurate pre-operative planning and definitive surgical management.

Proteus mirabilis meningitis following lumbar spine surgery in an elderly diabetic patient: a rare case report

Sachin Santosh Narate, Vishal Sharma, Shreya Chaudhuri, Puneet Malik — Wed, 28 Jan 2026 00:00:00 +0530

Postoperative meningitis is a rare complication following spine surgeries, more commonly caused by gram-positive organisms. Proteus mirabilis, a gram-negative bacillus, is a highly unusual causative agent, particularly in adults and post-spinal surgery cases. Elderly patients with comorbidities, especially diabetes mellitus, are at elevated risk for serious postoperative infections, with prognosis dependent on early diagnosis and aggressive management. A 76-year-old female with diabetes mellitus underwent transforaminal lumbar interbody spinal fusion (TLIF) for L4-L5 spondylolisthesis. She presented with altered sensorium, vomiting and generalised seizures ten days post-discharge. CSF analysis confirmed neutrophilic pleocytosis and culture yielded Proteus mirabilis which is extremely rare occurrence. Management with intravenous antibiotics and supportive care led to complete neurological recovery. Extensive literature review confirms the rarity of such cases and highlights the formidable mortality associated with gram-negative postoperative CNS infections. This case underscores the necessity of high vigilance for atypical pathogens in elderly, immunocompromised patients presenting with CNS symptoms post-surgery and the critical importance of timely, targeted therapy for optimal outcomes.

A large acquired seminal vesicle cyst presenting with urinary symptoms: a case report

Archit Sabberwal, Arun Kumar, Radhika Katiyar, Dileep K. Chaurasia — Wed, 28 Jan 2026 00:00:00 +0530

Seminal vesicle cysts are infrequent urogenital lesions, typically classified as congenital or acquired. Acquired cysts usually develop due to chronic obstruction, inflammation, or infection. This report describes the clinical course, evaluation, and surgical management of a large acquired seminal vesicle cyst in a 55‑year‑old man who presented with lower abdominal discomfort, urinary difficulty, and intermittent hematuria. Cross‑sectional imaging revealed a sizable cystic lesion arising from the left seminal vesicle, and definitive treatment was achieved through open surgical excision after failed laparoscopic dissection. The patient recovered well and remained symptom-free postoperatively.

The impact of the RoboticScope™ exoscope on cleft lip and palate surgery: surgical advances stimulated by last generation technologies

Wed, 28 Jan 2026 00:00:00 +0530

RoboticScope™ (RS™) is a robotic exoscope that integrates three-dimensional high-definition visualization with hands-free control, offering potential advantages in microsurgical procedures. Cleft lip and palate (CLP) repair require a small and deep surgical field, precise tissue handling, and presents ergonomic challenges for surgeons and limitations in surgical teaching. This case series describes. The feasibility, safety, advantages, and limitations of using RS™ during cheiloplasty and palatoplasty. Eight patients with unilateral cleft lip and/or palate were included: four cheiloplasties and four palatoplasties, half performed with RS™ and half with conventional techniques by the same surgical team. Intraoperative variables, postoperative outcomes, and surgeon satisfaction were evaluated. No differences were observed between groups regarding bleeding, aesthetic-functional outcomes, or short-term complications at six months. Surgical time was longer when using RS™, reflecting the initial learning curve. Surgeons reported superior visualization, improved ergonomics, and enhanced educational value with RS™, allowing real-time sharing and recording of procedures. Despite limitations related to equipment cost and unfavorable angles in specific surgical steps, RS™ demonstrated technical feasibility and safety in CLP surgery. This case series represents the first clinical report of RS™ use in cleft lip and palate repair and suggests that it is a promising adjunct to conventional techniques, particularly for microsurgical precision, ergonomics, and surgical education.

Clavicular hook plate fixation for acromioclavicular joint injuries and lateral clavicle fractures: a case series of 13 military patients

Chaminda Amarasekara, Chinthaka P. Wijedasa, Amaila P. Gunasekara — Wed, 28 Jan 2026 00:00:00 +0530

Acromioclavicular joint (ACJ) injuries and lateral clavicle fractures are common among military personnel due to high-energy trauma sustained during training, sports, and operational activities. Reliable fixation is essential to restore function and enable early return to duty. We present a case series of 13 serving naval patients treated with clavicular hook plate (CHP) fixation between September 2012 and November 2018 at the Navy General Hospital, Colombo, Sri Lanka. Inclusion criteria were Rockwood Type III/IV ACJ injuries or lateral clavicle fractures. Functional outcomes were assessed using the Disabilities of the arm, shoulder, and hand (DASH) score. The mean patient age was 32.8 years (range: 21-41). Mechanisms of injury included road traffic accidents (53%), accidental falls (31%), and sports injuries (15%). Diagnoses comprised Rockwood type III ACJ injuries (79%), lateral clavicle fractures (14%), and Rockwood type IV injuries (7%). The mean interval from injury to surgery was 14 weeks. At follow-up, 69% achieved excellent outcomes (DASH<2), while 23% reported moderate impairment. One patient developed ACJ separation following plate removal. This case series demonstrates that clavicular hook plate fixation combined with structured rehabilitation is effective for Rockwood Type III and lateral clavicle injuries in young, active military personnel. Early intervention facilitates favorable recovery, though implant-related complications highlight the need for careful monitoring.

Evaluation of the quality of life of adult patients with digestive stomas in Congo-Brazzaville: a multicenter study

Wed, 28 Jan 2026 00:00:00 +0530

Background: Digestive stomas remain a surgical option indicated for various gastrointestinal pathologies. However, living with a stoma can significantly impair a patient's quality of life. The objective of this study is to evaluate the perceptions of adult Congolese patients with digestive stomas regarding their quality of life.

Methods: This multicenter, descriptive, and prospective study was conducted from 01 August 2019 to 01 November 2020. It included patients aged 18 years and older living with digestive stomas. They were consecutively recruited from seven hospitals in Congo-Brazzaville. Quality of life (QoL) was assessed using the Stoma-QoL questionnaire.

Results: In total, 56 patients (39 men and 17 women, male/female ratio of 2.29), aged. A mean age of 42±17 years (range: 18–75 years) participated in the study. All ostomy patients reported a change in body image. They felt self-conscious about their appearance and significantly affected their physical attractiveness. Nearly all patients (96%) experienced negative psychological repercussions (depression, anxiety). Most of them (87%) had stopped their professional or daily activities due to the ostomy. The quality of sexuality was impaired for both patients and their partners. Those close to the patients experienced anxiety and spent more time at home.

Conclusion: The daily lives of ostomy patients are significantly disrupted in every way. It is therefore essential to provide more support to ostomy patients to help them better adapt to daily life. To this end, a multidisciplinary approach involving surgeons, ostomy therapists, and psychologists is crucial to improving their quality of life.

Granulomatous mastitis: difficult to differentiate from tuberculous mastitis

Wed, 28 Jan 2026 00:00:00 +0530

Background: Granulomatous mastitis (GM) is a rare, chronic inflammatory breast disease of unknown etiology, characterized by controversial treatment options and a high recurrence rate. Its clinical and radiological presentation often overlaps with other conditions, particularly tuberculous mastitis (TBM), making differentiation challenging. This study aimed to differentiate granulomatous mastitis from tuberculous mastitis in patients presenting with chronic breast abscess.

Methods: A prospective observational study was conducted at the Department of Surgery, Mugda Medical College Hospital, Dhaka, Bangladesh, from January to December 2023. Twenty women with symptoms and signs of breast abscess were selected from outpatient and inpatient departments. Each case underwent triple assessment: clinical evaluation, imaging and histopathology.

Results: Among the 20 cases, 16 were diagnosed as non-lactational bacterial abscesses, 3 as granulomatous mastitis and 1 as tuberculous mastitis. Non-lactational abscesses healed with scarring within six weeks. All three GM cases recurred within five months; one developed steroid-related complications and two developed painful breast lumps after treatment. The single TBM case recurred after six months, with associated breast deformity and pain.

Conclusions: Granulomatous mastitis is difficult to treat and clinically mimics tuberculous mastitis. Accurate diagnosis requires histopathological confirmation alongside clinical and imaging assessment to guide appropriate therapy.

Impact of COVID-19 on penile fracture

Awaj Kafle, Rikesh J. Karkee — Wed, 28 Jan 2026 00:00:00 +0530

Background: Penile fracture is an uncommon urological emergency. Before the era of the novel corona virus, we hardly dealt with one case per year. But with the imposition of lockdown due to COVID-19, there was a surge in penile fracture cases. The objective of this study was to investigate the relationship between COVID-19 and penile fracture.

Methods: From April 2020 to December 2020, when nationwide lockdown was imposed, all the patients presenting with penile fractures were enrolled in the study. The study was a retrospective study. Patients were also assessed for symptoms of COVID-19, and a nasal swab was taken for COVID-19 polymerase chain reaction (PCR).

Results: The study included 9 patients. The age range was 22-50 years with a mean of 31.2 years. Manual bending was the most common cause (66.7%). The mean time interval between trauma to hospital admission was 44 hours. While one patient had mild upper respiratory tract symptoms, none tested positive for COVID-19.

Conclusions: Though there was a surge in penile fracture cases, no association was found between the two. Neither patient tested positive for COVID-19, nor had developed upper respiratory tract symptoms. The reason for the sudden surge may be due to the lockdown itself, when people had to stay indoors and were involved in activities leading to penile fracture. The other reason may be the shutdown of other local hospitals when all the patients landed up in a tertiary care center like ours.

Evaluation of delayed versus immediate bone reduction with rigid internal fixation for high-velocity ballistic maxillofacial injuries with severely comminuted fractures

Morshed Rakan Morshed — Wed, 28 Jan 2026 00:00:00 +0530

Background: High-velocity ballistic maxillofacial injuries cause extensive bone comminution and soft-tissue destruction. Determining the optimal timing of definitive fixation remains controversial, especially in contaminated wounds. To compare infection rate, bone-healing complications, and functional recovery between immediate and delayed bone reduction with rigid internal fixation in severely comminuted ballistic maxillofacial injuries.

Methods: A retrospective cohort study of 90 patients treated between 2011 and 2013 at Tishreen Military Hospital, Damascus, Syria was conducted. Group A (n=32) received immediate fixation (< 24 h); Group B (n=58) underwent delayed fixation (7–21 days) after staged debridement and stabilization. Outcomes included infection, non-union/malunion, and six-month functional success. Analyses used chi-square tests, absolute-risk reduction (ARR), and number-needed-to-treat (NNT).

Results: Delayed fixation reduced infection (10% vs 41%), non-union/malunion (8% vs 35%), and improved function (93% vs 60%). ARR values were 31%, 27%, and 33%, respectively.

Conclusions: In severely comminuted high-velocity ballistic facial injuries, delayed rigid fixation following thorough debridement yields fewer complications and better functional outcomes than immediate fixation.

Clinical presentation, intraoperative findings and short-term outcomes among patients with appendicitis at Mbarara Regional Referral Hospital

Ellyson B. Bainomujuni, David Mutiibwa, Eden Micheal Ssetabbi — Wed, 28 Jan 2026 00:00:00 +0530

Background: Appendicitis remains a significant cause of acute abdomen and is characterized by high complication rates despite advancements in surgical care. Factors influencing post appendectomy outcomes, including clinical presentation, intraoperative findings, and procedural interventions, require detailed documentation in our context.

Methods: This retrospective study analyzed 108 patients who were managed surgically for appendicitis. Demographic data, clinical parameters, intraoperative findings, hospital stays, and postoperative complications were assessed. Multivariate logistic regression identified factors associated with unfavorable outcomes (p<0.05).

Results: Among the 108 patients, 51.9% were male, with the highest incidence of appendicitis in the 20-39 years age group. Common presentations included RLQ pain (45.4%) and tenderness (86.9%), with 39.0% exhibiting tachycardia >100 bpm. The subumbilical midline incision (SUMI) was predominant (54.6%), while 20.4% presented with a ruptured appendicular abscess. Postoperatively, 23.6% of the patients experienced complications, predominantly constipation (43.5%) and surgical site infections (20.3%). Factors significantly increasing the odds of unfavorable outcomes included age 40-59.9 years (aOR=9.66; 95% CI 1.82-15.2), symptom duration >5 days (aOR=6.14; 95% CI 1.69-12.2), ruptured appendicular abscess (aOR=23.96; 95% CI 1.75-11.97), and peritoneal lavage (aOR=7.72; 95% CI 1.69-9.1).

Conclusions: In this study, most of the patients presented nonspecifically and late with complicated forms of appendicitis, indicating a high incidence of unfavorable postoperative outcomes. We therefore need to increase awareness of the nonspecific presentation and unfavorable outcomes related to late presentation of the condition to all health workers and communities. The adoption of screening protocols such as the Alvarado score could help ensure timely diagnosis and prediction of treatment outcomes to reduce the burden of unfavorable outcomes.

Ultrasonographic gallbladder wall thickness as a risk stratification tool in elective laparoscopic cholecystectomy: a cross-sectional study from a tertiary care center

Wed, 28 Jan 2026 00:00:00 +0530

Background: Laparoscopic cholecystectomy (LC) is the gold standard for gallstone diseases. Preoperative ultrasonography findings can have a significant impact on the perioperative and postoperative outcomes. This study aimed to evaluate the influence of preoperative gallbladder (GB) wall thickness, measured by ultrasonography, on the perioperative outcomes of patients undergoing elective LC.

Methods: This prospective, cross-sectional study was conducted at a tertiary care center and included 60 patients undergoing LC. Preoperative GB wall thickness was measured via ultrasonography, and patients were stratified into four groups: <2 mm, 2-4 mm, 4-6 mm, and >6 mm. Intraoperative complications, postoperative complications, and the duration of hospital stay were prospectively documented and correlated with GB wall thickness. Statistical analysis was performed using ANOVA and chi-square tests to compare outcomes among the four groups.

Results: The mean age was 44±13 years, and 68.3% were female. A GB wall thickness of 2-4 mm was the most common finding (40%), followed by <2 mm (30%). Patients with a thicker GB wall had significantly more intraoperative complications (p=0.001). Thicker GB wall was significantly associated with postoperative bile leak (p=0.007) and wound infection (p=0.041). The mean hospital stay was also significantly longer for patients with a thicker GB wall (p=0.001).

Conclusions: Preoperative GB wall thickness on ultrasonography is a strong predictor of operative difficulty, postoperative complications, and prolonged hospitalization following LC. Incorporating this simple, non-invasive measure into routine preoperative assessment may improve risk stratification and surgical planning.

Prospective comparative study of outcomes in primary repair and delayed primary repair of flexor tendon injuries of fingers

Manoj Kumar Reddy Vanga, Ram Mohan R. — Wed, 28 Jan 2026 00:00:00 +0530

Background: Hand is the chief executing organ of humans and plays a vital role in carrying out day to day activities both in professional and activities of daily living. Data regarding incidence of flexor tendon injuries and mechanism causing injuries and common age group affected and post-surgical outcome of patients is lacking in an Indian context. In this study we compared the outcomes of flexor tendon injuries undergoing primary repair and delayed primary repair.

Methods: 40 patients between the ages 19-50 years with flexor tendon injuries in zones 2-5 of the hand admitted to department of burns and plastic surgery were included in the study and were divided into primary repair and delayed primary repair groups. All patients were subjected to modified Kessler core suture with continuous epitendon suture for repair of tendons. Duran Houser mobilization protocol was followed in all patients.

Results: Patients were assessed with total active motion score by measuring range of motion along with grip strength measured with digital dynamometer at 1, 3, 6 months following repair.

Conclusions: Outcomes of primary repair of tendon injuries showed more promising results than delayed primary repair. Less complications rate makes primary repair more favourable than delayed primary repair.

A prospective comparative study on early versus traditional late enteral feeding after loop ileostomy reversal

Ankit Yadav, Brij B. Banga, Harish Sharma — Wed, 28 Jan 2026 00:00:00 +0530

Background: Loop ileostomy reversal, though a routine procedure, is often associated with postoperative morbidity and delayed recovery. Traditional delayed feeding protocols prolong ileus and hospital stay. This study aimed to evaluate the safety and efficacy of early enteral feeding compared to conventional delayed feeding following loop ileostomy reversal.

Methods: A prospective, randomized controlled trial was conducted on 40 patients undergoing loop ileostomy reversal, equally divided into early and late enteral feeding groups (n=20 each). The early group received oral fluids 4 hours postoperatively, while the late group resumed oral intake after the return of bowel activity. Parameters assessed included time to bowel recovery, duration of hospitalization, postoperative complications, and cost-effectiveness. Statistical analysis was performed using the Chi-square and independent t-tests, with p<0.05 considered significant.

Results: Baseline demographic and biochemical characteristics were comparable between groups. Early enteral feeding significantly reduced recovery time—clear liquids (6 hours versus 54 hours), stool passage (18 hours versus 67 hours)—and shortened hospital stay (43±5 hours versus 94±9 hours; p<0.001). No increase in postoperative complications such as nausea, vomiting, distension, or anastomotic leakage was observed. All patients tolerated feeds within 24 hours, with complete wound healing by day 14.

Conclusions: Early enteral feeding after loop ileostomy reversal is safe, well tolerated, and accelerates gastrointestinal recovery, thereby reducing hospital stay and healthcare costs. Its integration into enhanced recovery protocols can substantially improve postoperative outcomes and surgical efficiency.

A prospective study of exploratory laparotomy and their correlation with microbiological profile in view of anatomical site of perforation peritonitis

Mudavathu Poolchend Naik, Zil Desai, Vishal Desai, Ankit Rathod, Sarvagya Jha — Wed, 28 Jan 2026 00:00:00 +0530

Background: Surgical peritonitis is a common and life-threatening emergency in tertiary care hospitals in India. Secondary peritonitis, most often due to gastrointestinal perforation or ischemia, constitutes the majority of intra-abdominal infections and usually presents late, resulting in high morbidity and mortality. Outcomes vary with the site of perforation and the causative organisms. These infections are typically polymicrobial, involving both community- and hospital-acquired pathogens. The growing problem of antimicrobial resistance further complicates management. Identifying the microbial profile and antibiotic sensitivity patterns in relation to perforation site is crucial for appropriate empirical therapy. This study evaluates the spectrum of community-acquired acute bacterial peritonitis and the role of microbiological cultures in its management.

Methods: A prospective study was conducted on 100 patients undergoing emergency laparotomy for perforation peritonitis at GMERS Medical College and Hospital, Sola, Ahmedabad. Intraoperative peritoneal fluid and postoperative wound discharge samples were collected using sterile techniques. Isolates were identified by Gram staining and culture, followed by in-vitro antibiotic susceptibility testing.

Results: Males predominated (male:female ratio 3.2:1), with the highest incidence in the 18–30-year age group (41%). The ileum was the most common site of perforation (31%), followed by the stomach (21%) and appendix (17%). Culture positivity was seen in 74% of cases. Escherichia coli was the most common isolate (92%), followed by Klebsiella spp. (42%), Citrobacter (8%), and Acinetobacter (5.4%). Culture positivity increased distally along the gastrointestinal tract. E. coli showed high sensitivity to amikacin (85.3%) and moderate sensitivity to meropenem (37%), while resistance to ampicillin (91%) and piperacillin-tazobactam (87%) was high. Although anaerobes were not isolated, empirical anaerobic coverage remained clinically relevant.

Conclusions: E. coli was the predominant pathogen irrespective of perforation site, highlighting discordance between expected gut flora and actual isolates. Rising resistance to third-generation cephalosporins underscores the need for rational antibiotic use. Early empirical therapy with agents such as amikacin, guided by culture and sensitivity results, along with prompt surgical source control, is essential for improving outcomes in perforation peritonitis.

A comparative study of open haemorrhoidectomy and stapled haemorrhoidopexy in grade 3 and 4 haemorrhoids

Abhijit G. Bagul, Aditya C. Oak, Yashraj Shah — Wed, 28 Jan 2026 00:00:00 +0530

Background: Haemorrhoids are a common anorectal condition seen in surgical practice. Open haemorrhoidectomy described by Milligan Morgan is a widely used procedure. According to Dr. Antonio Longo, basic pathology of haemorrhoidal disease is prolapse above the haemorrhoidal tissue. He proposed correction of prolapse by resecting the prolapsed suprahaemorrhoidal rectal mucosa using stapler popularly known as stapled haemorrhoidopexy. We aim to compare stapled haemorrhoidopexy with open haemorrhoidectomy in the management of grade 3 and grade 4 haemorrhoids.

Methods: Fifty patients with grade 3 or grade 4 haemorrhoids were included in the study. The 25 patients underwent open haemorrhoidectomy and 25 underwent stapled haemorrhoidopexy. Patients were followed up on day 7, day 15, 1 month, 3 months, 6 months and 1 year for any complications encountered. The two groups were compared for duration of surgery, duration of hospital stay, postoperative pain, postoperative bleeding, urinary retention, anal incontinence, postoperative infection and return to work.

Results: In our study, mean age was 44 years, majority of patients were males and had grade 3 haemorrhoids. Stapled haemorrhoidopexy group had shorter duration of surgery and hospital stay, less postoperative pain, earlier return to work and good patient compliance. In the follow up period there was no postoperative bleeding, no postoperative infection, recurrence, residual prolapse or incontinence in the stapled group.

Conclusions: Stapled haemorrhoidopexy is superior and a safe alternative to open haemorrhoidectomy in management of grade 3 or grade 4 haemorrhoids.