International Surgery Journal

Giant Zenkers diverticulum treated with diverticulectomy plus myotomy in tertiary hospital: case report

Thu, 29 Aug 2024 00:00:00 +0530

Zenker's diverticulum (ZD) is the most common esophageal diverticulum. Its prevalence is higher in older adults. It arises in the area called Killian's triangle, which is an area of weakness in the posterior wall of the upper esophagus, at the level of the upper esophageal sphincter (UES). This area is delimited by the fibers of the thyropharyngeal muscle laterally and by the fibers of the cricopharyngeal muscle (CPM) in the inferior. Due to its composition, it is classified as a false diverticulum because it contains mucosal and submucosal layers in its walls. The predominant symptom in 90% of patients is dysphagia, followed by regurgitation of undigested food content. We present the case of the successful diagnostic approach with tomography and esophageal-gastro-duodenal and therapeutic series with diverticulectomy plus myotomy with the use of a stapler to a patient with usual symptoms of ZD, but with an unusual size: a giant ZD.

A rare case of odontogenic myxoma of maxilla

Subbiah Shanmugam, Karthik Arumugam — Thu, 29 Aug 2024 00:00:00 +0530

Odontogenic myxoma is a benign locally aggressive rare intraosseous neoplasm, originating from the odontogenic ectomesenchyme in second and third decades of life. Clinically they are slow growing, indolent, expansile, non-metastasizing involving predominantly mandible than maxilla. Maxillary odontogenic tumor spreads more aggressively through maxilla than mandible hence the need to address the tumor early and also the reconstruction of the maxillary defect following defect is uniquely challenging. This is a report of a rare case of left maxillary odontogenic myxoma which was locally aggressive and causing significant maxillary erosion in a 35 year old female, left subtotal maxillectomy done using Weber-Fergusson approach with Dieffenbach’s modification and the defect repaired with temporalis muscle flap.

Laparoscopic management of hydatid cysts of liver in two different presentations: case reports

Prem Kumar, Jaspreet S. Bajwa, Amit S. — Thu, 29 Aug 2024 00:00:00 +0530

Hydatid cyst is a zoonotic infection caused by Echinococcus granulosus is mostly asymptomatic in humans till they progressively grow to larger masses mostly in liver lungs and spleen. Aim of this study is to study laparoscopic management of liver hydatid cyst (single and multiple) and combining it with most common laparoscopic procedure i.e. laparoscopic cholecystectomy. In case 1, a 23-year-old female presented with history of progressive epigastric fullness from last 1 year and dull abdominal pain since last 2-3 months. Ultrasound showed two hydatid cysts (one in each lobe of liver) and cholelithiais. She was managed laparoscopically for both pathologies and was discharged on drain on post-operative day 3. There were no perioperative complications. Post operatively drain was kept in view of biliary fistula which gradually reduced and stopped by day 3. This is the overall second case mentioned in literature and first case where cholelithiasis is managed along with two large hydatid cysts. In case 2, a 21-year-old male presented with complaint of dull aching pain abdomen and on evaluation was found to have a large cystic swelling originating from left lobe of liver and adherent to pericardial surface of diaphragm. He was operated laparoscopically and left subhepatic drain was placed in which, output was bilious for 4-5 days and was in decreasing trend. There was no other perioperative and post-operative complication. Laparoscopic surgery is becoming preferred modality in managing not only individual cases of abdominal hydatid cysts, but also along with other benign diseases like gall bladder.

Choledochal cyst type VI: a rare case report

Viral G. Sangani, Aasit L. Pathak, Bhupesh Patel, Aayushi Pugaliya — Thu, 29 Aug 2024 00:00:00 +0530

Choledochal cyst or biliary cyst is a congenital anomaly affecting the biliary tree. It involves the dilatation of the biliary tree that could affect the extra hepatic and/or the intrahepatic segments. We present a 40 year old female with constant right upper abdominal pain, diagnosed with choledochal cyst. She underwent laparoscopic cholecystectomy with choledochal cyst (CDC) excision. She was uneventful postoperatively and then discharged.

A diagnostic dilemma: enterolith formation secondary to stricture and subsequent bowel obstruction: a case report

Thu, 29 Aug 2024 00:00:00 +0530

We report a case of a 67 years male patient who presented with complaints of pain in abdomen, loose motions since 3 months and distension of abdomen since 1 day. At the time of admission patient was vitally stable, with no history of vomiting and constipation. Plain x-ray abdomen erects showed evidence of approximately 4-5 radio opaque foreign bodies in the abdomen. Contrast Enhanced computed tomography (CECT) of abdomen revealed multiple ileal strictures with closed loop obstruction with large monoliths. Exploratory laparotomy confirmed 7 ileal strictures each 10 cm apart with proximal dilatation. Resection of ileal stricture was performed and ileoileal anastomosis done. The resected segment contained seven hard, black enteroliths.

Cervical extension of pancreatic pseudocyst an unusual entity

Roshil Charutha, Madhur Arun Joshi, Sampada Joshi — Thu, 29 Aug 2024 00:00:00 +0530

Pancreatic pseudocyst is a common complication that occurs following acute or chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of pseudocyst can occur into mesentery, retroperitoneum, inguinal region, pleura and lung. Extension of pseudocyst into mediastinum and cervical spaces is extremely rare. Mediastinal extension of pseudocyst is a rare occurrence reported in fewer than 100 cases. Cervical extension of pseudocyst is even rarer. Due to the rarity of the condition, there is a lack of uniform treatment protocols which poses a challenge in the management of this condition. Here we report a rare case of bilateral cervical extension of ruptured pseudocyst and its management.

Multi-visceral resection in colonic cancer - “Boon or Bane?”: exploring the role and rationale through case reports

Subbiah Shanmugam, Suganthan Thirunavukkarasu — Thu, 29 Aug 2024 00:00:00 +0530

Colonic cancer invading into the adjacent organs or structures is detected in 5% to 20% of all surgical interventions performed for the management of colonic cancer. These adhesions may be either due to frank tumor infiltration or due to peritumoral inflammation. Nature of these adhesions cannot be ascertained intraoperatively. Standard management entails in block resection of the diseased organ along with adjacent organ infiltration. The release of macroscopically infiltrated tissue is not recommended due to the risk of perforation, tumor seeding and the possibility of leaving residual disease (R1, R2) with high recurrence rates. We share our experience with two case reports regarding the role of multi-visceral resection in clinically diagnosed locally advanced colonic cancers adherent to adjacent structures but pathologically down staged and proved to be inflammatory adhesions and desmoplastic reaction. In both patients even adjuvant therapy was not needed. Multi visceral resection in carcinoma colon has better prognosis and overall survival, if the histopathology reveals inflammatory adhesions or desmoplastic reaction rather than direct tumor infiltration into adjacent structures. So upfront surgery may be beneficial particularly in patients where the adjacent organ involvement is really not the involvement by tumor.

Traumatic abdominal wall hernia and bowel perforation leading to shock: a case report

Nasir Ali, Shavi Rayoo, Aina Kaleem, Tanisha Singh, Zahur Hussain — Thu, 29 Aug 2024 00:00:00 +0530

Traumatic abdominal wall hernia (TAWH) is a rare clinical entity resulting from blunt force trauma that disrupts the abdominal wall muscles and fascia, leading to the protrusion of intra-abdominal contents without skin penetration. It accounts for approximately 0.07% of all abdominal trauma cases and often presents diagnostic challenges due to its rarity and association with other injuries. We present a case of a 66-year-old male who presented with a TAWH and small bowel perforation after being struck by a bull. He exhibited hemodynamic instability and abdominal tenderness. Imaging revealed a strangulated hernia. Surgical exploration found a 5 cm abdominal wall defect with herniated, gangrenous small bowel, with jejunal perforation. The affected bowel segment was resected, and the abdominal wall was repaired. The patient stabilized postoperatively and was discharged on day 14. TAWH requires a high index of suspicion for diagnosis, especially in the presence of blunt abdominal trauma. Immediate surgical intervention is often necessary to prevent complications such as bowel strangulation and peritonitis. This case underscores the importance of early recognition and timely surgical management to improve outcomes in patients with TAWH complicated by bowel perforation. Early diagnosis and prompt surgical intervention are crucial in managing TAWH, particularly when accompanied by bowel perforation. This case highlights the need for vigilance and rapid response in emergency settings to mitigate the significant morbidity and potential mortality associated with this rare condition.

Unmasking the enigma - recurrent odontogenic keratocyst: a continual challenge

Thu, 29 Aug 2024 00:00:00 +0530

Odontogenic keratocysts (OKCs) represent 10% to 14% of all jaw cysts and are notable for their high recurrence rate compared to other odontogenic cysts. This case study details a recurrent OKC in a young woman, highlighting the critical need for diligent long-term follow-up and effective management strategies. A 25-year-old female presented with a recurrent OKC in the maxilla. The treatment involved surgical enucleation of the cyst, apicectomy of affected teeth, and application of Carnoy's solution to reduce recurrence risk. Follow-up imaging and clinical evaluations were conducted periodically to monitor healing and detect potential recurrences. Postoperative recovery was uneventful, with no immediate complications. Serial radiographs and clinical examinations during the follow-up period showed satisfactory healing and no signs of recurrence. The patient reported no discomfort or functional impairment. This case underscores the importance of comprehensive surgical intervention and long-term follow-up in managing recurrent OKCs. The combined approach of cyst enucleation, apicectomy, and Carnoy's solution application proved effective in preventing recurrence in this patient. Ongoing monitoring remains essential to ensure early detection and management of potential recurrences, ultimately improving patient outcomes.

Giant rare esophageal malignancy in adolescent boy: a case report

Prashanth Puvvada, Sugaprakash S., Prabhakaran Raju — Thu, 29 Aug 2024 00:00:00 +0530

Synovial sarcoma is rare soft tissue tumour affecting mostly extremities and less commonly head and neck, lungs, heart and digestive system in adult age group. Only about 20 such cases arising from oesophagus have been reported in literature but none have been reported in adolescent age group with large size in Indian population. So here we present a case report of synovial sarcoma of oesophagus seen in a 14-year-old boy and successful management. Our patient was a 14-year boy who came to our outpatient department (OPD) department with complaints of dysphagia to and retrosternal pain from past 2 months. A contrast enhanced computed tomography (CT) scan showed vertically oriented long and large hypodense lesion arising from right anterolateral wall of pharyngoesophageal junction to upper two-thirds of esophagus from C6 to D8 causing >50% narrowing of trachea. Upper gastrointestinal (GI) endoscopy was done which showed linear submucosal lesion from 17 to 28 cm from incisors. After anaesthetic clearance patient was planned and taken up for minimally invasive esophagectomy. Intraoperatively bulky submucosal growth extending from just cricopharynx to lower thoracic esophagus till inferior pulmonary ligament. Histopathology report came out as synovial sarcoma spindle cell type with Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade 2. After tumor board discussion, adjuvant therapy with doxorubicin and ifosfamide was given for five courses. After Six months follow up, the boy is free from tumor recurrence. Synovial sarcoma in esophagus is very rare with nearly 20 reported cases, of which most were polypoid and located in upper and mid esophagus and biphasic histology. The treatment for patients with localized disease is surgery with an adequate wide margin combined with adjuvant chemotherapy and/or radiation is regarded as the preferable treatment. Esophagectomy mostly with minimally invasive approach is preferred surgical option. Robotic minimally invasive surgery is also a safe and feasible option. Clinical follow-up has been limited, and synovial sarcoma is widely known to recur or metastasize after long disease-free intervals.

A case report on rare case of left thigh recurrent liposarcoma

Prakher B. Nathani, Sahil M. Patel, Meet V. Dholariya, Manav Chothani — Thu, 29 Aug 2024 00:00:00 +0530

Lipomas are non-cancerous growths made up of mature fat cells and are considered the most common type of tumor, with an estimated occurrence rate of 10%. They can develop anywhere in the body, typically weighing a few grams and usually measuring less than 2 cm in size. Liposarcomas, on the other hand, represent 10% to 35% of all soft tissue sarcomas, comprising 24% of those found in the limbs and 45% in the abdominal cavity. These tumors can emerge in any area where fat is present and exhibit a variety of histological features, as well as diverse imaging characteristics and behaviors. We have studied a case of a 56-year-old male patient who presented with a complaint of swelling in left thigh since last 4 years, which varied in size with time. The patient was investigated and underwent surgical excision. diagnosis of liposarcoma was confirmed with histology. Lipomas have the potential to transform into one of three types of liposarcomas. Therefore, it is crucial to reevaluate the conventional view of all lipomas as benign growths and consider diverse approaches, as they can occasionally progress to a sarcomatous state. Aggressive forms often require a combination of surgery, chemotherapy, and radiation therapy for treatment. It is crucial to distinguish between different subtypes of liposarcomas due to their significant implications for treatment and prognosis. Liposarcomas tend to affect individuals aged 40 to 60 years, with an equal likelihood in both men and women.

Anorectal gastrointestinal stromal tumor: a rare case report

Subbiah Shanmugam, Suyash Singodiya — Thu, 29 Aug 2024 00:00:00 +0530

A gastrointestinal stromal tumor (GIST) is a mesenchymal tumor of gastrointestinal tract arising from the interstitial cell of Cajal with rare occurrence in anorectum. Mutations of c-KIT proto-oncogene characterized by the expression of the KIT (CD-117) tyrosine kinase or platelet-derived growth factor receptor alpha (PDGFRα) is frequently seen with these tumours. Elderly patients with age greater than 50 are at higher risk of GIST. Here, we present a case of a 51-year-old male who presented with vague dull aching pain in the right-side perianal area since last one month with a submucosal mass in the right posterolateral wall of the anal canal and rectum. The histopathological and immunohistochemistry study of the biopsy sample reported strongly positive for CD117 and less than 3% of tumor cells showed Ki67 positivity. The patient underwent laparoscopic abdomino-perinel resection. Post-operatively, the patient was started on adjuvant imatinib with regular follow-up.

Pediatric adnexal torsion - from presentation to outcomes: a 5 years experience of a tertiary center in Bahrain

Sara Husain, Zainab Alqubaiti, Barrak Ayoub, Fayza Haider — Wed, 21 Aug 2024 00:00:00 +0530

Background: This study aims to explore the clinical signs, diagnostic methods, and surgical treatments of adnexal torsion in children under 14. The study included 19 children, with an average age of 12, who presented with severe abdominal pain leading to a diagnosis of adnexal torsion.

Methods: We conducted a retrospective review of pediatric patients who underwent surgery for suspected adnexal torsion at a pediatric surgery center from January 2018 to December 2022. Data collected included age, symptoms, diagnostic tests, surgical details, and histopathology results.

Results: The predominant symptoms were abdominal pain, vomiting, nausea, and elevated white blood cell counts in about 50% of the cases. Laparoscopy was the initial approach in 68.4% of cases, with 21.1% requiring conversion to open laparotomy. Ovarian-sparing surgery was performed in 73.7% of the cases, while oophorectomy was necessary in 26.3%. Most histopathological examinations disclosed benign ovarian cysts, including simple cysts, serous cystadenomas, and mature cystic teratomas, often complicated by torsion and leading to ovarian infarction. Younger patients and those with higher leukocyte count found to have higher rates of oophorectomy.

Conclusions: Adnexal torsion, although rare and challenging to diagnose in children due to non-specific symptoms such as abdominal pain, vomiting, and nausea, necessitates prompt recognition and management to minimize severe complications. Awareness among clinicians is crucial for early diagnosis and treatment, significantly impacting long-term outcomes.

Accuracy of 128-slice multi-detector computed tomography in the detection of stenosis at different cut-off values in corresponding target areas on conventional angiogram

Farhana Zaman, M. Javed Mahfuz Khan, Abdulla Al Mahaj Chowdhury — Thu, 29 Aug 2024 00:00:00 +0530

Background: Coronary artery disease (CAD) is a common medical condition. Over the years, assessment methods for CAD have evolved, with non-invasive techniques gaining prominence. Multi-detector computed tomography (MDCT) coronary angiography has emerged as an alternative to conventional invasive coronary angiography (ICA). This study aimed to evaluate the diagnostic accuracy of 128-slice MDCT in detecting stenosis at various thresholds and compare its efficacy with traditional coronary angiography.

Methods: This cross-sectional study was conducted at the radiology and imaging department of combined military hospital (CMH) in Dhaka from August 2021 to July 2022. Forty-three patients were selected through purposive sampling. Computed tomographic angiography was performed using a 128-slice MDCT scanner. Data analysis was conducted using SPSS, with statistical significance set at p<0.05. Sensitivity, specificity, diagnostic accuracy, negative predictive value (NPV), and positive predictive value (PPV) were calculated for each patient and segment. Sensitivity and specificity were assessed for stenosis exceeding 75% and 50%.

Result: For diagnosing stenosis less than 50%, the sensitivity, specificity, PPV, NPV, and accuracy were 83.9%, 95.6%, 61.0%, 98.6%, and 94.7%, respectively. For stenosis greater than 50%, they were 84.2%, 99.3%, 86.5%, 99.1%, and 98.5%. For stenosis exceeding 75%, the values were 100.0%, 99.9%, 97.0%, 100.0%, and 99.9%.

Conclusions: 128-slice CT provides a reliable non-invasive method to assess hemodynamically significant CAD with high diagnostic accuracy. The study findings suggest that at the artery level, MDCT demonstrates high level of accuracy in identifying significant obstructive CAD.

Open versus laparoscopic colectomy - which is better from immunity-point of view: three-year single-center retrospective study

Tawfik A. T. Hussein, Ahmad M. Ajawi — Thu, 29 Aug 2024 00:00:00 +0530

Background: Objective of the study was evaluation of the impact of colorectal surgery on patients' immune milieu through comparison of outcomes of patients had open colectomy (OC) versus laparoscopic colectomy (LC) for colorectal carcinoma (CRC).

Methods: The design of the study was retrospective observational study. The study setting was Mediclinic Airport Road Hospital, Abu Dhabi, UAE. Files of CRC patients who had LC (group-LC) or OC (group-OC) were revised for perioperative data and estimated serum inflammatory cytokines' levels. Statistical analyses of the relation between the postoperative (PO) outcomes and serum cytokines' levels estimated in samples obtained immediately PO.

Results: Patients underwent LC had significantly lower amount of operative bleeding and shorter operative time with lower frequency of patients required ICU and shorter duration of ICU stay. LC provided lower pain scores with shorter duration till 1st ambulation and passage of flatus and shorter duration of hospital stay. LC significantly reduced serum cytokines' levels in immediate PO samples of LC than OC patients. At 1-week PO, serum cytokines' levels were significantly lower than in immediate PO samples with significant difference between LC and OC samples. Moreover, epidural anesthesia (EA) and opioid-free general anesthesia (GA) had lower serum cytokines' levels than opioid-based GA. Statistical analyses defined laparoscopic surgery under EA and non-opioid analgesia as the highly significant predictor for favorable PO surgical outcomes and proper control on surgical immune response.

Conclusions: LC significantly improved PO surgical outcomes and attenuated the surgical immune response with significant difference than OC. EA juxtaposed with opioid-free analgesia significantly provided further control on the surgical immune response.

Prediction of severity of acute pancreatitis using neutrophil to lymphocyte ratio

Ashish Shrestha, Smeena Pradhananga, Niliza Shakya — Thu, 29 Aug 2024 00:00:00 +0530

Background: Patients with mild acute pancreatitis (AP) have mortality rates of less than 1% which increases up to 10% to 30% in severe AP (SAP). Early prediction of severity helps in complication prevention. Neutrophil lymphocyte ratio (NLR) could be simple, easy and cheap tool for predicting severity of AP in its early course.

Methods: This prospective, observational study included forty-five patients admitted over a period of six months from August 2020 to January 2021 with diagnosis of AP at Bir hospital. NLR was performed at the time of admission.

Results: The 22.2% patients had SAP with mean age of 45.6±14.73. It was common in male (60%) and the most common cause was gallstone. Etiology, BMI, neutrophilia, lymphopenia, SIRS scores were found to have statistically significant association to severity of AP. A cut off value of 4.49 was calculated for NLR for predicting severity of pancreatitis with sensitivity of 100%, specificity of 97.1%, PPV of 90.9 % and NPV of 100%. Mean NLR was 7.80±1.69 for mortality group.

Conclusions: NLR can be used as a simple, easy and inexpensive prognostic marker of severity of AP.

Outcome of early and delayed closure of temporary ileostomy in children

Thu, 29 Aug 2024 00:00:00 +0530

Background: Ileostomy is frequently utilized in the surgical management of various congenital and acquired gastrointestinal conditions, often leading to significant patient morbidities. This study aimed to evaluate the outcomes of early versus delayed closure of temporary ileostomies.

Method: A prospective comparative interventional study was conducted at Dhaka Shishu (Children) Hospital from March 2017 to September 2019. A total of 48 patients with temporary loop ileostomies were included based on specific inclusion and exclusion criteria. These patients were randomly divided into two groups: early closure (Group A, n=25) and delayed closure (Group B, n=23). Comparative parameters included wound infection, anastomotic leakage, and incisional hernia, with a follow-up period of 6 months postoperatively.

Results: In the early closure group, over 50% of patients were less than 1 month old, while 78.3% in the delayed closure group were aged 2-3 months. The cohort comprised 26 males (54.2%) and 22 females (45.8%). Group A patients had a significantly lower mean weight than group B (p<0.05). The predominant diagnosis in both groups was meconium ileus, followed by volvulus neonatorum, small gut atresia, and typhoid ulcer perforation. Post-closure, the overall wound infection rate was 35.4% (40.0% in group A and 30.4% in group B). Anastomotic leakage occurred in 8.0% of group A and 13.0% of group B. Incisional hernia developed in 4.0% of group A and 13.0% of group B (p=0.388). Mortality rates were 4.0% in group A and 8.7% in group B (p=0.601).

Conclusion: Early closure of temporary loop ileostomy appears to be a comparatively safe option with lower morbidity, suggesting it as a viable alternative to delayed closure.

Survival and complications in splenic trauma: surgical versus non-surgical outcomes

Mohamad B. A. Kassis — Thu, 29 Aug 2024 00:00:00 +0530

Background: Splenic injuries are common in trauma patients, accounting for approximately 20% of abdominal trauma cases. Given the spleen's anatomical vulnerability and the critical nature of timely intervention, understanding the impact of different management strategies on patient outcomes is essential. This study investigates the effectiveness of surgical versus non-surgical management in splenic trauma, focusing on mortality and complication rates based on injury severity and patient stability.

Methods: A retrospective cohort study was conducted, analyzing trauma patients with splenic injuries admitted to Azahra Hospital from January 2020 to December 2022. Medical records were reviewed to collect data on patient demographics, injury severity, management strategies, and clinical outcomes.

Results: A total of 50 patients were included in the study, with 32 undergoing operative treatment. The analysis revealed that operative treatment was associated with significantly lower mortality rates (21% in surgical cases versus 4.3% in non-operative cases) and fewer complications (p<0.001). A positive correlation was observed between splenic injury stage and mortality, as well as between hemodynamic instability and complications.

Conclusions: Initial findings indicated higher mortality and complication rates in surgical patients; however, after controlling for confounding variables, operative treatment demonstrated an unexpected inverse correlation with both mortality and complications. This emphasizes the importance of personalized management approaches in splenic trauma to optimize patient outcomes.

Incidence of surgical site infection in elective inguinal hernia surgery and factors affecting it

Zahid H. Z. Shah, Syed A. Ali, Syed Qaisaruddin — Tue, 06 Aug 2024 00:00:00 +0530

Background: Surgical site infections (SSIs) are a significant concern in surgical patients. The present study aims to estimate the incidence and evaluate the risk factors, microbiology, prevention strategies, and management of SSIs in patients undergoing elective inguinal hernia repair.

Methods: This prospective observational study included 1053 patients who underwent elective inguinal hernia repair at our institution. Patient demographics, surgical characteristics, and outcomes were collected and analysed. Independent risk factors for SSI were identified by univariate and multivariate analyses.

Results: Thirty-one patients developed SSIs within 30 days after surgery, resulting in an overall SSI rate of 2.94%. The most common microorganism isolated from SSI was Staphylococcus aureus. Identifiable risk factors associated with SSIs included age ≥65 years, body and mass index (BMI) >24.6 kg/m², current smoking and diabetes mellitus.

Conclusions: The study highlights the importance of identifying high-risk patients and implementing preventive measures to reduce the incidence of SSIs in elective inguinal hernia surgery. The findings suggest that age ≥65 years, BMI >24.6 kg/m², current smoking and diabetes mellitus are risk factors for SSIs. The study also emphasizes the importance of proper skin preparation and antibiotic prophylaxis in reducing the risk of SSIs.

The use of scrotal support post inguino-scrotal hernia repair: a prospective observational study

Abrar Khan, Syed Ameenuddin Ali, Arefa Almas — Sat, 17 Aug 2024 00:00:00 +0530

Background: Inguino-scrotal hernias pose a significant clinical challenge, requiring surgical intervention for resolution. Post-operative care is crucial for optimizing outcomes and enhancing patient comfort. Scrotal support has emerged as a potential adjunctive therapy in this context. The aim of this study was to compare the occurrence of scrotal swelling in the form of edema and hematoma in post-operative cases of inguinal hernia repair cases in our surgical unit in a tertiary care center.

Methods: Our study was carried out at a rural tertiary care center from July 2022 to June 2024 and includes 389 patients who underwent elective surgical repair for inguino-scrotal hernias. Scrotal support was provided post-operatively, and patients were followed up at regular intervals. The study population was divided into two groups, group A with regular under garments and group B were given scrotal support (coconut bandage). Total numbers of 1050 inguino-scrotal hernia surgery were performed of which 389 patients were operated in a single unit by two surgeons and we included in the study. Of the 389 cases, 208 cases were in group A and 181 cases were in group B. All are male patients with the age ranges from 35-75 years.

Results: In group A, 37 patients (17.78%) developed scrotal hematoma and edema and in group B, 16 patients (8.83%) developed similar findings.

Conclusions: Scrotal support post inguino-scrotal hernia repair demonstrates promising benefits, including decreased pain and swelling and improved patient satisfaction, without compromising surgical outcomes.

Role of laparoscopic cholecystectomy in atypical/asymptomatic gall stone disease patients: a randomized controlled trial from a tertiary care centre in North India

Thu, 29 Aug 2024 00:00:00 +0530

Background: Gallstone disease (GSD) exhibits considerable heterogeneity, ranging from biliary colic to severe complications such as acute cholecystitis and gallstone pancreatitis. The majority of cases have no prior history of biliary symptoms and are diagnosed incidentally, often labelled as "asymptomatic GSD." Detailed questioning often reveals the presence of vague abdominal discomfort such as pain, dyspepsia, and flatulence.

Methods: In this study, we randomized patients with asymptomatic or atypical gallstone disease into two groups: Group A (Control group) and Group B (Interventional group), where standard laparoscopic cholecystectomy was performed. All patients were followed up at 1 week, 6 months, and 12 months to monitor the development of biliary symptoms, postoperative complaints, and the impact on atypical gastrointestinal symptoms.

Results: The results showed no significant change in atypical symptoms from the initial presentation at the 1-year follow-up in the control group. There were no serious biliary complications or hospitalizations for this subgroup of patients. Among the 13 patients in the observation arm, three (23.1%) underwent laparoscopic cholecystectomy due to the development of biliary colic during the follow-up.

Conclusions: In conclusion, laparoscopic cholecystectomy does not appear to improve atypical abdominal symptoms or decrease the risk of gallbladder carcinoma in patients with asymptomatic GSD from North India. However, surgical intervention may be offered to patients with large stone sizes, as they are at increased risk of becoming symptomatic within 1 year, as observed in our study.

Management of early hollow viscus perforation: laparoscopic repair in contrast to laparotomy repair

Nadigadda Mohammed Shukur Shaik, Kalesha Shaik — Thu, 29 Aug 2024 00:00:00 +0530

Background: Acute abdomen refers to severe abdominal pain that occurs suddenly. This study was conducted to compare open versus laparoscopic repair for the treatment of early hollow viscus perforation.

Methods: The study involved 50 patients of both genders, divided into two groups. Group I underwent laparoscopic repair, while group II underwent open repair. Variables such as the time taken for resumption of daily activities and operative time were recorded for all patients. Study was done in Kamineni institute of medical sciences, Narketpally Nalgonda (d.t) Telangana prospective observational study for a period from March 2023 to April 2024.

Results: Abdominal distension occurred before pain in 7 patients in group I and 6 patients in group II, after pain in 4 patients in group I and 3 patients in group II, and with pain in 14 patients in group I and 16 patients in group II. Bilious vomiting was observed in 12 patients in group I and 11 patients in group II, while no vomiting occurred in 13 patients in group I and 14 patients in group II. Gastric perforation was diagnosed in 5 patients in group I and 5 patients in group II, ileal perforation in 2 patients in group I and 3 patients in group II, and duodenal perforation in 18 patients in group I and 17 patients in group II. The difference was significant (p<0.05).

Conclusions: This study compared laparoscopic and open repair for hollow viscus perforation in 50 patients. Both groups had similar demographics and initial clinical characteristics. The laparoscopic group experienced significantly shorter surgical times (102.08 vs. 133.52 minutes, p<0.0001), shorter hospital stays (most discharged within 7-14 days vs. 14-21 days), and quicker resumption of daily activities (9.32 vs. 13.68 days, p=0.0042). These findings suggest that laparoscopic repair offers advantages in terms of faster recovery and reduced hospital stays compared to open repair, making it a preferable option for managing hollow viscus perforations.

Penile reconstruction post-oncologic surgery: comprehensive approaches

Thu, 29 Aug 2024 00:00:00 +0530

Post-oncologic penile reconstruction aims to restore penile form and function following surgical resection due to penile cancer. This reconstructive surgery is essential as treatments like partial or total penectomy can severely impact a patient’s quality of life. The primary goals include maintaining urinary and sexual function while achieving a cosmetically acceptable result. Techniques range from simple resurfacing of the glans to complex procedures like phalloplasty, while penile-sparing therapies, including topical treatments and laser ablation, are also used to minimize disfigurement. Penile cancer, predominantly squamous cell carcinoma, is rare but more prevalent in developing countries, with risk factors such as human papillomavirus (HPV) infection and poor hygiene. The preoperative evaluation involves assessing comorbidities, psychological state, and functional capacity to ensure optimal outcomes. Criteria for reconstruction include the extent of the defect, oncological status, and desired outcomes. Techniques employed in reconstruction include local, inguinal, anterolateral thigh, and myocutaneous flaps, as well as grafts and alloplastic materials. Innovations in surgical methodologies and multidisciplinary strategies have significantly improved outcomes. However, complications, including high perioperative morbidity, underscore the need for careful patient selection and management. Psychosocial support is crucial for optimal recovery and quality of life, emphasizing the importance of a comprehensive, patient-centered approach in post-oncologic penile reconstruction. This holistic approach ensures that patients not only achieve cancer survival but also maintain a high quality of life following their treatment.

Subtotal cholecystectomy: a case series

Vinod Kumar Nigam, Siddharth Nigam — Thu, 29 Aug 2024 00:00:00 +0530

Subtotal cholecystectomy is a method of removing most of the gallbladder instead of whole of the gallbladder in case of a difficult gallbladder. The term “subtotal cholecystectomy” was introduced by Morse and Barb. Subtotal cholecystectomy is a bailout procedure undertaken in situations where the anatomical structures are not easy to identify making total cholecystectomy difficult and risky. We have done twelve cases from June 2019 to June 2024, while performing laparoscopic cholecystectomy as we could not continue, due to risk of injury and complications. Post-operatively there were some cases of mild bile leak, but no serious complications. All cases belong to Nassar scale grade 3 and 4. Here we are describing how and when subtotal cholecystectomy should be done.