Asian Journal of Research in Surgery

The Role of Splenectomy in Hematological Diseases

Tue, 25 Jul 2023 00:00:00 +0000

Since the 20th century, splenectomy has played an important role in diseases of the spleen, however, an increased incidence of infections has been observed in asplenic patients, for this reason, efforts have been made to improve the procedure, achieving minimally invasive surgery, along with partial splenectomy.

Aim: Describe the current role of splenectomy in hematological diseases, its surgical technique, risks, and complications, and evaluate its results according to the approaches used.

Study Design: Bibliographic review.

Materials and Methods: The Medline, PubMed, Cochrane, and Medigraphic databases were consulted using the keywords spleen, splenectomy, hematological diseases, postoperative complications, including systematic reviews, original articles, and management guidelines in this article.

Results: The spleen is formed in the 6th week of gestation by the dorsal mesogastric layer on the cephalic side. It is the largest lymphoid organ and is in the left hypochondrium, of reddish-purple color, measures of 10 and 12 cm and weighs of 150-200 grams. Since the first splenectomy was performed by Sutherland and Burghard, the laparoscopic approach is the reference for elective surgeries and emergency surgeries. The worldwide incidence of this surgery is reported to be 6 to 7 per 100,000 people per year. Complete laparoscopic splenectomy is currently the gold standard in both malignant and benign diseases, as in hematological disorders. There is no agreed definition of splenomegaly; however, the guidelines of the European Association of Endoscopic Surgery (EAES) consider it larger than 15cm and massive, larger than 20cm. Although there is no indication to perform it laparoscopically, it is considered that the larger the size, the greater the risk of complications. Splenectomy is the best second-line treatment in patients with hematological diseases. The most important and deadly complication in post-splenectomized patients is the so-called OPSI (overwhelming post-splenectomy infection).

Conclusion: Splenectomy, although it is performed in fewer numbers every day, continues to be an important tool for the treatment of hematological diseases, with minimally invasive techniques being the ones of choice.

The Difference between the Complications of Early Vs. Late Reconstruction in Patients with Traumatic Orbital Fractures

Somar Hassan Ali — Mon, 27 Nov 2023 00:00:00 +0000

Traumatic orbital fractures, resulting from facial trauma, can lead to significant aesthetic and functional issues if not managed appropriately. These fractures typically result from blunt force trauma to the face, such as in car accidents, sports injuries, or physical altercations. The orbit is a complex structure formed by several bones, including the frontal, zygomatic, maxilla, and ethmoid bones, which protect and support the eyeball and surrounding structures. When a traumatic orbital fracture occurs, it can cause a range of symptoms and potential complications. Common signs include periorbital swelling, bruising, double vision, and restricted eye movement. In severe cases, the injury can damage the optic nerve, leading to vision impairment. This literature review investigates into the ongoing debate concerning the optimal timing for surgical intervention in these cases, comparing early and late reconstruction. Studies indicate that early reconstruction tends to yield more favorable outcomes. For instance, one study demonstrated that early correction of enophthalmos within one month of injury led to significantly better outcomes, whereas delayed surgery was associated with more severe complications, including tissue fibrosis and atrophy. Factors such as diplopia and enophthalmos were evaluated in patients undergoing surgical treatment for orbital blowout fractures at different time intervals post-injury. The findings revealed that early intervention reduced postoperative diplopia, especially when performed within two weeks of the injury. Similarly, another study focusing on orbital-floor trap-door fractures emphasized the importance of early surgery within eight days of injury, showcasing superior outcomes compared to delayed surgery. A retrospective analysis further suggested that successful fracture repair can be achieved within 29 days following trauma, challenging the notion of a strict 14-day timeframe. In the context of pediatric patients, early intervention was recommended within two weeks for most cases, except for those showing minimal symptoms, where observation and monitoring were deemed appropriate. Overall, the existing literature emphasizes the benefits of early surgical intervention in managing orbital fractures. Timely care within the first two weeks is associated with a higher likelihood of complete recovery of symptoms, lower rates of postoperative diplopia and enophthalmos, and the resolution of motility restriction.

Retroperitoneal Schwannoma: A Case Report

Wed, 07 Jun 2023 00:00:00 +0000

Schwannomas are benign tumors that arise from neural sheath Schwann cells, generally located in the head and neck, often along the cranial nerves, they constitute a particularly rare neoplasm among tumors of the retroperitoneal area.

We report the case of a 63-year-old lady consulting for abdominal discomfort and urinary symptoms and was found to have a retroperitoneal mass at CT Scan and MRI.

A Rare Case of Phytobezoar Impaction in a Giant Meckel’s Diverticulum Causing Small Bowel Obstruction

Sopan N. Jatal , Sudhir Jatal , Sachin Ingle — Fri, 16 Jun 2023 00:00:00 +0000

Meckel’s Diverticulum is the most common anomaly of the gastrointestinal tract, found in almost 2% of the population, it rarely gives rise to symptoms and its discover usually incidental. Meckel’s Diverticulum size more than 5 cm are classified as Giant Meckel’s Diverticulum, are relatively rare and may be prone to complications especially for obstruction in adults. Phytobezoar is concretion of poorly digested fruits and vegetable fibres that is found in the Giant Meckel’s diverticulum can be the cause of small bowel intestinal obstruction.

Herein we report a rare case of 16 years’ adolescent boy was having Giant Meckel’s Diverticulum containing Phytobezoar causing intestinal obstruction. We did explorative laparotomy and resection of the involved segment along with Giant Meckel’s Diverticulum with ileo-ileal anastomosis was done.

An Extremely Rare Case of Small Bowel Strangulation Due to Meckel’s Diverticulum

Sopan N. Jatal , Sudhir Jatal , Sachin Ingle — Sat, 24 Jun 2023 00:00:00 +0000

Meckel’s diverticulum is the most common congenital gastrointestinal anomaly. Intestinal obstruction is the common presenting symptom in the adult population, due to complications like intussusception, Incarceration, adhesion and torsion around a fibrous band attached to the umbilicus. The life time risk of complication is 4-9%. It is an uncommon cause of acute intestinal obstruction in adults. Strangulation of small bowel with an encircling Meckel’s diverticulum around the base of the mesentery or loop formation of Meckel’s diverticulum leading to small bowel obstruction is an extremely rare event causing strangulation of small bowel and high mortality if the treatment is delayed.

We present a case report of a 15 years-old boy, who present with small bowel obstruction, requiring an emergency laparotomy. He was found a strangulated loop of small bowel with an encircling Meckel’s diverticulum around the base of the mesentery. So five feet of gangrenous small bowel along with Meckel’s diverticulum is resected and end to end anastomosis done.

Appendicitis Causing Small Bowel Strangulation a Rare Presentation– Three Case Reports

Sopan N. Jatal , Sudhir Jatal , Sachin Ingle — Thu, 06 Jul 2023 00:00:00 +0000

A strangulation of the intestine caused by appendicitis is extremely rare with few cases reported in the literature. Strangulation can be due to the appendix wrapping or appendiceal tourniquet around the base of a bowel loop, or when inflamed appendix tip adheres across the loop of small bowel to the mesentery or long appendix tip attached to posterior wall forming a close loop, obstruction may lead to strangulation and gangrene of the bowel.

The diagnosis of such a condition is possible only on the operation table, after midline explorative laparotomy. There are only 10 cases reported in the literature. Mechanical small bowel obstruction and strangulation is a very rare and dangerous complication of a very common disease of appendicitis required emergency laparotomy, to reduce the high mortality. Every emergency surgeon needs to be aware of such possibility.

Herein we are reporting three cases of mechanical small bowel obstruction caused by appendicitis. Two patient were presented with as a strangulation of the small bowel, due to the long appendix causing constriction around a loop of the small bowel, acts as an appendiceal tourniquet or band syndrome, is an extremely rare surgical entity and third case presented with mechanical small bowel obstruction having an appendicular inflamed tip attached to the mesentery, producing constriction or compression of its ileum, producing the obstruction. In all cases we performed midline laparotomy with appendectomy and adhesiolysis.

Post-traumatic Mesenteric Pseudocyst Due to Bicycle Handlebar Injury

Sopan N. Jatal , Sudhir Jatal , Sachin Ingle — Fri, 14 Jul 2023 00:00:00 +0000

Mesenteric Pseudocyst is a cystic mass in the abdomen. The aetiology is either due to trauma or infection. True mesenteric cysts are lined by epithelium while pseudocysts are not. Mesenteric pseudocysts are very rare. Only 29 case reports were retrieved via the Medline/PubMed search engine. Incidental diagnosis of mesenteric Pseudocyst is during abdominal imaging or laparotomy.

We report an extremely rare case of post-traumatic mesenteric Pseudocyst in a 10-year-old girl. There was a history of falling from the bicycle and causing a handlebar blunt abdominal injury to the abdomen. After 5-6 months, she was presented with acute intestinal obstruction, due to volvulus of small bowel. The patient was managed by open explorative laparotomy, and we did total segmental resection of the ileum along with post-traumatic mesenteric Pseudocyst and also ileo-ileal anastomosis.

Mesenteric Dermoid Cyst in Adult and Review of Literature

Sopan N. Jatal , Sudhir Jatal , Sachin Ingle — Fri, 21 Jul 2023 00:00:00 +0000

Mesenteric dermoid cysts or teratoma are germ cell tumors composed of three germinal layers, ectoderm, mesoderm and endoderm. These tumors occur usually in children and 80-90% are benign and less than 3% tumors change in to malignancy.

They are more common occur in the region of the head and neck, as well as in the gonads but extremely rarely present in the abdomen as an extra-gonadal mass. The occurrence of mesenteric teratoma in males is less common than in females. Mesenteric dermoid cyst may present as asymptomatic mass, abdominal pain and acute intestinal obstruction due to volvulus has been reported According to English literature and PubMed data base only 21 cases of mesenteric dermoid cysts are reported.

Herein, we are reporting an extremely rare case of mesenteric dermoid cyst in a 35 years’ adult male patient. Clinically he presented with a lump in abdomen at right ileac fossa, pain in abdomen and diagnosis of mesenteric cyst confirmed on abdominal ultrasonography. We performed complete enucleation of a large mesenteric dermoid cyst without resection anastomosis of small bowel.

A Giant Epidermoid Cyst of the Spleen and Mini Review of Literature

S. N. Jatal , Sudhir Jatal , Sachin Ingle — Fri, 18 Aug 2023 00:00:00 +0000

Splenic cysts are rare. They may be congenital, neoplastic, vascular, inflammatory and post traumatic in origin and may contribute to 30-40% of the total splenic lesion. Epidermoid cysts are primary congenital cysts that contains an epithelial lining. Epidermoid cyst are congenital cysts contribute approximately 10% of total splenic cysts. They are encountered more commonly in children and young adults. Congenital splenic cysts are usually asymptomatic and they are discovered incidentally on radiography investigation. Splenic epidermoid cysts are true cysts, as they possess inner epithelial lining of stratified squamous epithelium. Splenic epidermoid cysts also known as splenic epithelial cysts or primary splenic cysts are usually unilocular.

We are reporting a rare case of a 18 years old male patient with history of dull aching pain and palpable mass in left hypochondrium on physical examination. CT abdomen showed a large well defined cystic mass in the spleen. On laparotomy, open total splenectomy was performed.

Huge Multicystic Splenic Lymphangioma in an Adult: A Case Report

S. N. Jatal, Sudhir Jatal, Sachin Ingle — Sat, 26 Aug 2023 00:00:00 +0000

Splenic Lymphangiomas are incredibly uncommon lesions that mostly affect children. These are divided into benign and malignant tumors, as well as real splenic cysts. A rare and slowly developing benign tumor of the spleen is called a splenic lymphangioma. So far fewer than 100 cases have been reported in the literature. The incidence of splenic lymphangioma is 80-90% in children’s less than two years age and few cases are reported in adults. Splenic lymphangiomas are accounting for less than 0.007% of all splenic tumours, that appears as a single or multiple cystic lesions of the spleen.

We report an extremely rare cases of a 38 years old male, presented with left upper quadrant abdominal pain and huge palpable lump extending up to umbilicus. We performed open total splenectomy.

Primary Splenic Diffuse Large B-Cell Lymphoma with Massive Splenomegaly

S. N. Jatal, Sudhir Jatal, Sachin Ingle — Sat, 26 Aug 2023 00:00:00 +0000

Primary malignancies of the spleen are very rare, diffuse large B-cell lymphoma of the spleen is a rare primary neoplasm. Primary splenic diffuse large B-cell lymphoma is a type of non-Hodgkin’s lymphoma that constitute, less than 1% of non -Hodgkin’s lymphoma and less than 2% of all lymphomas. Primary splenic lymphoma has been associated with the hepatitis C and HIV virus. It affects men more than women and present in late middle age.

Patient with diffuse large B cell lymphoma typically present with fever, fatigue, weight loss, palpable splenomegaly and left upper quadrant pain. Diffuse large B cell lymphoma stage I being limited to the spleen, whereas stage II spleen and hilar Lymph-node involvement and stage III is distant metastasis including liver and surrounding organs involvements, stomach, pancreas, kidney and colon. Stage I disease, a splenectomy is the standard treatment for DLBSL. Radiation and chemotherapy can be used. When the cancer is confined to the spleen, the prognosis is quite favourable with a median survival of 7.48 years.

We are reporting an extremely rare case of primary splenic lymphoma in a 45 years old female patient, presented with abdominal pain and huge splenomegaly. The CT revealed a bulky, low density, irregular mass in the spleen and clinically disease limited to spleen only. So we performed open total splenectomy.

Gastric Trichobezoar: A Case Report

Tue, 05 Sep 2023 00:00:00 +0000

Trichobezoar is a foreign body in the digestive tract, made up of hair and fibers. Rarely encountered, and usually occurring in adolescent girls with a proven psychiatric history, it is often strictly gastric in location. We report the case of a 21-year-old breast-feeding patient with a poorly elucidated psychiatric history, who unconsciously consumed her own hair for two years. Upper digestive endoscopy was sufficient to make a positive diagnosis. Treatment was surgical, and the post-operative course was straightforward.

We therefore strongly recommend oesogastroduodenal fibroscopy in the management of identical forms. However, supportive psychotherapy after surgical treatment should be the rule.

Does Abdominoplasty Add Morbidity to Incisional Hernia Repair? Case Series and Review of the Literature

Mon, 11 Sep 2023 00:00:00 +0000

This study presents a case series of five obese female patients with significant incisional hernias. All cases underwent a combined procedure involving incisional hernia repair and abdominoplasty. No postoperative complications were observed, and patients achieved satisfactory functional and cosmetic outcomes. The study suggests the safety and effectiveness of this approach, emphasizing potential improvements in patients' quality of life and aesthetics. Additionally, a comprehensive review of the literature underscores the significance of this combined approach in managing incisional hernias in obese individuals. Further research is needed to validate these findings in larger patient cohorts, highlighting the importance of considering abdominoplasty during incisional hernia repair in this population.

Complication of a Concomitent Cure of a Hiatal Hernia at the Time of Sleeve Gastrectomy: A Case Report

Kaba I., Condé A. Y., Bakunda Christian , Djogbe M., Raoul M., Sami S., Maen H. — Wed, 04 Oct 2023 00:00:00 +0000

Bariatric surgery is the most optimal treatment for morbid obesity, diabetes and other metabolic disorders, as well as many other diseases. There is currently a consensus in bariatric surgery to systematically assess for hiatal hernia at the time of sleeve surgery and to repair it if present. The treatment is frequently SG have a concomitant hiatal hernia repair (SG+HHR). There are frequent complications from this surgery, in particular post-operative vomiting. We report the case of a 24-year-old patient who underwent sleeve gastrectomy with concomitant hiatal hernia repair as part of the surgical treatment of obesity at Sens Hospital. The surgical consequences were marked by the occurrence of food vomiting, which required surgical revision with removal of 2 stitches from the hiatal orifice after radiologic exploration.

Primary Epithelial Splenic Cyst in a Boy: Laparoscopic Management

Sudhir Jatal, S. N. Jatal , Supriya Jatal, Rupesh P. Gundawar — Wed, 18 Oct 2023 00:00:00 +0000

Splenic cysts are a rare condition, with an incidence of only 0.07%, and there have been approximately 800 reported cases in the English literature to date. These cysts can be classified as primary or secondary, depending on whether they have an epithelial lining. They can also be categorized as parasitic or non-parasitic in origin. Primary cysts are also known as true, congenital epithelial, or epidermoid cysts and account for about 10% of all benign, non-parasitic splenic cysts.

They are the most common type of splenic cyst in children. Typically, splenic cysts are asymptomatic and are often discovered incidentally during imaging studies or during surgery.

Symptoms associated with splenic cysts are generally related to the size of the cyst. When these cysts grow large, they may cause sensations of fullness in the left abdomen, splenomegaly (enlargement of the spleen), local or referred pain, or in rare cases, thrombocytopenia (low platelet count). Complications can also arise, such as infection, rupture, and haemorrhage.

The preoperative diagnosis of primary splenic cysts is typically made using imaging techniques like ultrasonography, CT scans, and MRI scans. However, a careful histopathological evaluation, along with immunostaining to confirm the presence of an epithelial lining, is essential to arrive at a definitive diagnosis.

We would like to present the case of a 13-year-old boy who came to us with an abdominal lump and associated pain that had persisted for one month. Ultrasonography and a CT scan of the abdomen revealed a unilocular cyst measuring 8x7x6 cm, originating from the upper pole of the spleen. To address this, we performed a partial cystectomy, marsupialization, and omentoplasty to manage the condition.

Midgut Volvulus Secondary to Intestinal Malrotation in Adult Male: A Case Report and Mini Review

S. N. Jatal , Sudhir Jatal , Supriya Jatal , Ganesh Swami — Sat, 04 Nov 2023 00:00:00 +0000

Intestinal malrotation is a congenital anomaly that occurs due to abnormal rotation and fixation of the intestine when it returns to the abdominal cavity during fatal development. There have been only 92 documented cases of this condition in medical literature. The incidence of malrotation is approximately 1 in 6,000 live births. Most malrotation cases, about 60-80%, become evident in the first month of life, with 90% being diagnosed within the first year. Adult presentations of malrotation are exceedingly rare, accounting for only 0.2 to 0.5% of cases, and among these, only 15% present with midgut volvulus. The incidence of midgut malrotation in adults has been reported to be between 0.00011 and 0.19%. Most diagnoses of midgut malrotation in adults occur in asymptomatic patients, often through imaging investigations or incidental findings during surgeries for other medical issues.

Diagnosis of midgut volvulus is primarily established through various methods, with CT abdomen being the most common (67%), followed by ultrasonography (15%), and during exploratory laparotomy (18%). It's important to note that midgut volvulus is associated with a high risk of bowel ischemia and necrosis, as it affects the blood supply to the intestines through the mesenteric artery, resulting in a significant 5% mortality rate.

We are reporting an unusual case involving a 20-year-old male who was found to have midgut volvulus affecting his jejunum and small bowel. This condition was a consequence of congenital malrotation of the bowel. The patient underwent an exploratory laparotomy, during which the volvulus was corrected by detorsion, inter-mesenteric bands adhesiolysis, and an appendectomy was performed.

Juvenile Polyposis Syndrome Presenting as Intussusception in Adolescent Girl

S. N. Jatal , Sudhir Jatal , Supriya Jatal — Mon, 27 Nov 2023 00:00:00 +0000

Juvenile polyposis syndrome is a hereditary condition characterized by the presence of benign hamatomatous polyps in the gastrointestinal tract that typically develop before the age of 20. These polyps can range in number from 5 to 200 and often lead to symptoms such as gastrointestinal bleeding, anaemia, abdominal pain, and diarrhoea. Around 15% of individuals with juvenile polyposis syndrome also have other congenital anomalies, such as cleft palate, polydactyly, and abnormalities in the genital and urinary tracts. We are reporting a rare case of juvenile polyposis syndrome in an 18-year-old adolescent girl who presented with ileo-ileal intussusception. She was admitted to our centre as an emergency case due to acute intestinal obstruction caused by this condition. She underwent open surgery, which involved segmental small bowel resection with stapler anastomosis. During the surgery, the entire small bowel was examined, and numerous single polyps were removed through enterotomy and polypectomy.

Annular Pancreas with Intestinal Malrotation in 12 Years’ Girl: A Rare Case Report

S. N. Jatal, Sudhir Jatal , Supriya Jatal, Ganesh Swami — Fri, 01 Dec 2023 00:00:00 +0000

Annular pancreas is a congenital anomaly characterized by the presence of a ring of pancreatic tissue that partially or completely encircles the second part of the duodenum. This condition results from the failure of the vertical pancreatic bud to rotate properly, leading to its elongation and encircling of the upper section of the duodenum.

The first description of annular pancreas was made by Tiedemann in 1818, and the term "Annular pancreas" was coined by Ecker in 1982. In the normal development of the pancreas, the dorsal and ventral pancreatic buds fuse during the first 4-8 weeks of embryonic life. In cases of annular pancreas, the ventral bud fails to rotate as it should, causing it to elongate and encircle the upper part of the duodenum. This condition can affect individuals from neonates to the elderly, making it challenging to diagnose.

Diagnosing annular pancreas can be accomplished through various methods, including preoperative procedures such as upper GI endoscopy, Barium meal follow-through, CT and MRI scans, ERCP (endoscopic retrograde cholangiopancreatography), and endoscopic ultrasonography (EUS). In approximately 40% of cases, surgical intervention is necessary to confirm the diagnosis.

We present a rare case of annular pancreas in a 12-year-old girl who also had intestinal malrotation. She was experiencing frequent episodes of vomiting. Her diagnosis was confirmed through a Barium meal follow-through, which revealed a typical "Double bubble" sign. She underwent a gastrojejunostomy and a modified Ladd's operative procedure to address the condition.

Recent trends in Indocyanine Green Fluorescence Angiography in the Field of Neurosurgery

Suraj Ethiraj , Soumith Subhash , Udit Bagchi — Thu, 20 Jul 2023 00:00:00 +0000

The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “Recent trends in Indocyanine Green Fluorescence Angiography in the Field of Neurosurgery”. No formal abstract is available. Readers are requested to read the full article.

Non-Compliance with the Operating Program: Analyzing the Causes and Consequences: A Case Study

Tue, 23 May 2023 00:00:00 +0000

Background: Surgical scheduling in hospitals is critical to optimize surgical activity and ensure quality of care. Surgical scheduling can be affected by a variety of factors leading to cancellation or delay of surgical procedures, which can result in financial and personal hardship for patients and their families. The study aimed of to identify the incidence and causes of non-adherence to the surgical schedule in the operating room of the Mohammed V Military Teaching Hospital in Rabat, Morocco.

Methods: We analyzed the medical records of patients admitted for surgery over a 12-month period. Data collected included the number of scheduled, canceled, and added surgeries, epidemiological data of the patients, pathologies involved, reasons for cancellation and addition, and patient outcomes.

Results: We analyzed a total of 3023 scheduled surgeries, of which 215 (7.11%) were cancelled and 167 (5.6%) were added. Neurosurgery was the most frequently cancelled surgical specialty. The most common reasons for cancellation were infection, decompensation of a chronic pathology, and lack of availability of the operating room. Orthopedic surgery was also the most affected specialty in the added surgeries, mostly due to surgical emergencies. Our analysis of patient demographics revealed that the average age of cancelled surgery patients was 52.16 ± 14.6 years, with a male predominance of 63.25%. Based on ASA classification, 57.6% of patients were classified as ASA I, 33.48% as ASA II, and only 8.84% as ASA III. Medical and anesthesia-related causes accounted for 30 cancellations, with anesthesia contraindications (13.3%) and abnormal test results (40%) being the most common reasons. Surgery-related causes accounted for 22 cancellations, with non-availability of the surgeon (50%) being the most frequent reason. Patient-related causes accounted for 55 cancellations, with non-compliance with pre-anesthesia treatment (58.18%) being the most common reason. Organizational causes accounted for 108 cancellations, with equipment failure (40.7%) being the most frequent reason.

Conclusion: This review demonstrates that the main causes for surgery cancellation can be controlled by hospital managers, who can aim to improve areas such as patient flow and capacity management. Ultimately, this will improve the quality of health care delivered by hospitals.

Evaluating the Comparative Efficacy of Midazolam and Clonidine as Premedication Agents: Assessing Heart Rate Response and Anti-Sialogogue Effect in Patients Undergoing General Anesthesia

Tue, 06 Jun 2023 00:00:00 +0000

Aim and Objectives: The present study aimed to compare the efficacy of oral premedication with midazolam and clonidine in patients undergoing general anesthesia for various surgeries. The study evaluated the age distribution of patients, heart rate response following induction and intubation, and the anti-sialogogue effect of the two medications.

Materials and Methods: This randomized, interventional, single-centered study was conducted at Sadar Hospital, District of Chuadanga, Bangladesh, from August 2022 to January 2023. A sample size of 50 patients was included, with 25 patients in each group. Age distribution analysis revealed similar patterns in both groups, with a higher concentration in the middle-age ranges. Following induction and intubation, Group M (midazolam) exhibited significantly higher heart rates compared to Group C (clonidine). Group M also had a lower incidence of dry mouth, indicating a more effective anti-sialogogue effect compared to Group C.

Results: In our study, which included 50 patients divided into Group M and Group C, we found significant differences in heart rate response following induction and intubation. Group M exhibited higher heart rates compared to Group C, with mean values of 79±7.2 bpm and 78±4.7 bpm, respectively. These differences were statistically significant (p < 0.001). Moreover, the evaluation of the anti-sialogogue effect revealed that Group M had a significantly lower incidence of dry mouth compared to Group C, with only 3 patients experiencing dry mouth in Group M compared to 23 patients in Group C (p < 0.001). These results indicate that midazolam premedication leads to a stronger cardiovascular response and a more effective reduction in dry mouth symptoms compared to clonidine. These findings emphasize the importance of selecting the appropriate premedication to optimize patient outcomes during general anesthesia.

Conclusion: The study highlights the importance of considering the specific premedication agents used in patients undergoing general anesthesia. While midazolam may provide better sedation and anti-sialogogue effects, it should be administered cautiously due to its impact on heart rate. Clonidine may offer advantages in terms of hemodynamic stability but may be associated with a higher incidence of dry mouth. The findings provide valuable insights for anesthesiologists in selecting appropriate premedication to optimize patient care and improve perioperative outcomes.

Robotic Colorectal Surgery: A Single Tertiary Care Experience

Wed, 02 Aug 2023 00:00:00 +0000

Introduction: Over the past two decades, minimally invasive surgery has changed the perspective in the general surgery. The advantages of minimally invasive surgery are reduced postoperative pain, a shorter hospital stay, return to normal function, and better cosmesis.

Materials and Methods: This study includes 50 patients with clinically, radiologically, endoscopically, and pathologically confirmed adenocarcinoma who underwent robotic rectal cancer surgery.

Results: In this study of 50 patients who underwent Robotic rectal surgery we observed that the most common age group was above the age of 46 years with male predisposition. The most commonly performed Robotic surgery was Anterior Resection which was done in 43 among 50 patients. Commonly encountered T STAGE WAS T2 and T3 with 20 and 11 patients respectively, mean operative time in our study was 240 minutes and TME was performed more than in 95% of patients with median lymph node retrieval of 17. Analyzing the operative time BMI we found it to be statistically significant with P-value of less than 0.005 reflecting that less operative for patients lower BMI.

Conclusion: In this study we concluded that Robotic Rectal Surgery is safe, effective alternative in terms of short perioperative outcomes like reduced hospital stay, better recovery especially in lower BMI.

E-Cadherin Expression as a Cell Marker in Benign and Malignant Breast Lesions

Shalini Goswami , Rahul Kumar Giri , Afzal Anees — Wed, 09 Aug 2023 00:00:00 +0000

Background: Breast cancer continues to be a major cause of morbidity and mortality throughout the world. The behaviour of breast cancer varies widely. Several parameters have been investigated to predict the prognosis in breast cancer. But still there is no single parameter that can predict prognosis in an individual patient. Among the novel prognostic markers is E-cadherin; a calcium-dependent epithelial cell adhesion molecule. Its loss has been associated with metastases, thereby providing evidence for its role as an invasion suppressor. This study was conducted to evaluate the expression of E-cadherin as epithelial cell marker in the differential diagnosis of benign and malignant breast lesions and to evaluate it’s role as a diagnostic bio marker in breast cancer.

Methods: This prospective study was carried out from November 2020 to November 2022 in the Department of Surgery, at Jawaharlal Nehru Medical College, Aligarh, India. The study was conducted on 117 patients presenting with breast lesions. A detailed history, complete physical examination and preliminary investigations were done. Histopathological examination one on formalin fixed and paraffin embedded tissue sections of breast lesion. Immunostatins for E-cadherin were employed on cases. The data was collected and analyzed using SPSS 2020.

Results: Most of the patients were below 30years of age (36.7%) and the mean age was 38.1±16.9 years. 54 patients (46.4%) were benign and 63 patients (53.6%) were malignant. Out of a total of 63 malignant breast lesions, Infiltrating ductal carcinoma Not otherwise specified (IDC NOS) was most frequent, comprising 34 cases (53.9%). We stained cases of carcinoma breast for E-cadherin. Out of 15 cases of Grade 1 IDC NOS, 11 (73.3%) showed 3+ proportion score, 3 (20.0%) cases showed 2+ score, whereas 1(6.6%) case showed 1+ score. Out of 12 cases of Grade 2 IDC NOS, 6 (50.0%) showed 3+ and 5 (41.6%) showed 2+ proportion score and 1 case (8.3%) showing 1+ score. Out of 7 cases of Grade 3 IDC NOS, 6 (85.7%) cases showed 2+ proportion score and 1 case (14.2%) showed 1+, none showed 3+ score. A statistically significant finding (p=0.0059) was seen between grade and E-cadherin score. A statistically significant (p=0.0169) between E-cadherin scoring on benign and malignant cases overall implying stronger expression of E-cadherin in benign lesions as compared to malignant ones.

Conclusion: It is concluded that expression of E-Cadherin is associated with benign or malignant nature of breast lesion, with expression stronger in benign. It has a prognostic value in IDC grading.

Approach to Acute Appendicitis during Covid-19 Outbreak: One Year Experience of a Single Centre

Nurullah Damburacı , Barış Sevinç — Fri, 25 Aug 2023 00:00:00 +0000

Objective: After announcement of Covid-19 pandemic, elective surgeries were postponed, and all hospitals were reserved primarily for Covid-19 patients. Aim of this study is to evaluate the change in treatment trends of acute appendicitis during Covid-19 pandemic.

Materials and Methods: For this retrospective study patients diagnosed as acute appendicitis during the pandemic period and one year before the pandemic were evaluated. Diagnostic methods and treatment modalities were compared.

Results: During pandemic period number of cases diagnosed as acute appendicitis did not change with similar rates of complicated cases. During pandemic period 16.1% of the patients had medical treatment. During the one-year period before Covid-19 pandemic rate of patients having medical treatment was found as 7.2%.

Conclusion: During the pandemic period use of medical treatment for acute appendicitis significantly increased.

A Study on Risk Factors Associated with Anastomotic Leakage in Gastrointestinal Surgeries

Tue, 05 Sep 2023 00:00:00 +0000

Aims: To study the risk factors associated with anastomotic leakage in Gastrointestinal surgery and to study the measures by which these complications can be minimized and managed in a better way.

Study Design: This was a prospective observational study.

Place and Duration of Study: Conducted in the Post Graduate Department of Surgery, Government Medical College Jammu, over a period of one year from 1^st November 2019 to 31^st October 2020.

Methodology: 102 patients who had undergone gastrointestinal anastomosis irrespective of age and gender were included in the study. The patients were thoroughly evaluated and pre operative and post operative details were noted followed by analysis of risk factors associated with those who had anastomotic leaks pos operatively were analysed and results obtained.

Results: Distribution of anastomotic leak was comparable in elective and emergency (5.06% v/s8.70% respectively) .Proportion of anastomotic leak was significantly higher in >25 body mass index as compared to <25 body mass index (27.27% v/s3.30% respectively, significantly higher in anaemic (Hb<10gm%) as compared to non- anemic (Hb>10 gm%) (16.67% v/s2.56% respectively), higher in hypoalbuminemia (<3.5g/dL) as compared to patients with albumin (>3.5g/dL) (17.39% v/s2.53% respectively) .Proportion of anastomotic leak was significantly higher in patients with history of radiotherapy as compared to patients without history of radiotherapy (66.67% v/s 4.04% respectively). Comorbidities also contributed to higher rate of anastomotic leak (diabetes mellitus, hypertension, COPD, bronchial asthma, tuberculosis, malignancy and others) (25% v/s0% v/s33.33% v/s0% v/s16.67% v/s20% v/s0% respectively).

Prospective Assessment of the Prognostic Value of Different Nutritional Assessment Scores on Short-term Outcome after Emergency Colorectal Surgery

Ahmed Taher, Sherif A. Saber , Sherif M. Elgarf , Mohamed Abo Rayia — Wed, 13 Sep 2023 00:00:00 +0000

Background: Pre-operative nutritional state has a direct impact on complications following surgery and the prognosis of individuals with malignant tumors. It has been shown that enhancing perioperative nutrition may save costs while also improving clinical outcomes for patients having major gastrointestinal surgeries. As a result, individuals having significant abdominal surgery should have careful evaluation to their nutritional condition. So, accurate scoring method to detect patients with inadequate nutritional status has been looked for by several studies. The controlling nutritional status (CONUT) scoring, the nutrition risk index (NRI) and the prognosis nutritional index (PNI) are some of them. The objective of this research was to prospectively assess the prognostic effect of the PNI, the CONUT score and the NRI on postoperative wound problems following urgent colorectal cancer procedures.

Patients and Methods: This prospective research was conducted between November 2020 and June 2022 at Tanta University's emergency department, general surgery department, and gastrointestinal surgery unit. The research comprised thirty individuals who were hospitalized for emergency colorectal cancer procedures. We calculated the three scores (CONUT, PNI and NRI) after measuring the pre-operative blood albumin level, total peripheral lymphocyte number and serum cholesterol, and compared them to the post-operative result.

Results: Based on CONUT score: 38.89% patients had normal nutrition, 47.22% had light malnutrition, 13.89% had moderate malnutrition with a cut-off value 4.The mean value of NRI is 45.9 ± 2.95, and cut off value is 46.1. The mean value of PNI is 46.3 ± 5.68 and cut off value is 45.23.

Conclusion: This study revealed significant relation between PNI blew a cut-off value 45.2, low CONUT score blew a cut-off value 4, low NRI blew a cut-off value 46.1, and the development of postoperative complication after urgent surgeries for colorectal cancer with a diagnostic accuracy of 72%, 67% and 65%, respectively. PNI is superior to CONUT and NRI in predicting postoperative complications in urgent surgeries for colorectal cancer.

Geriatric Anesthesia: A Prospective Study on the Prevalence of Comorbidities and Associated Challenges in Elderly Surgical Patients in Bangladesh

Thu, 21 Sep 2023 00:00:00 +0000

Background: This study is built upon the understanding that ageing is a physiological phenomenon characterized by degenerative changes to organ and tissue structure and function. This physiological process can be seen in the geriatric population's heightened sensitivity to anaesthetic drugs, which often requires reduced dosage for desired clinical results. The complexities of the geriatric population necessitate specialized perioperative care plans to optimize patient outcomes. This study examines the difficulties associated with geriatric anaesthesia, focusing on anaesthesia-related intraoperative and postoperative problems in elderly individuals.

Objective: Geriatric anesthesia necessitates understanding, observing, and managing associated difficulties, risks, and co-existing conditions for optimal patient outcomes.

Methods: This research employs a prospective observational study design and was conducted at the Department of Anesthesia, Sadar Hospital, Chuadanga District, Bangladesh. A sample of 100 patients aged over 60 who received surgical treatments was studied. The patients were evaluated through medical history, physical examination, and necessary investigations were conducted. Data were analyzed using SPSS-25 software.

Results: The study's primary findings were that the most prevalent cardiovascular comorbidity was hypertension (40%), followed by emphysema as the most common pulmonary comorbidity (30%), and epilepsy and seizure disorders were the most common neurological conditions (22%). In addition, the age distribution revealed the majority (60%) of patients fell within the 66-70 years age bracket.

Conclusion: This prospective study highlights the high prevalence of co-existing medical conditions, especially hypertension, emphysema, and epilepsy in the geriatric population undergoing surgery in Bangladesh. Anesthesia management in the elderly is challenged by a higher susceptibility to complications such as intraoperative hypotension and postoperative delirium, particularly in the 70-79 age group. These findings underscore the importance of specialized perioperative care, meticulous preoperative evaluation, and targeted anaesthesia strategies to optimize outcomes in elderly surgical patients in resource-limited settings like Bangladesh.

Hydatid Disease: Long Term, Single Centre Experience

S. N. Jatal, Sudhir Jatal, Sachin Ingle — Wed, 27 Sep 2023 00:00:00 +0000

The objective of this study is to establish the diagnosis of hydatid disease and outline its surgical treatment approach. The origin of hydatid disease can often be attributed to the echinococcus granulosus tapeworm. While pulmonary hydatids have been linked to Echinococcus multilocularis. This type of infection has been extensively documented in various regions, including South Africa, South America, Iran, Australia, and New Zealand. Within India, cases of this disease have been reported in locations such as Punjab, Varanasi, Lucknow, Kashmir, Pondicherry, Madurai, and Himachal Pradesh.

The liver is the most common site for hydatid disease in 75% of cases, followed by the lung in 50% and 10% being reported in the kidney, spleen, peritoneal cavity, ovary, bones, brain and muscles. Diagnosis of hydatid disease is based on clinical signs and symptoms and radiological imaging studies.

eTEP RS Approach for Ventral Hernia - A Short Term Observational Case Series of Our Initial Experience

Anushtup De , Jaspreet Singh Bajwa , Chandraketu Solanki , Rishabh Jain — Sat, 07 Oct 2023 00:00:00 +0000

Background: There has been a significant increase in ventral hernia surgeries over the last few decades. The operative modalities have changed from open surgery to a wide variety of laparoscopic surgery procedures. Our objective of this study is to present the early clinical results of the procedure, its feasibility and key technical aspects.

Methods: This is a prospective short term 6 months analysis of 15 patients in our hospital who underwent eTEP RS surgery for small to medium size ventral hernias between December 2021 and December 2022. We performed an observational study of the feasibility and clinical outcome of the procedure and analysis of the data in terms of operative details, intraoperative and postoperative complications.

Results: Out of 15 patient, 1 patient required conversion to Open Rives Stoppa procedure and was excluded from the study. 14 patients underwent eTEP RS procedure. One patient required additional Transversus Abdominis Release (TAR) procedure for tension free posterior wall closure. The mean duration was 187.5 min and mean postoperative stay was 2.07 days. The mean defect size was 15.28 cm² and average mesh size 359.64 cm². At 6 months follow up, there was no recurrence on clinical examination. However 2 patients had seroma which was managed conservatively.

Conclusion: eTEP RS Procedure is a safe and effective procedure for ventral hernia repair. However surgeons need to have a reasonable skill and expertise in minimally invasive surgery with an understanding of anterior abdominal wall anatomy. Proper case selection in the initial few patients is important.

A Holistic Approach to Assess Patient Satisfaction and Experience at a Tertiary Gastrointestinal Surgery Center

Devendra, Hirdaya H. Nag — Tue, 17 Oct 2023 00:00:00 +0000

Aims: To assess the patient experience and overall satisfaction using a holistic approach in patient with gastro-intestinal and hepato-pancreato-biliary diseases managed at tertiary care center.

Place and Duration of Study: The study was conducted from January 2022 to December 2022 in a single unit of the Department of Gastrointestinal Surgery at G.B. Pant Hospital, New Delhi.

Methodology: A total of 216 patients participated in the feedback survey. The study design utilized a patient feedback questionnaire consisting of 20 multiple choice questions and two open ended questions. The Questionnaire was designed in a four point Likert scale format. Response to each question was scored from 1 to 4, score 1 being least satisfied and 4 for most satisfied and a cumulative score was then generated by adding scores of all the 20 questions (maximum score-80).

Results: A total of 216 patients participated in the feedback survey. Out of which 134 (62%) were female and 82 (38%) were male. The mean satisfaction score was 70.31(out of 80). The mean satisfaction score for males was 69.22 and for females 70.99, and the difference was not statistically significant (p = 0.254). The satisfaction score was 69.17 for patients with malignant disease as compared to those who had benign diagnosis; 70.94 (p = 0.262). A total of 176 patients had highest satisfaction with the care and checkups done by the treating surgical team and the mean satisfaction score for this group was 74.2 compared to the group who scored less than 4; 53.1 ( p = 0.001). Similarly patients who were highly satisfied with the time given by the doctors and the behavior of the treating surgical team had significantly higher mean satisfaction score as compared to the patients who were less satisfied ( p = 0.001).

Conclusion: The clinical outcomes alone are not an indicator of patient’s experience during his or her hospital stay. Hence a well-designed feedback form including factors other than the clinical outcomes leads to a more complete assessment of patient satisfaction and experience.

Tailoring Gynecological Surgical Techniques to Bangladeshi Patients: A Cross-Sectional Study Assessing Global Advancements, Local Challenges, and Post-Operative Outcomes

Sat, 25 Nov 2023 00:00:00 +0000

Background: Gynecological surgical techniques have seen significant global advancements in recent years. This study aimed to understand the degree to which these innovations align with the unique socio-cultural, anatomical, and physiological challenges of Bangladeshi patients and to assess the efficacy of locally adapted procedures.

Methods: A cross-sectional study was conducted with a sample size of 1492 Bangladeshi women, focusing on their awareness of global advancements, the unique challenges they face, the local adaptations of surgical techniques they underwent, and post-operative outcomes.

Results: 56.4% of participants reported awareness of global advancements. Major challenges identified were socio-cultural barriers (43.6%) and anatomical/physiological concerns (38.7%). 65.1% underwent surgeries with local adaptations, especially prevalent in rural areas (72.4%). Surgeries with local adaptations showed a 92% success rate, reduced post-operative complications, and shorter average recovery time by 2 days compared to standardized global techniques.

Conclusion: While global innovations in gynecological surgeries provide foundational knowledge, the superior outcomes of locally adapted techniques emphasize the importance of tailoring these advancements to the specific needs and challenges of Bangladeshi patients. The study underscores the paramount significance of contextualizing medical interventions to optimize health outcomes in diverse settings.

Enteric Duplication Cyst Presenting as Volvulus: Two Case Reports

Sopan N. Jatal , Sudhir Jatal , Sachin Ingle — Wed, 26 Jul 2023 00:00:00 +0000

Enteric duplication cysts are congenital malformations of the gastrointestinal tract. As the name duplication cyst suggests, which mimics the native gastrointestinal tract, having all the three layers of the gastrointestinal tract. Enteric duplication cyst most frequently occurs in the small bowel, particularly the ileum, but can occur anywhere along the gastrointestinal tract from tongue to rectum. An incidence of 1 in 4500 births, with a slight male preponderance. 80 % of the duplication cysts are symptomatic within first 2 years of life. Due to the varied clinics presentation, radiological evaluation is required for the diagnosis.

Herein, we are reporting two cases of enteric duplication cyst. The first case of 25 years old male patient presented to our center, with the features of acute intestinal obstruction due to volvulus. He was having a duplication cyst at the terminal ileum, causing volvulus. Treated by explorative laparotomy and second case of a 7 years old boy, diagnosed on CT scan, as an enteric duplication cyst, was treated by laparoscopic surgery.

Primary Hydatid Cyst of the Breast: A Mini Review

S. N. Jatal, Sudhir Jatal, Sachin Ingle — Sat, 26 Aug 2023 00:00:00 +0000

Hydatid cyst of the breast is a very rare only few cases of breast hydatid cyst are published and majority of the reported cases have been diagnosed post operatively. Hydatid disease is parasitic infection caused by echinococcus granulosus. The definitive host is dog, intermediate host is sheep and human are accidental intermediate hosts. Hydatid disease is endemic in many parts of the world such as middle east Africa, South America, New-Zealand, Australia, Iran, Iraq and Turkey. In India highest prevalence is reported in Andhra Pradesh, Tamil Nadu and Jammu and Kashmir.

Common location of hydatid cyst is liver (75%) and Lungs (15%) while unusual location like kidney, spleen, pancreas, heart, brain, bones, thyroid and muscles including the remaining 10% cases. Breast is very rare site for hydatid disease, accounting for 0.27% of cases.

We are reporting a rare case of hydatid cyst of the breast in a 40 years old female, patient having painless lump at left upper quadrant of the breast since one year. On ultrasonography diagnosed a benign simple cystic lump in the left breast. Intraoperative revealed the cystic lump was containing hydatid cyst with multiple daughter cysts, so we performed complete excision of the cyst with wide margin and pericystectomy was done.

Primary Hydatid Cyst of the Thigh – A Case Report

S. N. Jatal, Sudhir Jatal, Sachin Ingle — Sat, 26 Aug 2023 00:00:00 +0000

Hydatid cyst is caused by the dog tapeworm echinococcus granulosus. Hydatid cysts are most frequently found in the liver (75%) and lungs (15%) and 10% occur in any part of the human body. Primary muscular hydatidosis is very rare and occurs in 1-4% in of all hydatidosis. The localizations of hydatid cyst in muscles is rare 0.7-0.9% even in endemic countries. Muscular hydatidosis is rare, because of muscle lactic acid content and muscle contraction, there two factors that likely prevent cyst growth in striated muscles.

Muscle hydatid disease most often manifests as a slow growing soft-tissue tumour and mostly present with a painless growing mass. However, the cyst is clinically asymptomatic and diagnosed incidentally. The most common skeletal muscle sites include the hip and thigh and the shoulder and humours regions.

We report a rare case of primary hydatid cyst of the right thigh in a 32 years’ male patient, with asymptomatic thigh mass and diagnosed on ultrasonography. We performed total surgical excision of the mass with pericystectomy, and Albendazole therapy was given preoperative and postoperatively.

Transmesenteric Internal Hernia Presenting with Strangulation of Bowel in Adult- A Case Report

S. N. Jatal , Sudhir Jatal, Sachin Ingle — Mon, 18 Sep 2023 00:00:00 +0000

A congenital transmesenteric hernia is a rare condition characterized by the presence of a congenital defect in the mesentery, allowing bowel loops to herniate through the mesenteric defect. This herniation can lead to bowel strangulation and small bowel obstruction. While more frequently observed in the paediatric population, it is exceptionally uncommon in adults. Overall, internal hernias have an incidence of 0.2 to 0.9%, and congenital transmesenteric hernias make up only 5-10% of all internal hernias. As of May 2016, there were only 18 reported cases of adult congenital transmesenteric hernias in the medical literature. This condition presents with recurrent abdominal pain or acute intestinal obstruction, often accompanied by a mortality rate exceeding 50%. Early intervention and surgical treatment are crucial to prevent severe morbidity and mortality.

We present the case of a 21-year-old female who complained of severe abdominal pain, constipation, and two days of bilious vomiting. Ultrasonography and plain X-rays indicated acute intestinal obstruction. An emergent laparotomy revealed a transmesenteric internal hernia with strangulated small bowel. Fortunately, there was no evidence of gangrene. We successfully untwisted the small bowel and reduced it through the large congenital terminal mesenteric defect. A simple repair of the mesenteric defect was performed.

Surgical Treatment of Anal Incontinence after Cure of a Post-Partum Recto Vaginal Fistula: A Case Report from the "A" Surgery Department of the IBN Sina Hospital in Rabat, Morocco

Mon, 25 Sep 2023 00:00:00 +0000

Anal incontinence is defined as the repeated involuntary loss of rectal contents (solid or liquid faeces, gas or mucus and phlegm) in patients over the age of 3 years who have been incontinent for at least 1 month. In women, the most common cause is obstetric trauma. Diagnosis is based on endoanal ultrasound and anorectal manometry.

We report the case of a 48-year-old woman who underwent surgery for a recurrent rectovaginal fistula and developed postoperative anal incontinence. The diagnosis was made by endorectal manometry. We performed anterior sphincterography, which was enhanced by bringing the anal sphincter muscles closer together, with a simple post-operative follow-up. Despite the fact that this condition is considered shameful, it is still necessary to consult a specialist in order to obtain the best possible treatment and a better quality of life.

Strangulated Pericecal Internal Hernia –Two Case Reports

S. N. Jatal , Sudhir Jatal , Supriya Jatal — Thu, 05 Oct 2023 00:00:00 +0000

A Pericecal hernia is a relatively uncommon form of internal hernia, accounting for only 6-13% of all cases of abdominal internal hernias. It presents with clinical symptoms that closely resemble appendicitis, often causing severe lower abdominal pain and potential complications. This type of hernia occurs due to a defect in the mesentery of the cecum, which can be either congenital or acquired. The most prevalent subtype of Pericecal hernia is the retrocecal hernia, where ileal loops herniate through a defect in the cecal mesentery and the right paracolic gutter. These hernias typically develop within one of four peritoneal fossae: the superior ileo-cecal, inferior ileo-cecal, retro-cecal, and paracolic sulci. Pericecal hernias are also referred to as ileo-colic, retrocecal, ileocecal, or paracecal hernias.

Diagnosis of a Pericecal hernia is often made through abdominal CT scans, which reveal a cluster of bowel loops, typically ileal, located posteriorly and laterally to the normal cecum, extending into the right paracolic gutter. These hernias can lead to small bowel obstruction and displace the cecum anteriorly and medially. Early diagnosis and surgical intervention are crucial to prevent complications.

We present two cases of Pericecal internal hernia: one involving a 9-year-old boy and the other a 35-year-old male patient. Both patients exhibited symptoms of small bowel obstruction. Abdominal CT scans confirmed the presence of a Pericecal hernia with a strangulated small bowel. Exploratory laparotomy revealed the strangulated Pericecal hernia, which was successfully treated through manual hernia reduction and repair of the mesenteric defect.

Obstructed Inguinal Littre’s Hernia: A Case Report and Mini Review

Sopan N. Jatal , Sudhir Jatal , Sachin Ingle — Thu, 02 Nov 2023 00:00:00 +0000

Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. Any hernia sacs containing Meckel’s diverticulum is called Littre’s hernia. This term was coined after the pioneering work of Alexis Littre, a French surgeon, who, in the 1700s, documented three instances of femoral hernias containing a small bowel diverticulum. Since then, hernias encompassing Meckel's diverticulum have been designated as Littre's hernias. It's a relatively rare variation, making up approximately 10% of all complications associated with Meckel's diverticulum. Among Littre's hernias, around 50% occur in the inguinal region, 20% in the femoral region, 20% in the umbilical region, and the remaining 10% in other locations. Due to its infrequent occurrence, Littre's hernia is usually not suspected, and preoperative diagnosis is unlikely.

We would like to present a unique case involving a 20-year-old boy with an incarcerated Littre's hernia in the right inguinal region, which was effectively managed through wedge resection of the Meckel's diverticulum followed by hernia repair.

The Implications of AI in Optimizing Operating Theatre Efficiency

Fri, 01 Sep 2023 00:00:00 +0000

Operating theatre efficiency remains a crucial concern within health care systems, directly influencing the timeliness and effectiveness of surgical care. However, persistent challenges like surgical delays, suboptimal scheduling, and inefficient resource allocation persist. Artificial Intelligence (AI) has emerged as a promising avenue to address these challenges and optimize operating the atre efficiency. This article provides an in-depth exploration of the implications of AI in improving surgical punctuality, scheduling precision, and resource allocation.

Key components of AI-driven strategies encompass machine learning models, intelligent management systems, and optimization algorithms. Notably, recent research demonstrates that machine learning models exhib it remarkable accuracy in predicting surgical case durations, leading to improved surgical punctuality. Simultaneously, intelligent management systems play a pivotal role in facilitating streamlined surgical scheduling, patient flow management, and optimizing resource distribution. Furthermore, the application of optimization algorithms, including genetic algorithms, is instrumental in resolving intricate scheduling dilemmas and curtailing waiting times.

The integration of AI into efforts to enhance operating theatre efficiency heralds numerous benefits, including elevated patient care standards, reduced costs, and heightened operational efficiency. However, challenges pertaining to data quality, interpretability, and organizational adaptability need rigorous addressing. Ethical and legal considerations, encompassing patient privacy, data security, and algorithm icbias, also prominently emerge with AI's use in healthcare. To harness AI's full potential, future advancements should focus on real-time data analytics, predictive modeling, and autonomous decision-making. This article's finding sunder score AI's transformative impact on optimizing operating theatre efficiency, while emphasizing the need for well-defined ethical guidelines and comprehensive regulations to ensure responsible implementation.

The Differences between Facial Aesthetics Improvements of Patients with Unilateral Cleft Lip & Palate with Bilateral CLP

Somar Hassan Ali — Wed, 15 Nov 2023 00:00:00 +0000

This literature review summarizes a series of studies on facial aesthetics improvements in individuals with unilateral and bilateral cleft lip and palate conditions. These studies assess surgical techniques, patient satisfaction, and treatment outcomes. Notably, a 2-stage palatoplasty technique with a vomer flap is found to yield favorable results for unilateral cleft lip and palate patients, underlining its reliability. Additionally, patient satisfaction is explored, revealing variations between self-assessment and clinical evaluations. The aesthetics of the nasolabial region have improved over several decades for individuals with bilateral cleft lip palate, with notable differences based on gender and professional background. The effectiveness of the computer-aided design and nasoalveolar molding for people with bilateral cleft lip/palate is also investigated, showing promising results for both modalities. Finally, the impact of the Latham-Millard protocol on dental occlusion is examined, revealing a higher prevalence of crossbites, particularly anterior crossbites, compared to conservative treatments, with statistical significance in most cases. These studies provide valuable insights into the aesthetics and treatment outcomes for individuals with cleft lip and palate conditions.

Effects of the Combination of Neoadjuvant Immunotherapy with Chemotherapy versus Placebo with Chemotherapy on Pathologic Complete Response in Early Triple-Negative Breast Cancer: A Systematic Review

Hendra Aditama , Dampit Pinaluki — Tue, 16 May 2023 00:00:00 +0000

Introduction: One of the most aggressive forms of breast cancer is triple-negative breast cancer (TNBC). TNBC has a poor prognosis and limited therapeutic options. Therefore, therapeutic intervention is strongly suggested when treatment with the intention of cure is still possible. Chemotherapy and immune checkpoint inhibitors have already been utilized to raise the pathologic complete response (pCR) rates in early-stage TNBC patients.

Objectives: The study aims to assess the efficacy of neoadjuvant immunotherapy in combination with chemotherapy, in the early-stage TNBC, with the primary endpoint of pCR (ypT0/is ypN0).

Methods: The medical term “Immunotherapy”, “Pembrolizumab”, “Atezolizumab”, “Durvalumab”, “Neoadjuvant treatment”, and “Triple-negative breast cancer”, were used in Pubmed and Google Scholar to discover studies of the efficacy of immunotherapy combined with chemotherapy in early-stage TNBC by following the PICO framework up to January 2023. All phase 1, 2, and 3 clinical studies demonstrating safety and efficacy data were included. Two independent reviewers excluded the non-RCTs and other clinical studies irrelevant to the study question. Five remaining studies were reviewed and screened for the inclusion criteria, based on the relevance to the study subject and clinical outcomes.

Results: Based on five studies included in this review, a combination of immunotherapy (pembrolizumab, atezolizumab, or durvalumab) with chemotherapy has shown superior effects of increasing pCR rates, compared to the chemotherapy alone, regardless of PD-L1 status, in early-stage TNBC. Adverse events were not more frequently reported with the immunotherapy compared to placebo.

Conclusions: A combination of neoadjuvant immunotherapy with chemotherapy has revealed superior effects of increasing pCR rates, compared to the chemotherapy alone in early-stage TNBC, irrespective of PD-L1 status, with an acceptable safety profile. However, further studies are needed to explore this issue.

The Effects on Surgical Gastorintestinal Diseases Urgent Due to the Covid-19 Pandemic

Fri, 28 Jul 2023 00:00:00 +0000

Aim: Know the impact of COVID-19 on emergency gastrointestinal surgeries in Mexico and the world and the possible complications that the pandemic could cause in post-surgical results.

Results: From its beginnings in 2019 in China, until the start of the pandemic declared by the WHO in March 2020, it caused changes in health care. Following the COVID-19 outbreak, COVID restrictions were implemented in Mexico on March 24, 2020, 26 days after the outbreak. The operation of the emergency surgery service had to continue to avoid an increase in morbidity and mortality in the population, but this was not the case for the elective surgery service, which canceled its activities to focus on the care of the COVID patient. For this reason, knowing the impact that the pandemic has generated in emergency services on perioperative results has been a priority. Systematic reviews have found that around 50% of articles recommend postponing elective surgeries, but 13% do not offer recommendations regarding this, with the conclusion that surgery is postponed as long as possible. There is no discussion of the benefit generated by emergency laparoscopic surgery versus open surgery in gastrointestinal diseases. It is important to note that there is no evidence of aerosolization risk of the virus during pneumoperitoneum and surgery.

Conclusion: During the pandemic there were changes in the health environment, complications were found in patients due to the delay in attending, diagnosing and treating these pathologies, it being of vital importance to initiate in each country a medical-surgical protocol on how to act in the event of a pandemic.

Audit on Patients Admitted with Fresh PR Bleeding Due to Non-Anal Causes

V. B. Pathirana — Wed, 15 Nov 2023 00:00:00 +0000

Aim: To audit the diagnoses, management and outcome of patients presenting with fresh PR bleeding due to non-anal causes.

Place and Duration: Emergency Surgical ward – National hospital Sri Lanka – 2019 November to 2020 October.

Methodology: All patients admitted with acute fresh PR bleeding were identified from patient records during this time period and based on final diagnosis, patients with anal causes, post-surgical/ polypectomy patients, known cancer patients and traumatic causes were excluded. Comorbidity, drop of haemoglobin, duration of hospital stay, imaging and colonoscopy findings, management and outcome data were collected from the records with patient consent.

Results: 18 patients were included in the study, and there were two [11.1%] patients with small bowel causes and 3 with no identified cause for the bleeding. Colitis was the commonest colonic cause of bleeding among the patients. CT and colonoscopy are complementary to each other in diagnosing the cause for bleeding with good diagnostic yield. Overall patients had good outcomes with conservative management and majority of patients [66.7%] were managed without blood transfusion. A drop of haemoglobin was the only factor shown significantly associated with a hospital stay [P< 0.003]. Age, comorbidities did not show such association.

Conclusion: Most of the time fresh bleeding due to colonic causes can be managed conservatively and non-colonic causes often need surgical intervention. A drop of haemoglobin is the main factor that determined the hospital stay.