Asian Journal of Research in Surgery

Diagnostic Dilemma of Radiopaque Lesion: A Series of Two Cases of Complex Odontoma

Sharanbasappa Japatti, Prashant Chopda, Yash Nawali, Shubham Patade — Tue, 02 Jun 2026 00:00:00 +0000

Complex odontomas are benign odontogenic hamartomatous lesions composed of enamel, dentin, cementum, and pulp tissue arranged in a disorganized pattern. They are usually asymptomatic and are commonly detected incidentally during routine radiographic examinations. However, erupting complex odontomas associated with pain, infection, cortical perforation, and impaction of adjacent teeth are uncommon and may present a significant diagnostic dilemma because of their resemblance to other mixed radiopaque lesions of the jaws. This case series presents two rare cases of erupting complex odontoma involving the mandibular posterior region in young patients aged 19 and 17 years. Both cases were associated with pain, swelling, and eruption disturbance of the mandibular second molar. Cone Beam Computed Tomography (CBCT) revealed large radiopaque masses associated with impacted teeth and close approximation to the inferior alveolar nerve. Surgical excision of the odontomas along with removal of the associated impacted molars was performed successfully under local anaesthesia. Histopathological examination confirmed the diagnosis of complex odontoma. Postoperative healing was satisfactory, with only minimal transient paraesthesia observed in one case. These cases highlight the importance of detailed radiographic evaluation, particularly CBCT, in establishing an accurate diagnosis and surgical plan for large radiopaque lesions of the jaws. Early diagnosis and timely intervention are essential to prevent complications such as cortical perforation, infection, pathological fracture, and nerve compression, thereby ensuring favourable functional and aesthetic outcomes.

Clinical Presentations and Surgical Outcomes in Patients with Spondylitis Tuberculosis: A Case Series

I Made Yedi Wisnawan, I Gusti Lanang Ngurah Agung Artha Wiguna — Mon, 13 Jul 2026 00:00:00 +0000

Aims: To describe the clinical presentations, diagnostic findings, surgical indications, and available postoperative outcomes of patients with spinal tuberculosis who underwent surgical management with debridement or decompression, stabilisation, and fusion.

Study Design: Retrospective case series.

Place and Duration of Study: Department of Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia. The study period was based on the treatment and follow-up data available in the medical records.

Methodology: Three patients aged 17, 24, and 34 years with clinically and radiologically suspected spinal tuberculosis were included. Demographic data, symptoms, neurological findings, radiological features, microbiological and histopathological results, surgical management, perioperative complications, and available postoperative information were reviewed. Diagnosis was interpreted using clinical presentation, magnetic resonance imaging, polymerase chain reaction testing for tuberculosis, culture results, and histopathological findings.

Results: All three patients presented with back pain and pathological vertebral fracture. Two patients had neurological involvement described clinically as sensory symptoms or lower-limb weakness; standardised ASIA or Frankel grades were not recorded. Magnetic resonance imaging showed vertebral destruction, deformity, canal compromise, and abscess formation in selected cases. All patients underwent decompression or debridement with stabilisation and fusion, together with biopsy and culture. No perioperative complications were documented. Cultures showed no growth in all cases, polymerase chain reaction testing for tuberculosis was positive in all cases, and histopathology showed chronic granulomatous inflammation in one patient and non-specific chronic inflammation in two patients. Follow-up duration and objective postoperative radiological fusion findings were not consistently documented.

Conclusion: In this small case series, surgery was used as an adjunct to antituberculosis therapy in selected patients with spinal tuberculosis complicated by pathological fracture, instability, deformity, abscess formation, or neurological involvement. The findings should be interpreted cautiously because only three patients were included and objective long-term radiological outcomes were limited. Larger studies with standardised neurological grading, defined follow-up, and postoperative radiological assessment are needed.

Port-Site Complications Following Laparoscopic Gynaecological Surgery: An experience from a Camp-Based Surgical Setting

Jahar Lal Baidya, Arup Laha, Pratap Sanyal, Tapan Majumder — Sat, 06 Jun 2026 00:00:00 +0000

Background: Gynaecological laparoscopy has become the standard of care for a wide range of benign and malignant conditions. Despite its advantages, port site complications remain a source of morbidity and concern for both patients and surgeons.

Aim: To determine the morbidity associated with port-entry complications during gynaecological laparoscopy.

Materials and Methods: This study included 739 patients undergoing laparoscopic procedures for various gynaecological indications between May 2013 and January 2020. Demographic data, surgical details, and postoperative outcomes were recorded. Port site complications were classified according to CDC and NNIS definitions. Microbiological evaluation (Gram stain, AFB stain, GeneXpert, culture sensitivity, biopsy) was performed when indicated. Statistical analysis was conducted using SPSS v15.0.

Results: Of 739 laparoscopic procedures, 18 patients (2.44%) developed port site complications. The most frequent complication was port site infection (n=13; 1.76%), of which 9 were due to atypical mycobacteria (Mycobacterium fortuitum, M. chelonae). Other complications included abdominal wall vessel injury (n=2), ecchymosis (n=2), and omental entrapment (n=1). Port site complications showed a statistically significant association with the type of laparoscopic procedure performed (p = 0.004), indicating that the occurrence of complications varied meaningfully across different surgical categories. Port site infections were most common at the left lower secondary port. All aerobic infections responded to sensitive oral antibiotics, while atypical mycobacterial infections required prolonged second‑line antimicrobial therapy and surgical exploration in selected cases.

Conclusion: Port site complications in gynaecological laparoscopy are infrequent but can be clinically significant. Port site infections, particularly those caused by atypical mycobacteria, are the most agonising for patients and surgeons. Strict adherence to aseptic protocols, meticulous sterilisation of reusable instruments, and early recognition with appropriate antimicrobial therapy are essential to minimise morbidity.

Analysis of Risk Factors Associated with Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy: Experience from a Tertiary Care Center

Thu, 11 Jun 2026 00:00:00 +0000

Background: Pancreaticoduodenectomy (PD) remains the standard surgical procedure for malignant and selected benign lesions involving the pancreatic head and periampullary region. Although advances in surgical techniques and perioperative care have substantially reduced postoperative mortality, morbidity remains high. Postoperative pancreatic fistula (POPF) is one of the most common and clinically significant complications following PD and is associated with prolonged hospitalization, increased healthcare costs, and mortality. This study aimed to identify risk factors associated with POPF following pancreaticoduodenectomy in a tertiary-care center.

Methods: This prospective observational study was conducted in the Department of Hepatobiliary Surgery, National Institute of Gastroenterology and Hospital, Dhaka, Bangladesh, from January 2025 to December 2025. Fifty consecutive patients who underwent pancreaticoduodenectomy were included. Patients were categorized into two groups: Group A (without POPF) and Group B (with POPF). Demographic, clinical, laboratory, operative, and postoperative variables were analyzed. Risk factors associated with POPF were evaluated using univariate and multivariate logistic regression analyses. A p-value of less than 0.05 was considered statistically significant.

Results: Among the 50 patients included, 42 (84.0%) did not develop POPF, whereas 8 (16.0%) developed POPF. Clinically relevant POPF (Grade B/C) occurred in 6 patients (12.0%). The mean age of the study population was 53.4 ± 8.6 years, and most patients were male. Periampullary carcinoma was the most common indication for surgery (70.0%). Patients who developed POPF had significantly lower serum albumin levels (2.9 ± 0.4 vs. 3.6 ± 0.5 g/dL, p=0.002), a higher prevalence of pancreatic duct diameter <3 mm (75.0% vs. 11.9%, p=0.001), and a greater frequency of soft pancreatic texture (62.5% vs. 9.5%, p=0.001). Operative time, intraoperative blood transfusion, postoperative hospital stay, and mortality were significantly higher in the POPF group. Grade B fistula was the most common subtype (62.5%). On multivariate analysis, soft pancreatic texture (OR 4.81, 95% CI 2.12–9.74; p=0.001), pancreatic duct diameter <3 mm (OR 3.72, 95% CI 1.89–7.45; p=0.001), serum albumin <3 g/dL (OR 2.97, 95% CI 1.54–5.84; p=0.001), and type of pancreatojejunostomy (OR 2.41, 95% CI 1.38–4.62; p=0.001) were identified as independent predictors of POPF.

Conclusion: The incidence of POPF following pancreaticoduodenectomy was 16.0%, while clinically relevant POPF occurred in 12.0% of patients. Soft pancreatic texture, pancreatic duct diameter <3 mm, low preoperative serum albumin level, and the type of pancreatojejunostomy were identified as independent predictors of POPF. Careful preoperative optimization and appropriate reconstruction techniques may reduce the occurrence of POPF. Larger multicenter studies are required to validate these findings.

Predictors of Delayed Extubation Following Paediatric Cardiac Surgery: A Retrospective Study

Sat, 13 Jun 2026 00:00:00 +0000

Background: Early extubation after paediatric congenital cardiac surgery is an important component of fast-track perioperative management and may reduce ventilator-associated complications, shorten intensive care unit (ICU) stay, and improve postoperative recovery. Identification of factors associated with successful early extubation may help optimize perioperative care and patient selection.

Aim: To identify preoperative, intraoperative, and postoperative factors associated with early versus delayed extubation after paediatric congenital cardiac surgery.

Methods: This retrospective observational study included 57 paediatric patients undergoing congenital cardiac surgery between 2023 and 2024 at Queen Alia Heart Institute (QAHI), a tertiary cardiac centre in Amman/Jordan. Patients were categorized into early extubation (including on-table extubation) and delayed extubation groups. Demographic, operative, and postoperative variables were analysed, including age, surgical complexity, cardiopulmonary bypass (CPB) duration, aortic cross-clamp time, ICU stay, and haematocrit changes. Statistical analysis was performed using independent t-tests, Mann–Whitney U tests, Chi-square tests, and Fisher’s exact tests.

Results: Early extubation was achieved in 22 patients (38.6%), including 7 patients (31.8%) who underwent successful on-table extubation, while delayed extubation occurred in 35 patients (61.4%). Delayed extubation was significantly associated with younger age (newborns and neonates) (p=0.041), complex cyanotic congenital heart disease (p=0.011), prolonged CPB duration (81.4 ± 67.2 vs 43.9 ± 28.4 minutes, p=0.021), longer aortic cross-clamp time (47.2 ± 31.5 vs 24.7 ± 14.1 minutes, p=0.031), and high-complexity procedures including Tetralogy of Fallot repair, arterial switch operations, Glenn procedures, and TCPC procedures (p=0.009). Early extubation was associated with significantly shorter ICU stay (2.1 ± 1.2 vs 5.4 ± 2.8 days, p=0.004). On-table extubation was strongly associated with simple acyanotic heart lesions and successful fast-track recovery (p<0.001).

Conclusion: Early extubation after paediatric congenital cardiac surgery is feasible and safe in selected patients. Low body weight was an independent predictor of delayed extubation, while lower surgical complexity and shorter cardiopulmonary bypass duration favoured successful fast-track recovery.

Reliability and Safety of 1% Methylene Blue for Sentinel Lymph Node Localisation: A Prospective Study

Swapandeep Kaur, Manjit Singh Uppal, Prabhjot Kaur Gill — Wed, 24 Jun 2026 00:00:00 +0000

Aim: The present study evaluates the feasibility and diagnostic performance of 1% methylene blue dye for sentinel lymph node localisation in patients with clinically node-negative early-stage breast cancer.

Study Design: Hospital-based prospective study.

Place and Duration of Study: Department of Surgery, SGRDIMSR, Amritsar, from July 2024 to December 2025.

Methodology: This prospective study included 69 female patients aged 25 years and above with operable early-stage breast cancer classified as T1-T2 and clinically node-negative. Patients underwent sentinel lymph node mapping using 2-5 ml of 1% methylene blue dye injected intradermally or subdermally in the peritumoral region, followed by sentinel lymph node identification and excision. Histopathological findings from sentinel lymph nodes were compared with final axillary lymph node status. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, false-negative rate, and false-positive rate.

Results: Sentinel lymph node identification was successful in 66 of 69 patients, giving an identification rate of 95.6%. The largest age group was 41-50 years, comprising 24 patients (34.78%). Invasive ductal carcinoma was the most frequent histological subtype, observed in 56 patients (81.16%), and most tumours were T2 lesions, reported in 56 patients (81.15%). Among the 66 evaluable patients, sentinel lymph node status correctly predicted axillary nodal status in 48 cases. Sensitivity was 77.42%, specificity was 68.57%, positive predictive value was 68.57%, negative predictive value was 77.42%, and overall diagnostic accuracy was 72.73%. The false-negative rate was 22.58%.

Conclusion: Methylene blue dye demonstrated a high sentinel lymph node identification rate in clinically node-negative early breast cancer. However, the observed false-negative rate indicates that negative sentinel lymph node findings should be interpreted cautiously. Larger comparative studies are needed to further evaluate its clinical utility.

Epidemiological Factors, Comorbidities, and Treatment Outcomes of Diabetic Foot Ulcers: A Cross-Sectional Study from a Tertiary Care Hospital in Mumbai, India (2021–2024)

S. K. Nijesh, Ashok Kumar Sharma, Thirunavukkarasu Sivashankari — Fri, 26 Jun 2026 00:00:00 +0000

Foot complications are serious consequences of diabetes mellitus and pose substantial medical and economic burdens. This study was conducted to evaluate the association of epidemiological factors, comorbidities, and complications with diabetic foot ulcers and treatment outcomes among patients who presented to Jagjivan Ram Railway Hospital, Mumbai, from January 2021 to December 2024. A total of 1,863 patients aged 18 years and above with peripheral complications of diabetes were selected from the medical and surgical wards and outpatient departments during the study period. Data were collected from medical records, examined, and systematically analysed in relation to risk factors such as age, gender, and associated complications. The results showed that males had a higher occurrence of peripheral complications of diabetes than females; however, there was no significant association between gender and the treatment outcome of diabetic foot ulcers. Associated complications, including peripheral neuropathy, atherosclerosis, and peripheral vascular disease, showed a significant association with treatment outcome (OR 2.01) [Table 4]. Patients without comorbidities had better treatment outcomes than those with complications. Age was also significantly associated with treatment outcome; patients older than 60 years had poorer outcomes than patients aged 60 years or below (OR 1.63, p < 0.001) [Table 6]. These findings support early risk stratification, multidisciplinary care, and intensified monitoring to reduce poor outcomes among patients with diabetic foot ulcers.

Clinical Profile, Surgical Outcomes, and Long-term Follow-up in Children with Esophageal Achalasia: A Retrospective Study of 22 Cases

Tue, 30 Jun 2026 00:00:00 +0000

Background: Oesophageal achalasia (EA) is a rare primary motility disorder of the oesophagus characterised by absent oesophageal peristalsis and incomplete relaxation of the lower oesophageal sphincter (LES). In children, diagnosis is frequently delayed because of an atypical and polymorphic clinical presentation.

Objectives: To describe the epidemiological, clinical and paraclinical profiles of children operated on for oesophageal achalasia in our department, analyse the outcomes of surgical management, and evaluate long-term outcomes.

Materials and Methods: This was a single-centre retrospective study of 22 children who underwent surgery for oesophageal achalasia at the Department of Paediatric Surgery, University Hospital Centre Hassan II, Fez, between January 2009 and December 2023. Of these patients, 18 were included in the actuarial follow-up analysis (median follow-up: 6.7 years; range: 21 days-15 years). All patients underwent Heller seromyotomy combined with anterior Dor-type fundoplication: 11 by laparotomy and 11 by laparoscopy.

Results: The median age at surgery was 6.5 years, with a male predominance (sex ratio: 1.4). Six patients (27%) had Allgrove syndrome. Chronic vomiting was the dominant symptom (95%). Oesophageal dilation was confirmed by upper gastrointestinal endoscopy in 95% of patients; EGDT showed the characteristic bird-beak appearance in 64% of cases. All patients underwent Heller seromyotomy with Dor fundoplication. Actuarial analysis showed asymptomatic rates of 76% at 1 year, 58% at 3 years and 52% at 5 years. Two patients required surgical revision, and both achieved complete remission.

Conclusion: Heller seromyotomy combined with Dor fundoplication remains the standard surgical treatment for oesophageal achalasia in children. Long-term outcomes support the need for prolonged and structured postoperative surveillance.

Utility of One-month Follow-up Cystoscopy after Transurethral Resection of Bladder Tumour in Non-muscle-invasive Bladder Cancer: A Prospective Study

Ajaybir Singh Bhullar, Manjit Singh Uppal, Sidharth Khullar, Prabhjot Kaur Gill — Fri, 03 Jul 2026 00:00:00 +0000

Aim: This study evaluated the utility of one-month follow-up cystoscopy after transurethral resection of bladder tumour (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC), focusing on residual disease detection and early management decisions.

Study Design: Prospective observational study.

Place and Duration of Study: The study was conducted in the Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, from July 2024 to December 2025.

Methodology: A total of 52 patients with histologically confirmed non-muscle-invasive bladder cancer, including Ta, T1, and carcinoma in situ, who underwent transurethral resection of bladder tumour were included. Baseline demographic, clinical, radiological, cystoscopic, and histopathological variables were recorded. All patients underwent follow-up cystoscopic evaluation approximately one month after surgery. Residual disease, early recurrence at three months, changes in stage or grade, and subsequent treatment modifications were assessed. Statistical analysis was performed using appropriate tests for continuous and categorical variables, with statistical significance set at p < 0.05.

Results: The mean age of the study population was 65.23 ± 6.36 years, and 69.2% of patients were male. Haematuria was the most common presenting symptom. Residual disease at one month was identified in 24 patients (46.2%) and was significantly associated with higher primary tumour stage (p = 0.012) and tumour multiplicity (p = 0.001). Early recurrence at three months occurred in 20 patients (38.5%) and was significantly associated with high-grade tumours (p < 0.001), tumour size ≥3 cm (p < 0.001), larger mean tumour size (p = 0.001), and older age (p = 0.015). One-month cystoscopy resulted in a change in clinical management in 40 patients (76.9%), including intravesical therapy or repeat transurethral resection of bladder tumour (TURBT).

Conclusion: One-month follow-up cystoscopy after transurethral resection of bladder tumour may help identify residual disease and guide early management decisions in selected patients with non-muscle-invasive bladder cancer, particularly those with higher-risk clinicopathological features.

Association of Cancer Antigen 15-3 Levels and Metastasis in Clinically Diagnosed Early Breast Cancer Patients

Gurdev Singh, Arun Kumar Gupta, Meena Sudan, Jashandeep Singh — Thu, 09 Jul 2026 00:00:00 +0000

Introduction: Breast cancer is the most common malignancy among women worldwide and remains a major cause of cancer-related mortality. Early identification of metastatic disease is essential for prognosis and treatment planning. Cancer Antigen 15-3 (CA 15-3), a serum tumour marker derived from the MUC1 glycoprotein, has been widely studied for its role in monitoring breast cancer progression and metastasis. The present study was conducted to evaluate the association between serum CA 15-3 levels and metastasis in patients with clinically detected early breast cancer.

Materials and Methods: A prospective observational study was conducted in the Department of General Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Amritsar, from July 2024 to December 2025. A total of 80 patients with biopsy-proven early breast carcinoma were included. Serum CA 15-3 levels were estimated using an automated electrochemiluminescence immunoassay system. A cut-off value of >30 U/mL was considered elevated. Patients with elevated CA 15-3 levels underwent radiological investigations for detection of metastatic disease. Statistical analysis was performed using SPSS version 26, and p-value < 0.05 was considered statistically significant.

Results: The mean age of the study population was 57.29 ± 12.68 years. Elevated CA 15-3 levels were observed in 27 patients (33.75%), while 53 patients (66.25%) had normal levels. Distant metastasis was present in 24 patients (30.0%), with liver metastasis being the most common site. Significant associations were observed between elevated CA 15-3 levels and clinical nodal status (p = 0.0002), histological grade (p = 0.038), lymph node involvement (p = 0.001), and metastatic status (p < 0.001). All patients with metastatic disease demonstrated elevated CA 15-3 levels, whereas none of the patients with normal CA 15-3 levels had metastasis.

Conclusion: Serum CA 15-3 levels showed a strong association with metastatic disease and other adverse prognostic factors in early breast cancer patients. Elevated CA 15-3 may serve as a useful non-invasive biomarker for identifying patients at increased risk of metastasis and may support prognostication and surveillance.

Critical Limb Ischaemia: Pathophysiology, Diagnosis, and Contemporary Management Strategies: A Critical Review

Ketan Vagholkar — Tue, 30 Jun 2026 00:00:00 +0000

Critical limb ischaemia (CLI), increasingly designated chronic limb-threatening ischaemia (CLTI) in contemporary vascular practice, represents the most severe manifestation of peripheral arterial disease and constitutes one of the foremost challenges in modern vascular medicine. Characterised by ischaemic rest pain, non-healing ulceration, and tissue gangrene attributable to chronic arterial insufficiency, CLI carries a one-year mortality rate approaching 20–25% and a risk of major amputation of comparable magnitude in the absence of timely and effective intervention. Despite considerable advances in both endovascular and open surgical techniques over the past two decades, outcomes remain disconcertingly poor, and a substantial proportion of patients continue to receive care that falls short of established guideline recommendations. This critical review synthesises evidence from peer-reviewed journals published between January 2000 and February 2026, encompassing the epidemiology, pathophysiology, diagnostic strategies, medical management, revascularisation options, and emerging therapies relevant to CLI. The landmark BASIL, BEST-CLI, and BASIL-2 randomised controlled trials are critically appraised alongside major guideline frameworks from the Global Vascular Guidelines, the European Society of Cardiology, and the American Heart Association/American College of Cardiology. The emerging controversy surrounding paclitaxel-coated devices, the evolving role of antithrombotic therapy, and advances in biological and regenerative medicine for patients lacking conventional revascularisation options are also examined. The review concludes that whilst revascularisation — particularly open bypass surgery in patients with adequate saphenous vein — remains the cornerstone of CLI management, a holistic, multidisciplinary approach integrating optimal medical therapy, structured wound care, and carefully selected emerging biological strategies is essential to improving both limb salvage and long-term survival in this high-risk patient population.

Electromyography in Intraoperative Neurophysiological Monitoring: Principles, Applications, Guidelines and Clinical Relevance

Wed, 01 Jul 2026 00:00:00 +0000

Electromyography is a central component of intraoperative neurophysiological monitoring because it gives the surgical team real-time information about motor nerves, nerve roots and muscles during procedures in which neural injury is a credible risk. Its clinical value lies not in a single waveform or threshold, but in the way electromyographic information is interpreted alongside anatomy, anaesthesia, surgical manoeuvres and other monitoring modalities. Intraoperative electromyography includes free-running recordings, triggered stimulation, cranial nerve mapping, laryngeal electromyography and muscle-recorded responses used within broader multimodal strategies. These techniques are applied in spinal instrumentation, nerve-root decompression, intradural spinal tumour surgery, vestibular schwannoma and skull-base surgery, thyroid and parathyroid surgery, and selected peripheral nerve operations. The method is highly useful for localising functional neural tissue and detecting irritation, but it is vulnerable to false-positive and false-negative findings when used without technical discipline or clinical context. This critical review examines the principles, applications, professional guidance and clinical relevance of intraoperative electromyography. It argues that electromyography should be understood as a decision-support tool rather than an isolated warning device. Its strongest role is in structured workflows where baseline testing, anaesthetic planning, alert verification, team communication and postoperative outcome audit are all treated as part of the monitoring intervention. Future progress will depend on better standardisation of reporting, more procedure-specific warning criteria, prospective studies linking alerts to surgical responses and patient outcomes, and careful integration of quantitative signal analysis with expert clinical judgement.

Early-onset Scoliosis: Current Concepts and Narrative Review

Maria Anastasia, Ida Bagus Gede Arimbawa — Wed, 08 Jul 2026 00:00:00 +0000

Background: Early-onset scoliosis is a complex spinal deformity that occurs before 10 years of age and may impair spinal growth and respiratory development, requiring individualised multidisciplinary management to optimise functional and clinical outcomes.

Aims: This narrative review summarises current knowledge regarding early-onset scoliosis, including its definition, aetiology, classification, clinical and radiological assessment, conservative management, surgical treatment options, complications, prognosis and future research directions.

Study Design: Narrative review.

Place and Duration of Study: Department of Orthopaedic and Traumatology, Faculty of Medicine, Udayana University, Bali, Indonesia. The literature included in this review was selected from studies published between 2000 and 2023.

Methodology: A literature search was conducted using PubMed, Scopus and Google Scholar. The keywords used included “early-onset scoliosis”, “early-onset scoliosis management”, “early-onset scoliosis treatment”, “clinical assessment of early-onset scoliosis”, “pulmonary evaluation in early-onset scoliosis” and “surgical intervention for early-onset scoliosis”. Articles were selected if they discussed early-onset scoliosis diagnosed before 10 years of age, including diagnostic evaluation, clinical outcomes, conservative treatment, surgical management, complications and outcome assessment. Non-English articles, studies unrelated to early-onset scoliosis and studies focusing only on adolescent or adult scoliosis were excluded.

Results: Early-onset scoliosis is a complex spinal deformity that may arise from idiopathic, congenital, neuromuscular or syndromic causes. Its progression can affect spinal growth, thoracic development, pulmonary function and quality of life. Appropriate assessment requires careful history-taking, physical examination, radiographic evaluation, curve flexibility assessment, pulmonary evaluation and identification of associated comorbidities. Conservative treatments such as observation, bracing and serial casting may help control curve progression and delay surgery. Surgical options include distraction-based systems, compression-based systems and guided-growth techniques. However, complications such as implant failure, infection, repeated procedures, wound problems, pulmonary limitations and unplanned revision surgery remain important concerns.

Conclusion: Early-onset scoliosis requires individualised and multidisciplinary management. Treatment decisions should consider age, aetiology, curve magnitude, progression rate, pulmonary status, growth potential, comorbidities, family expectations and risk of complications. The main goals are to control spinal deformity, preserve thoracic growth, optimise pulmonary development, delay spinal fusion when possible and improve long-term functional outcomes. Further studies are needed to establish standardised assessment methods, treatment algorithms, pulmonary outcome measures, patient-reported outcome tools and long-term comparative evidence.

Mini Arthrotomy in the Management of Primary Osteoarthritis of the Knee Joint: A Literature Review

I Made Gilang Pinggan Kalimantara, Stedi Adnyana Christian — Thu, 09 Jul 2026 00:00:00 +0000

Aims: This literature review aims to evaluate the possible role and limitations of mini arthrotomy in the management of primary knee osteoarthritis (OA), with attention to patient selection, clinical rationale, available evidence, and comparison with conservative, arthroscopic, and arthroplasty-based strategies.

Study Design: Narrative literature review.

Methodology: A narrative search of PubMed, Google Scholar, ScienceDirect, and guideline sources was performed using keywords related to knee osteoarthritis, mini arthrotomy, arthroscopy, debridement, loose bodies, osteophytes, and surgical treatment. English-language articles, guidelines, reviews, and clinically relevant comparative studies published mainly from 2000 to 2024 were considered. Evidence was synthesised descriptively because direct studies of mini arthrotomy for primary knee OA are limited.

Results: Knee OA is a major cause of pain, disability, and reduced mobility. Conservative treatment remains the first-line approach, while surgery is considered for persistent symptoms or structural pathology. The available literature does not support mini arthrotomy as a disease-modifying procedure. Its potential role is limited to selected patients with mild to moderate OA, preserved joint space, and clear mechanical symptoms caused by loose bodies, focal osteophytes, or localised synovial pathology. Evidence for mini arthrotomy in primary knee OA is indirect and mostly extrapolated from minimally invasive open procedures, arthroscopy, debridement, and guideline recommendations. Therefore, claims of effectiveness should be interpreted cautiously.

Conclusion: Mini arthrotomy may be considered only as a targeted symptomatic procedure in carefully selected patients with localised mechanical pathology, particularly where arthroscopy is unavailable or costly. It should not be presented as a routine treatment for primary knee OA or as an alternative to arthroplasty in advanced disease. Further prospective comparative studies are required to define its indications, outcomes, complications, durability, and cost-effectiveness.

A Systematic Review on Breast Cancer Surgery in Cameroon: Current Practice, Challenges and Future Perspectives

Mon, 08 Jun 2026 00:00:00 +0000

Background: Breast cancer is the most frequently diagnosed malignancy among women worldwide and has become the leading female cancer in Cameroon. Surgery remains the cornerstone of curative treatment for non-metastatic disease, yet the type and quality of surgical care depend heavily on diagnostic capacity, multidisciplinary coordination, and access to adjuvant therapies. In Cameroon, most patients present with locally advanced tumors, resulting in a predominance of modified radical mastectomy and limited opportunities for breast-conserving approaches. This systematic review evaluates current surgical practices, outcomes, and structural barriers affecting breast cancer surgery in Cameroon.

Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, African Journals Online, and Google Scholar were searched for studies published between January 2010 and April 2026. Eligible articles reported epidemiological, surgical, pathological, therapeutic, or health-system data related to breast cancer management in Cameroon. When national evidence was scarce, data from comparable sub-Saharan African countries were incorporated to contextualize findings. Data were synthesized narratively because of substantial methodological heterogeneity.

Results: Forty-two studies met the inclusion criteria. Breast cancer in Cameroon affects predominantly women aged 40–55 years, approximately a decade younger than in high-income countries. Between 60% and 85% of patients present with stage III or IV disease. Modified radical mastectomy remains the most commonly performed procedure, accounting for more than 80% of curative operations in most reported series. Breast-conserving surgery is uncommon because of large tumor size at diagnosis, limited access to radiotherapy, and inadequate preoperative imaging. Sentinel lymph node biopsy is rarely available, and axillary lymph node dissection remains the standard approach. Surgical outcomes are constrained by delayed diagnosis, financial barriers, insufficient pathology services, limited reconstructive options, and restricted access to systemic and radiation therapies.

Conclusion: Breast cancer surgery in Cameroon remains dominated by radical procedures performed under significant structural constraints. Earlier diagnosis, expanded radiotherapy capacity, improved pathology services, and development of multidisciplinary breast units are essential to enable more conservative and personalized surgical care. Strengthening surgical oncology infrastructure should be considered a national priority to improve both survival and quality of life for women with breast cancer in Cameroon. Improved histopathological confirmation, margin assessment, and multidisciplinary decision-making are also necessary to optimize surgical quality and reduce inappropriate treatment decisions.

Acute Pancreatitis Complicated by Rapunzel Syndrome in a Patient with Incomplete Situs Inversus: A Case Report

Thu, 28 May 2026 00:00:00 +0000

Background: Situs inversus is a rare anatomical anomaly that renders surgical presentations atypical. The association of acute pancreatitis, a gastrointestinal trichobezoar, and Rapunzel syndrome in a patient with situs inversus is exceptional.

Case Report: We report the case of a 17-year-old female patient with unknown situs inversus who presented with biochemical acute pancreatitis that progressed to multiple digestive perforations associated with gastrointestinal trichobezoars fulfilling the criteria for Rapunzel syndrome.

Conclusion: This case highlights the importance of a thorough and multimodal diagnostic evaluation in the setting of acute abdominal symptoms, and the need to anticipate rare complications — particularly Rapunzel syndrome — in patients with congenital anatomical anomalies.

Complicated Pelvic Appendicitis Presenting as a Pelvic Pseudotumoral Mass with Intraoperative Suspicion of Gynecological Malignancy: A Case Report

Tue, 02 Jun 2026 00:00:00 +0000

Pelvic appendicitis is an uncommon anatomical variant that may create significant diagnostic challenges because of its proximity to gynecological, urinary, and colorectal structures. In elderly women, delayed diagnosis may lead to perforation, abscess formation, and inflammatory extension to adjacent organs, occasionally mimicking pelvic malignancy.

We report the case of a 72-year-old woman who presented with prolonged right lower quadrant pain associated with vomiting, diarrhea, intermittent fever, and deterioration of general condition. Laboratory investigations revealed severe inflammatory syndrome and anemia. Contrast-enhanced computed tomography demonstrated a large multiloculated pelvic abscess of probable appendiceal origin with significant compression of adjacent pelvic structures.

Surgical exploration was initially performed laparoscopically but required conversion to laparotomy because of dense inflammatory adhesions. Intraoperative findings revealed a retro-uterine abscess, severe pelvic appendicitis, uterine perforation, parametrial infiltration, and suspicious pelvic lymphadenopathy, raising concern for gynecological malignancy. Retrograde appendectomy, subtotal hysterectomy, peritoneal lavage, pelvic drainage, and biopsies were performed.

Histopathological examination demonstrated extensive suppurative inflammation without evidence of malignancy. The postoperative course was favorable, and the patient remained asymptomatic at follow-up.

This case highlights the diagnostic complexity of complicated pelvic appendicitis and demonstrates how severe inflammatory disease may mimic gynecological cancer both radiologically and intraoperatively. Histopathological analysis remains essential for definitive diagnosis.

Transmesenteric Internal Hernia: A Case Report

Fri, 05 Jun 2026 00:00:00 +0000

Transmesenteric internal hernias are a rare cause of small bowel obstruction and are most frequently described in pediatric patients. Their occurrence in adults, particularly in the elderly, is exceptional and often associated with diagnostic difficulty because of non-specific clinical and radiological findings. We report the case of an 80-year-old man with no previous medical or surgical history who presented with acute diffuse abdominal pain associated with vomiting and obstipation. Imaging findings suggested small bowel obstruction without a clearly identified etiology. Emergency surgical exploration revealed a congenital transmesenteric defect of the terminal ileum with incarceration of a small bowel loop. The herniated bowel was congested but viable, allowing reduction without intestinal resection, and the mesenteric defect was closed with interrupted sutures. The postoperative course was uneventful, and the patient was discharged on postoperative day two. Congenital transmesenteric internal hernia should be considered in cases of unexplained small bowel obstruction in patients without prior abdominal surgery, and early surgical management is crucial to prevent bowel ischemia and ensure favourable outcomes.

Late Isolated Abdominal Wall Recurrence of Uterine Carcinosarcoma: A Favourable Outcome in a Case Report Treated with Wide Surgical Excision and Prosthetic Reconstruction

Mon, 22 Jun 2026 00:00:00 +0000

Introduction: Uterine carcinosarcoma is a rare and highly aggressive malignancy associated with a high risk of recurrence. Relapse usually involves the pelvis or distant organs, whereas isolated abdominal wall recurrence is exceptional. This report describes a late isolated abdominal wall recurrence and its surgical management, highlighting the need for prolonged surveillance in affected patients.

Case Report: A 71-year-old postmenopausal woman presented with metrorrhagia. Diagnostic curettage revealed grade 2 endometrioid adenocarcinoma, and pelvic magnetic resonance imaging suggested stage IA disease. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy in July 2021. Final histopathological examination confirmed uterine carcinosarcoma with myometrial invasion greater than 50%, cervical stromal involvement, lymphovascular space invasion, negative pelvic lymph nodes, and clear vaginal margins. Adjuvant external beam pelvic radiotherapy, vaginal brachytherapy, and six cycles of paclitaxel-carboplatin chemotherapy were completed in April 2022. After more than two years of complete remission, routine surveillance imaging in March 2025 identified an isolated median subumbilical abdominal wall mass. Magnetic resonance imaging showed features suggestive of abdominal wall metastasis. Core needle biopsy demonstrated a poorly differentiated carcinoma, and immunohistochemistry showed CK7 and PAX8 positivity with oestrogen and progesterone receptor negativity, supporting recurrence of the known gynaecological malignancy. Wide en bloc resection of the abdominal wall lesion was performed, followed by reconstruction using a 30 × 30 cm dual-layer intraperitoneal mesh. No peritoneal carcinomatosis or ascites was observed intraoperatively. Final histopathological examination confirmed abdominal wall localisation of spindle cell sarcoma with heterologous osteosarcomatous differentiation, complete resection, and R0 margins. The postoperative course was uneventful.

Conclusion: This case illustrates that, in selected patients with isolated abdominal wall recurrence of uterine carcinosarcoma, complete surgical excision with prosthetic reconstruction may provide effective local control. Long-term surveillance remains essential because atypical late recurrence may occur after an apparently sustained remission.

Minimally Invasive Management of Hydatid Disease Across Multiple Organs: A Case Series of Hepatic, Renal, Pulmonary and Splenic Involvement

J. Mittal, A. Jain, S. Khandelwal, P. Naik — Thu, 25 Jun 2026 00:00:00 +0000

Aims: This case series describes the minimally invasive management of hydatid disease involving four anatomically distinct organs and evaluates the feasibility and peri-operative safety of laparoscopic and thoracoscopic approaches in selected patients.

Presentation of Case: Four patients with hydatid cysts involving the liver, kidney, lung, and spleen were managed at a tertiary care centre in Rajasthan, India. Diagnosis was based on ultrasonography and/or contrast-enhanced computed tomography findings consistent with hydatid disease. All patients received albendazole for 14 days before surgery. The operative approach was planned according to the involved organ and cyst characteristics. The hepatic cyst was managed by laparoscopic aspiration, de-roofing, and marsupialization; the renal cyst by laparoscopic aspiration and de-roofing; the pulmonary cyst by video-assisted thoracoscopic surgery with cyst aspiration, de-roofing, and intercostal drainage; and the splenic cyst by laparoscopic cystectomy. Standard precautions were used in all cases, including operative-field protection and the use of hypertonic saline as a scolicidal agent.

Discussion: All four procedures were completed using minimally invasive techniques without conversion to open surgery. No intraoperative cyst spillage, anaphylactic reaction, or significant postoperative complication was documented. The postoperative course was uneventful in all patients. These findings support the practical feasibility of organ-specific minimally invasive procedures when careful patient selection, preoperative albendazole therapy, and meticulous intraoperative precautions are applied.

Conclusion: In this single-centre experience, laparoscopic and thoracoscopic management of hydatid cysts affecting the liver, kidney, lung, and spleen was feasible and was associated with favourable short-term perioperative outcomes. Longer follow-up is required before conclusions can be drawn regarding recurrence or durability of treatment.

The "Glove-VAC" Technique: A Two-Patient Case Series of Custom Sealing Systems for Complex Hand Injuries

Fri, 03 Jul 2026 00:00:00 +0000

Background: Negative pressure wound therapy (NPWT) is widely used to support wound-bed preparation in complex soft-tissue injuries. Its application to hand wounds can be challenging because the contours of the digits and interdigital spaces may compromise maintenance of an airtight seal. In resource-limited settings, the cost and availability of commercial NPWT systems may also restrict use. This case series describes a modified, low-cost sealing method using a sterile surgical glove for complex hand injuries.

Technique and Cases: A sterile latex or nitrile glove was used as the occlusive interface after wound debridement and placement of gauze or foam over the defect. A French size 16 suction tube, with additional distal fenestrations, was positioned within the dressing and brought out proximally through the glove cuff. The cuff and tube exit site were sealed at the distal forearm using adhesive drapes, and the system was connected to continuous institutional wall suction. The technique was applied in two patients with complex right-hand wounds. The first patient had a partial degloving injury with flap necrosis after primary closure under tension. After debridement, the modified system was used for two dressing cycles, followed by split-thickness skin grafting. The second patient was a 30-year-old male with a high-voltage electrical burn involving the right hand, with exposure of deep structures. The modified system was also used for two dressing cycles to prepare the wound bed for planned pedicled inguinal flap coverage.

Results: In both cases, the dressing maintained wound coverage and supported the formation of healthy granulation tissue. The first case proceeded to skin grafting, while the second case achieved wound-bed stabilisation before planned flap reconstruction.

Conclusion: The modified Glove-VAC technique may provide a simple and accessible option for temporary negative pressure wound management in selected complex hand injuries, particularly where commercial systems are limited. This is an early technical experience rather than evidence of superiority over commercial NPWT systems.

Early Small Bowel Herniation through a 10-mm Port Site Immediately after Removal of a 30-Fr Pelvic Drain Following Laparoscopic Appendicectomy: A Case Report and Review of Preventive Measures

Jai Mittal, Amit Jain, Aditya Soni — Fri, 03 Jul 2026 00:00:00 +0000

Background: Drain-site bowel herniation is an uncommon but potentially serious postoperative complication that requires prompt recognition and timely surgical intervention. Although trocar-site hernias after laparoscopic surgery are recognised, herniation specifically through a drain site remains a distinct and rarer event. Research Gap: Immediate small bowel herniation following removal of a large-bore pelvic drain placed through a 10-mm trocar site after laparoscopic appendicectomy has been sparsely described, and preventive measures require continued emphasis.

Aims: This case report aims to describe a rare case of immediate small bowel herniation through a drain site following laparoscopic appendicectomy and to discuss the mechanisms, risk factors and preventive strategies relevant to this complication.

Presentation of Case: A 52-year-old man underwent laparoscopic appendicectomy complicated by an intraoperative caecal perforation, which was repaired primarily. Because of peritoneal contamination, a 30-Fr polyvinyl chloride pelvic drain was placed through the left iliac fossa 10-mm trocar site. The drain was removed on postoperative day 5 after minimal serous output. Within 30 minutes, the patient developed sudden severe pain and visible bowel protrusion through the drain site. Emergency re-exploration confirmed herniation of an approximately 8 cm viable small bowel loop through a 10–12 mm fascial defect. The bowel was reduced, and the fascial defect was closed under direct vision. Recovery following re-exploration was uneventful.

Discussion: The large-bore drain probably prevented spontaneous fascial apposition, leaving a patent channel after removal through which mobile small bowel could herniate rapidly.

Conclusion: Drain-site bowel herniation is rare but may progress rapidly. Avoiding large-bore drains through trocar sites, using separate drain incisions and closing all fascial defects of 10 mm or greater are important preventive measures.

The Reconstructive Ladder Meets Marine Biotechnology: Acellular Fish Skin Grafts and Negative Pressure Wound Therapy for Complex Pediatric Foot Trauma: A Two-Case Report and First Institutional Experience

Wed, 08 Jul 2026 00:00:00 +0000

Background: Complex pediatric foot trauma with exposed deep structures presents a major reconstructive challenge. The classical answer—flap reconstruction—carries donor-site morbidity, long operative times, and intensive monitoring poorly suited to young children and to resource-limited public hospitals. Intact acellular fish skin grafts (AFSG) derived from Atlantic cod (Gadus morhua) are an omega-3–rich biomaterial that preserves a native three-dimensional extracellular matrix and promotes rapid vascularization and granulation, without the zoonotic risk or harsh chemical processing of mammalian substitutes.

Case description: We report two boys treated at CHU Ibn Rochd, Casablanca, in what is, to our knowledge, the first use of AFSG at our institution. Case 1 was a 5-year-old with an 8 × 10 cm heavily contaminated dorsolateral foot defect after a motor-vehicle accident; after wound-bed conditioning, an AFSG was applied under continuous negative pressure wound therapy (NPWT) and a vascularized granulation bed was obtained within three days, allowing definitive split-thickness skin grafting (STSG), with closure approximately 18 days after injury. Case 2 was a 3-year-old referred with full-thickness dorsal necrosis after a failed degloving repair, with exposed navicular and cuneiform bone and extensor tendon loss; an AFSG under petrolatum gauze and NPWT produced granulation over bare cortical bone within four days, enabling immediate STSG and complete closure.

Conclusion: In both children, AFSG combined with NPWT rapidly converted complex bone- and tendon-exposing wounds into graftable beds, markedly shortening the time to definitive closure and avoiding free-flap reconstruction. Its principal limitations are limited local availability and high cost, compounded by the absence of insurance or hospital reimbursement coverage, which currently constrain routine use in our resource-limited setting.

A Tale of a Fatal Massive Upper Gastrointestinal Bleed in a Patient of Chronic Pancreatitis: A Case Report

Sagardeep Grewal, Hakam Singh, Vinay Tripathi, M. Ranjith — Fri, 10 Jul 2026 00:00:00 +0000

Aim: Chronic pancreatitis (CP) is associated with venous and arterial complications, some of which may lead to life-threatening haemorrhage. Early identification and appropriate intervention are essential for managing these vascular complications. This report describes the diagnostic evaluation, operative management, postoperative course, and fatal outcome of a young male with chronic pancreatitis who presented with massive upper gastrointestinal bleeding.

Presentation of Case: A 33-year-old male with a five-year history of alcohol consumption presented with severe anaemia, leucocytosis, and deranged liver function tests. He subsequently developed haematemesis and melaena. Computed tomography revealed grade III fatty liver, splenic vein occlusion, a thick-walled pancreaticoduodenal collection, gastroduodenal artery encasement, a pseudocyst near the spleen, and chronic calcific pancreatitis. Upper gastrointestinal endoscopy showed a large duodenal bulge with an associated ulcer but no active bleeding. Recurrent haematemesis one week later prompted urgent endoscopy, which demonstrated active bleeding and failed endoscopic haemostasis. Surgical management included midline laparotomy, anterior gastrotomy with evacuation of blood clots, gastric devascularisation, ligation of the encased gastroduodenal artery, duodenal resection, and Roux-en-Y gastrojejunostomy. Despite intensive care, the patient died on postoperative day 14 due to septic shock and multi-organ failure.

Discussion and Conclusion: This case highlights the diagnostic and therapeutic complexity of pancreatitis-related upper gastrointestinal bleeding and the need for timely multidisciplinary assessment.

Perforated Ileocecal Adenocarcinoma Revealing Long-Standing Crohn's Disease: A Rare Cause of Generalized Peritonitis

Mon, 13 Jul 2026 00:00:00 +0000

Introduction: Small bowel and ileocaecal adenocarcinomas are rare but recognised complications of long-standing Crohn's disease. Their diagnosis is challenging because symptoms frequently mimic inflammatory disease activity. Presentation with bowel perforation and generalised peritonitis is exceptional.

Case Presentation: An 87-year-old overweight woman with a more than 30-year history of medically treated Crohn's disease presented with acute diffuse abdominal pain, vomiting, abdominal distension, and cessation of bowel transit. Clinical examination revealed generalised peritonitis associated with haemodynamic instability (heart rate 120 beats/min, blood pressure 90/60 mmHg). Laboratory investigations demonstrated leucocytosis (14,100/mm³), C-reactive protein of 449 mg/L, hyponatraemia (132 mmol/L), and severe hypokalaemia (2.66 mmol/L).

Contrast-enhanced computed tomography demonstrated irregular heterogeneous thickening of the caecum associated with multiple intra-abdominal collections, pneumoperitoneum, mesenteric lymphadenopathy, diffuse ascites, peritoneal nodules suggestive of carcinomatosis, and suspicious bilobar liver lesions.

Emergency laparotomy revealed generalised purulent peritonitis secondary to perforation of a thickened ileocaecal segment. Ileocaecal resection with double stoma formation was performed.

Histopathological examination demonstrated a moderately differentiated adenocarcinoma with a 40% mucinous component infiltrating the entire bowel wall with perforation and visceral peritoneal invasion. Vascular emboli were present without perineural invasion. Six of twenty-one lymph nodes were metastatic, including four with extracapsular extension. The tumour was staged as pT4aN2Mx.

The postoperative course was complicated by hydroelectrolytic disturbances that were successfully corrected. Intestinal continuity was restored later, and the patient remained free of clinical recurrence after six months.

Conclusion: Advanced adenocarcinoma should be suspected in elderly patients with long-standing Crohn's disease presenting with acute abdominal complications. Histopathological examination remains essential for establishing the diagnosis and guiding postoperative management.