New Indian Journal of Surgery

Background: Cholelithiasis is a common gastrointestinal disorder influenced by metabolic and endocrine factors. Subclinical hypothyroidism, characterized by elevated TSH levels while FT4 levels remain normal, has been linked to metabolic dysregulation, which may indirectly contribute to gallstone formation. However, the exact association between subclinical hypothyroidism and cholelithiasis is still debated.

Aim: To assess the association between hypothyroidism and gallstone disease in a hospital-based population, and to analyze metabolic variables along with age that may influence this relationship.

Methods: A hospital-based Prospective study was conducted involving 46 patients, 28 with gallstone disease (cases) and 28 without gallstones (controls). Both groups underwent comprehensive clinical evaluation, laboratory testing, imaging, and gallstone analysis, where applicable. Data were analysed using appropriate tests to assess significance.

Results: Hypothyroidism was significantly more prevalent in the case group (46%) than in controls (12%). Cholesterol stones were the most common type, predominantly among hypothyroid patients (92.5%). Female sex and age 25–45 years were the predominant demographic factors. A significant association was found between Hypothyroidism and gallstone disease (p<0.05)

Background: Gallstone disease is a global health problem with multifactorial etiology. In recent years, Helicobacter pylori has been suggested as a possible contributor to gallstone pathogenesis. This study investigates the association between H. pylori infection and gallstone disease in patients undergoing cholecystectomy. Findings demonstrate a significant correlation, suggesting that H. pylori may act as an additional risk factor for gallstone formation.

Objective: To investigate the association between Helicobacter pylori infection and gallstone disease by detecting the presence of H. pylori in gallbladder tissue of patients undergoing cholecystectomy, and to evaluate its potential role as a risk factor in gallstone pathogenesis.

Methods: This was a prospective observational study conducted at the Department of General Surgery, Sardar Patel Medical College, Bikaner. Patients admitted with gallstone disease who underwent elective or emergency cholecystectomy were included for Giemsa staining

Introduction: Urinary calculi are a common complaint, affecting the cases in a ratio of 3 men to 1 woman, with advanced incidence between 40 to 50 years of age. Size of the calculus influences the rate of spontaneous calculus passage. Medical expulsive therapy (MET) has been described as an effective conservative treatment option in the initial management of small distal ureteral/ Vesico-Ureteric Junction (VUJ). Ureteroscopy (URS) is indicated in unsuccessful cases of MET. Current European Association of Urology advocates the use of URS as first line treatment for distal ureteric calculus larger than 10 mm.

Methods: The study was conducted at a tertiary care hospital in Gujarat, India, nvolving both outpatient and inpatient cases. Patients underwent radiological, blood, and urine evaluations. They were instructed to take silodosin, deflazacort, diclofenac, and maintain supra-hydration. Follow-ups were scheduled every 7 days with X-ray KUB to monitor spontaneous calculus passage. If stone passage was unsuccessful after 28 days, patients underwent planned URS with or without lithotripsy and DJ stenting under anaesthesia.

Results: In a cohort of 170 patients with small distal ureteral stones, 89% were successfully managed with medical expulsive therapy (MET), while 11% required ureteroscopy (URS) after unsuccessful MET. Comparative analyses considered factors such as patient demographics, stone characteristics, medical history, lab results, and URS findings, leading to the study’s conclusions.

Conclusion: Our study has 170 patients with mid and distal ureteric calculi with size ranging from 4 to 10 mm with mild or no backpressure changes, which were subjected to MET with tablet silodosin, tablet deflazacort, tablet diclofenac and supra-hydration. We documented 88.8% MET success and 11.2% unsuccessful cases of MET. MET success is unaffected by age, gender of the patient, history of prior surgical procedure, diabetic status, hypertension or recurrent stone former status. For calculus size between 4 to 10 mm stone-free rate was achieved with medical therapy in 88.8% of patients with no overt complications. Size of the calculus is a significant predictor of expulsion rate. In our study all cases with unsuccessful MET underwent ureteroscopy for calculus clearance.

Background: Thyroid nodules are a common clinical entity, with an increasing detection rate due to widespread use of ultrasonography (USG). Differentiating benign from malignant nodules is essential for optimal management. The Thyroid Imaging Reporting and Data System (TIRADS) standardizes sonographic evaluation to stratify malignancy risk, aiding clinical decision-making in a non invasive manner.

Objective: To evaluate the diagnostic accuracy of the TIRADS classification system in the risk stratification of thyroid swellings and to compare its performance with fine-needle aspiration cytology (FNAC) and histopathology.

Methods: This was a hospital-based cross-sectional study conducted over one year in the Department of Surgery at Sardar Patel Medical College, Bikaner. A total of 115 patients with thyroid swellings scheduled for surgery were assessed. All underwent USG with TIRADS classification, FNAC based on the Bethesda system, and subsequent histopathological examination. Diagnostic accuracy parameters were calculated using histopathology as the gold standard.

Results: Out of 115 patients, 36 (31.3%) were found to have malignant nodules on histopathology. TIRADS demonstrated a sensitivity of 88.2%, specificity of 83.7%, and an overall accuracy of 85.6%. FNAC showed a slightly higher specificity (93.2%) but lower sensitivity (82.4%). Malignancy risk increased proportionally with higher TIRADS categories.

Conclusion: TIRADS is an effective, non-invasive tool for thyroid nodule risk stratification. When combined with FNAC, it enhances diagnostic precision and guides surgical decisions.

Contribution: This study provides regional validation for TIRADS use in northwest Rajasthan, advocating its integration into routine thyroid nodule assessment protocols.

Background: Enhanced Recovery After Surgery (ERAS) protocols represent a multidisciplinary, evidence-based approach to perioperative care aimed at improving patient outcomes, reducing surgical stress, and shortening hospital stays. Their application in elective colorectal surgery has shown promising results globally, yet implementation challenges and outcome variability persist.

Objective: This study aimed to evaluate the clinical impact of ERAS protocol implementation in patients undergoing elective colorectal surgery, focusing on postoperative recovery, complication rates, and length of hospital stay.

Methods: A prospective observational study was conducted involving patients scheduled for elective colorectal resections. The ERAS protocol included preoperative counseling, limited fasting, carbohydrate loading, standardized anesthesia, early ambulation, and early oral feeding. Outcomes were compared with a historical cohort managed with conventional care. Primary endpoints were length of hospital stay and postoperative complications; secondary outcomes included time to first bowel movement, readmission rates, and patient satisfaction.

Results: Implementation of the ERAS protocol led to a significant reduction in mean hospital stay (5.2 vs. 8.4 days; p < 0.01). Patients in the ERAS group experienced fewer postoperative complications (18% vs. 30%), earlier return of bowel function, and higher satisfaction scores. No significant differences were observed in readmission rates between the groups. Compliance with key protocol elements was over 85%.

Conclusion: ERAS protocol implementation in elective colorectal surgery is both feasible and effective. It significantly improves recovery metrics, reduces complication rates, and enhances patient satisfaction without increasing readmission risk. Widespread adoption and adherence to ERAS principles can lead to better clinical outcomes and more efficient healthcare utilization in colorectal surgical practice.

About 10%-18% patients02 undergoing Cholecystectomy for Cholecystectomy for cholelithiasis also require choledocholithotomy For choledocholithiasis. In Open cholecystectomy with choledocholithotomy common bile duct (CBD) clearance for residual stones saline Irrigation and saline flushing is required, which needs determination of superior efficacy in between.

Aims: to evaluate the efficacy of saline irrigation and saline flushing in clearance of CBD from residual calculi.

Settings and Design: A retrospectivestuy study conducted in a single centre retrieving data of 185 patients whose operations were carried out during the period between 2010 to 2022.

Methods and Material: A total of 185 patients (N=185) were categorised into two Groups. Group-A): patients (n=123) stones of CBD were extracted by milking and Desjerdin instrumentation combining saline irrigation for CBD clearance of residual stone. Group-B). patients (n=62): Instead of irrigation, CBD Clearance were obtained by saline flushing.

Statistical analysis used: In total of N=185 patients P-value is 0.05 at 95% confident limit, OR is than 1, Fisher exact test is 1,98, mann Whiteney U test is 1, t-test=0.7, Chisquare test is 1.77. Group-A): In total of 123 patients, mean age is 40.98 in Male and 39.08 in female, standard deviation is 7.04 in In male, OR is 049, P-value is 0.04. Group B): In total of 62 patients, mean age is 45’8 in Female and 48.5 in male, P-value is 0.02, OR is less Than 1~o

Results: In total N=185 patients clearance rate is achieved in 97.29%, Patients (n=5) had retained stone (2.70%), Group-A): In n=123 patients mean age is 40.98 in male and 39.08 in female, clearance rate is 96.74%, patients (n=4, female) had retained stone (3.25%). Group B): In n=62 patients mean age is 45.8 in female and 48.5 in male, clearance rate is 98.38%, patient (n=1, female) had a retained stone, who 23 calculi in CBD. Mortality and complications like Cholangitis, stricture are nil.

Conclusions: Both saline irrigation and saline flushing are equally safe manoeuvre in CBD clearance of residual calculous but saline flushing demonstrated superior efficacy in CBD clearance of stones.

Congenital diaphragmatic hernia (CDH) is a birth defect involving improper formation of the diaphragm, leading to the protrusion of abdominal organs into the chest cavity. The CDH is classified depending on the location of the defect as postero-lateral, central and anterior. Depending on the side, it is classified as right, left and bilateral. A majority of CDH defects are postero-lateral defects and are commonly referred to as Bochdalek hernias (BH). Herein, the authors present the case of a 29 years old male patient diagnosed with a large left recurrent Bochdalek hernia. He was operated for it in another hospital by another surgeon 5 months back. That previous surgical intervention was initially planned via laparoscopy. But, intraoperatively, it had to be converted to open surgery due to technical difficulty. Post the first surgery, after about 1.5 months, he started developing pain in the back of his left chest. However, due to financial constraints, he did not seek any consultation with anyone at that time. The authors successfully performed a laparoscopic repair of this difficult condition. The rationale for reporting this case is to underscore the relative ease of a laparoscopic over open surgical intervention, on the ‘roof’ of the abdomen and also the lower chest. Also, it hopes to highlight that laparoscopic repair of BH is feasible even in challenging, difficult and recurrent scenarios, in an advanced setup backed up by the requisite surgical expertise.