New Indian Journal of Surgery

This article was aimed at throwing light on the relatively under-researched area in diabetic peripheral neuropathy (DPN), the presence of visceropelvic disorders secondary to bladder, bowel and sexual dysfunction through a scoping overview of current research evidence. The three studies on bladder dysfunction in DPN uniformly found increased residual urine, urinary retention and slowing of nerve conduction velocities. Three studies on bowel dysfunction found fecal incontinence, increased rectal sensitivity thresholds, prolonged pudendal distal motor latency, asymptomatic sensorimotor deficit, higher mucosal electrosensitivity thresholds and increased fibre density of the external anal sphincter. Three studies on sexual dysfunction demonstrated erectile dysfunction, altered copulatory behaviors and infertility which suggested role of ‘central’ neuropathy in DPN. The study findings indicate future surgical research on appropriate management for these problems in this patient population.

Keywords: Visceropelvic disorders; Urogenital surgery; Surgical neurology; Diabetic neuropathy.

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Ascaris lumbricoides [AL] is common resident of intestine especially low socioeconomic areas in the world and may cause medical, social & surgical problem. Ascariasis can cause serious intra-abdominal complications such as intestinal obstruction, biliary obstruction, pancreatitis, acute appendicitis, intestinal perforation etc. We report an adult with intestinal obstruction due to entangled mass of AL, presented as a lump in right iliac fossa, managed by laparotomy and manually passing worms into colon without enterotomy.

Keywords: Intestinal obstruction; Roundworm; Ascaris lumbricoides.

Gall stone ileus is an infrequent complication of symptomatic cholelithiasis accounting for 1%-4% of intestinal obstructions. It has a high mortality of 12%-15% associated with it as most patients are of  advanced age, have concomitant diseases, present late and hence undergo delayed intervention. Controversy still surrounds its treatment-whether to perform one stage procedure consisting of enterolithotomy, cholecystectomy with repair of biliary fistula or a staged procedure where enterolithotomy alone is performed at the initial surgery. A retrospective study was conducted at Dr. RML Hospital with the aim to evaluate the outcome of enterotomy and stone extraction (two staged procedure) alone as the preferred treatment of choice in the four patients who presented between January 2005 to July 2010. All underwent enterolithotomy and stone extraction alone as the first surgery with a mean operating time of one hour twenty five minutes, no mortality and minimum morbidity. Hence, we strongly believe that enterolithotomy alone should be the procedure of choice for gall stone ileus. One staged procedure should be reserved for patients with absolute indications (acute cholecystitis and/or gangrene of gallbladder).

Keywords: Gallstone ileus; Cause of small bowel obstruction; Complication of symptomatic cholelithiasis; Cholecystoduodenal fistula; Retrospective study.

Objective: To evaluate the effects of diaphragmatic breathing exercise on pulmonary function and diaphragm excursion in patients who underwent laparoscopic surgery Materials and Methods: Twenty subject ( twelve men and eight women) who underwent laparoscopic surgery were randomly divided as follows: 10 subjects performed diaphragmatic breathing exercise, (other therapies like bronchial hygiene therapy, Thoracic mobility exercise and mobilization) and 10 participated as a control group. All of them underwent evaluations of pulmonary function test with measurement of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/ FVC ratio, peak expiratory flow (PEF) and diaphragm excursion by ultra songraphy before the operation and first, second postoperative day (POD). Results: Pulmonary function and diaphragm excursion values between preoperative and postoperative (first, second) days were found to be higher in the exercise group when compared to control group. Conclusions: Chest physiotherapy contributed towards early recovery of pulmonary function and diaphragm excursion among patients who had undergone laparoscopic surgery.

Keywords: Chest physiotherapy; Laparoscopic abdominal surgery; Diaphragmatic breathing exercise; Post operative period.

Purposes: The success of skin grafting surgery depends on various factors like contouring and pressure dressing, immobilization splints. The purpose of this study is to include all the factors in one single dressing. Methods: 20 patients with wounds of difficult geometry studied. Wound etiology varied and patients contraindicated for negative pressure therapy were excluded from study. Results: 19 patients had good take of skin grafts and one patient lost all the grafts because of associated co-morbities. Conclusion: Negative pressure therapy acts as an effective all-in-one dressing.  

Keywords: Negative pressure therapy (NPT); Skin grafts; All-in-one dressing; Portable VAC pump.