New Indian Journal of Surgery

 Diagnosis of appendico-vesical fistula (AVF) is challenging because clinical symptoms are frequently nonspecific. Radiologists have to detect subtle abnormalities from frontline imaging modalities, such as plain abdominal radiograph or ultrasound (US); those may indicate more specific diagnostic modalities to demonstrate the fistula.

 Introduction: laparoscopic cholecystectomy is considered as the gold standard treatment for cholecystectomy, which is mainly due to improved results of laparoscopic surgery compared to the open surgery, and its cosmetic benefits. Methodology: This study consisted of 30 patients treated withcholecystectomy in  Medical College Hospital. They were subjected for thorough history, physical examination and available investigations required for study and particular note was made. Results: the mean operation time for males undergoing laparoscopic cholecystectomy was 90 minutes (range -75 180mm) as compared to females undergoing laparoscopic cholecystectomy, the mean operation time was 95 minutes. Conclusion: Laparoscopic cholecystectomy is the method of choice for treatment of symptomatic gallstone disease.

 Introduction: During the past decade metronidazole has emerged as highly effective agent, both for treating and preventing a wide variety of anerobic bacterial disease. It is a stable and readily available drug that rapidly achieves theraputic concentration in virtually all body tissue and fluids after rectal, oral and intravenous administration. Methodology: This work essentially consists of management of tetanus cases admitted to Government General Hospital  and compare the results of cases treeated with I.V. Metronidazole and pencillin Results: In penicillin group 90% deaths occurred whereas in Metronidazole group 47% deaths occurred among severe cases. In penicillin group  30% deaths occurred whereas in  Metronidazole group  28% deaths occurred among mild cases. Conclusion: Duration of stay in hospital in metronidazole group is shorter compared to penicillin group.

 Introduction: Gallstones are hardened deposits of the digestive fluid bile,that can form within the gallbladder. They vary in size and shape from as small as a grain of sand to as large as a golf ball. Gallstones occur when there is an imbalance in the chemical constituents of bile that result in precipitation of one or more of the components. Methodology: A study was carried out in a tertiary care hospital to know the profile of patients with gall stones. Totally 50 patients were considered for their study and these patients were selected by using non probability purposive random sampling technique. Results: The most common presenting complaint was hypogastric (56%) followed by epigastric (24%) and acute cholecystitis (20%). Conclusion: Gallstones are 4-10 times more frequent in older than younger subjects. Biliary cholesterol saturation increases with age.

 Introduction: Tetanus is more common in warm climate and rural areas, where the soil is fertile and cultivated with manure, where poverty dominates and people walk barefoot, where animal population is high, where there is no good sanitation, and facilities to prevent sepsis is not available and people are more prone to minor cuts and bruises. Methodology: Then a case of tetanus was admitted to Isolation ward of Government General Hospital, a detailed clinical history was taken and clinical examinations was performed, these findings were entered in cyclostyled proforma. Necessary relevant investigations were performed at the time of admission Results: The site of infection revealed that the most common site was lower extremity (34%) followed by upper extremity (21%) and head/neck (17%),Unknown cases constituted 22%. Conclusion: The incidence of tetanus is supposed to be more in the age group 11 to 30 years. Because of the active life of persons. They are exposed to frequent injuries.

 Introduction: Peritoneal paracentesis is a simple, accurate and bedside procedure. This requires an appropriate sized needle attached to a disposable syringe which isavailable everywhere. The basic principle is that in many cases of acute abdomen,there is collection of fluid in the peritoneal cavity. Methodology: All patients who present with acute abdomen including blunt trauma toabdomen and post-operative cases are included for study and those who give consentfor study. A total of 50 cases were studied during the period. Results: In  the present study there were 46 positive taps, among them 35 cases were non-traumatic and 11 cases were traumatic. Out of 35 cases in nontraumatic group, 04 cases were gastric perforation, 20 duodenal perforation, 05 ileal perforation, 02 jejunal perforation, 01 caecal, 01 appendicular perforations, 01 transverse colon and 01 sigmoid colon perforation. Of the 11 cases in traumatic group 08 were due to solid organ injury, 02 gastric perforation and 01 jejunal perforation noted. Conclusion: Diagnostic abdominal tap is extremely reasonable diagnostic aid

 Introduction: Peptic ulcers are ulcers, occurring in any portion of the gastrointestinal tract (GIT), in which mucosa is bathed in hydrochloric acid (HCl) and gastric juice. Ulcers can develop in the esophagus, stomach or duodenum, at the margin of a gastroenterostomy, in the jejunum, and in association with a Meckel’s diverticulum containing ectopic gastric mucosa. Methodology: The study was conducted in the Department of Surgery, Basaveshwara Teaching and General Hospital, Gulbarga Karnataka during the period of  Nov. 2011 to Sep. 2013. The diagnosis of duodenal ulcer perforation was that established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confined at operation. Results: The morbidity rate was 10.17% and the mortality rate was 11.67%. Conclusion: Wound infection was common post operative complications

 Introduction: Worldwide, nodular goitre remains a problem of enormous magnitude affecting no less than 5% of the population. Neither a well formulated nor a simple procedure is available for the management of MNG. Methodology: A total number of 30 were investigated. The investigations included Hemoglobin, total count, differential count,  urine analysis, blood sugar estimation, blood urea estimation, blood grouping and Rh typing, serum cholesterol, X-ray of the neck-AP and lateral views and chest X-ray and ENT examination. Thyroid profile, USG neck and FNAC was  done in all the patients. Results: FNAC was found to be very useful in evaluation of MNG. FNAC was done in all cases and results were compared. This shows that FNAC is 100 % accurate, indispensable tool and is minimally invasive technique. Conclusion: FNAC is indispensable, minimally invasive technique, cost effective, highly accurate technique in diagnosis and management of MNG.

 Introduction: Thyroid diseases are, arguably, among the commonest endocrine disorders worldwide. India too, is no exception. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases. Methodology: The material of present study consists of patients admitted with multinodulargoitre in Medical college Hospital and research centre. A total number of 30 cases were admitted and treated. After admission, a detailed history was taken and thorough clinical examination  was carried out as entered in proforma. Results: The chief complaint was swelling in front of neck (100%) other symptoms were pain in 4 cases (13%), palpitations in 10 (33%) cases, and dyspnoea in 1 (3%) case, dysphagia in 3 cases (10 %) and weight loss in 4 cases (13%) Conclusion: Subtotal thyroidectomy was found to be an adequate and safe treatment for   MNG with minimal complications.

 Introduction: Thyroid diseases are, arguably, among the commonest endocrine disorders worldwide. India too, is no exception. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases. Methodology: The material of present study consists of patients admitted with multinodulargoitre in Medical college Hospital and research centre. A total number of 30 cases were admitted and treated. After admission, a detailed history was taken and thorough clinical examination  was carried out as entered in proforma. Results: The chief complaint was swelling in front of neck (100%) other symptoms were pain in 4 cases (13%), palpitations in 10 (33%) cases, and dyspnoea in 1 (3%) case, dysphagia in 3 cases (10 %) and weight loss in 4 cases (13%) Conclusion: Subtotal thyroidectomy was found to be an adequate and safe treatment for   MNG with minimal complications.

 Introduction: Recent advances have included improved preoperative diagnostic studies, interventional radiologic procedures to drain established periappendiceal abscesses, and the use of laparoscopy to confirm the diagnosis and exclude other causes of abdominal pain. Laparoscopic appendectomy was first reported by the gynecologist Kurt Semm in 1982 but has only gained widespread acceptance in recent years. Methodology: Patients admitted in Victoria hospital, Bengaluru with features suggestive of Acute Appendicitis and undergoing surgery for the same were included in this study. For each patient Alvarado Score was calculated and the result of Ultrasonography was noted. Results: The sensitivity, specificity, positive predictive value and negative predictive value for Alvarado Scoring considering a score of >7 as positive in diagnosing acute appendicitis are 52.08%, 100%, 100%,8% respectively. The diagnostic accuracy is 54%. Conclusion: No statistical difference could be proven between Alvarado scoring and Ultrasonography in diagnosing Acute Appendicitis.

 Introduction: Accuracy rates in diagnosis of appendicitis are variable; the role of blood tests, radiological investigations, laparoscopy and computer analysis has been studied. Even with all investigations, the negative appendicectomy rate is 15-30%. Methodology: The source of data for this study was patients admitted to various surgical units in Department of Surgery, K.R. Hospital, which is attached to Mysore Medical College and Research institute. A period of four months has been given for follow up period to study the outcome of Surgery. These patients were diagnosed to have acute appendicitis and were operated on the same day.During the study period, 100 cases with provisional diagnosis of acute appendicitis which were posted for surgery were selected using randomization. Results: In this study, all 100 patients underwent emergency open appendectomy. Conclusion: Negative appendectomy rate can be decreased if appendectomy is avoided in patients where WBC count, neutrophil count and abdominal graded compression USG is normal.

 Introduction: Appendicitis  is  notorius  in  its  ability  to  simulate  other  conditions  and  also  it  can  be  mimicked  by  other  possibilities.  Although  considered  one  of  the  most  elemental  of  general  surgical  disease  processes ,  it  is  difficult  to  obtain  an  accurate  preoperative  diagnosis  in  many  cases,regularly  confounding  the  diagnostic  acumen  of  many  surgeons.  Therefore  delay  in  diagnosis  and  surgery  result  in  perforation,  the  rate  of  which  rises  by  5%  per  12  hour  period, 36  hours  after  the  onset  of  symptoms  Methodology: Patients  admitted  in  Victoria  hospital,  Bengaluru  with  features  suggestive  of  Acute  Appendicitis  and  undergoing  surgery  for  the  same  were  included  in  this  study.  For  each  patient  Alvarado  Score  was  calculated  and  the  result  of  Ultrasonography  was  noted Results: Maximum number of positive cases was associated with Alvarado Score of  5 to 7 Conclusion: Right Tenderness was more common clinical sign

 Introduction: Patients who have appendicitis commonly report anorexia; appendicitis is unlikely in those with a normal appetite. Anorexia nearly always accompanies appendicitis. It is so constant that the diagnosis should be questioned if the patient is not anorectic. Methodology: 100 cases with provisional diagnosis of acute appendicitis which were posted for surgery were selected using randomization. Patients were methodically enquired according to the proforma. Results: Pain was the commonest symptom. The entire 100 patient suffered from right lower quadrant pain or periumbilical pain migrating to right lower quadrant. Migration of pain was present in 48 patients (48%) and the mean duration of pain was 24 hours. Conclusion: Pain occurred in right lower quadrant in all patients. Migration of pain (typical) was present only in half of the patients. The sequence of symptom appearance is of great diagnostic value. It will begin with pain, followed by nausea and/or vomiting and later fever of low grade

Objectives: To assess the influence of venous reflux pattern and superficial venous surgery on ulcer healing and long-term recurrence rates and also to prove that surgery for varicose veins will help in resolution of venous ulcer, thereby improving their quality of life and improve their efficiency at work. Design: Retrospective observational study Methods: Data was collected from the inpatient and outpatient records at a tertiary care setup hospital. All operated cases of varicose veins with venous ulcers(CEAP C class 6) were followed up. A proforma was made highlighting all the salient findings as type of varicose surgery and choice of post operative compression and datas were collected. Study duration was from june 2012 to june 2015. Results: A total of 91 cases of operated varicose veins (11 GSV stripping, 72 GSV stripping + perforator ligation and 8 cases of perforator ligation alone) with venous ulcers were studied, out of which 27 patients were non compliant to postoperative compression and 11 cases had recurrent venous ulcers with 6 cases having recurrent varicose veins. Pattern of superficial venous reflux and risk factors associated with recurrent ulcers were also studied. Conclusion: Superficial venous surgery done in an effective manner, with proper postoperative compression of these patients definitely produces good results with less recurrence of both venous ulcers and varicose veins. 

Keywords: Varicose; Venous; Ulcer; Veins; Trendlenbergs; Procedure; Stripping; Ligations; Compliance; Compression; Stockings; Crepebandage; Insufficiency; Duplex Imaging; Saphenous; Veinsurgery.

 Background: Vestibular fistula is the most common type of anorectal malformation seen in females and it can be of low variety which is an anovestibular fistula for which a cut back is good enough, but usually an intermediate variety is seen that is called rectovestibular fistula. Standard surgical treatment for this anomaly is either ASARP (Anterior sagittal anorectoplasty)  or PSARP(Posterior sagittal anorectoplasty). We have adopted a technique of Transfistula Anorectoplasty, which doesn’t divide the sphincteric complex. Materials and Methods: The current study involves 24 cases of rectovestibular  fistula which were treated by primary TFARP without colostomy. We analysed the functional and cosmetic results with this method in our study. Results: Functional results were good in all patients except one which had complete retraction of rectum and needed a colostomy and revision of procedure. The cosmetic result was good with an almost normal looking perineum in most cases as the perineal body was not divided . However constipation was the major problem in majority of cases. Conclusion: We found TFARP a very useful and simple procedure with good cosmetic and functional results saving the patients from a colostomy. 

 Objectives: To study correlation between International Prostate Symptom Score (IPSS), maximum flow rate (Q-max), Prostate Volume (PV), Post Void Residual Urine (PVR) and Resistive Index (RI) and to evaluate changes in these parameters in cases of benign prostatic hyperplasia (BPH) pre and post treatment. Methods: The study was conducted on 30 cases of BPH. Parameters studied were IPSS, Q-max, PVR, PV and RI. 22 patients were subjected to medical therapy [Group I] and 8 to transurethral resection of prostate (TURP) [Group II]. They were reassessed at 6-weeks and 6-months post treatment. Statistical Analysis: Pearson’s coefficient of correlation was used for statistical analysis. Results: The mean age was 58.2 years (range 50–65). The mean pre-treatment IPSS of Groups I and II were 23.09±6.07 and 23.50±9.98 and prostate volumes were 48.90±12.42 ml and 37.75±9.5 ml respectively. Post-therapy, IPSS became 19.9±6.1 at 6-weeks and 14.18±5.8 at 6- months in Group I and 7.0±1.15 at 6-weeks and 4.5±1.0 at 6-months in Group II. In Group I, RI reduced from 0.75±0.05 to 0.69±0.03 at 6-weeks and to 0.62±0.04 at 6- months. In Group II, the RI reduced from 0.72± 0.06 to 0.59± 0.09 at 6-weeks and to 57±0.09 at 6-months. Conclusions: RI was significantly high in cases with moderate to severe symptoms that significantly reduced after treatment. It may become a non-invasive index for measuring bladder outlet obstruction in cases of BPH and may also serve as a prognostic marker.