New Indian Journal of Surgery

Introduction: Inguinal hernia is one of the commonest cases to be dealt with in surgical practice. Giant inguinal hernia on the other hand is a rather distinct and rare entity. Not only they pose special problems in  management, but also they reflect the ignorance and neglect among general population in developing countries. Presentation of Case: A 50 year old male patient presented with a left sided inguinal hernia extending upto just above the knee joint without any complications. The hernia was explored using a combination of preperitoneal approach with intra-peritoneal manipulation. Omentectomy , left orchidectomy and caecopexy was also performed. Defect was closed by performing Ilio-pubic tract repair using a polypropylene mesh. Discussion: Treatment of giant inguinal hernias requires adequate consideration regarding the approach to be chosen as well as thorough preoperative preparation as post-operatively patient may develop abdominal compartment syndrome which may lead to a series of unwanted complications. Conclusion: The appropriate management of such hernias require detailed knowledge of anatomy of inguinal region along with good pre and postoperative care in order to achieve the desidered outcome. 

Keywords: Giant Inguinal Hernia; Treatment; Ilio-Pubic Tract Repair

Introduction: Inguinal hernia in females is quite rare and is diagnosed late due to the rarity of this condition and hence lack of awareness. Hernia of canal of nuck can be managed by various methods but Non-mesh repair still remains to be the best choice of repair as transversalis fascia in females is stronger than in males. Presentation of Case: A 50 year old female presented with a swelling in the left inguinal region since 3 years and irreducible since 7 days. Patient was diagnosed to have irreducible hernia of canal of nuck which was explored and knotted omentum was found as content. Defect was repaired by Bassini’s method. Discussion: The diagnosis of Hernia of Canal of Nuck is based on clinical presentation, physical findings and ultrasonography
is a useful tool to detect the content of inguinal hernia. Many surgical treatment modalities are available these days like tension free prosthetic repairs, laparoscopic repair (totally extraperitoneal/transabdominal preperitoneal) and tissue suture repair such as Bassini and Shouldice technique. Non-mesh repair is justifiable in female patients as transversalis fascia is strong  compared to men. Conclusion: Even without the signs of any complication this type of hernia should be managed promptly with early surgical intervention such as tension free prosthetic repairs, laparoscopic repair (totally extraperitoneal/transabdominal preperitoneal) and tissue suture repair such as Bassini and Shouldice technique 

Keywords: Hernia of Canal of Nuck; Bassini’s Repair. 

Foreign bodies are an occasional entity in the urinary bladder. They may present in a different number of ways. In most cases, the cause is accidental and the foreign body can be removed via the transurethral approach. A 18-year-old female patient came to our hospital’s outpatient department with complaints of lower urinary tract irritative symptoms and on investigating, was diagnosed to have a foreign body in her urinary bladder. We herein report a case of foreign body, about 8 cm long wooden pencil, in urinary bladder which was successfully removed using a cystoscope. Prompt surgical management of the condition prevented long term complications.

Keywords: Foreign Body; Urinary Bladder; Cystoscope.

Context: The diabetic foot syndrome is a very severe and common complication in patients with diabetes mellitus with a cumulative lifetime incidence of up to 25 %. Management is based on the simple principles of eliminating infection, the use of dressings, offloading techniques, debridement to accelerate endogenous healing and facilitate the effectiveness of topically  applied substances. Timely healing and closure is critical to reducing the cost and morbidity associated with chronic diabetic lower extremity wounds. Split thickness skin grafts (STSG) are a well-known and widely accepted method for soft tissue coverage of open wounds though there are a vast number of wound care products and synthetic grafts available to the clinician today. Aims: Aim is to study the clinical use of STSG in a diabetic population and also identify any risk factors that may affect healing time or lead to complications. Settings and Design: A Prospective with 50 diabetic wound patients during November 2012 and September 2014. Methods and Material: up on admission random sugars and HbA1c were sent and sugars were managed with insulin and drugs. Regular dressing and debridement was done and once granulation appeared posted for skin grafting. Wound size and mean healing times were noted. Results: In our study 32% were seen in 51-60 years age group. According to Wagner’s Grade 70% were in Grade 2, 14 % in Grade 3, 8% in Grade 4. On culture 72% of cases were infected with single organism, 16 % had polymicrobial infections. 26 (52%) patients had wound size < 50cm2, 18 ( 36%) patients  had 50-100cm2 and 6 (12%) patients had > 100cm2. The mean healing time was 5.3, 5, 6.2 weeks. There was no significant difference in the healing times of wounds based on the wound size. The mean healing time at STSG site was 6.5 weeks in poorly controlled patients when compared to 5.6 weeks in patients with good glycemic control. Donor site mean healing time was almost similar in all the groups 42 patients had associated morbidities and 8 patients had only diabetes without any other risk factors. 7 cases had complications like infection and failure. Conclusions: Diabetis is emerging cause of non healing foot ulcers and major cause of hospitalisation and surgery. Wound debridement and glycemic control is must for proper wound healing. Once a good granulation appears split skin graft provides adequate cover for the wound. 

Keywords: Diabetic Foor; Debridement; Split Skin Grafting.  

Background: Recurrent and complex bilateral inguinal hernias are associated with high recurrence rate. Giant Prosthetic Repair of Visceral Sac (GPRVS) is popular in America and Europe. In india it is less frequently performed procedure.we wanted to prospectively analyse the procedure. Materials and Methods: In this prospective study 50 patients were operated, at our institute, over 2.5 years, for bilateral inguinal hernias, which included direct, indirect, recurrent and rerecurrent hernias. Patients were treated by GPRVS method of stoppa. Patients were observed for complications and followed up in O.P.D. for at least 1 year. Results: Developing pre-peritoneal plane was quite easy and there were minimal complications. operativetime varies from 30 minutes to 90 minutes and recurrence rate was nil at 1 year follow up. Conclusion: GPRVS is a very good operation for recurrent and re-re current inguinal hernias with minimal morbidity and mortality.

Keywords: Recurrent Inguinal Hernia; PrePeritoneal Plane; Prolene Mesh; Stoppa’s GPRVS.  

Aim: To analyse the day care urologic surgery cases in various paediatric surgical units in tertiary care centers in Bhopal. Material and Methods: This is a retrospective study; we reviewed the data of all urologic patients treated at two day case Paediatric surgery units between June 2012 to June 2018. The parameters studied were: age, type of surgery/ procedure, and complications. Results: In total, 200 urological cases were performed in the major operating theatre on day case basis. 102 (51.0%) patients were children aged between 4-6 years of age. Most of the cases in this series were males. Phimosis 62 (31%) was the most common surgical condition treated surgically, followed by congenital hernia 44 (22%) and hydrocele 42 (21%). Local oedema (05%) was the commonest complication observed in these patients. Conclusion: The experience and outcome of the day case surgeries in this study shows encouraging results. Pediatric day care anesthesia and surgery is safe and practically helpful. Patient selection criteria, good setup, and adequate post operative care are needed for good results. 

Keywords: Day Care Urology; Day Surgery Unit (DSU); Phimosis.   

Background: During the intrauterine life, the testis is located just below the developing kidney within the abdomen. As the testis descends through the inguinal canal and enters into the scrotal sac it is accompanied by a sac like extension of peritoneum known as the processus vaginalis. Once the testis descends completely into the scrotum, the processus vaginalis obliterates under normal circumstances but remains as a fibrous cord without any lumen. However, the most distal portion of it remains as tunica vaginalis sac around the testis with a potential space between the two layers of the sac, the visceral layer around the tunica albugenia of the testis and the parietal layer just beneath  the internal spermatic fascia of the scrotal layers. Under certain circumstances, the processus vaginalis does not obliterate and its patency persists. Depending upon its extent of patency and its communication with the peritoneal cavity various anomalies occur. I had an opportunity of working in various Armed Forces hospitals located all over India. As a surgeon I worked in the North- eastern region, western region and the southern region over a period of three decades. During that time I operated upon 778 children of various age groups with persistent processus vaginalis in various forms. In this article I will discuss about the incidence of various variations of processus vaginalis amongst Indian children. Methods: The various anomalies of the persistent processus vaginalis observed in the children who underwent surgery in different armed forces hospitals spread all over India, for the same were  recorded and analysed. Results: The commonest anomaly observed was communicating congenital hydrocele. The rare anomaly was encysted hydrocele of the cord. The other anomalies in order of frequency were congenital inguinal hernia, infantile hydrocele, funicular hydrocele and non-communicating congenital hydrocele. Conclusions: One can encounter all types of variations of persistent processus vaginalis with variable frequency in Indian children. 

Keywords: Processus Vaginalis; Congenital Inguinal Hernia; Congenital Hydrocele; Funicular Hydrocele; Infantile Hydrocele; Encysted Hydrocele of the Cord.  

The Efficacy of Metronidazole and Tinidazole has been compared in 18 patients with Amoebic Liver Abscess. Only those with unequivocal clinical,radiological and laboratory evidence of Amoebic Liver Abscess were included; diagnostic and therapeutic aspiration was performed where necessary. This study was conducted in department of general surgery at PES Medical College, Kuppam in the period of September 2017 to May 2018 over a study population of 18 patients. 9 patients received metronidazole and 9 patients received tinidazole in random order. The 2 groups were compared for the efficacy of drugs. Both drugs were given Intravenously (that is, metronidazole 500mg TID and tinidazole 800mg BID) and intra cavity instillation ( If needed, both once daily) for a minimum of 3 days. With treatment extended if considered clinically advisable. 5 of 9 patients (55.56%) were cured with metronidazole given for an average period of 7 days (range 4 to 14 days). 8 of 9 patients (88.89%) given tinidazole were cured and the mean duration of treatment was 4 days (range 3 to 6 days). There were fewer side-effects with tinidazole. Tinidazole was found to be superior to metronidazole in overall efficacy because a shorter course of treatment was necessary and it caused fewer side-effects.

Keywords: Metronidazole; Tinidazole; Amoebic Liver Abscess.  

Background: Hypospadias is the commonest congenital anomaly of the male urethra that occur in every 300-400 live male births. It involves an abnormally placed urinary meatus anywhere along the urethral groove running from the tip along the ventral aspect of the shaft of penis to the junction of the penis and scrotum  or perineum. Single stage repair with TIP technique has become the procedure of choice with its versality in repairing almost all types of hypospadias with satisfactory cosmetic and functional results. Materials and Methods: This is a prospective study carried out at Dhiraj hospital, Piparia, Vadodara, from March 2017 to April 2018. Twenty five male patients selected from those who presented to pediatrics or surgery OPD underwent different techniques of single stage repair of hypospadias. Follow-up was done up to one year. Conclusions: In conclusion, the present study reveals that patients with Snodgrass repair obtained a neourethra with a slit-like meatus at the tip of the glans. It provides satisfactory cosmetic and functional results and is versatile in repairing almost all types of distal and proximal hypospadias and has become the procedure of choice. High rates of fistula and meatal stenosis initially encountered have improved with modifications to technique with regular follow up and dilatation. One stage repair of Hypospadias is better because of time, money, hospitalization can be saved. 

Keywords: Hypospadias; TIP-Repair; Snodgrass Technique; Stricture; Fistula. 

Introduction: The etiopathogenesis of gallbladder cancer is a multistep process and hardly any of the existing biomarker(s) have a positive relation with the clinico-pathological parameters and outcome. Ki-67, a proliferative marker, is a fair prognostic indicator in cancers like the breast. The present study was conducted to assess its validity for the same and its influence on the treatment in gallbladder cancer. Methodology: Histopathological examination and immunohistochemistry for Ki-67 was performed on 41 patients of GBC and 31 cases of gallstone disease in the age of 40-70. Follow up was done at 3 months by history and physical examination. Student’s unpaired t-test, ANOVA test, Chi square test and Pearson correlation coefficient analysis were applied to assess the relation of mean Ki-67 value to the TNM status, pathological grade, clinicopathological variables, stage and postoperative outcome at 3 months. Results: Mean Ki- 67 levels were significantly raised in the malignant cases (40.00±17.42) as compared to benign (2.22±1.54, p=0.0001). Significantly higher Ki-67 levels were noted in gallbladder cancer patients with deranged liver function tests (p<0.05). Mortality within 3 months was associated with significantly higher Ki-67 (45.66±21.11, p=0.0001). Similarly, mean Ki-67 was significantly high
in patients with nodal metastasis (47.05±17.23, p=0.03). However, no significant difference was noted in relation to the tumour (T) (p>0.05) and distant metastatic (M) status (p=0.77) and the stage (p=0.21). Conclusion  Higher Ki-67 index suggests an advanced disease in the form of nodal metastasis and jaundice. It has an independent and inverse impact on the prognosis. Due to its overexpression in gallbladder cancer, it can be exploited for targeted therapy. 

Keywords: GBC; Gall Bladder Cancer; Ki-67; IHC; Immunohistochemistry  

Background: This is a retrospective study aimed at evaluating patients presenting with Granulomatous Mastitis at Dr.D.Y. Patil Medical College, Pimpri, Pune. Affiliated to be Deemed University Dr. D.Y. Patil Vidyapeeth, Pune. It outlines various clinical patterns in Granulomatous mastitis; this includes age, type of presentation and side. Methods: A retrospective study was conducted at Dr. D.Y. Patil Medical College, Pimpri, Pune, between May 2015 to March 2018. We evaluated 20 patients, female, of all ages, presenting with complaints suggestive of a Granulomatous mastitis. Results: The mean age of incidence of Granulomatous mastitis was 35.85 years. Among 20 patients 10 of them presented with lump (50%), 7 presented with Mastitis (35%), 3 presented with breast abscess (15%). The Right breast (60%) was noted to be more commonly involved than the Left breast (40%). Conclusions: Granulomatous mastitis presents in a certain age group and follows a certain clinical pattern as outlined in this study. Detailed history taking and clinical examination while keeping in mind these clinical patterns, along with ultrasound and FNAC (triple test), aids in establishing the diagnosis. Hence, the anxiety caused by breast lumps and nodularity can be releived by excluding the diagnosis of carcinoma breast.

Keyword: Breast; Granulomatous Mastitis

Background and Aim: Road traffic accidents are commonest cause resulting Blunt Abdominal trauma. Liver injury is second most common solid organ injury in blunt abdomen trauma after spleen. Latent period,vital status and associated organ injuries and grade of liver injury decide the outcome of patients. Present study was performed with an aim to ascertain conservative or operative approach of management of liver trauma with help of investigating modalities haemodynemic status of patients and associated injuries. Materials and Methods: This prospective study was conducted in 30 patients presenting with liver injury in blunt abdominal trauma during the period from May 2015 to january 2018 at P.D.U. Government
Medical College and Hospital, Rajkot. Data were collected from the patients by their history, examination and appropriate investigations. Documentation of patients, which included history, vitals of patients, clinical findings, blood investigations, diagnostic tests, intraoperative findings, operative procedures were all recorded on a Performa specially prepared. Results: out of 30 cases, 24 were males accounting 80% of study populations and 6 (20%) were females. Mean age in present study was 29.22years. In 20 (66.67%) cases, road traffic accident was the most common mode of injury. Mean latent period was 4.68 hours. Out of 30 cases 23 patients having grade 3 & 7 patients having grade 4 liver injury. USG was done in 30 cases and computed tomography Abdomen was done in 28 patients. 86.67% managed by non-operative management as they were  hemodynamically stable and Primary operative management group includes (13.33%) primarily underwent operative management as they were hemodynamically unstable at presentation in liver grade 3 & 4. Conclusion: In Patients with high grade liver injuries, better investigation modalities, hemodynamic stability by proper resuscitation and blood transfusion can be managed with conservative approach which decreases significanty morbidity and mortality of patients in hemodynamically stable patients. 

Keywords: Blunt Injury; Diagnostic Modalities; Liver Trauma; Mortality.  

Aim: To evaluate the solitary thyroid nodule (STN) cases clinically and pathologically, study the frequency of malignancy and correlating it with FNAC and histopathology. To observe which pathological variant of carcinoma occurs most commonly. Method: The present study of “Solitary thyroid nodule and its chances of being malignant” has been conducted retrospectively utilizing 100 cases which were diagnosed clinically as STN and managed both as inpatient and outpatient basis in the department of General Surgery at NRI General Hospital from October 2014 to September 2016, Chinakakani. Results: There were 87 female and 13 male patients in STN group,
resulting in a female to male ratio of 6.69:1. This ratio varied throughout the various age groups. Mean age for STN is 38.07 years. Malignant cases were 28 in STN out of which 3 were males (10.71%) and 25 were females (89.28%). Conclusion: Thyroid swellings and thyroid carcinomas are more common in females. The risk of malignancy is high in STN (28%). Amongst the malignant lesions most common was papillary carcinoma in STN (75%). 

Keywords: Solitary Thyroid Nodule; FNAC; Histopathology; Malignancy.

Background: Early assessment of disease severity and prediction of the course has been an important part of the initial resuscitation and management protocol in acute pancreatitis. Various markers for severity assessment ranging from multi parametric scores like Ranson, APACHE II, modified Glasgowto single laboratory markers like serum creatinine, IL -1, IL -6 are complex or lack sensitivity. The present study deals with the role of soluble CD73 (sCD73) and its correlation with serum CRP and creatinine levels in patients of acute pancreatitis. Methodology: SerumCD73, qCRP and creatinine was measured in patients of acute pancreatitis who presented to the surgical emergency within 120 hours of the onset of pain.The serum levels of CD73, qCRP and serum creatinine were correlated with the clinical severity of acute pancreatitis, duration of hospital say. Serum levels of CRP, creatinine and sCD73 levels were independently assessed in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for defining cut-off levels for prediction of diseases outcome. Results: Serum levels of sCD73 were significantly different in mild, moderate and severe acute pancreatitis (17.75±7.38 vs 25.69±7.92 vs 35.50±7.88 p ï‚£ 0.0001). Similarly the sCD73 levels had significantly high correlation with the duration of hospital stay (r = 0.75, p ï‚£ 0.0001) but duration of stay was poorly correlated to either CRP or creatinine levels (r = 0.236 and 0.130 respectively p =  0.069 and 0.322 respectively). Unfortunately, none of the markers had high sensitivity or specificity for predicting mortality. Conclusion: Soluble CD73 levels at the time of admission can be a reliable prognostic marker to assess the severity, hospital course and final outcome of acute pancreatitis however,the findings in this study demand a larger multicentre study so as to validate the results with greater significance.

Keywords: Acute Pancreatitis; Prognostic Marker; CD 73).  

Background: The incidence of oral cancer has significant local variation. In India and other Asian countries, oral and pharyngeal carcinomas comprise up to half of all malignancies, with this particularly high prevalence being attributed to the influence of carcinogens and region-specific epidemiological factors, especially tobacco and betel quid chewing. Aim: This is a cross-sectional study of the etiological factors and histo-pathologyof 100 oral cancer patients in our institution. Methods: This study was conducted among the oral cancer patients who visited the out-patient department in the Government Arignar Anna Memorial Cancer Hospital. A complete history was taken and the patients were evaluated for the presence of risk factors. A study of the histo-pathology report was also done for the 100 patients. Results: The incidence of oral cancer is more among males than females. Tobacco is the potent risk factor in several of its forms: smoking, betel-nut chewing and quid. Conclusion: The study confirms the usefulness of theprogrammes aimed at primordial prevention of the oral cancer in the form of preventing the risk factors. 

Keywords: Histopathology; Etiological Factors. 

Background: Incisional hernia repair especially large ones still remains a challenge to the surgeons even today. With the advent of minimal invasive surgery, rapid advances had taken place in the working concept of incisional hernia. It is a long-term and common complication following abdominal surgery especially in females and estimated to occur in 03 to 13% following laprotomy incisions. At present, no consensus exist on the ideal placement of mesh in open hernia repair.But for laproscopic repair,mesh is always placed in Underlay position.Repair of incisional hernia with mesh either by open or laproscopic repair is now well accepted as gold-standard treatment worldwide. Here, in open hernia repair,we aim to identify the ideal position for mesh placement to assess complications like recurrence rate and surgical site infections. Materials and Methods: The study was carried out in the department of General surgery, Gems and Hospital, Srikakulam, Andhra pradesh. A total of 60 patients were enrolled for the study from among admitted cases.A thorough clinical assessment, laboratory investigations and radioimaging studies were performed in all cases. Later the patients were categorized for open and laproscopic repair as per suitability. Results: Incisional hernia was found most commonly in the age group of 30-50 years [46.6%]. Females constitute about 61.7%. Middle aged females undergoing laprotomy with midline vertical incision with wound dehiscence are more prone to  develop incisional hernia with in a period of 01-03 years. Conclusion: Sub-lay mesh placement in open hernia repair and Underlay in laproscopic repair were found to be ideal and yielded good results. 

Keywords: Incisional Hernia; Component Separation Technique; Laproscopic Repair; Onlay Repair; Sub-Lay Repair; Surgical Site Infections  

Background: Diabetic foot ulcer is one of the common presentation of diabetic foot. The number of people with diabetes worldwide was estimated at 131 million in 2000; it is projected to increase to 366 million by 2030. It is estimated that approximately 20% of hospital admissions among patients with DM are the result of diabetic foot ulcer. The aim of this study is to evaluate the clinical scenario of diabetic foot ulcer patients in our hospital and study the percentage of surgical intervention like debridement, amputation. Materials and Methods: 50 patients of diabetic foot ulcer admitted in the Department of General surgery at NRI Institute of Medical Sciences and Hospital, Visakhapatnam, Andhrapradesh, India during the period of April 2017 to March 2018. Results: The male to female ratio was approximately 1.7 Maximum number of patients was found in the age group of 56-65 years. Most of the patients had history of diabetes in between 5 to 10 years. Surgical complications was more common in male patients than female patients. Staphylococcus aureus was the most common organism found in culture report.The mainstay of treatment was conservative approach by controlling diabetes with human insulin along with antibiotics and wound debridement. The surgical procedure opted were split skin grafting, disarticulation and below knee amputation in few cases.In our study there was no mortality. Conclusion: The success of diabetic foot ulcer management depends on prevention, early assessment and treatment by multidisciplinary approach. 

Keywords: Diabets Mellitus; Foot Ulcer; Vasculopathy; Neuropathy; Debridement; Amputation.  

Background: Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality [1]. Surgery plays an important role in the management of hollow viscous perforation. Peptic viscus perforation is one of the most common causes of acute abdomen. Evaluating patients who have hollow viscus perforation remains one of the most challenging and resourceintensive aspects of acute surgical care. Aim: To discuss the surgical management in regard with 26 cases of peptic perforation. Methods: A retrospective analysis of 26 cases that underwent exploratory laparotomy for an indication of hollow viscus perforation in the period between June, 2015 and December, 2017. Results: Of the 26 cases that were included in the study it has been observed that the median age of patients has been 46.8 years and 22 (84.6%) were male and 4 (15.4%) were female. 23 (88.4%) cases were managed successfully and had recovered while 3 (11.6%) case expired. Conclusion: The analysis of patient data reveals that early attention and prompt management of a patient presenting with hollow viscus perforation can significantly improve chances of survival. 

Keywords: Omental Patch; Peptic Perforation; Laparotomy

Background: Cholelithiasis is a benign disease of the biliary tract is one of the most common indications for major abdominal surgery in India. The most prevalent complication of gallstone is chronic cholecystitis occurs in approximately 4% of cases. Cholelithiasis or gallstones are quite common in adults. Antibiotic prophylaxis in biliary surgery, when correctly used, has led to the reduction in postoperative infections. Cephalosporins are one of the most commonly prescribed agents for surgical prophylaxis because of their favourable pharmacokinetic profiles, low incidence of adverse effects and low costs Methods: Minimum of 50 Patients admitted under General Surgery, who are scheduled to undergo laparoscopic cholecystectomy.Five ml of bile will be aspirated from the gall bladder during laparoscopic cholecystectomy. The samples will be transferred onto a plain sterile container and then transferred at room temperature in an hour to the laboratory for antibiotic sensitivity pattern. Results: Our study revealed that amikacin being the most powerful as its sensitive to e.coli and klebsiella and eneterococcus [100%]. Klebsiella shows complete sensitivity to ampicilin and ciprofloxacin and linezolid are moderately sensitive Ceftriaxone is 100 percent sensitive to klebsiella and 62.5 percent to e.coli Imipenem shows 100 percent sensitivity to enterococci, 33.3% to klebsiella and 50 percent to e. coli. Conclusions: Isolating bacteria and determining their susceptibility to different antibiotics may help physicians to manage cholecystitis and its associated complications. It helps  in reducing the costs associated with health care and help to reserve drugs for future use in case of need of newer microorganisms. Exhausting all available antibiotic options before antibiotic sensitivity will result in paving way for bacterial kingdom to develop a bug which will be resistant to all antibiotics.

Keywords: Gall Stones; Microflora; Culture and Sensitivity; Antibiotics.
 

Background: Abdominal trauma from Blunt injury is found in most of the patients with polytrauma. For diagnosing Blunt abdominal trauma, we have to keep high index of suspicion and through physical examination and investigations are required. Prompt and proper management in time reduces morbidity and mortality. Aim: The aim of this retrospective study was to know the percentage of different organ involvement in Blunt trauma abdomen. As well as to find out types of injury, age group, male to female ratio, operative to conservative ratio and respective outcome. Material and Methods: This study is based on 295 cases of Blunt trauma abdomen; managed there from admission, investigation, management and possible follow up. Observations are shown in different tables. Result: we found that Liver is the most common organ to get involved in Blunt trauma abdomen. After that comes spleen, kidney and pancreas respectively. Solid organ injuries cases were treated by operative as well as conservatively as per hemodynamic parameters of patients. Operative management of Bowel injuries was done by either repair of perforation or resection and anastomosis of Bowel. Out of 295 patients 53 died because of complication like Hypovolemic shock, septicemia, renal failure and multi organ failure. Concusion: Timely diagnosis and proper management reduces mortality after Blunt trauma abdomen. Early management should start from accident site to hospital with close supervision 

Keywords: Blunt Trauma Abdomen; Operative/ Nonoperative Management; Road Traffic Accident.
 

Background and Objectives: The cystic swellings of scrotum are one among the common surgical problem in all age group. Objective of this study is to identify the cause, mode of presentation, various modalities of treatment and outcome of these with least complications. Methods: A total of 50 cases of cystic swellings of scrotum fulfilling the methodology criteria’s were subjected to preformatted study. Final diagnosis was made with Clinical examination and Ultrasound. All 50 cases  were treated surgically. Results: Most of the patients were in age group of 31-40 years (32%), presenting feature being scrotal swelling as a main complaint in 56% of cases, majority of them were right sided (60%), majority of them presented with in a year, 48% presented with in first 6 months and 26% in next 6 months. Primary vaginal hydrocele was the commonest cystic swelling (56%), followed by Epididymal cyst, Sebaceous cyst, Haematocoele, Pyocoele. Lord’s plication was the procedure, which was associated with early discharge of the patient and least post-operative complications. Most of the patients were discharged around 8th Post-operative day. Conclusion: Primary vaginal hydrocoele was the commonest cystic swellings of scrotum. Most of the cystic swellings were treated surgically with good results. Lord’s procedure was the least to have postoperative complication. 

Keywords: Hydrocoele; Epididymal cyst; Spermatocoele; Pyocoele; Haematocoele; Lord’s
plication.
 

Introduction: Hemorrhoids are most common human  disease defined as downward vascular displacement of submucosal cushions of the anal canal. In the past, various methods of treatment were presented for asymptomatic patients, however the surgical management has remained the best option available throughout. The commonest complication of open hemorrhoidectomy is post operative pain due to spasm of the internal sphincter which is also the cause of post operative urine retention, thus commonly performed procedure for relieving spasm and pain is lateral sphincterotomy. Lateral sphincterotomy adopted as a method to relieve sphincter spasm was thought to cause fecal incontinence as sphincter fibres are cut causing loss of anal tone. Hence a trial was made to evaluate whether combination of lateral sphincterotomy along with hemorrhoidectomy can help in the post-operative pain relief and reduce incidences of post operative urine retention and to know if lateral sphincterotomy is associated with fecal incontinence. The study aim was to evaluate the advantages of hemorrhoidectomy with lateral sphinctreotomy over hemorrhoidectomy done alone and association of fecal incontinence as a complication of lateral sphincterotomy. Material and Methods: This prospective study was conducted at Great Eastern Medical School, Srikakulam, and Andhra Pradesh, India between JULYS 2015 and JULY 2017 after obtaining an ethical clearance on consenting 100  patients who chose conventional open hemorrhoidectomy. Using lottery methods the patients were divided into two groups. Group A included patients with conventional open hemorrhoidectomy and lateral sphincterotomy. In Group B only open  hemorrhoidectomy was done. Using Visual Analog Scale pain assessment was done on day - 0, 1, 2, and 7 respectively. Based on symptoms urine retention was assessed according to need for catheterization, fecal incontinene. Results: We found statistically that there was significant pain relief in the group to whom lateral sphincterotomy was added, lesser incidences of urine retention no cases of fecal incontinence were reported. Conclusion: In this study we conclude that the convenient and effortless way to reduce the postoperative pain with lesser urinary retention chances without risk of fecal incontinence is with conventional open hemorrhoidectomy along with lateral sphincterotomy which ensure better post operative period. 

Keywords: Pain; Hemorrhoidectomy; Lateral Sphincterotomy; Urinary Retention; Fecal Incontinence; Visual Analog Scale.
 

Introduction: Colorectal cancer is a major cause of morbidity and mortality throughout the world. The widespread implementation of neoadjuvant radiotherapy and chemotherapy (CRT) has reduced local recurrence rates from 25% to 40% to less than 10%. However, many patients undergo radiotherapy and chemotherapy for resistant cancers, thus incurring side-effects without benefit. Expression of particular genes at molecular level can be related to response or resistance to systemic therapies. In this study we have assessed the predictive value of VEGF, EGFR and p53 in predicting the response to neoadjuvant CRT in locally advanced rectal cancers. Material and Methods: Patients with locally advanced carcinoma rectum (stage II and III) were included in the study. Following completion of neoadjuvant CRT patients were evaluated to assess the response of CRT. The response of CRT was assessed using RECIST criteria. The response to CRT was correlated with the level of molecular markers. Results: Total 35 patients were included in the study. Over expression of VEGF, EGFR and p53 was associated with poor response to neo-adjuvant chemo-radiotherapy. The findings were statistically significant in case of VEGF and EGFR. Conclusion: We conclude that molecular markers (VEGF, EGFR and p53) may become tools for selection of patients suitable for chemoradiation in carcinoma rectum. However, more studies are needed with larger sample size and longer follow up for establishing molecular markers as predictors of  response to chemoradiation and overall outcome in patients of carcinoma rectum.

Keywords: Rectal Carcinoma; Neoadjuvant Chemoradiotherapy.  

Aims & Objectives: In the present study we have compared between recent stapled  haemorrhoidectomy  and conventional haemorrhoidectomy (Milligan Morgan Technique) for treatment of haemorrhoids in terms of operating time, postoperative pain and bleeding and other complications, hospital stay and time to return  to work. Materials & Methods: This is a prospective comparative study conducted in the department of general surgery of J.L.N.Medical College, Ajmer, Rajasthan in the duration of November 2015 to December 2017. Sixty (60) patients of age>20 years with symptomatic internal hemorrhoids of 3rd & 4th degree were randomly assigned to either conventional or stapled haemorrhoidectomy (30 in each group). Visual analog scale was used for evaluation of pain. Intraoperative blood loss, procedure time, postoperative pain and other complications like urine retention, bleeding, infection, constipation and recurrence rate were studied. Postoperative hospital stay duration, days required to resume normal bowel habits and normal daily activities and satisfaction with treatment. Follow up was done at 1 week, 1 month and 3 month. Data collected and analyzed. Results: Intra-operative blood loss (70.33 v/s 30.33 ml, p value<0.01), duration of surgery (32.8 v/s 27.1 minutes, p value <0.01), post operative pain (p value <0.01) and hospital stay (2.2 v/s 1.0 days, p value<0.001) were less in stapled haemorrhoidectomy. Earlier normal bowel habits (3.6 v/s 2.2 days, p value <0.01) and earlier resumption of normal personal activities (5.6 v/s 4.2 days value <0.001) and better patient satisfaction  (53.33% v/s 93.33%, p value < 0.001) were associated with stapled haemorrhoidectomy. Results regarding post operative complications like bleeding, urinary retention, infection and constipation were no statistical difference found (p value >0.05). Conclusion: Stapled haemorrhoidectomy procedure is superior to conventional haemorrhoidectomy in terms of intra operative blood loss, operative time, post-operative pain, first defecation, early resumption of activity, hospital stay and patient‘s satisfaction. Regarding anal stenosis and recurrence rate long term follow-up is necessary. 

Keywords: Anal Stenosis; Haemorrhoids; Post Operative Complications; Recurrence; Urinary Retention.  

Peptic ulcer disease causes high morbidity worldwide anually. The incidence of PUD has been estimated at around 1.5% to 3%. High risk of morbidity  and mortality are found in patients with perforated peptic ulcer. PPU carries a high risk of motality.perforation is the major complication and treating them is most challenging. Perforation is the most disastrous complication of peptic ulcer and in spite of modern management it is still life threatening catastrophe (Hugh TB, 1990). The mainstay of treatment for bowel perforation is repair of perforation-surgically, Endoscopic, Laparoscopic procedures are now being increasingly performed instead of conventional laparotomy. The most common emergency in india compared to western world is peritonitis caused due to perforation. Materials and Methods: This study has been based on the analysis of 75 cases of hollow viscous perforation admitted to MVJ Medical College & Research Hospital. Duration of study was from AUG 2016 to MARCH 2017 (9 months) Type of study: Prospective study. Study was conducted after obtaining ethical clearance from ethics committee. Out of the 75 cases of peritonitis secondary to hollow viscus perforation all underwent emergency laparotomy and the site of perforation, its pathological condition, post operative complications , mortality were studied. Medical management can be attempted in peptic ulcer disease.perforation remains as the important complication in treating the peptic ucer.perforated oeptic ulcer presents with abdominal pain gyuarding and  tachycardia. Erect chest radiograph may not establish the diagnosis and an index of suspicion is essential. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improveoutcomes. Non-operative management should be conducted by experienced teams with optimal resources and ideally under trial conditions. Exploratory laparotomy and grams omental patch stills remains as the gold standard. Gastrectomy is  recommended in patients with large  or malignant ulcer to enhance outcomes; however the outcomes of patients treated with gastric resections remain inferior. Gelatin sponge plugs, fibrin glue sealants, selfexpandable stents and endoscopic clipping techniques are the newer advancements. Results: Duodenal to gastric ulcer perforation ratio when we compare to western population it stands out at 4:1 and in Indian population it is 30:1. In our study, interestingly for every 4 duodenal ulcer perforations there were 2.5 gastric ulcer perforations. This indicates the changing ratio of duodenal to gastric ulcer perforation approximately 2:1. Conclusion: Peptic ulcer can now be treated with medications instead of elective surgery. However, ulcer may perforate and carries a high mortality risk. There is a changing trend of increasing perforated gastric ulcer, but still duodenal ulcer perforation remains most common cause of peritonitis. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes.

Keywords: Perforative Peritonitis; Peptic ulcer; Gastrectomy.   

Context: There is no data published on the outcome and complications of Modified Asopa-I repair, though it is conceptually proved to be superior and results are better. Hence study on this subject was necessary. Aims: To evaluate the results of Modified Asopa-I repair in patients of hypospadias. Settings and design: A retrospective and prospective, Analytical study was carried out at Asopa Hospital and Research Centre,  Agra. Methods and Material: 56 patients operated by Modified Asopa-I repair procedure for hypospadias between April 2012 to March 2016 at Asopa Hospital and Research Centre, Agra were included. Surgery for hypospadias is done after the patient is 18 to 24 months of age and onwards but preferably before age of school going. Statistical Analysis: Proportions were used to analyze the data. Results: 23 (41.07%) patients developed one or more complications. Majority of which were minor complications. Early post-operative complications, like suture line infection and edema developed in 21.42% patients each. 3.57% patients had flap necrosis. 7.14% patients developed urethrocutaneous fistula. On follow-up for 1 month to 4 years, residual chordee, meatal stenosis & stricture urethra was not detected in any patient. Diverticulum, sacculation and ‘S’ shape deformity was also not detected in any case. 3 (5.35%) patients required second surgery. Conclusion: The Modified Asopa-I repair can be done in patients of hypospadias with chordee & urethral opening from glandular to pen scrotal region  with adequate prepuce, and flat, concave or conicalglands.

Keywords: Modified Asopa-I Repair; Hypospadias; Complications; Follow up.  

Background: Abdominal incisional hernias are a common condition in surgical practice. Numerous surgical procedures have been used to repair them with different results. Objective: This study aims to find the place of shoelace darn in the repair of incisional hernias. Method: Fifty patients with abdominal incisional hernias have been managed by shoelace darn method in this prospective study. The details of operative technique has been described. Results: Shoelace darn was relatively easy procedure associated with fewer complications. There were no true recurrences noted. Conclusion: Shoelace darn repair still remains as an excellent technique in management of abdominal incisional hernias , despite advent of mesh. 

Keywords: Incisional Hernia; Shoelace Repair; Diabetes Mellitus; Mesh; Modified Shoelace Technique.

Peripheral vascular disease (PVD) is a silent killer and In view of the raising trend in the atherosclerotic heart disease and syndrome X in the Indian population the prevalence of the peripheral arterial disease (PAD)  is likely to register similar increase [1,2]. The mortality and morbidity of the peripheral arterial disease is comparable to that caused by the coronary artery disease, especially so, when the patient presents with Critical limb ischemia [3]. Since the peripheral arteries, unlike, the coronary and cerebral arteries are not end arteries, adequate time is likely to result in development of collaterals [4]. Early detection of the peripheral arterial disease, especially in the asymptomatic stage is likely to prevent and delay the consequences of the disease, through simple measures like life style modification, simple clinical tests,pharmacological interventions etc. Thus early detection of the Peripheral vascular disease will reduce the Public health expenditure involved in treating the disease and prevents the complications, saves limbs and life [6]. Though, Doppler evaluation of the peripheral arterial system is eminently suitable non- invasive technique for early detection and screening for peripheral vascular diseases [7] but has the fo drawback of being costly and hence unaffordable by the middle income group and poor patient population. Not freely available at the PHC and RHC level and requires technical expertise Ankle brachial index (ABI) is a reliable method for early detection and screening Of the peripheral vascular diseases, on account of It being non invasivec,can be undertaken in the OPD it self. Equipment to measure Ankle brachial index is cheap and can be done with the  minimal technical skill even by a Para medical worker with adequate training. The present study is to evaluate the role of ABI in screening for the prevalence of peripheral arterial diseases in asymptomatic patients at risk attending the general OPD at Narayana Medical College hospital in Nellore, to estimate the severity of the same in the asymptomatic and symptomatic patients.And To provide the suitable preventive health education to the individuals found to have risk factors for peripheral arterial diseases.

Keywords: Peripheral Vascular Disease; Ankle Brachial Index.  

Background Acute appendicitis is a common surgical emergency that we have to consider when patients present with pain in right iliac fossa. Though one can come to a conclusive diagnosis of acute appendicitis with history and correlation with clinical signs, the negative appendicectomies have remained considerably high (about 15-30% cases). A number of clinical and laboratory based scoring system have been devised to assist the diagnosis. Most widely used is “Alvarado Score” and equally its modifications ie, Modified Alvarado Score [MAS]. The present study aims to evaluate the usefulness of Appendicitis Inflammatory Response Score [AIRS] system in patients with a provisional diagnosis of appendicitis and to avoid negative appendicectomies. Methods The present study selected 60 consecutive patients who presented to emergency department, Sri Adichunchanagiri Hospital and Research Centre, B.G. Nagara, with suspicion of acute appendicitis between March 2017 and Augest 2017. The variables necessary for evaluation are registered and diagnostic performance of two scores was compared. Results The present study included 60 patients with suspicion of acute appendicitis. The results analyzed shows the rate of negative appendicectomy in MAS score found to be 36.66% and rate of negative appendicectomy in AIR score to be 3.33%. the difference between the score to be 33.33%. Hence, proving it to be a better clinical score, when compared to Alvarado score in decresing the rate of negative appendicitis. Conclusions: This study externally validates  the AIR Score for patients with acute appendicitis. The scoring system has a high discriminating power and outperforms the Alvarado score.

Keywords: Appendicitis Inflammatory Response Score; Acute Appendicitis

Surgical management of groin hernias continues to attract the interest of General surgeons as it is the most common surgery performed in surgical practice. Over 80 variants of techniques have been tried; the time tested ones being Ex Bassini’s heriorrhaphy using tissue repair and the other by using prosthetic mesh (Lichtenstein’s) are done by anterior approach through the inguinal canal. The posterior (preperitoneal) approach to the repair of groin hernias using synthetic mesh brought to light by Nyhus et al. have fascinated many surgeons. Though current trend is to use laparoscopic approach (which itself can be preperitoneal or intraperitoneal ) we have taken up this study by open method as it is much less expensive and can be done at peripheral hospitals. The current study is to evaluate its efficacy in terms of post operative pain, duration of hospital stay, return to preoperative physical activity and early recurrence. 

Keywords: Inguinal Hernia; Preperitoneal Repair; Opens Posterior Approach; Mesh Repair.