New Indian Journal of Surgery

Background: Surgical jaundice is caused by complete or partial obstruction of biliary flow. The etiology can be benign or malignant, of which the malignancies carry a grave prognosis. In rural setup of our country patients undergo conservative management for long due to shortage of advanced radiological, clinical and laboratory setup, leading to delayed referral at tertiary care centres and worsening the scenario. Diseases causing jaundice reflect as a change in liver function which can be easily assessed by simple laboratory tests. Aims & objectives: To assess the difference of liver function derangement in obstructive jaundice due to stones and malignant causes and to analyse if there is any specific pattern of liver function derangement with respect to etiology. Material and methods: A prospective descriptive study was done with 50 patients of obstructive jaundice, with group 1 (stones, n=22) and group 2 (malignancy, n= 28). Patients presenting with obstructive jaundice were subjected to clinical, laboratory and radiological evaluation and those fulfilling our criteria were assigned either group. The data was recorded and evaluation was done, using MedCalc Statistical Software. Results: The mean and highest values of total and direct bilirubin, Alkaline phosphatase, GGT, was much higher in group 2. S. albumin was significantly lower in group 2 compared to group 1. Conclusion: These parameters appear to follow a pattern as per etiology. Considering the cut off patterns, a scoring/predictive system can be developed for early diagnosis.

Keywords: Hepatic; Biliary; Pancreatic.

 Objective: To study the role of Tele-Health Camps in Plastic Surgery.Methods:It is a retrospective analysis of the feedback given by patients and doctors attending the tele-health camp. Total number of feedback forms analyzed were 1183. Results: 97% of the patients have found tele-health camps, very useful and satisfactory. All of them agreed with benefits like reduction in waiting period & overcrowding in Out Patient Department (OPD) and saving of their travel time & expenses. All the resident doctors who attended telehealth camp agreed that tele-health camps provided good learning experience and the consultants were agreeing in giving satisfactory consultation through tele-health camps and felt that their valuable time is also saved. Conclusion: Tele-health camps are useful for both patients and doctors in the field of plastic surgery.

Keywords:Tele-Health Camps; Tele-Consultations.

 Introduction: Cystic lesions within the pericardial space are a rare entity and comprise 7% of the mediastinal masses and 33% of mediastinal cysts. The reported incidence of pleuropericardial cyst is 1 in 1,00,000 population and most cases are detected incidentally. Most cases are congenital and asymptomatic but life threatening complications may occur in the course of disease. Case Report: A 60 year old male pt. came to our hospital with chief complains of chronic cough, chest pain, dyspnoea , palpitation, a feeling of retrosternal pressure and right shoulder discomfort radiating to right arm since 2 months. Chest X-ray showed e/o isolated cystic shadow in right mediastinum. Patient was advised surgery and underwent Anterior Thoracotomy and excision of cyst. Discussion: Patients with pleuropericardial cysts are usually asymptomatic (up to 60-75% cases). Symptoms usually appear when the cyst compresses on a nearby structure. Common symptoms include chronic cough, chest pain, dyspnoea and a feeling of retrosternal pressure. Conclussion: Pleuropericardial cyst occurs rarely, is clinically silent in majority of cases but can cause life threatening complications. Therefore it is prudent to keep such anomalies in mind when evaluating patients from third and fourth decade of life either during routine health check-up or when such patients present with chest complaints.

Keywords: Pleuropericardial cyst; mediastinum; chronic cough; chest pain; dyspnoea; retrosternal pressure.

 Objective: To study the effectiveness of Live Transmission of Scientific sessions. Methods: Retrospective study of Feedback proformaswas done after completion of Live Telecast of 112 scientific sessions. Results: Both audio and video quality was satisfactory after analysing the feedback received from centres participated in the live telecast programmes. Conclusion: Live telecast is an important tool of knowledge sharing.

Keywords: Live Telecast, Scientific Session, Telemedicine

 Background: Chronic venous insufficiency of lower limbs is a common medical problem encountered by people atlarge in North-costal region of Andhra Pradesh and adjoining Odisha state. The presentation of symptoms varies from asymptomatic to cosmetic ones and if not treated in time, will lead to serious complications such as varicose ulcer and Deep vein thrombosis. Varicose veins of lower limbs is the most common peripheral vascular disease which needs proper evaluation and management. Hence the present study was undertaken to evaluate the various clinical aspects and modalities of treatment adopted for chronic venous insufficiency and varicose veins in this region. Methods: The study was conducted for a period of 2 years from February 2015 to January 2017 at GEMS and Hospital, Srikakulam, Andhra Pradesh. A total of 50 patients with Primary Varicose Veins were selected from among the admitted cases for the study. After thorough clinical examination, relevant biochemical and radiological studies were done. The patients were categorized and operated upon. The postoperative follow-up was also done. Results: In the present study, it was observed that varicose veins affect middle-aged adults (20-60 years) more commonly. Most of the patients were males (84%) and majority of them sought medical consultation for complications (22%). Long saphenous venous system involvement was seen in 60% of cases and 12% cases had both long and short saphenous venous system involvement. A good number of patients had also perforator incompetence. Saphenous-femoral flush ligation with stripping was the best surgical procedure adopted for great saphenous venous involvement and no recurrences were reported during the follow-up period. Conclusion: Surgical management was the main stay of treatment for patients with chronic venous insufficiency and varicose veins associated with complications. Flush ligation of Sapheno-femoral junction with stripping for great saphenous vein and sub-fascial ligation for perforators incompetence were found to be the best surgical procedures and yielded good results in the present study.

Keywords: chronic venous insufficiency; Duplex doppler study; sapheno-femoral junction incompetence; Trendelenburg’s surgery; varicose ulcer.

 The objective of this study was to find the effectiveness of laparoscopic surgery in case of peptic perforation. A study was carried out with 40 patients with peptic perforation closure done in G.G hospital, Jamnagar during period of January 2016 to august 2018 and there was a significant difference in the outcome of the patients of these two groups, which established laparoscopic surgery as preferred method over open surgery for peptic ulcer perforation closure in way of lesser days antibiotic requirement (3.2 ± 0.41 SD days vs 9.1 ± 2.14 SD days), lesser analgesic requirement (2.2 ± 0.83 SD vs 6.9 ± 0.78 SD days), lesser post-operative hospital stay (4.5 ± 0.51 SD days vs 9.2 ± 2.89 SD days) and early return to normal routine activity(5.0 ± 0.72 SD vs 7.5 ± 1.53 SD days) in selected patients. 3

Keywords: Peptic ulcer perforation- Laparoscopic repair - Open repair

 Background: Endoscopic Retrogarde Cholangiopancreatography is direct contrast study of hepatobiliary system by combining the use of endoscopy and fluoroscopy. It has added advantage of allowing duodenoscopy and pancratography which are helpful in diagnosis of Ampulary and Periampullary anomalies. This procedure can be performed in presence of ascites and hepatic malignancies. At present Endoscopic Retrograde cholangiopancreatography is more commonly used as therapeutic tool rather than diagnostic tool. Method: The present study was undertaken at a tertiary referral centre for duration of two years. A total of 40 cases, who underwent ERCP for various indications were included. Once patient was in the procedure room, baseline vital signs are recorded and an intravenous line started. Antibiotic prophylaxis was given at this time. ERCP performed with the patient on the x-ray table with radiological equipment and fluoroscopy at hand. Result: Choledocholithiasis 36% was the most common indication for ERCP. Successful extraction of CBD calculi was done in 78.57% cases. Biliary sphincterotomies was done in 92.5% (37) of the patients for successful drainage. Overall complication rate of ERCP was 12.5%. During this study Sensitivity of the biopsy was 57% while that of brush cytology was 40% and combined sensitivity was 60%. Conclusion: ERCP is effective for the pallation of malignant biliary obstruction, for which self – expanding metallic stents have longer patency than plastic stents. It helps in diagnosis, identification and palliation of post operative biliary leaks. Morbidity and mortality following ERCP biliary drainage is low as compared to surgical biliary drainage.

Keywords: Endoscopic Retrograde Cholangiopancreatography; Hepatobiliary system; Pancreas; Diagnostic; Therapeutic

 Context: Acute cholecystitis is a common surgical problem and was usually treated with conservative management followed by a delayed laparoscopic cholecystectomy after an interval of 6 to 8 weeks. Our aim was. Aims: To compare the efficacy of Early laparoscopic Cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) in patients of acute cholecystitis, and also to assess the complications between the two. Settings and Design: This study was a prospective randomized controlled trial in Vydehi Institute of Medical Sciences and Research Centre from January 2015 to June 2016 that was conducted on 50 consecutive patients diagnosed to have acute cholecystitis. Methods and Material: 25 patients underwent immediate laparoscopic cholecystectomy within 24-72 hours of admission and 25 patients underwent a delayed laparoscopic cholecystectomy after 6-8 weeks of the initial episode. Parameters related to surgery, complications and postoperative period were observed, tabulated and analysed. Statistical analysis used: The demographic variables were represented in percentage and continuous variables were represented using Mean and Standard Deviation. Possible associations were found out using chi-square test / Fisher exact test. Results: In the early surgery group, intraoperative complications noted were adhesions (16%), bleeding (16%), GB perforation (8%) and bile duct injury (4%). In late surgery group, complications that were noted were adhesions (68%), bleeding (40%), and GB perforation (12%), bile duct (12%) injury. Postoperatively, complications seen in early surgery were bile leak (4%), bile leak (4%) and postoperative jaundice (4%) which included SSI for 2 patients. In late surgery, postoperative complications seen were bile leak (16%) and jaundice (12%), again not statistically significant. Duration of surgery in ELC patients was statistically higher at 76.16 ± 23.38 minutes than that in LLC group which was 116.48 ± 23.14 minutes. Mean hospital stay was more in LLC when compared with ELC (6.48 days vs 3.84 days). Conclusions: Early laparoscopic surgery had similar intraoperative and postoperative complications compared to delayed surgery in acute cholecystitis, but was associated with a shorter surgery and lesser stay in the hospital.

Keywords: Early laparoscopic cholecystectomy; Delayed laparoscopic cholecystectomy; Late laparoscopic cholecystectomy; Acute cholecystitis.

 Background and objective: The skin surface is important as a biological layer for homeostasis. Restoring the skin surface is therefore critical even if underlying structure can wait later reconstruction. Skin act as a barrier to fluid loss and provide important protection against invasion by micro-organisms. The main objective of the present study is to evaluate the co-morbid condition associated with different type of ulcers. Research design: The observational and clinical design was applied in the purpose of the present study. Method: total 100 patients who admitted in the department of surgery and plastic surgery ward were included in present study. Result: The hypertension was to be most common co-morbid condition, patients were affected in 23% to be associated with the diabetics and infective ulcers. Smoking is the most second co-morbid condition (17%) patients, with the associated of infective, venous and diabetic ulcers. Tobacco-chewing (11%) and alcoholism in (10%) the most common co-morbid condition associated with the traumatic ulcers. Conclusion: findings of our studywe are concluded that the hypertension, diabetes type 2, smoking, tobacco-chewing and alcoholism was most common co-morbid condition of ulcer.

Keywords: Co-morbid condition; Ulcers.

 Objective: To analyze the efficacy of diagnostic laparoscopy for diagnosing abdominal tuberculosis in susceptible cases. Methods: The records of 20 patients (15 males, 5 females, mean age 35, range 20-70 years) diagnosed with abdominal TB by diagnostic laparoscopy in Dr. D.Y. Patil hospital between june 2017-june 2018, were analyzed. Results: Chronic abdominal pain was the most common presenting complaint (85% of the patients) followed by history of weight loss and loss of appetite (65% patients). Other common findings were evening rise of fever (50%), altered bowel habits (30%), ascites (35%), abdominal distension (25%). Radiological findings were suggestive of lymphadenopathy (60%), circumferential wall thickening (25%) and (10%) stricutres or adhesions. Patients were posted for diagnostic laparoscopy after thorough investigations and high suspicions of abdominal tuberculosis. Biopsies were taken in all cases and 40% patients required adhesiolysis whereas 10% patients required stricturoplasty. All biopsied specimens were sent for HPE, culture and sensitivity, geneXpert and TBPCR and it helped in the confirmation of abdominal tuberculosis. Conclusion: Diagnostic laparoscopy as a tool for early diagnosis and hence early medical management of abdominal tuberculosis has been a recent and novel advancement in the field of surgery. It has also lead to the prevention of mortality and morbidity caused by abdominal tuberculosis by eliminating emergency exploratory laparotomies and delayed diagnosis.

Keywords: abdominal tuberculosis; diagnostic laparoscopy.

 Background: Acute appendicitis, though a common surgical emergency, is often missed by young and inexperienced surgeons who need to know the importance of the age-old battery of investigative gadgets and laboratory tests along with the importance of estimation of total serum bilirubin to exclude the possibility of a rupture of the organ. Objective: Study To Assess the role of leucocyte and hyperbilirubinemia as a predictive factor for appendicular perforation in acute appendicitis. Materials and Methods: This study was performed on 125 patients who have been clinically diagnosed of having acute appendicitis and who were posted for appendectomy in Post-Graduate Department of General Surgery, in collaboration with the Department of Pathology and the Post-Graduate Department of Radiology, S.C.B. Medical College and Hospital, Cuttack, Odisha, India during the period from Jan 2013 to Dec 2014. Results: The sensitivity of TLC > 11 x 103 cells/µL and Total Bilirubin level > 1.1 mg/dL was found to be 21.43 and 89.29 respectively and Specificity was 2.33 and 53.49 for TLC and Bilirubin Level Respectively. Conclusion: The present day surgeons should emulate the findings of this piece of work to minimise the morbidity and mortality of acute appendicitis in future by just adding one more laboratory test i.e. total serum bilirubin; though the total serum bilirubin may not be very helpful for diagnosing the catarrhal and non-perforated appendicitis.

Keywords: Leucocyte; Bilurubin; Appendicities; perforation; Sensitivity; Specificity.

 Background: Repairing a Hypospadias is one of troublesome issues in pediatric surgery. Surgery results in various complications, variety of techniques have been applied and latest procedures still persist to evolve. Surgeons are still skeptical concerning finest procedure for repair. We focussed in ascertaining the consequence of procedures and elements bestowing to adverse upshots in patients with hypospadias. Materials and Methods: The retrospective review was undertaken from January 2014 to December 2018,. The research was conducted at Sri Guru Ram Das Institute of medical Sciences and Research, Amritsar, Punjab. ,All children who underwent repair of hypospadias and had regular follow-up were included in our study. Results: ,A total of 202 boys aged less than 14 years were assessed.,Most surgeries (82%) were performed in children older than 24 months., Transverse incised plate urethroplasty (Snodgrass procedure) was procedure performed for distal and middle hypospadias (95.5%),,while transverse preputial island flap technique (Duckett’s procedure) was the most common procedure done for proximal hypospadias (4.5%).

Keywords: Hypospadias, Snodgrass Procedure, Duckett’s Procedure.

 Introduction: A hydrocele is an accumulation of serous fluid in a body cavity. A hydrocele testis is the accumulation of fluids around a testicle. Vaginal hydrocele is the most common primary hydrocele. There are different operative and non-operative treatment for hydrocele and as many procedures are used for hydrocelectomy such as Jabouley’s Lord’s, Patch technique, Aspiration and sclerotherapy procedures. The common complications observed during the surgery of hydrocele are bleeding, injury to the cord structures and epididymis, torsion of the testis after a faulty positioning post operatively. Commonest among these is post-operative hematoma which is due to oozing from small vessels. Aims and Objectives: AIM - A comparative study of different surgical procedures in the management of primary vaginal hydrocele. Objectives: To study surgical management of hydrocele by different surgical procedures in following type of surgeries (Jaboulay’s Operation, Lord’s Plication and subtotal excision of sac). To assess postoperative complications associated with different surgical procedures. Material and Methods: A hospital based prospective study was conducted with 60 patients to assess the different surgical procedures in the management of primary vaginal hydrocele and postoperative complications associated with different surgical procedures. Observations & Results: The duration of hydrocele ranged from 2 months to 15 years. Majority of the patients (36.7%) had duration of 0-6 months while minimum number of patients (5%) had duration of 6-10 years. Hydrocele occurred more in right as compared to left side (53.3% vs. 26.7%). Bilateral hydrocele was seen in 12 (20%) patients. All patients (100%) presented with scrotal swelling. 12 (20%) patients had dragging type of pain while 8(13.3%) patients had mechanical discomfort due to scrotal swelling. Majority of the patients undergoing surgery (60%) were given spinal anaesthesia while 24 (40%) patients were operated under local anaesthesia. Jaboulay’s operation was performed on 37 (61.7%) patients of which 8 patients had bilateral hydrocele. Lord’s plication was performed on 11 (18.3%) patients of which 1 patient had bilateral hydrocele while Subtotal excision of sac was performed in 12 (20%) patients of which 3 patients had bilateral hydrocele. Majority of the complications were observed in patients that underwent Subtotal excision of sac and the least number of complications were observed in patients that underwent Jaboulay’s Operation. Conclusion: Considering the percentage of complications in different operative techniques, it is observed that there were least complications in Jaboulay’s Operation. So, Jaboulay’s Operation is best technique available in suitable cases for Jaboulay’s Operation.

Keywords: Vaginal hydrocele; testis; hematoma; Jaboulay’s operation; Lord’s placation; Subtotal excision of sac.

 Context: Open hemorrhoidectomy is known to cause longer duration of hospital stay, more pain post operatively compared to stapler hemorrhoidectomy. Aims: To study efficacy of stapler hemorrhoidectomy compared to open hemorrhoidectomy at a tertiary care hospital. Settings and design: Present study was hospital based prospective study carried out at Department of General Surgery, Government Medical College, Ambajogai. Methods and material: 100 cases were selected and were divided randomly into two groups of open and stapler haemorrhoidectomies with 50 cases in each group. Statistical analysis: Student t test, chi square test were used for statistical analysis. Results: Open hemorrhoidectomy took significantly more time of surgery, significantly more time for defecation, their VAS pain score was significantly more, Urinary retention, bleeding was significantly more in open group compared to stapler group. In open group significantly more patients required multiple doses of postoperative analgesia compared to stapler group. 90% of the patients in open group required postoperative hospital stay for > 2 days compared to only 62% in stapler group. 96% of patients from open group took > 7 days to return to their work compared to only 50% of the patients from stapler group. Only 10% of the patients from open group expressed that they were extremely satisfied compared to 40% of the patients from stapler group and this difference was statistically significant. Conclusion: Stapler hemorrhoidectomy is superior to open hemorrhoidectomy

Keywords: stapler hemorrhoidectomy; hospital stay; surgery; pain; symptoms

 Liver abscess is life threatening disease. Liver abscess occurs due to Bacterial, Parasitic, fungal, mixed infection. In this retrospective study 50 cases are admitted and treated in Shree M.P. Shah Medical College, Jamnagar during August 2016 to September 2018. Their age range between 0-80 years with mean age of 49 years. There are 40 Male and 10 Female. Patients having Pre-Morbid condition like Alcohol, Diabetes mellitus, Malignancy and Gall stone. Investigation like liver function tests, Ultrasonography, CT Scan and USG or CT guided aspiration are useful in diagnosis of liver abscess. In this Patients are treated by Antibiotics therapy only, Antibiotic Therapy + Aspiration, Surgical approach. Only antibiotic therapy given to 17 (34%) Patients, out of these 16 patients are cured. Aspiration and Antibiotic therapy (pigtail insertion) given to the 30 (60%) Patients, Surgical approach 3 (6%) Patients. There Pyogenic liver abscess are more common than the Amoebic liver abscess. Most common bacterial infection is Klebsiella > E.coli. Mortality rate in this study 4 patients (8%). Recurrence rate are seen 3 patients (6%). Hospital stay for treatment is average 11-15 Days.

Keywords: Liver abscess; pyognic abscess; amoebic abscess.

 Gastroesophageal reflux disease is the commonest gastrointestinal disease which causes reflux oesophagitis and complications like ulcerations, stricture of oesophagus. Patients present with either heartburn or reflux. Current treatment would include either lifestyle changes, pharmacological therapies, surgical fundoplications and endoscopic procedures. Patients who have reflux would require medical therapy, endoscopic approach or surgery. The choice of therapy depends on symptoms of the patient. This article reviews the various treatment strategies for management of GERD. +

Keywords: GERD; Reflux; Regurgitation; Endoscopy.

 Introduction: Bladder outlet obstruction (BOO) in men is traditionally linked to the prostate. Urodynamics with pressure flow studies remain the gold standard for diagnosing BOO and other voiding and storage abnormalities. Study had planned to measure various parameters of bladder dysfunction by using Cystometry in patients of Prostatism and to find out correlation between PVR measured by two different techniques i.e. Cystometry and Ultrasonography, if any. Methods: This was observational study conducted from 2010 to 2012 in patients visiting Rural Medical College, Loni. Total 75 patients with age> 50 year and IPSS > 19 having symptoms of Prostatism were included in the study. Patient detailed history was taken with recording of USG findings and simple cystometry procedure was performed to measure various parameters like Bladder capacity, postvoid residual volume of urine (PVR) and Urge capacity and repeted 2 weeks after operation/ catheterisation. Results: By applying Chi-square test there is a significant association between post void urine in USG and Cystometry (i.e. p < 0.05). By applying Student’s Paired ‘t’ test there is a highly significant decrease in post void urine before and after 2 weeks operation / Catheterization (p < 0.01). And there is a highly significant increase in urge (p < 0.01) and only significant increase in Capacity before and after 2 weeks operation / Catheterization (p<0.05). Conclusion: Simple cystometry can provide useful information for accurate diagnosis, management plan or for prognosis purpose to urosurgeons or urologists. Further studies involving larger number of patients are necessary to determine the optimal role of formal urodynamics in the elderly.

Keywords: Bladder outlet obstruction; Urodynamci study; Cysotmetry; Ultrasonography; Prostatism.

 Laparoscopic appendicectomy has gained considerable popularity, both among surgeons and patients as well for the advantage of being minimally invasive, less post operative pain and faster recovery and faster return to normal routine life. In this retrospective study 30 cases (19 male, 11 female, age range 5 to 60 year) were selected and laparoscopic appendicectomy in shri mp shah medical college, Jamnagar during 2016 to 2018 including patient came for interval appendicectomy and emergency appendicectomy (ultrasonography suggested non perforated, non gangreneous appendix). This study aims to reduce irrational antibiotic use and reduce post operative hospital stay of patient. In this study single shot of Piperacillin+Tazobactam given during operation. Overall surgical site infection rate was 10% and average hospital stay was 2.0 ± 0.4 days.

Keywords: laparoscopic; appendicectomy; single dose antibiotic.

 Gastric carcinomas are a commonly encountered malignancy worldwide. In India though the incidence is low as compared to worldwide statistics, it accounts for significant morbidity and mortality. Prognosis remains poor even today due to delayed presentations and delay in diagnosing. In recent years, hematological parameters are being studied as prognostic indicators for various cancers. There are not many studies on these hematological biomarkers as screening parameters in Gastric cancers. So we conducted a retrospective single center study to evaluate if these blood biomarkers can be utilized as screening parameters for Gastric malignancies. Aims & objectives is to determine if blood parameters are significantly different in patients with Gastric malignancies as compared to control cases. Hundred (100) cases of gastric malignancy and equal number of control – age, gender matched to cases without malignancy or infection were included. Both groups, evaluated with routine complete blood count and upper GI endoscopy were included. Hematological parameters like hemoglobin, neutrophils and lymphocyte count, Platelet count (PC), mean platelet volume, MPV/PC ratio, Platelet/ MPV ratio, red blood cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR), Monocyte/Lymphocyte ratio, and “Hematological MAHE- N-K index” were calculated and compared to look for statistical differences. We observed Blood biomarkers are statistically different in Gastric malignancy patients in comparison to controls. So we conclude that Hematological biomarkers can be utilized as a screening markers in Gastric malignancy.

Keywords: Gastric malignancy; hematological parameters; N-K Index; screening markers.