New Indian Journal of Surgery

Non healing wounds are a major functional and financial burden to the patient and treating surgeon alike. Many methods of adjuvant wound therapy and wound bed preparation exist like Autologous Platelet Rich Plasma injection (APRP), Autologous Lipoaspirate injections (ALA), Bone marrow aspiration therapy (BMAT) etc. Several methods of temporary wound cover are available nowadays like integra, apligraf, collagen etc. Though such temporary dressing materials are available none can meet the biological properties of an allograft. Cadaveric allografts have long been used as a temporary wound cover in patients with extensive burns to reduce the morbidity and mortality in patients. In this article we describe the use of cadaveric allograft as a method for wound bed preparation in patients with non-healing ulcers in a tertiary burns centre.

Aim: To study the efficacy of hydrostatic reduction of childhood intussusception using normal saline under US guidance. Materials and Methods: This prospective study was conducted over a period of 3 years from February 2016 to January 2019. All Children between three months to five years whose ultrasound scan shows Intussusception, symptoms of intussusception less than 48 hours and no features of peritonitis or intraperitoneal free gas were included in the study. Informed written consent was taken from the patient’s guardian for hydrostatic reduction. The child was sedated with midazolam and ketamine. A Foley’s catheter of size 14 Fr to 18 Fr were used according to the age of the child. Catheter was lubricated with 2% lignocaine gel and introduced into the rectum. The balloon of Foley’s catheter inflated with 10-15 ml distilled water, Catheter was connected with warm normal saline bag and flow of saline was allowed into the rectum. The saline bag was suspended on a drip stand at approximately 100 cm from the patient’s bed level. The ultrasound was then used to guide the reduction till the intussusception went beyond the ileocaecal valve. Complete reduction was assumed once intussusceptum was disappeared and passage of saline through the ileo-caecal valve into the ileum seen. Results: This study was done on total 35 patients diagnosed with intussusceptions, 21 males (60%) and 14 females (40%), the age ranged between 3 month and 5 years. Abdominal USG and plain X-ray were done for all patients. Abdominal pain was seen in 32 patients (91.4%), bilious vomiting in 30 patients (85.7%), rectal bleeding in 12 patients (34.3%), abdominal distension in 18 patients (51.4%), palpable abdominal mass was seen in 14 patients (40%) and absent bowel sound was seen in 12 (34.3%) patients. Volume of Normal saline required for reduction ranged from 300ml to 1300ml. Three of the children had recurrent intussusceptions. Two occurred a day after the procedure and one recurrence was noted four months later. In three patients (8.6%), US Guided hydroreduction of intussusception failed and they underwent surgical exploration. Conclusion: Ultrasound guided reduction of intussusception with saline is safe and effective method with high success rates with minimal morbidity or mortality due to the procedure.

Background: Laparoscopic cholecystectomy is the treatment of choice for symptomatic colelithiasis, it is also the most common laparoscopic procedure performed all over the world and in U.S.A. Methods: This is a prospective, randomized study comparing the (Group A) low pressure pneumoperitoneum (8-10 mmhg) with preemptive analgesia versus (Group B) standard pressure pneumoperitoneum (12-14mmhg) without preemptive analgesia. Results: Mean age in group A was 39.14 ± 6.12 Yrs and in group B was 40.34 ± 6.48Yrs. 14 male & 36 female were in group A and 13 male & 37 female were in group B. 58.00% patients in group A and 62.00% patients in group B were from rural area. Mean duration of surgery 46.2 ± 2.80 Mint in group A and Mean duration of surgery 44.90 ± 2.60 Mint in group B. The duration of surgery was less in group B compare to group A. VAS score at 4 hours in group-A was 6.2 ± 0.82 and in group-B was 6.8 ± 0.98. The difference in both group was statistically highly significant (p-value<0.001). VAS score at 12 hours in group-A was 4.1 ± 0.61 and in group-B was4.3 ± 0.52. The difference in both group was statistically highly Insignificant (p-value>0.05). VAS score at 24 hours in group-A was 2.52 ± 0.22 and in group-B was 2.6 ± 0.20. The difference in both group was statistically highly Insignificant (p-value>0.05). The need of analgesia in group A was 70mg/day and group B was 110mg/day. The difference in both group was statistically highly significant (p-value<0.001). Mean time of hospital stay in group B was 53.2 ± 2.40 Hrs and in group A was 51.8 ± 2.38 Hrs. The difference in both group was statistically highly significant (p-value<0.001). Conclusion: low pressure pneumoperitoneum (8-10 mmhg) with preemptive analgesia to be better than standard pressure pneumoperitoneum (12-14mmhg) without preemptive analgesia in terms of duration of surgery, lower incidence of pain and hospital stay.

Keywords: Pneumoperitoneum; Laparoscopic cholecystectomy; Colelithiasis.

 Background and Aim: Millions of patients are affected each year presenting with most commonly with primary ventral, incisional, and inguinal hernias. In this study we have made an attempt to study 200 cases of ventral hernias selected randomly from cases admitted to our hospital and compare quality of life between open and laparoscopic repair group during the post-operative period. Material and Methods: present study was the patients admitted to the medical institute in Gujarat in the department of Surgery. Patients underwent polypropylene mesh repair either Inlay repair or Onlay repair by open method. Laparoscopically mesh (dual layer mesh) was placed intraperitoneal after reduction of hernia. Both the group patients were followed up for 2months. SF-8 scoring card was filled by the patient during follow-up at 1st month and 2nd month. Results: Paraumblical hernia was present in 90 patients, incisional hernia was present in 36, epigastric hernia was present in 20 patient and 14 had umbilical hernia. However seroma was developed in 6 patients treated by laparoscopic means as compared to 18 patients in open repair wound. Surgical site infection was seen in 28 patients, 24 patients did underwent open mesh repair. There was post operative chronic pain at the operated site at the end of 2 months follow up. Conclusion: Laparoscopic ventral hernia repair provides lesser post-operative pain, lesser complications, shorter hospital stay and lesser economic impact as they returned to returned to work early. Thus patients have less morbidity and improved quality of life.

 Introduction: Up to 85% of people infected with H. Pylori never experience symptoms or complications. Acute infection may appear as an acute gastritis with abdominal pain or nausea. Where this develops into chronic gastritis, the symptoms, if present, are often those of non-ulcer dyspepsia, stomach pain, nausea, bloating, belching, and sometimes vomiting or black stool. Inflammation of the pyloric antrum is more likely to lead to duodenal ulcers, while inflammation of the corpus is more likely to lead to gastric ulcers and gastric carcinoma. Materials & methods: A retrospective study was done in 310 patients diagnosed to have peptic ulcer disease by upper gastrointestinal endoscopy in Adichunchanagiri Institue of Medical Sciences, B.G. Nagar. The study was from August 2018 to January 2019. All the patients were subjected to upper gastrointestinal endoscopy during which biopsies, each from the antrum and the pathological areas were taken. The two biopsy specimens were sent for routine histopathology and staining with Giemsa stain. The case was taken as H.pylori positive when the histopathological examination was positive. Results: Out of 310 patients, 246 patients were diagnosed to have been infected with H.pylori infection (79.4%). Out of 310, the duodenal ulcer were present in 204 (65.8%) patients, gastric ulcer were present in 88 (28.4%) patients and both duodenal and gastric ulcers were present in 18 (5.8%) patients. Conclusion:In this study, we found that in peptic ulcer disease, H. Pylori was consistently associated. Thus we conclude H. Pylori infection definitely have role in the etiopathogenesis of peptic ulcer disease. The study also gives information that H. Pylori is more common in rural and lower socioeconomic group. Hence, we recommend eradication of the bacteria only in patients positive for the bacterium, who have peptic ulcer disease. Our study implies that H.pylori infection has an overall prevalence of around 79.4% in peptic ulcer patients in our AIMS hospital. Its presence is more with ulcerative dyspepsia patients and its prevalence increases with age.

Keywords: Helicobacter pylori; Peptic Ulcer Disease; Duodenal Ulcer; Gastro-Intestinal Endoscopy.

 Background and objectives: Many different techniques are currently used to join segments of the gastrointestinal tract following resection. This study is intended to study the feasibility of single layer technique in our setup, to study the disease groups undergoing gastrointestinal resection and anastomoses, and to study safety and efficacy of polyglactin in single layer gastrointestinal anastomoses in terms of early postoperative leak. Methods: A total of 50 patients were selected randomly to represent different disease groups from 312 gastrointestinal anastomoses performed Govt Mohan Kumaramangala Medical College Hospita (GMKMCH) l, Salem, Tamilnadu during October 2012 to September 2017. Patient underwent laparotomy, resection and end to end anastomoses of gastrointestinal tract at various levels with single layer technique using polyglactin as suture material. Results: In upper GI tract most common disease in our study requiring resection and anastomoses was Meckels diverticulum 9 (18%) and lower GI tract was Intussusception 14 (28%). Out of 50 resection and anastomoses there were 2 anastomotic leaks, 1 anstomotic stricture, and 2 deaths (not related to anastomoses). Interpretation and Conclusion: Anastomoses performed in elective surgeries healed well with less complications as compared to emergency surgeries. Single layer anastomoses with vicryl is the method of choice throughout the gastrointestinal tract for various diseases with less complications in pediatric age also.

Keywords: Single Layer; Anastomoses; Disease Groups; Gastrointestinal; Anastomotic Leak; Complication.

Du perforation is common complication of PUD. Patients needs prompt resuscitation and surgical suturing of perforation. Mortality rate [1] is 15.2% and morbidity [1] is 5.2%. But mortality is low in early diagnosis & prompt treatment. Again operative outcome depends on skill, experience and procedure. Materials: This is retrospective study in Jorhat Medical College & Hospital where total 75 numbers of patients from January 2010 to December 2017 were analysed to evaluate effective and save open surgical suture. Result: In one layer repair two patients had bile leak and both expired. 3 patients had symptoms of APD. In one layer suture two patients had bile leak and both died. Definitive surgery is always restricted to its complication. In follow up, three patients were assessed to have clinical feature of APD. It responded to PPI. Laparoscopic repair has no provent advantage in PPU. Mean Age is 39.61 in Group A and 36.37 in Group B. Standard Deviation is ± 3.09 in Group A and ± 5.86 in group B. Chi-Square Test is 4.022 and P-value is 0.0525. So P value is just significant at 5% or not significant. Gender is not related to age for diseases as P-value is high. Conclusion: Two layer open surgical suture in PPD is found safe and secured than one layer suture.

 Context: Colorectal cancer (CRC) is the most common gastrointestinal cancer worldwide with a low reported incidence in India. There is significant geographical variation in the incidence rates, and the presentation may also vary. There are few studies evaluating the clinical profile of CRC in Indian patients. There is significant geographical variation in the incidence rates, and the presentation may also vary. There are few studies evaluating the clinical profile of CRC in Indian patients. Aims: The aim was to access the clinico-pathological details of young patients with CRC in India and compare it with those of the reported literature. Settings and Design: single centre tertiary care centre, cohort study, observational study Methods and Material: All patients below 50 years of age who are diagnosed with colorectal cancer in surgical units of Kasturba hospital, Manipal. Statistical analysis used: SPSS version 16. Results: One fifty three patients were studied in period of five years. The mean age was 37.6 years. Sixty percent were males. The commonest symptoms were rectal bleeding (60%), pain (44%), and altered bowel habits (26%), Sixteen percent of the patients had mucinous type. These patients have predominant peritoneal metastasis and right side preponderance. The median CEA level was 35.1 ng/mL. Most patients had localized or locally advanced disease. Twentyeight percent of the patients had metastatic disease. With liver being the commonest site of metastases (52%) followed by peritoneum and lung. More than eighty percent of the patients received treatment with a curative intent. We had younger patients, higher proportion of mucinous carcinomas, and more patients presenting with an advanced stage. Conclusions: Colorectal cancer in India differs from that described in the Western countries. Inadequate access to healthcare and socioeconomic factors may play a role in some of these differences.

Keywords: Colorectal Carcinoma; Young Adults; Adenocarcinoma; Mucinous Carcinoma.

Gastrointestinal endoscopies are commonly performed procedures following gastrointestinal symptoms. Endoscopy reporting, data entry and data management are standardized in developed countries. Here we audited the endoscopy reports in a handwritten record of rural medical college hospital. High number of missed data entry warrants digitalization of the reporting system, which might improve the standard of care of these patients and future research.

 Context: Empyema thoracic carries significantly morbidity and mortality in paediatric patient, if not properly treated. Aims: This study is focussed on treatment according to chronicity of the disease and its outcome. Methods and Material: In this prospective study, 22 patients with empyema under age group of 12 were treated according to American Thoracic Society (ATS) staging. 9 patient with ATS stage I were treated by antibiotics. 5 patient with ATS stage II underwent Video assisted thoracoscopy (VATS) while 8 patient with ATS stage III were treated by thoracotomy. Results: Average hospital stay of patients with ATS stage I, II and III were 7 days, 16 days and 18 days respectively. The complications rate were lowest among patients with ATS stage I followed by ATS stage II and III. There were no mortality. Conclusions: These study suggests treating empyema at early stage has significant favourable outcome in terms of morbidity. So all efforts should be made to detect and treat the disease in earlier stage.

Keywords: Empyema; Decortication; paediatric; American Thoracis Society (ATS).

 Antenatal ultra sonogram detects congenital malformations in utero. Antenatal detection of the malformation will help the Paediatric Surgeons to counsel the parents regarding the outcome and intervene in early postnatal period. Here we analyzed the common Thoracic Congenital Malformations detected in Fetus antenatal USG and followed postnatal in our institution. Congenital diaphragmatic hernia is the common lesion noted in the antenatal scan.

Keywords: Antenatal Ultra Sonogram; Antenatal Anomalies; Congenital Diaphragmatic Hernia; Thoracic Malformation.

 Aim: The aim of present research was to evaluate the efficiency of vacuum-assisted closure (VAC) against surgical debridement in diabetic foot ulcerations (DFUs) in stipulations of healing rate, protection, and patient agreement. Material and Methods: Present prospective randomized casecontrol study was performed in surgery department of tertiary care hospital in Kutch, Gujarat, India. Total 46 patients had participated in the study. The participants of the research were subjects with DM aged 18-75 years, with stage 2 or 3 DFU, divided into Group A (patients cured with VAC) or Group B (patients cured with conventional dressings), having equivalent Patients. Treatment effect was evaluated as time taken for manifestation of granulation tissue. Results: The patient’s age was in the center of 35 and 75 years in Group A with a mean age of 56.47 years and amid 38 and 69 years in Group B with a mean age of 54.36 years. By Week 2, wound discharge departed in 8 cases of Group A against not any in the control group. Granulation tissue emerged in 16 patients by the ending of Week 2 whereas it come out in 8 patients in Group B. Conclusion: VAC comes out to be further successful, secure, and patient suitable contrast to conservative dressings for the treatment of DFUs.

Keywords: Diabetic Foot Ulcerations; Granulation Tissue, Kutch; Wound Discharge.

 Context: Ventral Hernias are an abnormal protrusion of an abdominal viscous or a part of it through the anterior abdominal wall at a site other than the groin region. Laparoscopic surgery has reaped importance for being less invasive, lessen hospital stay and also has better aesthetic value. However debate on the role of laparoscopy in ventral hernia repair outcome needs further evaluation despite it becoming increasingly popular. Aims: To study demographics of ventral hernia and compare open and laparoscopic method of repair for ventral hernias, duration of surgery, hospital stay, and expenditure between two procedures and to find the difference in complication rate between two groups. Settings and Design: Prospective randomized clinical study Methods and Material: Comparative hospital based prospective clinical study was conducted on patients presenting with Ventral hernias in a tertiary care centre for a duration of 18 months. A total of 48 subjects were randomized into two groups. Ethical clearance and informed consent was obtained prior to the start of the study. Statistical analysis used: Categorical data was represented in the form of Frequencies and proportions. Chi-square was used as test of significance. Continuous data was represented as mean and SD. Independent t test was used as test of significance to identify the mean difference between two groups. p value < 0.05 was considered as statistically significant. Results: Laparoscopic surgery was performed in Smaller hernia and Open surgery was performed for hernia with Larger size. Mean time required for post operative mobilization and duration of ICU stay was lesser in Laparoscopic group compared to open group significantly. Expenditure was significantly greater in laparoscopic group than in the open group. Open group required longer duration of stay in ICU than Laparoscopic group. This difference in mobilization and ICU stay during post operative period was statistically significantly. Conclusions: Laparoscopic procedure in Ventral Hernia has shown good results and is widely consented for. It has dwarfed hospital stay, ICU stay and has seen to lower immediate complications such as pain, compared to open repair.

Keywords: Laparoscopic; Open; Ventral Hernia; Hernia Repair.

 Burn is a serious systemic illness not only injury to the skin which is followed by various serious complications such as infections, shock, renal failure etc. Renal failure has been well recognized complication of burns. In-spite of many advances and treatment, mortality rate of patients who develop renal failure in post burn conditions remain high. in this study, 50 burn patients were studied bty assessing various parameters in blood and urine, along with the urine output and the incidence of renal failure.

Keywords: Burn; Biochemical Renal Parameters; Renal failure.

 This Prospective study included 100 patients having urinary complains studied under the Department of General Surgery, M.P. Shah Medical College, Jamnagar from October 2017 to December 2018. Commonest in 50-75 years of age, burning micturation (45%) was the most common complain followed by lower abdominal pain (35%), urinary retention (21%). Hematuria (17%). Symptoms included nocturia (96%), increase in urinary frequency (84%), straining during urination (71.0%), weak stream during urination (84.0%), urgency (95.0%), incomplete emptying (81.0%) and intermittency (86.0). Most of the subjects presented with moderate severity of symptoms (42%) belonged to 50-75 years of age group. DRE revealed, prostatic size normal (13%), +1(57%), +2 (30%). Median sulcus obliterated (24%), overlying mucosa fixed (8%). Consistency was firm ( 86%), elastic (8%) and nodular (6%). IPSS Score - mild (19%) moderate (73%) and severe (8%). (2%) had prostatic volume <20cc, (20%) between 21-30cc, (38%) between 31-50cc, (33%) between 51-80cc, (7%) >80cc. Average MLP for prostatic <20 cc is1.1 cm, 21- 30 cc is1.04 cm, 31-50 cc is 1.326 cm and 51-80 cc is1.65 cm. Average PVRU for prostate < 20 cc is 5cc, 21-30 cc is 19.8 cc, 31-50cc is 32.05cc , 51-80 cc is 44.59 and > 80 cc is 69.86 cc. The person’s coefficient of correlation between the sonographic prostatic size and PVRU r1=0.54072 and between IPSS with PVRU r2=0.681461

 Background: Acute appendicitis is a common problem in children and early adult life. Appendicectomy is immediate or emergency procedure to reduce morbidity and mortality. The present study was conducted to find out incidence, position and clinical profile of acute appendicitis and also complications of appendicectomy. Methods: Around 186 patients presented with complaints of appendicitis. Out of these, 37 were managed conservatively with antibiotics and sent home. The remaining 149 patients had acute appendicitis and were operated. This retrospective study was conducted among 149 patients diagnosed as acute appendicitis in Department of Surgery, Gujarat Adani Institute of Medical Science, Bhuj, Kutch for a duration of one year. The clinical profile like age, sex, symptoms of the patients and post-operative complications were recorded. As per records, all patients underwent appendicectomy and were followed post operatively. Results: Out of 149 patients, 54% were males and 46% were females. Nearly 70% of the patients belonged to the age group of 15-30 years.100% had pain abdomen, 83% had fever and 76% had vomiting. Fever (10.7%) and wound infection (3.3%) were the common post-operative complications. Conclusion: Acute appendicitis is very common in younger age groups shows that whenever young patients present with acute abdominal pain, it may be considered acute appendicitis. The complication of appendectomy is very minimal and gives good prognosis.

Keywords: Acute Appendicitis; Pain Abdomen; Fever, Position of Appendix.

Ear pinna defects commonly occur following trauma, ear piercing, iatrogenic or infective or malignancy. Standard reconstructions of such defects are described but not applicable to every defect of which Conchal defects is rarely described with no standard technique. This article describes a simple technique for reconstruction of full thickness defects of the concha in bilayer with hinge flap taken from the posterior surface of the ear and full thickness skin graft to cover the resultant raw area.

 Introduction: Esophageal cancer had an estimated 482,300 new cases in 2014 worldwide. The incidence rates of esophageal cancer vary greatly based on region, with the highest rates found in Asia, including China and Central Asia, and in Africa. Presently, a number of endoscopy-based modalities are utilized to palliate these symptoms. Aims & Objectives: To evaluate if esophageal stenting in patients of esophageal carcinoma who has crossed stage of inoperability is of any use in improving symptoms or quality of life. To evaluate whether esophageal stenting is of any role in improving quality of life in inoperable carcinoma esophagus cases To see how esophageal stenting affects perception of pain in patients of esophageal carcinoma. Material and Methods: We conducted an observational study from 2016 to 2018. We included 30 patients with esophageal cancer in whom the cancer had spread beyond the stage of operability and only option available was palliative treatment. Before the start of my study we got approval from ethics committee. Stenting procedure was standardized. We used SEMS (Self Expandable Metallic Stents) for our patients and those were made available free of cost by the hospital administration. SEMS of size 100 mm, 120 mm, 140 mm, or 160 mm were used in different cases depending upon the length of the oesophagus. Observation: In our study we found that all patients had significant relief of dysphagia and improvement in quality of life, though with increase in pain scores. Following stent deployment, the relief of dysphagia is almost immediate lasting and excellent relief of dysphagia has been a consistent finding with the use of SEMS. Complications are uncommon following SEMS placement, major ones being perforation and aspiration pneumonia. In our study perforation was seen in one patient and aspiration pneumonia was observed in two patients. In one study, the procedure had a 7% mortality rate.in our study, there was one procedure-related death. Pain, gastroesophageal reflux and respiratory infection were the commonest complications. Conclusion: We concluded that SEMS placement is safe and effective in the palliation of dysphagia in selected patients with unresectable malignant esophageal carcinoma. It provides lasting relief of dysphagia and improves QOL significantly, without major complications. However SEMS do not increase the life expectancy in these patients. However our study had few limitations and a very small sample size so the results of my study cannot be generalized to the whole population in general.

Keywords: Esophageal Stenting; Carcinoma Esophagus; Chemoradiotherapy.

 Tuberculosis of gastrointestinal tract is the sixth most frequent form of extra pulmonary involvment, following lymphatic, genitourinary, bones and joints, miliary and meningeal tuberculsois. 5% tuberculosis patients have abdominal tuberculosis and most common site of involvement is ileocaecal region. Inspite of antitubercular drugs and investigative modalities the disease has significant morbidity. Considerably higher morbidity is noted in emergency surgery probably due to inadequate bowel preparation, contamination and fluid electrolyte imbalance. Early diagnosis and treatment, early initiation of ATT, regular follow up along with proper nutrition and education of patients about hygiene and sanitation is the key to success.

Keywords: Tuberculosis; In Surgical Patients; Management.

 Background: Since advent of Proton Pump Inhibitors (PPIs) use of H2 receptor blockers (Ranitidine) is on decline. There is no doubt that PPIs are superior gastric acid suppressors and should be first line of therapy for peptic ulcer disease. Surgeons routinely use gastric acid suppressors for prevention of stress ulcers in peri-operative period. PPIs are more expensive, especially in injectable form. Methodology: We studied incidence of complications in the form of 1. Haemetemesis or bloody aspiration from Ryle’s tube 2. Newly developing epigastric tenderness retrospectively in 1000 patients underwent, laparotomy under general anaesthesia over the period of October 2011 to June 2018 in our surgical department. Patients were classified according to whether they were given PPI or H2-receptor blocking agents in peri-operative period. Patients with portal hypertension and gastric surgeries were excluded from the study. Results: there was no statistical significant difference between use of either agent for prophylaxis of stress gastritis. Conclusions: H2- receptor blockers should be used in peri-oprative period instead of PPIs to reduce the cost of surgery as it does not increase risk of stress ulcers.

Keywords: Inj. Ranitidine, Inj. omeprazole, stressulcers, gastritis, haemetemesis