New Indian Journal of Surgery

Background: Actinomycosis is a rare chronic
granulomatous inflammatory disease caused by an
anaerobic bacterium, mainly residing in cervicofascial
region, and rarel affects the intestines. Diagnosis
is seldom made preoperatively due to the lack of
specific clinical, laboratory and radiological features.

Case presentation: We present a case of ileal
perforation secondary to actinomycosis infection
which was mimicking crohns ileitis. Patient under
went emergency laparotomy, followed by right
hemicolectomy. Post operative histopathology
revealed actinomycosis infection and was put on
penicillins later.

Conclusion:Preoperative diagnosis of actinomycosis
involving intestines is rare and difficult to conclude.
Penicillin is the drug of choice for treatment.

Keywords: Actinomyces israelii; Ileum; Perforation,
Crohns disease.
 

Abstract

A report of rare case of Drain Site Hernia through the defect created by previous scar of surgical drain tube placed twenty years back. Surgical drains are useful but have been noted not to be without complications. Small bowel herniation through a previous drain site is a rare complication of abdominal drain insertion. We report a case of drain
site hernia which was diagnosed with the help of CECT abdomen due to previous drain site incision.

Keywords: Abdominal; Drains; Herniacomplications; Small bowel; Predisposing factors; Prevention
 

Central venous access is an integral part of
critical care. It is used for – drugs or fluid infusions,
parenteral nutrition, hemodynamic monitoring as
well as for dialysis. This routine procedure is also
associated with numerous complications. Proper
care of central line is very important to prevent many
of these complications. Central line is secured in
place by sutures and dressing. Often dressing gets
dislodged especially in neck region. In this article
we describe an innovative and cost effective way of
holding central line.

Keywords: Central line; Catheter; i.v
 

Actinomycosis is a sub-acute-to-chronic bacterial
infection caused by filamentous, gram-positive,
non–acid-fast, anaerobic to microaerophilic bacteria
Actinomyces israeli. Clinically, it presents, in the
descending order, over cervicofacial, abdominal and
thoracic regions. Abdominal wall actinomycosis is
known to involve pelvic or intraperitoneal regions
but abdominal wall involvement primarily is rare.
Hereby, we report a case of primary abdominal wall
actinomycosis in a 43-year-old male who presented
with right-sided abdominal wall mass of 6 months
duration. CT abdomen done was suggestive of
heterogeneous enhancement of rectus abdominis
muscle. True cut biopsy revealed radiating
filamentous colony positive morphologically
suggesting actinomycosis. The main treatment is
antibiotics to which he responded well, and thus
it is essential to diagnose accurately and avoid
unnecessary surgery.

Keywords: Actinomycosis; Abdominal Wall
 

Introduction: Bowel resection and anastomosis are
very commonly performed gastrointestinal surgeries.
Anastomosis integrity is a major determinant of
mortality and morbidity among these patients,
however there is no clear consensus on the technique
used to create an anastomosis.

Aim: To compare and evaluate the clinical
outcomes with reference to the rate of anastomotic
leak, operating time and return of bowel activity
between single layer continuous versus double layer
interrupted intestinal anastomosis in risk-stratified
patients using APACHE-II scoring system.

Material and Methods: All the patients were risk
stratified using APACHE-II scoring system and those
with a score of more than ten were excluded. Computer
generated numbers were used for randomization.
On half of the patients, the intestinal anastomoses
were performed using a single layer continuous
technique and on the rest, using a double layer
interrupted technique. The criteria for anastomotic
leak are defined as complications of intra-abdominal
abscess, radiographic demonstration of a fistula,
visible disruption of suture line on re-exploration or
leak of enteric contents from the wound. Secondary
parameters including operating time, time of return of
bowel activity and hospital stay were also calculated.
Chi-square test was applied for categorical data (rate
of anastomotic leak) and student –t test was applied
for continuous data (time of anastomosis, return of
bowel activity and hospital stay).

Results: A total of 60 patients undergoing intestinal
anastomosis were included in the study. On 30
patients single layer (SL) anastomosis was performed
and an equal number of patients underwent double
layer (DL) anastomosis. The mean age for the SL
group was 33.17 years and 32.37 for the DL group.
The male to female ratio in the SL group and the
DL group were 23:7 and 26:4 respectively. The rate
of anastomotic leak in the SL group was 3.3% as
compared to 6.6% in the DL group but the difference
was statistically insignifcant as the p-value was
0.550. The mean operating time for the SL group was
15min 34 sec and it was signifcantly better than the
DL group with a mean of 24min 90 sec. The timing
of return of bowel sounds was also statistically
signifcant in the SL group (2.83 days) as compared to
the DL group (3.87 days). The difference in the mean
hospital stay was statistically insignifcant in both the
NIJS / Volume 11 Number 3 / July–September 2020
412 New Indian Journal of Surgery
groups (SL group was 7.20 days& DL group was 8.43
days).

Conclusion: We did not fnd any statistical
difference in the rate of anastomotic leak between the
two groups but a bigger sample size or meta-analysis
is required to establish superiority of one technique
over the other in terms of safety. Single layer was
signifcantly quicker to perform with an early return
of bowel activity.

Keywords: Intestinal anastomosis; Single layer;
Double layer; APACHE-II
 

The recent rapid development of non invasive
imaging techniques helps in the better understanding
of pancreatic disease and its pathology.Inflammation
of parenchyma of pancreas is called as pancreatitis.
It may be acute or chronic. In acute pancreatitis
symptoms appear suddenly in a previously healthy
individual and the symptoms disappear once the
disease subsides. But in chronic pancreatitis the
patient may had prior attacks or symptoms of
pancreatic insufficiency before the current attack, and
their symptoms persists even after the attack. Ability
to study these lesions noninvasively at variable
point in time allow us to differentiate between acute
and chronic pseudo cyst two seemingly similar
entities with different natural history and treatment
requirement.
Keywords: Pseudo Cyst of Pancreas.
 

Background: Surgical site infections (SSI) develops
when there is seeding of the operative site from
a distant site of infection or by endogenous flora
and other factors include host defences, bacterial
inoculums and virulence, preoperative care and
intraoperative management. They are associated
with prolonged hospital stays and increased
costs and complications associated with antibiotic
administration.

Objective: To assess the effcacy of single dose
prophylactic antibiotic for prevention of Surgical
site infection in clean and clean contaminated
surgeries.

Materials and Methods: A prospective study
was conducted which included 1002 patients
undergoing elective surgery in an institutional
setup, over a period of nine years and patients
enrolled considering inclusion and exclusion
criteria. Ceftriaxone was used preoperatively 30
min prior to incision and its impact on postoperative
wound infection was studied.

Results: We had 1002 cases in our study with
equal number in both sexes 52.3% males and
47.7% females with mean age of 38 years, we had
predominantly clean surgeries 96.7% and 3.3%
clean contaminated surgeries done and had 0.9 %
incidence of superfcial surgical site infection.

Conclusion: A single preoperative dose of
antibiotic is effective to prevent surgical site
infection in clean and clean contaminated cases. It
will help in decreasing healthcare cost, antibiotic
related drug toxicity, prevents development of
resistance due to overuse of antibiotics. It also
paves way for the development of newer studies
studying the impact of no prophylactic antibiotic
prior to elective surgeries on surgical site infection.

Keywords: Prophylactic antiobiotics; Clean
operative procedure; Single dose antibiotic;
Surgical site infection
 

Background: Ileal perforation is a common problem seen in tropical countries; the commonest cause being typhoid fever. The aim of this study is to assess clinical presentation, investigations, diagnosis, the management and postoperative complications of typhoid ileal perforation. The study also aims to assess the outcomes in these patients and the factors affecting prognosis.

Methods and Material: This prospective study was conducted by selection of consecutive 50 cases presenting with symptoms and signs suggestive of typhoid ileal perforation. The data in the study was collected by the use of a pretested proforma to collect relevant information from individual patient after the inclusion and exclusion criteria applied by a meticulous clinical examination, relevant investigations and appropriate management.

Results: In our series, typhoid perforation commonly occurred in second and third decade of life (70%) with male preponderance and 44% of cases occurred 8-14 days of onset of fever. Pain abdomen and dehydration being the most common presentation occurring in all patients. Pneumoperitoneum in chest X ray and erect x ray abdomen was seen in 78% of patients. Widal was positive in 86% of patients of typhoid perforation in this series. In our study lag period was between 1 hour and 96 hours with average of 31.66 hours. Over 96% of perforations were within 2 feet from ileocaecal junction. Simple two layer closure is the commonest procedure done. Wound infection is the commonest postoperative complication seen in 31.1% of patients.

Conclusions: We found typhoid fever as the most common etiology for ileal perforation. Widal test is useful in diagnosis of typhoid fever. Ileal perforations have significant morbidity and mortality despite adequate operative intervention and postoperative care. Lag period, hypoalbuminemia, azotemia and shock on admission were found to be significantly contributing to morbidity and mortality.
 

Background: Sutures, staples and adhesive tapes
are the traditional methods of wound closure, whilst
tissue adhesives have entered clinical practice more
recently. Tissue adhesives offer the advantages of
no risk of needle stick injury and no requirement to
remove sutures later.

Objectives:To determine the relative effects of
various tissue adhesives and conventional skin
closure techniques on the healing of surgical wounds.

Materials & Methods: Screening of only eligible
RCT studies and data extraction were conducted
independently and in triplicate whilst assessment
of the methodological quality of the trials were
conducted independently and in duplicate.

Results were expressed as random effects models using mean
difference for continuous outcomes and relative
risks with 95% confidence intervals for dichotomous
outcomes. Heterogeneity was investigated including
both clinical and methodological factors.

Results: 60 cases of inguinal hernia and recurrent
appendicitis skin closure were studied to compare the
results of cyanoacrylate glue and subcuticular sutures
with 2-0 prolene as closure technique. Mean age was
15-30 years. The average time taken (p=0.0001) and
average hospital stay (p=0.0000). Was statistically
significant and better in the glue group. The cosmetic
outcome (P value=0.522), wound complications,
difference of the Hollander Wound Evaluation Scale
(p=1.9479) Were statistically not significant.
 

Conclusion: Tissue adhesive has got a distinct
advantage over sutures. Time taken for closure
is low, antibacterial property of tissue adhesive
decreases the incidence of wound infection. Hospital
stay is decreased and thus cost effective. Needle stick
injuries to the surgeon, hematoma formation in the
wound edges is reduced and long- term follow up
shows cosmetically better scars than sutures.

Keywords: Cyanoacrylate glue; Tissue adhesives;
Subcuticular sutures; Hollander wound evaluation
score; Low tension skin incisions; Cosmesis
 

Introduction: The most frequently encountered
complaint, for a surgeon, which is an emergency also,
is pain in abdomen. One of the commonest cause,
among the various causes of abdominal pain, is acute
appendicitis, and it is also the commonest cause of
acute surgical abdomen. The Modified Alvarado
Scoring System (MASS) which uses some clinical
signs and symptoms is simple and easy way to
diagnose acute appendicitis.

Methodology: Fifty patients of either gender and
age > 18 years that showed up with pain that was
located in the area of right lower quadrant of the
abdomen and provided written informed consent,
over a period of one year and half year from January
2018 to June 2019 were enrolled. Modified Alvarado
score was calculated for each of the patient and the
score was correlated with histopathological findings.

Results: In the present study 50 patients that
had presented to the general surgery department
of Dhiraj Hospital with right iliac fossa pain were
enrolled. 66% (n=33) were males while 34% (n=17)
were females.

Conclusion: It can be concluded that Modified
Alvarado score aides’ surgeons in diagnosis of acute
appendicitis and this helps in reducing the incidence
of negative appendicectomies. Scores at both the
extremes of scales has high sensitivity, also the
sensitivity of high scores for males is high.

Keywords: Alvarado score; Appendix; Appendicitis;
Abdominal Lump.
 

Background: Diabetes mellitus is an iceberg disease.
It is a worldwide problem. The incidence of diabetes
mellitus is increasing globally. Patients with diabetes
have a 12% to 25% life time risk of developing a
foot ulcer.A majority of diabetic patients develop
foot ulcers in one point of time or other during the
course of their illness. A significant number of such
patients will require long-term hospital treatment
and amputations.

Methods: This prospective observational study
was conducted by the Department of General
Surgery at Mahatma Gandhi medical college and
research institute from Jan 2017 to Jan 2018. A total
of 50 patients were included in the study.The clinical
examination was done and all patients underwent
routine laboratory investigations and few with
relevant special investigations (Doppler study) if
necessary. Wound culture and sensitivity was done
in all cases.

Results: The maximum 28(56%) were in the age
group of 41-60 years followed by 16 (32%) from the age
group 61-80 years. The mean age of the patients was
54.73 (SD12.81).The most common site of lesion in the
diabetic foot was dorsum of foot which was in about
18 patients (36%) followed by whole fore foot.Most
of the patients(34%) were managed conservatively by
slough excision ,regular dressing and antibiotics with
diabetic control.

Keywords: Amputation; Diabetic foot; Ulcer.
 

Background: To evaluate the incidence of early
recurrence and chronic groin pain in the two groups
of patients (group A=Ligation and excision, group
B=Invagination) with indirect inguinal hernia and to
observe different intraoperative and post-operative
parameters in both groups.

Methods: This prospective randomized study
was done in MVJMC and RH , from 1st December
2016 to 30 th November 2017. All the cases of
indirect inguinal hernia attending the surgical
OPDMVJMC & RHhospital were enrolled in this
study. All the patients underwent Lichtenstein
tension free repair. A total of 50patients were
enrolled in this study. MedCalc Software
Version 12.5.0 was used for the analysis of the
data andMicrosoft word and Excel was used to
generate graphs and tables.

Results: 50 patients of indirect inguinal hernia
with more than 18 years of age were enrolled
and divided into twogroups. Intra operative
complications, post-operative pain by VAS
and post-operative complications observed,
whichwas found insignificant. There was no
seroma and induration on both the study group
at 3 months and 6 monthsinterval. No local
swelling (recurrence) in inguinal region was
seen in patients (both group A and group B)
during the6 months follow up period.

Conclusions: This study shows no difference
in outcome of results in Lichtenstein tension
free hernia repair forindirect inguinal hernia
with two different technique in dealing with sac
except less postoperative pain in invaginationof
sac as compare to ligation and excision.

Keywords: Excision of sac; Hernial sac;
Invagination of sac; Indirect inguinal hernia;
Postoperative pain.
 

Background: Diabetes mellitus is a common
metabolic disorder affecting 20% of the population in
various parts of the world. According to International
Diabetes Federation (IDF) it was estimated that
80% of people with diabetes live in developing
and underdeveloped countries with lower income
including India. India is home of 69.1 million diabetic
patients with overall frequency of 9.3% and second
largest country after china. Diabetes is associated with
numerous complications related to microvascular,
macrovascular and metabolic etiologies

Methods: This prospective observational study was
conducted by the Department of General Surgery
at Mahatma Gandhi medical college and research
institute from July 2016 to July 2017. A total of 60
patients were included in the study. A comprehensive
history taken from each patient followed by a thorough
physical examination and were recorded in the predesigned profoma and analyzed.

Results: Themaximum cases 42 (70.6%) were in
the age group of 41-60 years followed by 17 (28.3%)
from the age group 21-40 years. The mean age of the
patients was 46.62 (SD14.66) years ranging from 21 to
70 yrs. According to Wagner’s classification, maximum
number of patients presented with Grade II Wagner’s
lesion (46.7%) followed by Grade III (31.7%)

Keywords: Wagners score; Diabetic foot; Gangrene.
 

Introduction: Evaluation of abdominal lump
may pose difficulty in surgical practice. In a basic
anatomic approach, the abdomen is separated into
9 regions of epigastric, umbilical, hypogastric,
right hypochondriac, right lumbar, right iliac, left
hypochondriac, left lumbar, left iliac. As abdominal
lumps are seen in widely varying range it is not
correct to group them under a single diagnostic
category. Therefore, to diagnose an abdominal lump
step wise evaluation is required in the form of clinical,
radiological and histopathological evaluation.

Materials and Methods: This study included patients
presenting with palpable abdominal lump. Complete
detailed history and clinical examination were
taken prior to any investigation to find out possible
clinical diagnosis. Radiological investigations were
done to support the clinical diagnosis. After which
laparotomy was performed and excised specimen
was sent for histopathological examination to reach
the final diagnosis.

Results: 60 cases with abdominal lump were
included in the study depending on inclusion and
exclusion criteria. Male to Female ratio was 1:1.4. The
mean age was 43.77 ± 12.92. Right iliac region was
the most involved quadrant (25%). Most of these
lumps were gastrointestinal in origin (30%). Clinical
examination in total had accuracy of 96.67% which
was similar to Radiological investigation. Most of
the cases were non neoplastic (56.67%) and out of
neoplastic cases (43.33%), around 14(54%) cases were
benign and 12 (46%) were malignant.

Conclusion: Most of the cases of abdominal lump can
be well evaluated clinically in terms of the diagnosis
and organ of the origin.Both clinical examination and
radiological investigation have equal sensitivity as far
as organ of origin is concern. Histological diagnosis
which is confirmatory helps to distinguish between
neoplastic and nonneoplastic lesions and is vital for
patient management.
 

Keywords: Abdominal lump; Clinicopathological
correlation; Clinical diagnosis; USG; CT; MRI;
neoplastic non-neoplastic; Histopathological
diagnosis
 

Introduction: Laparoscopic repair of hernia can be
done by 2 ways with mesh fixation and without mesh
fixation. Laparoscopic hernia repair can be by two
approaches:
1. Total Extra Peritoneal (TEP) Repair
2. Trans Abdominal Pre Peritoneal (TAPP) Repair.
Postoperative complications like pain are one
of the most common complications that occur after
performing a TAPP.

Material And Methods: 31 patients who underwent
laparoscopic inguinal hernia repair without mesh
fxation for uncomplicated inguinal hernia at Dhiraj
hospital were included in my study. All patients
were assessed by thorough clinical examination
and consent was taken.After proper dissection of
the tissue and cord, mesh of size 15*12 cm size was
placed without fxation. The peritoneum closed with
vicryl 2,0 RB in continuous manner. All patients were assessed during the first postoperative day, day of discharge, and at follow up visits at 1st week, 1 month, 3 months and 6 months
post operatively.

Results: A total of 31 elective TAPP were performed
in my study. Out of 30 patients, 7 patients develoed pain in post
operative period, so 23.33%.Out of which 5 developed pain over the operativesite (16.67) and 2 developed pain in the testicular pain
(6.67).

Conclusion: In our study the most common
complication seen was postoperative groin pain and
testicular pain. It was seen in total 7 patients (22.57%)
whereas in Wang et. al. it was seen in 2.6% of patients
without mesh fxation and 23.68% of patients with
mesh fxation. So this suggests pain is due to mainly
extensive tissue dissection and cord dissection.
In our study in a span of follow up period of 6
months the recurrence seen was 0% but in Mayer et.
al. study it was seen in 1.1% of patients without mesh
fixation and 0.9% of patients with mesh fixation.
So our study proves that recurrence rate does not
depend upon the fixation of the mesh.

Keywords: Inguinal hernia; Laparoscopic hernia
repair; TAPP; Mesh fixation.
 

Context: Acute Intestinal Obstruction is the main
surgical emergency problem that a general surgeon
has to face place every day irrespective of day and
night. It is quite an exciting experience to examine,
investigate, diagnose, explore, and look into the
abdominal cavity where it would reveal the puzzling
conditions. This study is to assess cases of acute
intestinal obstruction.

Aims: To study the clinical profile in adult patients
with acute intestinal obstruction

Settings and Design: This is a tertiary care hospital
done prospective study.

Methods and Material: This study was conducted
in a tertiary care hospital of suburban Telangana.
During the study period, the total number of patients
with Acute Intestinal obstruction who underwent
surgery was 75.Total number of acute intestinal
obstruction with provisional diagnosis was 234. They
were evaluated for clinically and radiological.
Statistical analysis used: Statistical analysis was
done using ratios and percentage

Results: A total of 234 patients with provisional
diagnosis of acute intestinal obstruction where
diagnosed of which 75 patients underwent emergency
surgery. On analysis of etiological factors external
hernias (53%) is the most common cause of acute.
Intestinal obstruction, followed by adhesions and
bands (28%). This study showed male preponderance
(83%) against females (17%). Incidence in relation to
age was found maximum in 51-60yrs (33.3%). Most
common presentation is pain (100%) abdomen.

Conclusions: External hernia is the most common
cause of acute intestinal obstruction with male
preponderance. Age group affected most is sixth
decade. Most common presenting symptom is pain
abdomen
Keywords: Intestinal obstruction; Pain abdomen;
Adhesions.
 

Background: Ventral hernia is a protrusion of
an abdominal viscus or part of a viscus through
the anterior abdominal wall. Ventral hernias are
common clinical entity encountered in people of all
age groups. They present a challenge because they
occur in variety of sizes, may be quite complicated
to repair and have relatively high recurrence rates.
Mesh repair in ventral hernia can be onlay , inlay, pre
peritoneal. Each of the mesh placement techniques
are practiced widely and each have their own
advantages and disadvantages. This is a prospective
study to compare the pre peritoneal mesh repair and
onlay mesh repair techniques and their outcomes in
management of ventral hernias.

Aims and Objectives: To compare the onlay and pre
peritoneal mesh repair techniques and their outcomes
with respect to post operative pain , seroma formation,
wound infection and recurrence in the management
of ventral hernias. To assess the anatomical, clinic
pathological factors leading to ventral hernias.

Methods: Source of data:
Patients diagnosed by the surgeon as confirmed
cases of ventral hernias, admitted department of
general surgery, in hospitals attached to Bangalore
Medical College and Research Institute, Bengaluru

Methodology:It was a Prospective comparative study
Total sample size was 100.
After admission, patients fulfilling the inclusion
& exclusion criteria were taken into study after
obtaining written informed consent.
Patients were allotted to groups randomly using
computer generated random number.
Group A were 50 cases who underwent onlay mesh
repair and group B were 50 cases who underwent pre
peritoneal mesh repair
Patient details and investigations were recorded
were recorded in the case record form (CRF) at
baseline visit .
Patients underwent the mesh repair and duration
of surgery was recorded.
Patients were followed up at 4 weeks (visit 2), 8
weeks (visit 3) and 24weeks (visit 4) after the surgery.
The various complications were studied in the follw
up visits.

Results:The mean operative time was 46.68 minutes in
onlay group and 56.26 minutes in pre-peritoneal
group showing statistical significance. In our study,
22% of onlay group and 6.0% of pre-peritoneal group
complaint of chronic post operative pain during the
follow up visits showing p value which is statistically
significant. 22% were in onlay group and 6.0% in
pre-peritoneal group developed seroma with a p
value showing statistical significance. Average post
operative hospital stay period in present series for
onlay repair was 7.48 days, as compared to 5.90 days
average stay for Pre-peritoneal Mesh repair which
also was statistically significant.

Conclusion: According to our study onlay repair
had more complication rates in terms of seroma and
post operative pain compared to pre-peritoneal mesh
repair. Even though the operative time for onlay
NIJS / Volume 11 Number 3 / July–September 2020
332 New Indian Journal of Surgery
repair was less, increased chances of complications
limit its use. Taking into consideration all the above
our study concludes that pre peritoneal mesh repair
is superior to onlay mesh repair.

Keywords: Ventral hernia; Mesh repair; Onlay;
Pre-peritoneal; Seroma; Post operative pain.
 

Intestinal anastomosis is a surgical procedure
performed to establish communication between
two formerly distant portions of the intestine.
This procedure restores intestinal continuity after
removal of a pathologic condition affecting the
bowel. Intestinal anastomosis has been effectively
performed for more than 150 years using a
assortment of techniques, materials and devices.
This study included 50 patients, Out of them, 24
underwent hand sewn anastomosis, 26 underwent
stapler technique. This study was conducted in the
Department of General Surgery, Shri M.P. Shah Govt.
medical college and Guru Gobind Singh Government
Hospital, Jamnagar. In terms of mortality, 3
patients(12.5%) of handsewn anastomosis were
expired and 3 patients(11.5%) of stapler anastomosis
were expired. Rest all were discharged. In this
study we found that stapler technique is quicker to
perform, so duration of surgeries was less than that
in the handsewn technique. We can say that stapler
can be used in patients with poor general condition
and in emergency surgeries. Low complication rate
and lesser hospital stay makes the stapler patient
friendly. However, the only limiting factor for
stapler is its cost. Availability of cheaper stapler with
reusable gun will make stapler more patient friendly.
A day may come when as far as bowel anastomosis is
concerned, people may not remember or require the
art of suturing!

Keywords: Intestinal anastomosis; Stapler
technique; Hand sewn technique, Emergency GI
anastomosis
 

Background: Seroma formation is commonestc omplication incidence following MRM varying from 15% to 85%. Identifcation of patients
prone to develop seroma helps in early detection and adequate management of seroma thus decreasing its morbidity.

Aims: To analyse impact of age, Body mass index, weight of mastectomy specimen, drain volume, serum albumin, no. of lymph node
& neoadjuvant chemotherapy on seroma formation.

Design: Prospective observational study.Materials and methods: All Patients admitted with Carcinoma breast in Department of Surgery in KIMS, and undergoing MRM included in study.relevant clinical details noted. Patients followed up to look for seroma and its associatin with various factors mentioned above was calculated. Statistical analysis used t- test, z test and chi-square test. p- value < 0.05 was considered significant

Results: Study demonstrated association betweenseroma formation and age> 45 yrs, BMI more than 22.9, weight of specimen >750gm, post operative day1 drain output >120ml, total drain output >600 ml.

Conclusion: we concluded that higher incidence of seroma is anticipated in an elderly obese women with mastectomy specimen weighing >750gm especially if her post operative day 1 drain output is >120 ml and total drain output >600ml.these patients require more frequent follow up for early detection of seroma and its aspiration so as to prevent its complications. Serum albumin level, staging of tumour, number lymph nodes dissected, primary mode of treatment does not contribute for seroma formation.

Keywords: Carcinoma breast; MRM; Seroma; Factors
 

Pilonidal sinus is a common chronic benign
surgical condition affecting young males with thick,
coarse body hairs, deep natal cleft and involved in
profession requiring prolonged sitting like drivers..
It is associated with lot of distress and morbidity
leading to loss of wages. There are many different
modalities of surgical treatment of the disease and
simple excision, followed by regular dressing for
secondary healing is most commonly used method.
Present study was designed to compare Z-plasty with
simple excision in chronic pilonidal sinus. Z-plasty
is associated with early healing (16.6 days versus
42.2 days) and low recurrence rate(6% versus 20 %).
However, operating time (62.4 versus 34.8 minutes)
and post-operative stay (8.4 versus 5.9 days) was
slightly prolonged in Z-plasty.

Keywords: Pilonidal sinus; Z-plasty; Sinusexcision; Asymmetrical closure.
 

Objective-The main objective of the present study
to investigate the average time required for the
procedure of inguinal hernia and postoperative
complications.
Method- The present study contained 3 bilateral,17
right-sided and 7 left-sided herniae in the laparoscopic
group and 2 bilateral, 19 right-sided and 6 left-sided
inguinal hernia in open mesh repair group. A total of 54
patients had a primary inguinal hernia, 27 underwent
open repair and 27 underwent laparoscopic to open
repair.

Result- The patients were selected from the agegroup of 18-65 years in both the study and controlgroups. The mean duration of time in open repair foropen U/L -47 min, for open B/L- 90min whereas for laparoscopic repair was laparoscopic U/L - 85 min,lap B/L-136.67 min. patients in the open repair show wound infection, seroma formation, haematoma formation, cord oedema while in laparoscopic repair
only 2 patients show seroma formation, while open repair 1 patients show wound infection, and 3 patientswere shows cord oedema.

Conclusion-Conclude thepresent findings theoperative time is prolonged inlaparoscopic TEP repair as compared to open due tothe learning curve in our institution. It has a statisticaladvantage in relation to wound infection, seroma,haematoma only in 2 patients in the laparoscopic
hernia repair however statistically significant.

Keywords: Post Operative complication;
Laparoscopic Surgery; Open Repair Surgery.
 

Context: Gallbladder disease is one of the most
common gastrointestinal conditions in the Indian
population, but its true prevalence is unknown.
Gallbladder diseases are a common cause of
morbidity and among the most expensive digestive
tract disorders1. A population-based survey was
performed to determine the age, sex, and other
clinical and epidemiological profile of gallbladder
disease.
Aims: To study the epidemiological profile of
patients with gall bladder diseases.
To study the clinical profile of the patients with
gall bladder diseases.
 

Settings and Design: This is a tertiary care hospital
done study descriptive observational study.
Methods and Material: This study was conducted
in a tertiary care hospital of north Karnataka. In
this study total 200 cases admitted for gall bladder
related gastrointestinal complaints were screened
and studied. They were evaluated for gall bladder
diseases clinically and radiological. Total 200 cases
with gall bladder disease were identified and studied
in details
 

Statistical analysis used: Statistical analysis was
done using ratios and percentage
 

Results: Maximum number of patients [60%]
was females. Maximum number of cases [60%]
was present in fifth decade age group. Right
hypochondrial tenderness was present in 94.5%
cases. Maximum number of cases had pain abdomen
[94.5%] and fatigue [95%] as a major presenting
symptom. Acalculous gall stone disease was most
common diagnosed entity accounting for 43.5% of
cases.
Conclusions: Gall bladder diseases are more
common in females, commonest age group affected is
fifth decade. Right hypochondrial tenderness, fatigue
fever are common clinical manifestations.
 

Keywords: Cholelithiasis; Females; Right
hypochondrial tenderness.
 

Abdominal cystic lymphatic malformations are rare in children. In this article we reviewed our experience of the same for a period of 7 years with respect to their presentation and management. Advanced imaging modalities and regular use of laparoscopy has made diagnosis and management of cystic abdominal lymphatic malformations
straightforward and easy.

Keywords: Abdominal Cystic Mass; Lymphangioma; Abdominal lymphatic Malformation.
 

A retrospective study of surgical treatment modalities and outcomes in children with Choledochal cysts was carried out. 15 cases of Choledochal cysts were operated between December 2014 and January
2020 at our institution. All children in the study group were below 16 years of age. Various procedures7,8 like complete cyst excision
with Porto-Duodenostomy, Hepatico- jejunostomy with Roux -en-Y loop, with or without interpositioning valve in jejunal loop (Lillie’s modification), Partial cyst excision with cysto-duodenostomy or cystojejunostomy have been described in the treatmentof Choledochal Cysts. Laparoscopic and Robotic procedures,5 ERCP and sphincterotomy and Liver transplantation6 are the newer treatment modalities
also described in literature. Our experience over a 5 year period is presented in this article.We recommend complete cyst excision with PortoDuodenostomy or Hepatico-jejunostomy with Rouxen-Y loop as the procedures of choice.

Keywords: Choledochal Cyst; Portoduodenostomy Hepaticojejunostomy
 

Background: Salivary gland tumors account for between less than 1% of all neoplasms of the head and neck.

Objective: to find out clinico-pathological study of salivary gland tumours.

Methods: All patients with salivary gland tumoursin surgical wards of KIMS Hospital during theperiod of July 2013 to November 2015. Total 20
cases clinically presenting as salivary gland tumours during the period of July 2013 to November 2015 were taken for study.

Results: The age incidence of the patients in thestudy group ranged from 16–60 years. 7(35%) patientswere males and 13(65%) were females. Parotid glandis the most commonest site accounting for 90% of all cases. All patients presented with swelling. Features of rapid growth, pain, and associated facial paralysis were considered as signs of malignancy. Overall pleomorphic adenoma, constitute 80% of all salivary
gland tumours. Among malignant tumours sqamous cell carcinoma constitute 5% and myoepithelial tumour constitutes 5% of all tumours occuring in salivary glands.

Conclusions: It was concluded Most of the salivary gland tumours occur in females. Most of the salivary gland tumours arise in parotid gland. Most of them are benign and most of the benign tumours are
pleomorphic adenoma. Swelling is the commonest symptom of salivary gland tumours.

Keywords: Salivary gland tumours; Clinicopathological study; parotid gland; pleomorphic adenoma
 

Background: Ileal perforation is one of the most
common acute abdominal emergencies in surgical
field. There are multiple factors that influence the
prognosis and outcome of the patient.

Methods: Present study was a prospective
interventional study aimed at evaluating the clinical
profile, etiology and surgical management and
its outcome of patients with nontraumatic ileal
perforation.

Results: There were 50 patients of nontraumatic
ileal perforation; causes for perforation were typhoid
56%; non specific 26%; obstruction 12%; tuberculosis
3%.Simple closure of perforation and resection and
anastomosis were the mainstay of the surgical
management.

Conclusion: Terminal ileal perforation should
be suspected in all cases of peritonitis especially
in developing countries and surgical treatment
should be optimized taking various accounts like
etiology, delay in surgery and operative findings
into consideration to reduce the incidence of deadly
complications like septicemia,pyoperitoneum, fecal
fistula.
 

Context: For decades, there has been a discussion, whether thyroid disorders could cause gallstone disease. These explanations include the known linkbetween thyroid failure and disturbances of lipid metabolism 1 that may consecutively lead to a change of the composition of the bile.A population-based comparative study was performed to determine the
association between thyroid profile and gall stone diseases.

Aims: To know the association between thyroid function change and gall stone formation.

Settings and Design: This is a tertiary care hospital done study descriptive observational study.

Methods and Material: This study was conducted in a tertiary care hospital of north Karnataka .The study duration was January 2018 to December 2018. A total of 1004 patients with gastrointestinal problems and Gallstone were selected randomly for the study. Statistical analysis used: Statistical analysis was done using ratios and percentage.Comparative results were obtained using two group which were compared and calculated using independent t test for
the TSH levels and T4 levels.

Results: There was no difference in the median values of S-TSH (3.06, range 0.27–4.2 vs. 2.8, range 0.28–7.40ulU/ml) and S-T4 (13, range 5.5–13.0 vs. 13.0, range 5.5.–13 ug/dl) between the groups .The
prevalence of subclinical (S-TSH > 4.2ulU/ml;) hypothyroidism in women was 24% in Gallstone disease group and 2.3 than in the control group and in men 24% and 2% (total 5.5%) in the Gallstone disease group than in control group, respectively.

Conclusions: There is an association between change in thyroid function with gallstone disease.
 

Keywords: Cholelithiasis; Thyroid profile; Subclinical hypothyroidism.
 

Background: Acute pancreatitis, characterized by local and systemic inflammation, is a common causeof acute abdominal conditions. Revision of the 1992 Atlanta Classification provides a newer classificationto describe clinical behavior and imaging characteristics of acute pancreatitis. This study aims at assessing changes in serum lipid profile in acute pancreatitis and to correlate level of serum lipid profile
with severity of acute pancreatitis and outcome of the patient.

Methods: The study group included 70 cases of acute pancreatitis and control group included 70 cases of non traumatic acute abdominal conditions other than acute pancreatitis. The data for this study
include the lipid profile of the patients. Results: This study demonstrated a significant lowering of HDL in cases of severe acute pancreatitis when compared to mild and moderate acute pancreatitis and showed  that duration of hospital stay of a patient was more in cases of patients with significantly lower levels of HDL. Also there was lowering of all three lipid profile values of HDL, LDL and total cholesterol in cases of
acute pancreatitis when compared to control group.

Conclusion: Serum lipid levels can be used as one of the components for assessing the severity of acute pancreatitis and as a prognostic indicator to predict outcome of patients with severe acute pancreatitis.

Keywords: Acute Pancreatitis; Severity of AcutePancreatitis; Serum Lipid Profile Levels.