New Indian Journal of Surgery

A case of Osteomyelitic sinuses of the ilium with lower abdominal defect following a run over accident is treated with primary excision of sinuses
with bone and reconstruction using pedicled anterolateral thigh flap. The Anterolateral thigh flap is a versatile pedicled flap1,2 for  the reconstruction of the abdominal wall more effective and efficient than
the fascia lata flap or other rotation flaps. Here is a case report  describing the procedure and outcome in a complicated case.
Keywords: Anterolateral thigh flap; Abdominal
defects; Osteomyelitis of the pelvic bones; Sinuses of
lower abdominal regions.
 

We Report a case of Idiopathic granulomatous mastitis in a 30 year old pregnant woman who came to our hospital with complaints of painful lump in her right breast because the results of initial aspiration cytology was mammary abscess with focal mastitis, incision and drainage was performed when MRI breast showed intermediate concern for  malignancy – Excision biopsy was done. However the final histopathological diagnosis was granulomatous mastitis with no evidence of malignancy. A review of literature revealed that idiopathic granulomatous mastitis has a tendency to affect young woman with a history of child birth on oral  contraceptive usage. Clinical diagnosis and imaging has often been difficult. Complete resection or corticosteroid therapy can be recommended as appropriate treatment. Since recurrence rate is as high as 50%, long term follow up is indicated in such patients.

Pilomatrixoma is a rare benign skin appendage tumor of hair matrix origin. It is commonly seen in the first two decades of life, most often presenting on the face, neck or upper extremities. Pilomatrixoma of the breast is uncommon, and can mimic breast malignancy. Male breast Pilomatrixomas an extremely rare entity with only 9 cases reported in
English literature. We report a rare presentation of perforating Pilomatrixoma of the breast in a male patient aged 35 years.
Keywords: Pilomatrixoma; Male breast; Calcifying epithelioma; Pilomatricoma.
 

Purpose: The tubularized incised plate (TIP) technique for hypospadias repairis a well-known procedure for urethroplasty. The authors in this studyanalyze the application and outcome of TIP by the Pediatric Surgeon. They describe how this procedure helps to start hypospadias surgery services especially to the newly established centres. The procedure can provide surgeons required confidence and prepare them to undertake the complex surgeries for hypospadias. Method: This is a prospective study done on all cases of hypospadias operated with TIP technique in a newly established centre for Pediatric Surgery for a period of two years. The results were evaluated on the basis of outcome in the form location and shape of meatus, correction of curvature. The complications were noted and individually treated. Results: Total 100 patients were operated with TIP technique during the study period. The Distal type of the hypospadias was the main variety treated (n=64) followed by mid penile and proximal penile type of hypospadias (n=21 and n=13 respectively). All patients were offered TIP as the method of urethroplasty and were operated by a single surgeon. The procedure was well tolerated by all the patients. There were few complications, mainly meatal stenosis and urethrocutaneous fistula. No Major complications were found. The cosmetic and functional outcome was good in all cases. Conclusion: The TIP urethroplasty offers a considerable safe technique in the patients of hypospadias. It can be easily learnt and reproduced. There is a learning curve associated with the procedure. The authors can conclude that the procedure of TIP in the cases of hypospadias brings a good amount of confidence in a Pediatric Surgeon to offer the services of hypospadias surgery especially in newly established setup. Keywords: Hypospadias; Pediatric; Fistula; Hypospadias.

Context: The varicose vein is a common chronic peripheral vascular disease affecting the lower limbs. They have significant impact on the quality of life. Even though considerable advances in understanding venous pathophysiology and modern imaging techniques have revolutionized the lower limb varicosity management, whether these inferences hold good for our population is a pertinent question. Aims: To evaluate the clinical presentation and surgical outcome of management of varicose vein. Settings and Design: Prospective observational study. Methods and Material: Prospectively patients with symptoms and signs of varicose vein are evaluated. Precise proforma used to collect patient's demographic details, clinical features, and investigation reports; during the study from August 2016 to November 2018. Statistical analysis used: univariate analysis, percentages. Results: This study includes 132 patients, seventytwo (54.54%) are males, and sixty (45.45%) are females. In this study, varicose veins are commonly seen in the 40–50yr's age, and the right limb was affected in 51.38% than the left limb 88 (48.62%). The incompetence of the Saphenofemoral junction valve is seen in 24 (13.26%) patients, saphenopopliteal Valve incompetent in 17 (9.39%) patients & below knee perforator in 32 (17.67%) patients. Twenty-one out (15.90 %) of one thirty-two had a complication in our study; the commonest was surgical site infection in twelve (7.2%) patients. Conclusions: The varicose veins of lower limbs are a disease of the all-age adult group, common in fourth and fifth decades of life. Patients usually presents with complications rather than the disease itself. The wound infection is the common postoperative complication. Keywords: Flush Ligation; Saphenofemoral junction; Perforators; Varicose vein; Venous disease. Key Messages: Management of varicose vein is technology driven, Good results can be achieved by proper selection of patients and appropriate procedures.

Background: Bladder stones are common in males but not so common in females. They account for nearly 5% of the urinary system stone disease. We here share our journey of bladder calculi in female patients and will let you know various foreign bodies that can cause bladder calculus, various treatment modalities that exist to treat them and the lessons that we learnt. Methods: We did a retrospective study from August 2016 to July 2020 at SMBT IMS & RC, Nashik. A total nine patients were included out of the total twentythree bladder stone patients. Diagnostic investigations included X-ray of kidney, ureter and bladder region, ultrasonography of abdomen and pelvis, computed tomography and if needed, cystoscopy before every planned surgical procedure. Results: Nine patients of complicated bladder stone with or without foreign body were treated in the study. Two patients required open surgery. Six patients underwent per urethral cystolithotripsy for their stones and one patient underwent suprapubic percutaneous cystolithotripsy. Psychiatric evaluation was done for one patient. Clean intermittent catheterisation was advised for the neurogenic bladder patient. Conclusion: To find and treat a bladder stone in a female patient is much easy as compared to find out the cause of that stone. The reason being the rarity of bladder calculus in females, more so the secondary calculus. Therefore, whenever you find a bladder calculus in female patient you should find out the cause by taking prior proper history, doing proper clinical examination, ordering relevant investigations and treating them as per the current strategies. Keywords: Bladder calculus females; Foreign body; Calculus over foreign body; Giant bladder calculus; Fragmented D J stent.

Aim and Backround: To find out the common anastomosis done following choledochal cyst(CC) excision in our institution.
Material and Methods: A retrospective study in patients operated for choledochal cyst excision done at our institution was done for a period of 10 years.
Results: Total 41 patients operated for choledochal cyst excision. Hepatico-duodenostomy (HD) was the common anastomosis done in our patients.
Conclusion: HD was the common preferred
anastomosis done in our institution.
 

Context: Morbidity and mortality are higher for burn injuries in low- and middle-income countries. The treatment should be effective and cost-effective also for patients from these countries. Aims: To compare the outcome of Amniotic Membrane Dressing and Banana Leaves Dressing, in terms of pain during dressing change, comfort, recovery, hospital stay, complications and future need of skin grafting among partial thickness burn patients in Tertiary care centre Settings and design: Hospital based comparative study was carried out at Burn care unit of Tertiary care hospital of VilasraoDeshmukh Govt. Institute of Medical Sciences,Latur, Maharashtra, India. Methods and material: Hospital based comparative study was conducted among 50 cases with partial thickness burns. They were assigned in equal number of 25 each. One group received amniotic membrane dressing (AMD) while the other received banana leaf dressing (BLD). Statistical analysis: Mean scores of two group were compared with the help of independent t test. P value < 0.05 was considered as significant. Results: Most common cause of partial thickness burn was scalds contributing (42%). Total burn surface (TBSA) area was 16%-30% in 60% of cases. Both groups were comparable for age, sex and TBSA. Patients in AMD group had significantly less scores of pain during dressing removal, discomfort and significantly more scores for ease of dressing removal and less number of days for healing (p<0.05). Signs of infection and need for skin grafting was comparable in two groups. Conclusion: This study proved superiority of Amniotic Membrane Dressing (AMD) over Banana Leaves Dressing (BLD). Key messages: Amniotic Membrane Dressing should be used among partial thickness burn patients for good results Keywords: Effectiveness; Dressing; Amniotic membrane; Banana leaves; Burns.

Aim and Background: Percutaneous Nephrolithotomy (PCNL) is the primary treatment in renal stones more than 2 cms, staghorn calculi and
diffult stone to fragment with ESWL. Outcome of stone disease with PCNL was studied here. 
Materials and Methods: A prospective observational study was done in our institution to find the PCNL outcome/complications in relation to Guy’s Stone Score (GSS). Statistical analysis was done by using
Fisher's Exact Test, and ANOVA accordingly. P Value of <0.05 was considered significant.
Results: Total 50 PCNL were done. There were 25 males and 25 females. The mean age was 42.48 years. The mean stone burden average was 2.882 cm with a minimum of 2.5 cm and a maximum of 4 cm. Total complications noted was 25 (50%), but most were managed conservatively. As the GSS score increases the residual stones,
complications, operation time and length of hospital stay also increases (P Value <0.05). Conclusion: Increase in GSS associated with increase in residual, complications, operation time and length of hospital stay.
Keywords: Percutaneous Nephrolithotomy;
Complications; Outcome.
 

Context: Intussusception is a common disorder of children. The current treatment modality is non operative procedure either by pneumatic reduction or saline hydroreduction. The failure of hydroreduction is one of the disadvantages of non operative reduction. Clinical prediction score (CPS) has been designed by Khorana to predict the success or failure of non operative reduction. Aims: The present study aims to identify the risk factors for the success or failure of saline hydroreduction. Settings and Design: This is a prospective observational study conducted in a University Hospital in Kathmandu, Nepal. Methods and Material: All children with intussusception were subjected to hydroreduction unless contraindicated. The outcome of hydroreduction was measured as ‘Successful’ or Unsuccessful’ after the procedure. Clinical characteristics, ultrasound findings, and investigation results were compared between ‘Successful’ and Unsuccessful’ groups. The accuracy of CPS for prediction of success was calculated. Results: A total of 54 children underwent hydroreduction, among whom 47 (87%) were successful while 7 (13%) were unsuccessful. No patients developed complications. Rectal bleeding, fever and abdominal distension were significantly different between successful and unsuccessful groups. CPS was found to have a significant prediction of outcome for saline hydroreduction (P < .001). At a cut-off score of 11, sensitivity, specificity, positive predictive value, negative predictive value were 96%, 86%, 98% and 75% respectively. Conclusions: Rectal bleeding, fever and abdominal distension were independent risk factors for the failure of hydroreduction. CPS was a good predictor of the outcome of saline hydroreduction. Key Messages: Hydroreduction is a standard procedure for pediatric intussusceptions. Failure of reduction is a major concern of the procedure. This study focuses different parameters for outcome of hydroreduction. Rectal bleeding, fever and abdominal distension were found as significant predictor of failure of hydroreduction. Keywords: Intussusception; Hydroreduction; Risk factors; Clinical Prediction Score.