New Indian Journal of Surgery

Introduction: In females breast cancer is the second most common cancer in India with an incidence of 25.8 per 1,00,000 individuals. Most of the patients present with breast lump. Many due to lack of awareness present very late with advanced stage. Hence it is very important to diagnose the condition early with a proper screening modality. Materials and Methods: A prospective study was conducted on 100 women presenting with breast lump. All patients underwent mammography followed by histopathological assessment of the lump. Results: Irregular shape with ill defined borders on mammography was found to be significant marker of malignancy. Calcification in malignancy was 55.22 times more common than benign. The sensitivity of mammography was 84.62% and specificity of 80% with diagnostic accuracy of 83%. Conclusion: Mammography was found to be a reliable modality in diagnosing breast malignancy and hence concluding that it can be used as a diagnostic tool in breast lumps.

Keywords: Breast Cancer; Mammography; Benign lesion of breast; Diagnostic accuracy of mammography.

nternal Haemorrhoids has been the most common disease since ages and wide variety of treatment modalities available make it an equally enigmatic disease to approach. Polidocanol is the recent sclerosants in the surgeon’s armamentarium for its treatment. This prospective study included 86 patients with first or second degree internal haemorrhoids. Internal haemorrhoids had sexual predilection towards males in our study in the ratio of 2:1 with a age range of 24-68 yrs. Sixty-one of 86 patients had first degree haemorrhoids and the rest 25 had second degree. Bleeding P/R was the most common complaint followed by constipation and perianal discomfort. Response to first dose of 3% polidocanol was seen in 59.3% of patients, 29.07% patient responded to second dose and 11.63% patients responded to the third dose of sclerotherapy. Sclerotherapy is an effective option in the treatment of first and second degree haemorrhoids and 3% polidocanol has been an effective agent in this strategy.

Keywords: Internal haemorroids; Injection sclerotherapy; 3% polidocanol.

Introduction: Laparoscopic cholecystectomy is the gold standard procedure for gall stone disease. Few cases of acute calculous cholecystitis require conversion to open procedure. Patients with diabetes and hypertension are at increased risk of failure of laparoscopic cholecystectomy. Aims and Objectives: To evaluate the risk of failure of laparoscopic cholecystectomy in type 2 diabetes patients with patients without diabetes. Materials and methods: A prospective study was conducted at a tertiary care hospital. Study was conducted after obtaining ethical committee clearance and informed consent from patients. 90 patients were included in the study. Results: 90 patients of acute calculous cholecystitis were taken for laparoscopic cholecystectomy of which 38 patients had to undergo conversion to open procedure. Among these 17 where having diabetes and hypertension and 14 had type 2 diabetes alone. Conclusion: It is important to evaluate in detail before taking the patients with commodities like diabetes and hypertension for laparoscopic cholecystectomy and prevent morbidity

. Keywords: Acute calculous cholecystitis; Cholecystectomy; Laparoscopic cholecystectomy; Failure of laparoscopy; Conversion to open cholecystectomy; diabetes with cholecystitis; diabetes and laparoscopic cholecystectomy.

Background: A physiological basis of the ailments like hemorrhoids and fissure is necessary for symptom specific treatment of patients. We aimed to evaluate rectal compliance and resting anal pressure by anal manometry as an objective parameter to the disease in these patients and compare them with controls. Material and Methods: Study conducted in 150 patients, after informed consent and IRB approval,in institutional setup, divided into 3 groups. Group 1- patients with Hemorrhoids and fissure in ano (H+F), group 2-Hemorrhoids without fissure (H-F) and group 3-controls without any anorectal pathology. All patients underwent anorectal manometry, results evaluated, noted, and compared between all the three groups. Rectal compliance and resting anal pressure calculated and compared, and its significance evaluated using statistical analysis. Result: Each group consisting of 50 patients underwent Anorectal manometry and rectal compliance compared between all the three groups. Group 1 (H+F) was found to have mean rectal compliance of -0.100 ± 6.70 mL/mmHg, Group 2 (H-F) had a mean value of 8.92 ± 5.29 mL/mmHg and Group 3 (controls) had 13.08 ± 7.61 mL/mmHg of compliance. Group 1 had resting anal pressure of 115.04 ± 26.94mmHg, Group 2 had 79.92 ± 16.88 mmHg and Group 3 had 75.40 ± 28.39mmHg. The difference in rectal compliance and resting anal pressure was statistically significant between Group 1 & 2 and group 1 & 3. Group 2 had a lower rectal compliance and higher resting anal pressure than group 3 but not statistically significant. Conclusion: Hemorrhoids cause significant decrease in rectal compliance and increase in resting anal pressure, more pronounced in fissure in ano as compared to healthy individuals. Therefore, these values can be used as the objective parameter which should be routinely measured in these patients and treatment aimed at correction of the same.

Keywords: Hemorrhoids, anal fissure, rectal compliance, resting anal pressure, anal manometry

Background: Fistula-in-ano is the leading complication of perineal sepsis. Usually, a fistula has an external opening, a track, and an internal opening. Following infection and/or an abscess,External opening may appear acutely or with delayed appearance in a chronic manner. Management protocol for a fistula includesassessment of the extent of fistulous track &its relation to the anal sphincter muscle, control of infection,and finally, surgical treatment of the fistula & follow up. The principles in management of anal fistula aredrainage of infection or necrotic tissue, closure of internal opening of fistula tract, and removal of fistulous tract with preservation of sphincter function. The objectives of the studyis to compare the per operative and post-operative complications, mean hospital stay in the treatment of fistula in ano with treatment options like fistulotomy, fistulectomy, and setons. Methods: This is a comparative, prospective study of 60 patients who presented with their complaints to the Surgerical Outpatient department and who were admitted under the Department of General Surgery, P K Das Institute of Medical Sciences, Vaniamkulum, Palakkad, Kerala. Patients who met the inclusion criteria were included in this clinical study. Of the 60 patients selected for the sudy, 20 patients were surgically treated by fistulectomy, 20 by seton, 20 by fistulotomy over a period of 2 years. Results: Most common age of presentation is 21-30 years and more common in males then females (M:F= 2.3:1 ). Most common per operative complication was bleeding which was seen more in patients undergoing fistulectomy. 36% of the patients wound healed in less than 1 week, 22% of patients wound healed in 1 to 2 weeks,15% of patients wound healed in 2 to 3 weeks, 9% of the patients wound healed in 3 to 4 weeks. Conclusion: Fistula in ano is cured by various methods of surgery and higher antibiotics, local antibiotics with good post-operative wound management, like sitz bath without closing the wound and frequent/regular follow up.Seton technique is better compare to fistulectomy and which is better than fistulotomy.

Keywords: Fistula in Ano; Fistulotomy; Fistulectomy; SETON.

Background: Hydatid disease (cystic echinococcosis) is a zoonotic infection caused by larval form of tapeworm Echinococcus Granulosus. Echinococcus infestation has been known for many centuries. Most common sites for cysts are lung and hepatic hydatidosis. They have a diverse clinical spectrum from being asymptomatic to symptoms arising due to involvement of surrounding structures or dissemination or secondary infection. Disease is endemic in Mediterranean basin, Central Asia, Africa and South America. In India, Andhra Pradesh and Tamilnadu predominate with incidence of hydatid disease. Hydatid disease is common in Saurashtra region due to cattle rearing and farming as occupation. It is commonly seen in the lower socioecomic strata due to poor personal hygiene and sanitation. In India the highest prevalence is reported in Andra Pradesh, Tamil Nadu and Jammu Kashmir. Hydatid disease is a zoonotic disease caused by echinococcus granulosus (larval stage). echinococcus granulosus and echinococcus multiformis are the two main species causing hydatid disease. Animals are the Definitive host and intermediate hosts. Humans are accidental intermediate hosts. The aim of this study was to determine the sociodemographic characteristics, presentation patterns, type of surgical management and outcome of patient operated on for intra abdominal hydatid cyst. Materials and Methods: All the patients suffering from hydatid disease who were admitted in our hospital from May 2019 to June 2020 were included in this study. All the patients underwent thorough clinical examination with detailed history and investigation as per protocol. All patients were followed for 3 months. Inclusion Criteria: Documented intraabdominal hydatid disease. Conclusion: Hydatid disease is common in Saurashtra and Kutch regions of Gujarat & other states of India. Patients mostly present at the age group of 20-40 years. Sex distribution is equal. Occupation like agriculturist, residing in rural areas and low socioecomomic status are considered to be risk factor for hydatid disease. Most commonly involved organ was liver followed by peritoneal involvement followed by spleen. Most common lobe involved was right lobe. Gharbi type 2 cysts are common. Most common treatment modality is surgical with medical management only reserved for small cysts. Decompression of cyst with deroofing and omentoplasty/ capitonnage was the commonest procedure adopted to deal with hydatid disease.

Keywords: Hydatid cyst, Liver.

Background: Acute appendicitis is the most common general surgical emergency in young adults. Diagnosis of Appendicitis still remains a dilemma in spite of the advances in various laboratory and radiological investigations. Importance of hyperbilirubinemia or elevated Serum Bilirubin and its association in acute appendicitis and its complication as been postulated recently. The present study was undertaken to assess relationship between hyperbilirubinemia in predicting appendicitis and its complication. Methods: The present study was conducted in the Department of Surgery, SIMS & RH ,Tumkur during the period of August 2019 to August 2020. A total of 100 patients with clinical diagnosis of acute appendicitis or Appendicular perforation were studied. The serum bilirubin and LFTs were carried out in all the patients. Results: In this study, males (56%) outnumbered females (44%). Of the 100 patients, 91% were diagnosed as acute appendicitis clinically while 9% were diagnosed with Appendicular perforation. Postoperatively 82% were confirmed as acute appendicitis while 18% were diagnosed with Appendicular perforation. Of 82 patients with acute appendicitis, 74.39% had raised bilirubin levels, while 25.6% had normal levels. 18 patients were diagnosed as Appendicular perforation, 15 patients (83.33%) had raised bilirubin levels, while the remaining 03 patients (16.66%) had normal levels. Conclusion: The Sensitivity and Specificity of serum bilirubin as a marker in predicting acute appendicitis and Appendicular perforation was 74.39% and 83.33% respectively.Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis is essentially still - clinical. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia double the normal range (Raise in Direct Bilirubin being still higher) should be identified as having a higher probability of Appendicular perforation suggesting, serum bilirubin levels have a predictive potential for the diagnosis of Appendicular perforation.

Keywords: Appendicitis; Serum bilirubin; Appendicular perforation; Hyp

Background: Postoperative wound infections have an enormous impact on patient’s quality of life and contribute substantially to the financial cost of patient care. The potential consequences for patients range from increased pain and care of an open wound to sepsis and even death. Wound infections extend the average hospital stay by one week and increasing the cost of hospitalization by minimum of 20%. Appropriate antibiotics for prophylaxis in surgery depend on the most likely pathogens encountered during the surgical procedure and type of operative wound encountered during the surgical procedure. Inadvertent use of antibiotics is associated with Development of multi-agent drug resistance among nosocomial pathogens. The occurrence of new infections such as clostridium difficile colitis, respiratory tract infections Drug toxicity and allergy Enormous financial impact on health care costs. Objective: To know whether prophylactic dose of antibiotics is enough to prevent surgical siteinfections in post-operative period if there is no comorbidities and surgery is donewith complete aseptic precautions. Methodology: The patients who undergoes clean and clean contaminated surgeries in PK Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala over period of 2 years and who fulfill the criteria of study aredivided randomly into two different groups (70 cases and 70 controls). Routineinvestigations done in both groups. And all other parameters are kept similar like preoppreperations and intra-op strategies. Case group received only prophylacticantibiotic and control group received post-operative empirical antibiotics also. 70patients in case group contain 35 clean cases and 35 clean contaminated cases. 70patients in control group also divided like this. Results: Out of the 35 clean cases in study group 3 got SSI. Out of 35 clean contaminated cases in study group 7 got SSI Out of 35 clean cases in control group 4 got SSI Out of 35 clean contaminated cases in control group 8 got SSI Conclusion: The use of prophylactic antibiotics alone is as effective as post-op empirical therapy in preventing SSI. This will also avoid unnecessary antibiotic resistance and will reduce the cost of treatment.

Keywords: Prophylactic; Empiric therapy; Wound Infections; Antibiotic resistance.

Background and Objectives: Postoperative wound complication are one of the greatest issues in elective surgeries. Obesity, operative time, diabetes, age of the patient, anemia, associated infection and reduced nutrition are recognized risk factors for wound infections. With the seek to avoid wound infection, many research studies were performed and assessed the infuence of subcutaneous tissue closure in the past 20 years suturing of subcutaneous tissue, the anatomy of the fragile subcutaneous tissue layer is imperfect and suturing leads to a decrease in perfusion to the fatty layer thereby compromising the blood supply to the subcutaneous layer leading to fat necrosis. This study was under taken to study the various post-operative complications in elective surgery like ventral hernia, inguinal hernia and modified radical mastectomy closed with or without subcutaneous closure. Materials and Methods: This study was undertaken from December 2018 to December 2020 in the department of General Surgery, Shree M. P. Shah Govt. Medical College and G.G. Govt. Hospital, Jamnagar. After completing major operative steps subcutaneous suturing using 2-0 polyglactin was done in 54 patients and subcutaneous suturing was not done in 46 patients. Total number of patients–100.

Keywords: Subcutaneous Tissue Closure; Elective Surgery; anemia; Ventral hernia.

Wound infections continue to represent a major medical problem, both in terms of how they affect the outcome of surgical procedures (surgical site infections), and for their impact on the length of hospital stay and medical costs. Many otherwise successful surgical operations fail because of the development of wound infections. A major SSI is defined as a wound that either discharges significant quantities of pus spontaneously or needs a secondary procedure to drain it Wound infection predisposes the patient to wound dehiscence. Acute wound failure is defined as postoperative separation of the abdominal musculoaponeurotic layers, within 30 days after operation. Most surgical wound infections become apparent within 7 to 10 days postoperatively. Objectives of the study 1. To assess local wound complication in emergency midline laparotomy wounds with interrupted figure of eight technique over conventional continuous closure . 2. To Compare the operative time for interrupted figure of eight closure and Conventional layered closure of laparotomy wounds. 3. To determine the factors affecting wound dehiscence. Materials and Methods: A prospective study was performed at Victoria hospital and Bowring and Lady Curzon hospital , Bangalore during November 2017 – May 2019. A sample of 100 cases were considered. Each Group consisted of 50. Group 1 underwent Interupted figure of Eight suture technique and Group 2 underwent continuous conventional suturing technique. Results: The incidence of burst abdomen in current study was 8%. There were two burst abdomen seen in conventional continuous closure technique and none in the interrupted figure of eight technique group. Conclusion: All the patients with generalized peritonitis in emergency setting need special attention regarding the wound closure. This newer technique of midline emergency laparotomy wound closure, especially in our part of the world significantly reduces the incidence of wound infection and wound dehiscence.

Keywords: Wound dehiscence; Burst abdomen; Interrupted Vs continuous suturing.

Background and Objectives: Hernia is defined as abnormal protrusion of viscus through a normal or abnormal weakness in the wall of its containing cavity. Ventral Hernias are second most common type of hernias accounting for 21 to 35% of all verities of hernias. Reported incidence of Incisional hernias is 2 to 11%. It is the most common complication after laparotomy by a 2:1 ratio over bowel obstruction and is most common indication for reoperation by 3:1 ratio over adhesive small bowel obstruction. This study was under taken to study the various clinical presentation and management of ventral hernias. Materials and Methods: 300 cases of ventral hernias admitted to department of surgery Guru Gobind Singh hospital Jamnagar between periods of October 2010 to March 2021 were chosen for study. Data was collected including detailed history, clinical examination and investigation. Data was tabulated, analyzed and results interpreted.

Keywords: Ventral Hernia; Meshplasty; Scissors; Electro-cautery.