New Indian Journal of Surgery

Context: Pediatric intestinal obstruction is a fascinating subject. Because of the specificity of age group, the etiology and management will vastly differ from adult patient and pediatric patients will need very careful management. Because of poor symptomatology and thereafter management initially by either paramedical personnel or unexperienced personnel, the patient suffers a great deal, and early diagnosis and treatment gets usually delayed. Moreover, due to unavailability of trained institutes, morbidity and mortality in this age group significantly rise.In the light of present knowledge, it is possible to outline therapeutic principle which if applied promptly and skillfully, should result in a gratifying outcome to both patient and surgeon in a vast majority of cases. Intestinal obstruction in pediatric age group, due to many differences in aetiology and pathological effects in the body, differs considerably from adult age group. Due to anatomical and physiological difference between these two, the pathological picture and clinical manifestations will vary and accordingly, management also differs. A pediatric patient requires a great deal of scrutinization at every stage of management, diagnosis, preoperative, postoperative etc. The present study is a retrospective study of 30 cases of small intestinal obstruction in pediatric age group which makes a genuine effort to find out the aetiological factors, modes of presentation and special management in them. AIMS •     To study various clinical presentations in pediatric patients of small intestinal obstruction. •     To study the age and sex distribution of different etiological factors. •     To study etiopathology of small intestinal obstruction in pediatric patients. •     To study different treatment modalities in these patients. •     To evaluate the outcome in pediatric intestinal obstruction. Methods and Materials •     Study Settings: Department of General Surgery of teaching hospital attached to medical college •     Study period: Two year •     Sample Size: 30 Cases •     Study Type: Retrospective Study Results: Intestinal obstruction is one of the commonest intra-abdominal pathology encountered in paediatric age group. Cause of intestinal obstruction varies from intussusception, intestinal atresia, worm infestation and obstructed inguinal hernia. The cause of intestinal obstruction also varies with age. Success in treatment of intestinal obstruction depends largely upon early diagnosis, skillful management which comprises of investigations and treatment. Preop-resuscitation, per op-ventilatory and fluid management and post op fluid, nutrition and electrolyte management have an equally important role to play like the surgery itself. Improvement in surgical and anesthetic technique and advances in neonatal and pediatric health care have improved the final outcome in intestinal obstruction. However, being in developing country with a non-ignorable bulk of children suffering from malnutrition and communicable disease, a high degree of suspicion from pediatrician, radiologist and a surgeon working simultaneously for a common task shall always be beneficial for the society. Better understanding of pediatric intensive care and endoscopic advances in the field of surgery shall be able to extend the boundaries of curative treatment and thus further decrease the morbidity and mortality rates. Keywords: Instestinal obstruction; Pediatric age group; Intussusception; Obstructed inguinal hernia; Worm infestation; Early diangnosis; Treatment.

Introduction: Laparoscopic cholecystectomy is the gold standard procedure for gall stone disease. Few cases of acute calculous cholecystitis require conversion to open procedure which can increase the morbidity and financial burden to patient. Hence, through this study we are trying decide regarding the parameters which would help to assess the patient preoperatively and predict the outcome of laparoscopic cholecystectomy. Aims and Objectives: To assess the preoperative parameters to predict conversion of laparoscopic cholecystectomy to open cholecystectomy in patients with acute calculous cholecystitis. 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. 100 patients were included in the study. Results: 100 patients of acute calculous cholecystitis were taken for laparoscopic cholecystectomy of which 80 patients successfully completed the procedure and remaining 20 patients had to undergo conversion to open procedure. Conclusion: Male gender, older age, patients with higher pain (VAS) score, raised TLC, raised total bilirubin, raised serum ALP are associated with failure of laparoscopic cholecystectomy. Keywords: Acute calculous cholecystitis; Cholecystectomy; Laparoscopic cholecystectomy; Failure of laparoscopy; Conversion to open cholecystectomy.

Introduction: Breast cancer is one of the leading causes of death among females. This necessitates a proper screening modality for early diagnosis and treatment of breast cancer. Due to limited resources in few setups it would be difficult to get an access to mammography. Hence in our study we are trying to evaluate the diagnostic accuracy of ultrasonography to use it as an alternative to mammography in breast cancer patients. Materials and Methods: A prospective study was conducted on 80 women presenting with breast condition. All patients underwent sonomammography followed by histopathological assessment of the lump. Results: Irregular shape with irregular margins on sonomammography was found to be significant marker of malignancy with extensive vascularity. Calcification in malignancy was 7.92 times more common than benign. The diagnostic accuracy of sonomammography was 75% with sensitivity and specificity of 72.58% and 83.33% respectively. Conclusion: Our study concluded that sonomammography can be used as a diagnostic modality for breast conditions in resource limited facilities. Keywords: Breast Cancer; Sonomammography; Benign lesion of breast; Diagnostic accuracy of sonomammography; BIRADS.

Introduction: Inguinal hernia surgery remains till date one of the most commonly performed surgeries. Overall decrease in recurrence rate along with shorter hospital stay, faster return to normal activities and a lower incidence of post-operative pain has led to the widespread acceptance of laparoscopic hernia repair especially Laparoscopic Transabdominal Preperitoneal repair in the management of inguinal hernia. The study was done to evaluate the initial experience of a tertiary care center in the laparoscopic hernia repair including the intra and post-operative complications and associated technical difficulties. Methodology: This prospective, descriptive study was performed in 22 patients during the period of 2018 to 2021. The patients were evaluated thoroughly for the predisposing factors, technical aspects of the procedure, intra-operative details, post-operative complications and the time taken for the procedure were noted. The patients were also followed up for a period of 6 months for late complications. Results: All the patients in the study group were male and majority of them were older than 40 years. Majority of the patients had heavy work as the risk factor and all of them presented with inguinal or inguino-scrotal swelling which reduced by itself. Majority of patents had right indirect and incomplete inguinal hernia. The mean operative time in initial cases were longer, but on acquiring experience, the operating time came down to approximately 90 minutes. The complications associated with the procedure were minimal with a return to normal routine in a mean of 15 days. Conclusion: Laparoscopic hernia repair is a significantly lengthier procedure especially in the learning phase of the surgeon’s team, but the operative time decreases with increasing experience. Good technique and knowledge about laparoscopic anatomy of inguinal region ensures minimal complications and faster recovery. Keywords: TAPP; TEP; Laparoscopic Hernia Repair; Inguinal Hernia Surgery.

Background: Helicobacter pylori infection occurs worldwide, affecting more than half of the world population. The clear aetiology of dyspeptic symptoms is still unclear but helicobacter infection is main contributing factor for it we investigated Helicobacter pylori prevalence in dyspepsia. Methods: 100 cases of dyspepsia attended Adichunchanagiri hospital and research center, studied over a period of 18 months (January 2020 to June 2021), were subjected to upper gastrointestinal endoscopy, during which 4 biopsies, two each from the antrum and the pathological areas were taken. Two biopsy specimens, one of the antral area and the other of the pathological finding were immediately inoculated into freshly prepared urea broth containing phenol red as the indicator. Positive test for Helicobacter pylori was indicated by change in colour of the medium from yellow to pink or red. The other two biopsy specimens were sent for routine histopathology. The case was taken as Helicobacter pylori positive when the rapid urease test and/or histopathological examination were positive. Results: Out of 100 dyspeptic patients who were included in the study, there were 65 male patients and 35 female patients. In which 71 patients were found to have been infected with Helicobacter pylori (71%). Conclusion: In this study, we found that in Dyspepsia the Helicobacter pylori was consistently associated and its well proved with various studies done in past and present. Thus we conclude Helicobacter pylori infection definitely have role in the aetiopathogenesis of dyspepsia. Keywords: Giemsa; Helicobacter Pylori; Peptic ulcer disease; Urease; Ulcerative dyspepsia.

The understanding of wound healing has led to the inclusion of tissue regeneration therapy as an armamentarium to deal with both acute and chronic wounds. The bio constructs that aid in wound regeneration was made using natural, artificial, or a combination of both, widely known as regeneration scaffolds. The components of regeneration scaffolds promote the inherent self-renewal property of the skin and speed up the healing process by providing growth factors/stem cells. The scaffolds are in use for so many years. But the commercially available scaffolds are very expensive. Hence an indigenous scaffold was made use of multiple components like non-cultured keratinocytes, amniotic membrane, collagen, and silicone. Which was found to be in no way inferior to any of the commercially available scaffolds. Keywords: Regeneration Scaffold; Post Burn Raw area; Dermal Regeneration; Regenerative Therapy.

Background: In this study, we aimed to evaluate the value of FNAC in the diagnosis of solitary thyroid nodule, and asses the correlation with the histopathology. Materials and Methods: Prospectively FNACs of 90 cases of solitary thyroid nodule was compared with histopathology from July 1 2013 till June 31 2015. Results: The sensitivity and specificity of FNAC in our study is 77.7% and 98.7 respectively, the positive predictive value and negative predictive value is 87.5% and 97.5%respectively. Discussion: In our study, FNAC is proved to be an invaluable tool for pre-operative diagnosis of thyroid lesions, and its Bethesda system concords with histopathology results. Keywords: Solitary thyroid nodule; Fine needle aspiration cytology; Thyroid malignancy; Sensitivity; specificity.

Wound healing is a complex and regulated process that is critical in maintaining the skin barrier function. The numerous disease processes can affect the events involved in wound healing, resulting in chronic, non-healing wounds. These would subject them to significant discomfort and distress and drain the medical system resources enormously.

A chronic wound can be defined as that does not heal in an orderly set of stages and in a predictable amount of time or within three months. They remain in the inflammatory phase for too longand never heal or may take years.3,4 Chronic leg and foot ulcers occur in many adults with diabetes, chronic venous insufficiency, arterial disease, prolonged pressure, or neuropathy.5

Chronic ulcers may last for 12 to 13 months and even recur in 60-70% of cases. They cause loss of function and decreased quality of life and significant morbidity.6,7 These chronic ulcers are predominantly seen in elderly, becoming more prevalent and more difficult to treat and are associated with high treatment costs.

So wound care has become essential in these ulcers, and surgical debridement and dressings are the corners stones. Many wound dressings like gauge, films, hydrocolloids, gels, foams etc. were developed to both protect the healing wound from infection and to promote the healing process.1

Placental extract gel is a rich source of various peptides, amino acids, nucleotides, PDRNs and carbohydrates, which are believed to support the healing process.9 Application of placental extract preparation increases collagen synthesis, increases tissue protein, accelerates neoangiogenesis, and epithelialization.10 It has an immunotropic effect and causes the release of Epidermal growth factor, Fibroblast growth factor at the tissue level. It also reduces surrounding tissue inflammation and oedema and reduces microbial burden.11 Its application accelerates healing because of amino acids, nucleotide and vitamins that improve healing.

Introduction: Breast cancer accounts for about one third of female cancer. Of all lesions, benign breast diseases have been found to be commonest. The aim of study was to analyze the incidence of breast diseases over the period of 3 years and to study the spectrum of diseases and age distribution. Methods: Retrospective cross-sectional study of breast lump cases at general surgery department of Travancore medical college over a period of 3 years. Result: Of the total 200 cases up looked into, 27 out of 200 cases were found to be malignant. Fibrocystic disease was the commonest (43%), followed by fibroadenoma (34.5%), 67 had lumps in right breast, 87 in the left breast and 46 patients had lump in both breasts. Conclusion: From the study we found that, most of the breast lesions are benign and there is increase in the number of cases each year. Some of the benign lesions may remain undetected and lead to malignant change. So early detection of breast carcinoma and public awareness is crucial to save the patient from morbidity and mortality. Keyword: Breast Diseases; Carcinomabreast; Fibrocystic disease.

Aim: To study the etiology, clinical presentation, investigations, treatment modalities & their outcomes, post operative complications for scrotal swellings and follow up. Materials and Methods: The cases admitted to the surgical wards over a period of one and a half years i.e., November 2018 to May 2020, formed the material for this study. During this period 100 cases with h/o scrotal swelling admitted in various surgical units, selected at random were studied in detail as per proforma. Sampling Method: A Simple Random Sampling Results: 100 cases of scrotal swellings were studied and compared based on age, occupational distribution, mode of presentation, duration of symptoms, predisposing factors, treatment modalities and post operative complications. Conclusions: Scrotal swelling was commonest symptom. The other symptoms included pain/ heaviness of scrotum, fever, etc. •     Definitive surgery was done in 90 cases. •     Various forms of hydrocele constituted a major portion of the study (50 cases). •     Varicocele was the second commonest cause comprising of 13 cases. •     A total of 9 cases of Fournier”s gangrene, 6 cases of torsion of testis including one with scrotal abscess. •     There were 09 cases of epididymo-orchitis, 4 cases of testicular tumor, 3 cases each of sebaceous cyst and encysted hydrocele of cord and 2 cases of hydrocele with hernia. Keywords: Treatment modalities; Scrotal swellings; Hydrocoele; Varicocele; Outcome.

Introduction: Nano silver itself is not new. It has been used for various applications in consumer and commercial products over the past century without showing adverse effects on patients. Nano-silver dispersions were used as medical products already in the 19th century. Additionally, the concept of Nano-silver being used as a topical antibacterial dates back to the days of Sushrut in the 6th century where finely powdered Silver was used as a topical antibacterial/antiseptic after surgery. Material and Method: Silver ions and the compounds made like nanosilver exhibit a broad antimicrobial profile against bacteria, fungi and virus and also have low toxicity towards animal cells. Various studies have also demonstrated definitive antibacterial property of nanosilver against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, C. albicans, V. Parahaemolyticus, S. enterica, B. anthracis, B. Cereus, Bacillus subtilis, Salmonella entrica and Pseudomonas aeruginosa. Result: Nano silver particles have ability to alter the expression of matrix metallo-proteinases (proteolytic enzymes that are important in various inflammatory and repair processes), suppress the expression of tumor necrosis factor (TNF-α), interleukin (IL)-12, and IL-1b, and induce apoptosis of inflammatory cells. Therefore, nano silver gel also displays an anti-inflammatory action. Conclusion: In conclusion, Silveron gel due to its nano silver particles and unique formulation has the power to protect, penetrate, and heal in cuts, wounds, burns, diabetic foot ulcer, and surgical dressings. Keywords: Silveron Gel; Antimicrobial; Nano Silver.