New Indian Journal of Surgery

Abstract Background: Repair of incisional hernia with prosthetic mesh provides tension free closure of the abdominal wall with improved results. Different methods of fixation of mesh have been described with varying results. Mesh fixation to the fascia is the most important part of a hernia repair. Anterior rectus sheaths are tough aponeurotic structures and so are ideal for mesh fixation. This study reports the long-term results of placement of prosthetic mesh in pre-rectus position and fixation to anterior rectus sheaths along with linea alba by open technique, for incisional hernias occurring in the midline. The primary end point was hernia recurrence. Patients and Methods: A total of 126 consecutive patients with incisional hernias occurring in the midline were operated from July 2009 to October2020. After dissection of the plane between rectus muscles and anterior rectus sheath, a polypropylene mesh of suitable size was placed in front of the rectus muscles and fixed to the posterior surfaces of anterior rectus sheaths and the linea alba. In 2013, cases were reviewed and the study continued. The patients were followed on phone or by personal visits up to March 2021. Results: The average period of follow up was 60 months. There were five recurrences. Wound infection was noted in 16 patients with complete healing in all cases with antibiotics and dressings. There were 4 cases of seroma, 5 cases of skin edge necrosis and two cases of suture sinus. There was no mortality, mesh infection or extrusion. Conclusion: Open ‘pre-rectus’ technique for repair of midline incisional hernias is effective with a low recurrence rate.

Abstract Background:Acute abdomen remains the important cause of morbidity and mortality in emergency. It requires careful history taking and thorough evaluation of symptoms, clinical examination and judicious use of radiological investigation which simplify the evaluation of disease. Aim and Objectives: To assess the accuracy of radiological diagnosis in comparison to postoperative diagnosis in non-traumatic cases of acute abdomen. Materials and Method: A prospective observational study of non-traumatic acute abdomen was carried out at Sahyadri Narayana Multispeciality Hospital, Shimoga, Karnataka. Total of 78 cases of acute abdomen patients were evaluated and operated over a period from December 2018 to February 2020 and included in the study group. Pediatric age group (12 years and below), traumatic cases (blunt and penetrating), acute abdomen in pregnancy and gynecological causes of acute abdomen, urological cases, and conservatively managed cases were excluded from the study. Detailed history was taken and relevant physical examination performed. All patients underwent hematological and biochemical investigations, appropriate radiological investigation (USG, AXR and CT-scan) were performed based on clinical suspicion. Clinical and radiological diagnosis based on clinical examinations and radiological investigations was compared with post-operative diagnosis based on operative findings. Result: The most common age group was 20-60 years with male preponderance. Pain in abdomen was commonest symptom followed by vomiting, anorexia and fever. Tenderness was commonest clinical sign observed followed by rebound tenderness, tachycardia and guarding/rigidity. Acute appendicitis was the most common cause of acute abdomen followed by perforation peritonitis and intestinal obstruction. The overall diagnostic accuracy of clinical examination in acute abdomen was 81.8% and if radiological imaging techniques combined with this, the accuracy raised up to 94%. Conclusion: The study strongly suggested that with thorough history taking and proper clinical examination, clinical diagnosis was successfully achieved in 82% of patients. Radiological investigations help in confirming clinical suspicions and giving added information of underlying pathology with accuracy of 94%. Keywords: Abdomen Injury; Radiological Investigations; Trauma; Diagnostic Test; Perforation

Abstract In plastic and reconstructive surgery, skin flaps are widely employed. Large wounds that cannot be closed with normal treatments are treated with skin flap surgery. Skin flap necrosis is a well-known postflap cover issue that can affect cosmetic outcomes and patient satisfaction. Variable occurrence rates and inconsistent related factors have been reported in many retrospective studies of this condition. Despite advances in technology, the rate of flap necrosis remains significant in daily procedures. In this case study, we aim to evaluate the efficacy and safety of Low level laser therapy preventing flap failure. Keywords: Keystone flap failure; Necrosis; Lowlevel laser therapy; LLLT. Introduction Skin flap necrosis is a well-known post-flap cover issue that can affect cosmetic outcomes and patient satisfaction. Variable occurrence rates and inconsistent related factors have been reported in many retrospective studies of this condition. Despite advances in technology, the rate of flap necrosis remains significant in daily procedures. There are many methods which are used to ensure flap survival, one of them and with very few data available is low-level laser therapy (LLLT). In this article we share our experience of using LLLT and aim to evaluate the efficacy and safety in preventing flap failure.

Abstract Aim: To see the merits of the surgical treatment and hence to reaffirm the superiority of surgery in acute appendicitis. Background: Surgery was the treatment of choice for acute Appendicitis which was practised over centuries. During the last decade, there were some publications about the conservative management of uncomplicated acute Appendicitis in adults and its advantages over the surgery. And all that studies also states that there was recurrence of about 20-30 %. Methods: The data of patients that came to the surgical department with acute appendicitis and recurrent appendicitis during the period November 2020 to December 2021 were analysed. The patients treated with surgery alone were included in the study. Detailed history, laboratory investigations and radiological investigation including Ultrasonogram (USG) were analysed to differentiate acute and recurrent cases. From the data we could identify the number of both acute and recurrent cases. Hospital admissions, number of episodes for the recurrent treatment, loss of working days and other relevant data were collected from the patients. Results: There were 61 patients who were operated for appendicitis including both acute and recurrent cases in the period of 1 year in the COVID era. Among these 34 were acute appendicitis and 27 recurrent appendicitis. Male: Female ratio was 39:22. Our study shows that majority are male patients and the most numbers are in the age group 10-30 years comparable to the standard statistics. Our study shows that 44.26% (27) of the total cases (61) operated was recurrent appendicitis. The number of recurrent episodes varied from the period of 1 week to 2 years after conservative treatment". In them treatment also varied from outpatient to inpatient in different individuals. The advantage of less hospital stays and decreased morbidity of conservative treatment is lost with subsequent investigation and surgical treatment in those. All the patients who got operated on follow up had an uneventful post operative period. Conclusion: So conservatively managed patients had lost many working days and had economic loss compared to patients operated for acute appendicitis early. Early surgery in acute appendicitis actually decreased the cost and morbidity. Keywords: Acute appendicitis; Recurrent Appendicitis; Appendicectomy; Conservative treatment; Appendicular perforation.

Abstract Objective: To document and correlate different indications and findings of EGD scopy in our endoscopy unit. Methods: A retrospective descriptive study of 519 patients who underwent Esophhago gastroduodenoscopy (EGD scopy) was conducted in the Endoscopy Unit of Department of General surgery of Subbaih Institute of medical sciences, Shivamogga. Included patients underwent EGD scopy. Demographic data including indications and endoscopic findings of the patients were collected via study proforma. Results: Total five hundred and nineteen patients were studied; Out of all 64.54% were males and 35.06% were females. Epigastric pain or pain abdomen was the commonest indication (41.23%) followed by dysphagia (13.48%), Hematemesis (10%), vomiting and regurgitation, screening (9.05% and 7.51%respectively). The most common endoscopic findings were gastritis (35.45%), GERD (9.82%), Varices (9.02%), Carcinoma (7.32%), GI Ulcer (5.78%), hiatal hernia (5.58%), stricture (3.08%) and normal (20.03%). Conclusion: The most common indication was Epigastric pain or pain abdomen for EGD scopy and indications were relevant to the findings. Keywords: Esophhago Gastroduodenoscopy; Endoscopy; Upper GI diseases; Acidity.