New Indian Journal of Surgery

Telemedicine plays an important role in imparting healthcare facilities worldwide in special situations like the COVID-19 crisis. Use of technology in healthcare has come a long way. Special cameras for surveillance and interaction have been used in fields of industries, offices, home based and national security systems etc. Here we describe our experience regarding the use of Pan-Tilt camera in tele-interaction during surgical procedures during the time of corona pandemic.

Bronchogenic cysts are uncommon congenital anomalies of foregut origin usually located within the mediastinum and the lung and rarely diagnosed in adults. Surgical excision is the recommended to establish diagnosis based on histologic examination, alleviate symptoms if present, and prevent future complications. Thoracoscopic approach is becoming the primary therapeutic option.

Liver abscess is a common condition in tropical countries and is associated with significant morbidity and mortality. Traditionally, there are two major classifications of hepatic abscess; pyogenic and amoebic. There are various complications associated with hepatic abscesses, of which, rupture of the abscess is the most common. Intraperitoneal rupture of liver abscess is a rare but potentially fatal disease. Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis. Improving imaging techniques have aided the CLInicians in the diagnosis of hepatic abscesses and have subsequently become important treatment tools, the demographics of the hepatic abscess have changed. Though open surgery still remains most commonly used management modality, with advent of minimally invasive surgery. Thus, multiple management options are available today and ruptured liver abscess is a preventable and manageable. No specific guidelines are available for choosing the modality of treatment. Thus, this article purpose is to report a case of a patient that presented with acute abdomen at the emergency caused by a rupture liver abscess. A 7 year old male child presented to the Emergency Department due to severe abdominal pain during the last 7 days. The pain was located in the RHC, associated with constipation and three to four episodes of vomiting. On physical examination, generalized abdominal tenderness was present without any guarding or rigidity and no abdominal lump palpable. There were no signs of peritonitis. Blood tests including complete blood count, serum electrolytes, bilirubin, and liver and kidney function tests were performed which were unremarkable and showed no other abnormalities. Prothrombin time, partial thromboplastin time and INR (International Normalized Ratio) were normal. In our case in diagnostic laparoscopy after initial abdomen exploration around 200cc purulent fluid filled peritoneal cavity noted and ruptured liver abscess diagnosis confirmed so diagnostic laparoscopy converted to exploratory laparotomy. Peritoneal lavage given with approx 1500cc warm saline.and metronidazole wash is also given.after clearing all toxic fluid and. All abdominal organs examined and layer wise closing done. The total operative time was 120 minutes and our patient’s post-operative period was unevetful. He was discharged on the seven post-operative day.

Upper limb edema after any trauma or after any surgical procedure is very common. The edema of the hands can cause many complications including the stiffness of the joints. So, the edema of the hands should be managed promptly to get optimal results. There are many methods to reduce hand edema. Hand elevation is one of the time-tested methods to deal with hand edema. Hand elevation can be done by various methods. But in a certain number of patients who are on skeletal stabilization with an external fixator can find it difficult to elevate using a conventional cuff and collar or pillow. In such a patient we tried hand elevation using cloth and IV stand. The hand circumference of the patient was measured daily using a fabric tape and the findings were noted serially for two weeks results showed that edema reduced considerably following and elevation. The method is easy, safe, reproducible, and less costly.

Objective/Background: The objective of this study was to study the complications and failure rate after creating arteriovenous fistula in patients suffering from end stage renal disease (chronic renal failure). It was also intended to study the importance of preoperative Clinical assessment/physical examination of the patient; and if the vessels for anastomosis appeared to be of doubtful size, then doppler study was done to ensure that vein is of adequate size for creation of a good fistula. Method: In this study 121 cases of end stage renal disease (chronic renal failure) who needed vascular access for hemodialysis were taken. Ultrasound Doppler study was conducted in those patients whose vessels (for anastomosis) appeared to be of small size on Clinical examination. In the study, the arteriovenous fistulae were created under local anesthesia observing all aseptic precautions. Results: Most commonly, difficulty encountered during surgery was when the caliber of vein was small i.e. less than 2.5 mm. Arteriovenous fistula was created only when the size of vein was atleast 2.0 mm. When the size of vein was small, then longitudinal incision was given in the vein or Cheatlemanouvre was undertaken to perform anastomosis. In 4 of the 121 cases when radiocephalic fistula was attempted, we had to convert to brachio-cephalic. No major complication was encountered during the surgery or post operatively. Some patients (five) had redness and inflammation. Inflammation and redness subsided with antibiotics and it resulted in satisfactory recovery. The fistulas started well showing good thrill. After 30 days, 106 out of 121 AV fistulas created were functioning very well with a patency rate of 87.6%. Conclusion: There were no major complication after creating arterio venous fistula. It is important to do thorough physical examination before surgery so that vessel is assessed. In doubtful cases ultra sound doppler study should be done to know the size and patency of vessel. We should also take relevant history especially of hypertension, diabetes, i/v canulation etc.

Aims and Objectives: This study was designed to evaluate admission neutrophil lymphocyte ratio in predicting risk of amputation in critical limb ischemia patients who could not get surgical or radiological (percutaneous transluminal angioplasty) revascularization. Methods: A total of 150 patients presented with CLI to our hospital between June 2017 and June 2018 who could not have radiological or surgical revascularization are included in the study. Critical limb ischemia patients are those with is defined with ischemic rest pain and/or skin ulceration/gangrene in accordance to current guidelines reflecting patients with Fontaine class 3 and 4. This is a comparative study, 75 with CLI and rest pain and 75 without rest pain, so the NLR was significant in the rest pain group substantiated with the p value thus proving a vascular end point. An optimal cut-off value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our study occurrence of CLI significantly increased with an increase in NLR. A P value <0.05 was considered statistically significant and the CI was 95%. Analyses were performed using SPSS software. Results: Using an NLR cutoff of ≥3.2, the area under the receiver–operating characteristic curve was 0.71 (95% CI 0.54-0.78). Overall, there were a total of 9 (0.06%) deaths and 135(90%) amputations. The amputations were above ankle in 103 (77%) and below ankle in 32 (23%). Conclusion: The neutrophil lymphocyte ratio is an independent predictive factor for amputation in critical limb ischemia patients. An increased NLR is significantly associated with patients at high risk for CLI and other vascular endpoints. Stratification of patients with CLI according to admission NLR should be considered in the limb survival analyses of future adjuvant and neoadjuvant trials to validate these findings.