New Indian Journal of Surgery

Objective/Background: SSIs remain a significant cause of morbidity and mortality after surgery. One in eight patients develop SSI after exploratory laparotomies making it one of the major factors responsible for post-operative mortality and morbidity. Atypical mycobacteria are responsible for a spectrum of diseases ranging from superficial skin infections to widely disseminated systemic infections. Health care associated infections due to non-tuberculous mycobacteria is on the rise due to contaminated hospital water supplies, solutions, improperly sterilized instruments and devices. Our case is of an atypical mycobacterial infection in a patient with abdomino-thoracic trauma who underwent multiple surgeries. Case presentation: A 24 year old gentleman presented with a penetrating stab injury to the abdomen and left hemi-thorax following an assault. Patient underwent an emergency exploratory laparotomy which revealed a 4 x 4 cm defect in the left hemi-diaphragm, through which the stomach was herniating into the left thoracic cavity. During the 2nd post-operative week, patient developed empyema thorax, for which pigtail drain was placed initially and later thoracotomy with decortication and intercostal drainage were performed. Following discharge after 2 weeks, he presented with fever, body pain and pus discharge from the previously inserted intercostal drain site. Pus obtained was positive for acid fast bacilli and gene expert was negative. Atypical mycobacterial infection was diagnosed based on high index of suspicion and he received treatment for 6 months. Conclusion: This case highlights that identification of atypical mycobacterial infections in post-operative patients require a high index of suspicion. Management requires multi-drug approach and surgical intervention wherever necessary. Even with the existing sterilization techniques and preventive measure, atypical mycobacterial infection cannot be completely eliminated from a hospital set-up and hence must be considered in all nosocomial infections.

Chronic venous disease (CVD) is prevalent in the aging population and leads to venous leg ulcers (VLUs). These wounds can last and recur for years, significantly impacting quality of life. A large body of literature exists on CVD and VLU diagnosis and treatment. Multiple algorithms, guidelines, and consensus documents have been published on this topic, highlighting the importance of this issue in clinical practice. Compression is still the mainstay of treatment for CVD and VLUs. Compression is needed long term, but it does not suffice by itself to prevent recurrences without interventional correction. Venous intervention should be offered early to prevent or slow disease progression and reduce recurrence.

Background: Trauma is the leading cause of death in the population under the age of 45 year sold.1 Among trauma cases, Abdominal trauma accounts for the third most commonly injured part of the body. With the rising trend of road traffic accidents, the clinical patterns and profile of blunt abdominal trauma patients is also changing. Aim: To access the incidence, mode of injury and clinical presentation of blunt abdominal trauma patients in order to access the problem size in the study area. Material and Method: A prospective descriptive type of study was conducted in a tertiary care hospital including 100 study participants. All the patients with the diagnosis of the blunt abdominal trauma were assessed clinically at the time of presentation. After obtaining written informed consent, the detailed information regarding the mode of injury, clinical presentation was collected and recorded. Data Analysis: The data collected were then entered in MS Excel sheet and was analysed using SPSS v 20.0. the data was presented in the form of numbers and proportions. Results and conclusion: 85% of participants were male, majority (55%) belong to 21-40 years age group. The most common mode of injury was Road traffic accidents (75%) and most common clinical presentation was pain abdomen (98%). Spleen was the most common solid organ involved.

Lower limb injuries are most commonly due to road traffic accidents which cause lower limb defects. The management of lower limb fractures is guided by the Gustilo-Anderson classification of injuries. Simple leg defects are covered by localflap and complex defects by free flap. Complex defects of the lower limbs which were unfit for free flap require management by conventional cross leg flap. Colorado needle allows meticulous dissection of flaps due to the sharp tip and increases the efficiency in raising the flaps.

Background: Rectal cancer continues to be devastating malignancy worldwide. Faecal diversion is an important tool in the surgical management of rectal cancer. The presence of stoma may also increase the risk of complications related to stoma itself (high stoma flow, retraction, prolapse, kidney failure, skin excoriation etc.). Aims: To measure postoperative morbidity and mortality after low anterior resection with preventive diverting loop ileostomy in patients of rectal cancer Material and methods: This is a prospective study and was carried out between december 2021 to November 2022. Total 28 patients who underwent LAR with Diversion stoma were included according to pre-defined inclusion and exclusion criteria. Results: Male to female ratio was 1.8:1.Mean age was 57.92±15.85 years. 1 (3.57%) patient had anastomotic leak, 3 (10.71%) had wound infection, 6 patients (21.42%) had chest infection, 1 (3.57%) patients pelvic collection, 9(32.15%) patients had electrolyte imbalance, 2(7.14%) patients had ileus. Mean hospital duration during primary surgery of patients was 11.46±2.47. Mean Post stoma closure hospital stay was 5.84 (±1.57) days. Out of total 28 patients 1(3.57%) patient died, 25 (89.29%) patients underwent subsequent stoma closure. Rest 2(7.14%) patients had their ileostomy as a permanent stoma. Conclusions: Decision to create or not to create diversion stoma should be on case to case basis upon operating surgeon’s discretion with shared information to patient and his/her family with their involvement in decision making.

Aims and objectives: 1. To evaluate the outcomes of open and closed hemorrhoidectomy. 2. To compare the advantages and disadvantages in open and closed hemorrhoidectomy. Methodology: A randomised control trail was conducted on 56 patients presenting with grade 3 or grade 4 haemorrhoids at tertiary care centre. Patients were divided into groups of Group A – undergoing Open haemorrhoidectomy and Group B – undergoing Closed haemorrhoidectomy. Each group consisted of 28 patients. Patients in both groups were followed up and various parameters were assessed. Results: Mean duration of procedure for open haemorrhoidectomy was 22.32 minutes and for closed haemorrhoidectomy was 30 minutes. Mean intraoperative blood loss in both the procedures was 23.39 ml. 64.28% of patients showed wound healing at 3 weeks in group A and 46.42% in group B. Mean VAS score at discharge was 3.71 for group A and 4.64 for group B (p <0.001). Mean hospital stay for group A – 3.7 and for group B – 5 (p < 0.001). Conclusion: As per the observations made and data obtained in our study it showed that open haemorrhoidectomy to be superior to closed haemorrhoidectomy.

Closed incision Negative Pressure Wound Therapy (CiNPWT) which is a topical application of negative pressure over the wound plays a key role in healing and prevention of surgical site infections. We have used full thickness graft following post burn contracture release. We then applied negative pressure wound therapy over to this flap to assess its efficacy and safety in aiding healing.