New Indian Journal of Surgery

Background: Neonatal severe hyperparathyroidism is an extremely rare condition that presents in the first few months of life. Recognition at the early stage followed by prompt surgical intervention are of vital importance for survival. Hypotonia, respiratory distress, lethargy and delay in growth and development occur in association with the elevated serum parathormone levels and hypercalcemia. Definitive therapy involves total parathyroidectomy. Case Description: We are presenting a case with Neonatal severe hyperparathyroidism, who underwent total parathyroidectomy. The patient had been followed up with medical therapy until. Parathormone levels rapidly declined following total parathyroidectomy and the patient was discharged with full recovery. Literature Review: Sestamibi scintigraphy might fail to show an ectopic parathyroid gland. In such conditions, on table confirmation of parathyroid glands by frozen section and Intra operative parathormone monitoring is vital at this point. Persistently elevated parathormone levels might suggest a remnant parathyroid tissue at the surgical site or an ectopic parathyroid gland that should be excised. Clinical Relavance: Neonatal severe hyperparathyroidism is a life-threatening disease. In the present case surgery performed at the early is life-saving due to the failure of medical therapy to control the disease.

Amynad’s hernia is the term used for hernia with content as Appendix and part of caecum. This can be presented as incarcerated hernia and rarely with acute appendicitis. Here we are presenting a case acute abdomen with appendicitis in the inguinal hernia. This case is reported in a 68 yr old man with long standing hernia presented as acute pain and vomiting. This case report is reported due to its rarity.

Background: Haemmoroids refer to anal cushions and when it becomes pathological, it will produce symptoms of bleeding, mucus discharge, itching, pain and prolapse. The objective of the present study was to compare between the results of Longo’s and Chivate’s procedure in terms of operative time, post-operative pain and complications, return to normal work and recurrence. Materials and Methods: In the present study 30 number of patients clinically diagnosed as second degree, third degree and fourth degree haemmrhoids are enrolled and operated. 15 number of cases were selected under Group A category and Stapled Haemorrhoidopexy was perfomed. Another 15 number of patients were put under Group B category and Suture Rectopexy was performed. The results of both these procedures were compared. Post-operative check-ups at 12 hours, 24 hours and upto 48 hours were done. Follow-up of all the cases were done at 2 weeks, 4 weeks, 8 weeks and upto a period of 6 months. Statistical Analysis: Standard statistical analysis method like SPSS (software version 200) was adopted for the analysis. The data were evaluated by comparing two groups using Chi Square Test with a P value <0.05 as significant. Results: In Stapled Haemorrhoidopexy, there was less post-operative pain as per visual analogue score, less of operating time, fewer days of hospital stay and early return to normal work. In Suture Rectopexy, there were also similar results. Hence, no significant differences in post-operative complications were found in both the procedures. There were four recurrences with stapled haemorrhoidopexy and two recurrences with sutured rectopexy in the present STUDY. Conclusion: At present many surgical procedures are practiced for haemorrhoids. However, we found that stapled haemorrhoidopexy of Longos’s offers better results in terms of fewer post-operative complications, good patient compliance and better long term results.

Background: Fournier’s gangrene is an acute rapidly progressive necrotizing fasciitis of infectious etiology. It usually affects scrotum, penis, perineum, perianal region and anterior abdominal wall occasionally. It is a poly-microbial infection resulting in thrombotic occlusion of small subcutaneous blood vessels leading to cutaneous gangrene. In spite of low prevalence at present FG carries considerable morbidity and mortality. It affects all age groups and both sexes. It is more prone in individuals with Diabetes Mellitus, chronic alcoholism, urogenital, anorectal diseases and immune-compromised persons. The diagnosis of FG is mostly clinical but radiological imaging was also needed to assess the extent of the disease. The management comprises of mainly aggressive surgical debridement under broad spectrum antibiotics coverage and ICU support. Material and Methods: It is a retrospective study comprising 30 number of FG cases clinically diagnosed and admitted in Dr Bruno Cheong Hospital, Flacq, Mauritius from 2019-2023. The data collected from hospital records comprising of routine and emergency cases. The preexisting co-morbidities, socio-economic status and outcome of management as per FGSI scores were assessed and recorded. Statistical Analysis: Standard statistical method, like SPSS was adopted for the analysis. Results: In the present study FGSI scores were co-related with the clinical picture and biochemical parameters of 30 no. of cases to assess severity of the disease. Moreover, FG being a serious and complicated disease, it was managed by a team comprising of surgeons and ICU team. Conclusion: FGSI scoring system is an excellent tool to assess the severity of the disease, in terms of mortality risk and outcome of management.