New Indian Journal of Surgery

Introduction: Diversion stoma is very common in surgical practice. Aim: To compare the complications following early versus delayed ileostomy closure following bowel surgeries. Methods: This was a Hospital based comparative study on 112 patients undergoing ileostoma closure following bowel surgery from, March 2023 to February 2024 at Department of Surgery, S.P. Medical College and P.B.M Hospital, Bikaner. Patients of each gender with age >18 years, temporary loop ileostomy and temporary double barrel ileostomy of any aetiology, medically and mentally fit to undergo early stoma closure were included. Results: Mean age of group A (Early stoma closure) was 41.54±16.56 and group B (Delayed stoma closure) was 47.6±16.13. (p=0.066). Out of total 37 patients of Group A maximum 16 (43.24%) patients had intestinal perforation, as indication of stoma creation, whereas in Group B maximum 37 (49.33%) patients had intestinal perforation, as indication of stoma creation. (p>0.05). Mean time operative time for stoma closure of group A was 71.16±5.05 and group B was 75.70±7.73. (p<0.001). In Group A, 2 (5.40%) patients died whereas 6(8%) died in group B. Conclusion: it is preffered to EARLY STOMA CLOSURE as per patients fitness for stoma closure over unnecessarily DELAYED.

Background and objectives: Laparoscopic appendectomy has rapidly become established as the popular alternative to open appendectomy, it has a safety profile better than open procedure. Aim: Laparoscopic procedure for appendectomy is compared with open surgical Technique. Methods: hospital based study from July 2022 to August 2023, involved 60 patients with Diagnosis of acute appendicitis was entered into a study randomizing the Choice of operation to either the open or the laparoscopic technique. Statistical Comparisons were performed using the chi-square test and students ‘t’ test. Results: the mean post op pain score was 1.37±0.49 for laparoscopic and for open appendectomy is 3.27±0.828 (p<0.0001). as per complications in laparoscopic group vomiting, wound infection was more in open group (p<0.007). In the laparoscopic group, 26 (86.7%) patients were satisfied whereas only 50% were satisfied in open group. Conclusion: Laparoscopic appendectomy was better than open appendectomy in a properly prepared and selected patient in terms of Post-operative pain, Post-operative complications like vomiting, wound infection, fever, Duration of the hospital stay, Return to the work, Cosmetic benefit.

Corrosive ingestion remains one of the most devastating problems in developing countries that cripples patient’s body, mind and soul depriving them from leading a normal social life and living with a scar on their emotions, psyche and charisma. Appropriate management in the acute phase of corrosive injury reduces tissue damage and further morbidity and mortality. The aim of this case discussion is to evoke a light of hope for those patients of corrosive injury and a guide to clinicians worldwide for further better management and sharing our experience of surgical management of a case of such corrosive injury of gastrointestinal tract.

Objective: To assess the trends in Gossypiboma over 1975-2023 and the impact on the career of a surgeon. Background: Gossypibomas are the most feared and undesired complication of surgery. Despite numerous guidelines, they still exist in our modern society. Here, we examine worldwide data along with a case report. Patient: A 46-year-old diabetic anaemic female with a 6-month earlier history of operative management for cancer of the cervix (stage IA2) presented with features suggesting acute intestinal obstruction. She was managed by emergency laparotomy and removal of the retained foreign body. Methods: A literature search was performed on PubMed for gossypiboma and was limited to case reports from 1975-2023. Analysis using Excel and Python. Results: In a study of 289 total gossypiboma cases, analysis revealed that Asia had the highest incidence (53.53%, n=269), and the most common symptom was pain (36.5%, n=287). Additionally, age and time of discovery exhibited an upward trend, with thoracic cases taking the longest to discover. Conclusion: Surgeon accountability for unintentional mistakes, akin to random errors, sparks debate. Gossypibomas emphasize the need to follow rigorous safety standards and team work endorsed by WHO.

Introduction: Cutting diathermy is a more recent alternative to scalpel for surgical incisions. Its use was limited due to fear of increased risk of infection, impair healing and decrease cosmesis. However, recent studies suggest otherwise, claiming that diathermy may offer potential advantages with respect to blood loss, incision time and post-operative pain. The aim of this study was thus to evaluate the outcome of diathermic incision in terms of healing, post-op pain and scar characteristics in operations with incisions more than 5 cm in size. Materials & Methods: A hospital based observational study included 182 cases scheduled to undergo surgery requiring more than approximately 5 cm of incision. Cases were operated by surgeons who have a minimum of 3 years of experience. Incision time, wound healing, post-op pain and scar characteristics were noted at discharge and follow up at 7th and 30th day. Results: Mean incision time was 24.5 seconds with almost half of the cases (48.9%) had incision time between 20-30 seconds. A significant improvement was observed in all cases regarding mean Southampton wound score and pain score from day of discharge till day 30th of follow up. A significant improvement was also observed in patient and observer scar assessment scale in all the sub categories from day of discharge till day 30th of follow up None of the cases complaint of any surgical site infections or scar related complications. Conclusion: Electrocautery can be considered as effective and safe in making large skin incision. It is associated with less incision time, faster healing, low post-operative pain and good scar characteristics. Conclusion: Electrocautery can be considered as effective and safe in making large skin incision. It is associated with less incision time, faster healing, low post-operative pain and good scar characteristics.

Introduction: Diabetic foot is one of the common problems encountered by surgeons in India. The surgeon would be better equipped to treat if data regarding the demographics, clinical presentation and factors leading to foot complications in diabetics is available along with the treatment and outcomes. Materials and Methods: This study aims to describe the clinical profile of patients with diabetic foot. This is a retrospective study. The study material was obtained from the patient records from 2018 to 2019. A total of 40 patients were included in the study. The demographics, clinical features, treatment and outcomes were noted. Statistical analysis was done. Results: Most common presentation was diabetic foot ulcers in 50% patients. Other presentations included cellulitis and gangrene. In 20% cases, diabetes was newly diagnosed. The mean duration of diabetes was 5 years. Treatment included regular dressings for 27.5% patients, debridement for 30%, incision and drainage in 15% and amputations in 15% patients. Empirical antibiotics given were amoxicillin-clavulanate and cephalosporins. The mean duration of hospital stay was 12.9 days. All patients improved with treatment. Conclusion: Early treatment is effective and limb saving. This study suggests inadequate control of diabetes and infection as a major cause for diabetic foot which may progress to sepsis with/without gangrene in the presence of PAD or neuropathy.