New Indian Journal of Surgery

Introduction: Chronic pancreatitis (CP) is a progressive fibro-inflammatory disease of the pancreas with an increasing annual incidence characterized by intractable pain and poor quality of life. The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes. Methods: After IEC Clearance Consecutive CP patients diagnosed by disease history and radiological findings who underwent surgery at KIMS Hospital between March 2021 and May 2023. They were followed up for 18 months. The primary endpoint was pain relief, assessed at the end of follow-up using the Izbicki pain score. Results: 40 patients of pancreatitis who underwent surgery were studied retrospectively for the association of disease duration with outcome of pain relief. The patients were divided into early (< 3 years) and late groups (>3 years) based on the duration of abdominal pain.In these 80% of them had pain of <3 years duration, and the remaining 20% had pain of >3 years duration. Among these 77.5% were alcoholic and 12.5% had diabetes. On CECT evaluation, 35% had dilated pancreatic duct (> 10 mm) and the remaining 65% had duct size of <10 mm. Among these 82.5% underwent Frey’s procedure, LPJ was done in the remaining (17.5%). After surgery 90% had relief of postoperative pain and majority (62.5%) had long duration of stay (>2 weeks). There was a significant difference in Gender, Procedure done, Diabetes mellitus, Alcoholism, CECT duct size, and post-operative pain between early and late groups. There was no significant difference in Age, Steatorrhea, and duration of stay between early and late groups. Conclusion: Earlier surgery improves outcomes from painful chronic pancreatitis.

Background: Cellulitis is a bacterial skin and soft tissue infection which occur when the physical skin barrier, the immune system and/or the circulatory systems are impaired. Objectives: The purpose of our prospective observational study was to see the outcome of management of cellulitis in adults in department of General Surgery at tertiary care centre catering the patients from rural areas. Material: Present prospective observational study was carried out on 200 patients whoagedmorethan18years&werehospitalizedtothedepartmentofGeneral Surgery in tertiary care centre from December 2020 to November 2022. Result: Total 200 patients with cellulitis were enrolled in this study with mean age of 44.79 and range was 21-70 years. The most common age group in present study was 41-50 years of age 71(35.5%). There was male preponderance with male – female ratio of 3 : 2. About 71(35.5%) cases had trauma and 34(17%). Pain 189 (94%), swelling 178 (89%), redness 159 (79.5%) and local rise of temperature 150 (75%) were seen as hallmark features of cellulitis. Most common anatomical involvement in cellulitis was lower extremities 165 (82.5%). About 63.5% cases belonged to Class I according to CREST classification. About 60% of cases underwent surgical management while 40% cases responded to conservative line of management. All 120 patients who were managed surgically underwent fasciotomy. 50.8% cases underwent debridement. Morbidity was higher in elderly individuals above 60 years,malepatients&whohadhistoryoftraumafollowedbyDM. Conclusion: From this study we conclude that, as the age increases, complications and morbidity associated with cellulitis increases. CREST classification demonstrates good precision in deciding the duration of hospitalization. Proper understanding of the risk factors and factors associated with the complications of cellulitis will help healthcare professionals in implementing preventive measures.

Background: Microvascular free flaps are a versatile technique in reconstructive surgery but highly resource intensive traditionally, needing expensive operating microscopes and specialized micro instruments and sutures. Materials and Methods: This is a retrospective study of free flaps done in our institution using loupes between January to December 2023. Results: A Total of 7 patients underwent free flap surgery under loupe magnification mainly for oral cancer and diabetic foot reconstruction and flap success rate of 85.7%. Conclusion: Microvascular free flaps may be done in low resource setting using loupes and locally made micro instruments.

Tumors arising from structures located in paravertebral1 (region between the pericardium&vertebrae) sulcus are consideredposteriormediastinal tumors. Spindle cell tumours originating in the mediastinum are extremely rare. Due to profusionofstructures&organslocatedinthemediastinum,awidevarietyofthese neoplastic processes develop here (neural, vascular, epithelial). Schwannomas are the most common type of nerve sheath (neurogenic) tumors in adults. Mostof the mediastinal neurogenic tumour sare benign & slow growing most frequently originate posteriorly & they require surgical resectionas treatment.1 Clinical symptoms occur when the tumour reaches a large size or begins to compress on surrounding structures. So with increasing technical advances these mediastinal tumours can be approached for resection thoracoscopically to reduce the morbidity of the patient. Video-assisted thoracoscopic surgery (VATS) has an evolving role in the management of mediastinal pathology being less invasive. Through this case report we are trying to show the potential thoracoscopic part of the procedure in prone position with better ergonomics is technically feasible with anenlarged & optimal visualisation of the intra-thoracic structures for the surgeon, less operative time & better respiratory results with low incidence of respiratory complications for the patient that ease the difficulties faced in conventional surgery 1 (limitingtheburdenofinjurytoribs&underlyingstructuresduetoribretraction &muscledestruction), lessintraoperativebloodloss, lesschesttubedrainage,& shorter hospital stays than open procedures