New Indian Journal of Surgery

Background: Hiatal hernia often leads to gastroesophageal reflux disease (GERD), which may be refractory to medical therapy. Surgical intervention in the form of Nissens fundoplication can provide definitive relief. With advancements in minimally invasive techniques, the role of laparoscopic Nissens fundoplication is increasingly prominent. Aim: To compare the effectiveness of open versus laparoscopic Nissens fundoplication in patients with endoscopically confirmed hiatal hernia. Objectives: • Compare operative time, symptom relief, and complications in open and laparoscopic procedures. • Evaluate improvement using De-Meester Johnson reflux score. Material: A prospective study involving 38 patients (18-60 years) at a tertiary care hospital over 18 months (Sep 2022 - Mar 2024). Patients were randomized into two equal groups for open or laparoscopic Nissens fundoplication. Results: Both groups showed significant symptomatic improvement. Laparoscopic surgery had a longer operative time (135 vs 110 minutes) but fewer complications and better De-Meester scores Post-operatively. Statistically significant improvement in heartburn, regurgitation, and dysphagia was observed, especially by Postoperative day 7. Conclusion: Laparoscopic Nissens fundoplication is as effective as open surgery in relieving GERD symptoms, with additional benefits of fewer complications and faster recovery, despite longer operative duration.

Background: Stoma surgery involves the creation of an abdominal opening to divert feces or urine, commonly through colostomy or ileostomy. While often lifesaving, stoma formation can lead to several complications, affecting the patient’s physical, psychological, social, and financial well-being. Common complications include parastomal hernia, prolapse, retraction, and infection. Identifying risk factors associated with these complications is essential for improving outcomes. Aim: To study the stoma related complication, risk factors assessment which will include patient related factors and intraoperative factors and to see if any modifiable factors are seen with regards to these that could help change the patient outcomes. OBJECTIVE 1. To determine the incidence and prevalence of stoma-related complications • Identify the frequency of early (≤30 days) and late (>30 days) complications in stoma patients. 2. To classify and analyze the types of complications • Assess common complications such as ischemia, leakage, retraction, prolapse, parastomal hernia, stenosis, and peristomal skin irritation. 3. To identify risk factors associated with complications • Investigate patient-related factors (e.g., age, comorbidities, nutritional status). • Assess surgical factors (e.g., emergency vs. elective surgery, stoma site selection, technique) 4. To evaluate the impact of complications on clinical outcomes • Analyze hospital readmissions, reoperations, and prolonged hospital stays due to stoma-related issues.

Background: Acute cholecystitis is a pathology of inflammatory origin, usually associated with cholelithiasis, with a high incidence in the environment. The treatment of acute cholecystitis involves an important socioeconomic impact. There are two surgical therapeutic options: early laparoscopic cholecystectomy (ELC) during the same admission or delayed laparoscopic cholecystectomy (DLC) during a later admission after conservative treatment. Aim and Objective Aim: To evaluate and compare the effectiveness between the early laparoscopic cholecystectomy vs delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis. Objectives: • To compare the timing of surgery, number of days of antibiotic coverage. • To compare the number of days of hospital stay. • To compare the intraoperative, post-operative complications, conversion to open cholecystectomy and follow up. • To compare the overall mortality and morbidity Patients and Methods: It is a prospective study taking 65 patients were randomly selected to exclude any bias satisfying inclusion and exclusion criteria for the study, were admitted to the Dept. of General Surgery, MKCG Medical College and Hospital, Berhampur, Ganjam, Odisha, During the period from March 2023 to February 2025. Results: In the study out of 65 patients, 33 patients underwent ELC and 32 patients underwent DLC, who were selected randomly. The mean duration of timing of surgery in ELC and DLC were 47.36 minutes and 65.75 minutes respectively. The mean duration of antibiotic coverage in ELC and DLC was found to be 3.58 days and 5.50 days respectively. The complications like adhesions, bleeding, edematous gallbladder, bile leak, gallbladder perforations were noted in both the groups. But these were comparatively lower in ELC than in DLC. On comparing the mean duration of hospital stay in ELC and DLC it was found to be 4.67 days and 6.50 days respectively. In the group of ELC the follow up period was almost uneventful. But in the DLC group there were readmissions recurrently and also complications like gallstone induced pancreatitis was seen. Hence, the follow up period revealed that ELC is better than DLC. Conclusion: From the present study, we conclude that as compared to patients who underwent DLC, the parameters like mean timing of surgery, mean duration of antibiotic coverage, number of complications, mean duration of hospital stay, complaints in the follow up period are comparatively less in patients who underwent ELC. Hence, in patients of acute calculous cholecystitis, ELC is safe and preferable method of choice as compared to DLC, finally leading to reduction in the cost of treatment for the patient.

Donor site management is pivotal in overall grafting outcomes, emphasising rapid epithelialisation, minimal discomfort, and infection prevention. Polyhexanide and betaine preparations have shown promise in chronic wounds due to their antimicrobial and biofilm-disruptive properties. We report the case of a 24-yearold male who sustained 15% TBSA thermal burns and underwent full-thickness strip grafting following which the donor site wound dehisced. The graft donor site on the right lateral thigh was dressed with Polyhexanide (PHMB)-Betaine gel. The wound was dressed regularly, followed by periodic assessment. The wound demonstrated early re-epithelialization with minimal exudate, no signs of infection, and acceptable patient-reported pain scores. Complete healing was achieved by Post-operative day 14. This case highlights the potential utility of PHMB-betaine gel in donor site management, offering an effective balance of antimicrobial protection and tissue compatibility. Larger controlled studies are warranted to validate these findings further.

Neurothekeomas are a rare, benign superficial cutaneous tumours of the head and neck region, occurs commonly in females, usually in second decades of life. A 19-year-old man presented with a painless swelling in the left foot and had a previous history of excision done on the same site. MRI demonstrated the lesion extending into the subcutaneous layer, without involvement of the fascia. The patient underwent wide local excision and reverse medial plantar artery flap cover. The presence of epithelioid tumour cell nests exhibiting characteristic cytological features, regardless of their focal distribution, serves as a diagnostic indicator. Complete surgical excision is the standard of care and has an excellent prognosis, with recurrence rates remaining exceedingly low. The diagnosis is challenging due to the wide range of clinically and histologically similar tumours.