New Indian Journal of Surgery

Context: The risk of perforation and necrosis is elevated by delayed diagnosis of acute appendicitis, which is the most prevalent surgical emergency. The clinical relevance of identifying a simple biochemical marker for the early detection of complicated appendicitis remains intact. Aims: To study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its usefulness as a diagnostic marker for complicated appendicitis, and to differentiate appendicitis from other causes of right iliac fossa pain. Settings and Design: A prospective observational study was conducted at a tertiary care teaching hospital in India. Methods and Material: One hundred twenty patients with right iliac fossa pain were enrolled. Patients were categorized into two groups according to serum bilirubin levels: hyperbilirubinemia (>1 mg/dl) and normal bilirubin (≤1 mg/dl). Operative findings and histology were regarded as the gold standard. Statistical Analysis Used: Chi-square test and diagnostic accuracy measures. Results: Hyperbilirubinemia demonstrated a statistically significant correlation with complex appendicitis (p < 0.001). Serum bilirubin exhibited significant sensitivity and negative predictive value in predicting complicated appendicitis. Conclusions: Hyperbilirubinemia is a valuable adjunctive diagnostic marker for complicated appendicitis; nevertheless, its limited specificity diminishes its capacity to reliably differentiate appendicitis from non-appendicular pathology. Key Messages 1. Hyperbilirubinemia has a significant association with complicated appendicitis. 2. Normal bilirubin levels can help distinguishing severe appendicitis due to high negative predictive value. 3. Serum bilirubin is a simple, cost-effective adjunct in pre-operative assessment.

Background: Acute cholecystitis remains a common surgical emergency with variable management approaches. The Tokyo Guidelines 2018 (TG18) provide a standardized severity grading system and treatment algorithm, yet prospective validation comparing TG18-guided management with traditional clinical judgment remains limited. This study aimed to validate the clinical utility of TG18-based decision-making in improving patient outcomes. Methods: This prospective comparative study was conducted at the Department of General Surgery, Sardar Patel Medical College, Bikaner. A total of 124 patients with acute cholecystitis were randomized into two groups: Group A (n=83) managed according to TG18 protocol, and Group B (n=41) managed using traditional clinical judgment. Primary outcome was total complication rate. Secondary outcomes included specific complications (bile leak, ICU requirement, post-operative infection, 30-day readmission) and length of hospital stay. Statistical analysis included chi-square test, t-test, and multivariate logistic regression. Results: Tokyo severity grade distribution was comparable between groups (p=0.624). Total complication rate was significantly lower in Group A compared to Group B (16.9% vs 43.9%, p=0.001; OR 3.84, 95% CI 1.67–8.82). Bile leak occurred in 1.2% versus 31.7% (p<0.001), ICU requirement in 4.8% versus 26.8% (p=0.001), and 30-day readmission in 1.2% versus 12.2% (p=0.014). Mean hospital stay was significantly shorter in Group A (4.4±1.6 vs 11.0±4.8 days, p<0.001). Laparoscopic cholecystectomy rate was higher in Group A (69.9% vs 29.3%, p<0.001). Multivariate analysis confirmed TG18 guidance as independently protective (adjusted OR 2.89, 95% CI 1.12–7.46, p=0.028). Conclusion: TG18-guided management significantly reduces complications and hospital stay in acute cholecystitis. Implementation of Tokyo Guidelines 2018 as standard protocol is recommended for optimal patient outcomes.

Introduction: Hemorrhoids are a common benign anorectal disorder that significantly impacts quality of life. While open hemorrhoidectomy (OH) is considered the gold standard for advanced hemorrhoids, it is associated with severe postoperative pain and prolonged recovery. Laser hemorrhoidoplasty (LHP) is a minimally invasive alternative that ablates hemorrhoidal tissue with laser energy, aiming to reduce morbidity. Aim: To compare the outcomes of LHP and OH in terms of operative time, postoperative pain, hospital stay, complications, and recurrence. Methods: This prospective comparative study was conducted over 12 months in the Department of Surgery. Patients with Grade ll-III–IV hemorrhoids were randomized into two groups: Laser Hemorrhoidoplasty Group (LHPG, n=30) and Open Hemorrhoidectomy Group (OHG, n=30). Data on operative time, pain (VAS score), hospital stay, complications, and recurrence were collected and analyzed using SPSS v26. Results: LHP demonstrated shorter operative time (25.6 ± 3.8 min vs. 38.7 ± 5.2 min), lower VAS pain scores at 12, 24, and 48 hours, and reduced hospital stay. Complication rates were lower in LHPG, with reduced bleeding and constipation compared to OHG. Recurrence rates at 3 months were comparable between the groups. Conclusion: Laser hemorrhoidoplasty is a safe, minimally invasive alternative to open hemorrhoidectomy, offering significant advantages in terms of pain reduction, faster recovery, and fewer complications, though cost and availability remain limiting factors.

Background: Robotic inguinal hernia repair (RIHR) has gained increasing adoption in minimally invasive surgery; however, its clinical advantages over conventional laparoscopic and open techniques remain uncertain. Methods: This review was conducted in accordance with PRISMA 2020 guidelines. Published systematic reviews and meta-analyses comparing robotic, laparoscopic, and open inguinal hernia repair in adult patients were identified. Methodological quality was assessed using the AMSTAR-2 tool. Outcomes evaluated included operative time, postoperative complications, hernia recurrence, postoperative pain, length of hospital stay, and readmission. Results: Fifteen meta-analyses encompassing more than 200,000 patients were included. Robotic inguinal hernia repair was consistently associated with longer operative times compared with laparoscopic and open techniques. Overall complication rates, hernia recurrence, postoperative pain, and readmission were largely comparable between robotic and conventional approaches. Some analyses reported a higher incidence of surgical-site infection following robotic repair. All included reviews were rated as low or critically low quality using AMSTAR-2. Conclusion: Current meta-analytic evidence suggests that robotic inguinal hernia repair is a safe and effective alternative to established techniques, with comparable clinical outcomes but longer operative duration. High-quality randomized trials and cost-effectiveness studies are required to define its definitive role in clinical practice.

Wounds resulting from burns, trauma, or infection remain a significant clinical challenge, requiring appropriate infection control and timely soft-tissue coverage. Optimal wound bed preparation is essential before undertaking any definitive reconstructive procedure. Several approaches are available to improve wound bed quality, including dressings, debridement techniques, negative pressure wound therapy, and oxygen-based therapies. Topical haemoglobin spray has recently emerged as a promising adjunct to enhance oxygen diffusion at the wound surface, thereby promoting granulation and epithelialisation. In this report, we describe our experience using an innovative autologous haemoglobin spray formulation for wound bed preparation in a chronic post-burn wound.

Primary adrenal teratoma is a rare germ cell tumor that can mimic common adrenal lesions, posing a diagnostic challenge. We report a 41-year-old female with an incidentally discovered 8 cm right adrenal mass. Contrast-enhanced CT showed macroscopic fat, coarse calcifications, and a fat-fluid level. Hormonal evaluation was negative. The patient underwent laparoscopic right adrenalectomy, which was uneventful. Histopathology confirmed a mature cystic teratoma. This case emphasizes characteristic imaging features that aid preoperative diagnosis and supports the feasibility of minimally invasive adrenalectomy, even for large and complex adrenal masses.

Electrical burns constitute a complex subset of thermal injuries characterized by deep tissue damage and impaired wound healing. Autologous platelet-rich plasma (APRP) has emerged as a regenerative adjunct due to its high concentration of growth factors that enhance angiogenesis, fibroblast proliferation, and collagen synthesis. We report a case of a 46-year-old male with 40% total body surface area (TBSA) electrical burns (mixed second- and third-degree). APRP spray was applied over superficial second-degree burn areas in three sequential dressings alongside collagen scaffold application. Wound healing was assessed using the Bates-Jensen Wound Assessment Tool (BJWAT). Over six days, the BJWAT score reduced from 25 to 20, indicating improvement in wound status with reduction in exudate, improved granulation, and epithelialization. No adverse effects were noted. This case highlights the potential role of APRP spray as a regenerative adjunct in adult electrical burns to accelerate wound healing and improve wound bed preparation.