The Indian Journal Of Surgery[JOURNAL]
Sun
200 papers
The "Christmas Tree" Sign on MR Cholangiogram in Left-Sided Cholangiohepatitis.
Ibrarullah M, Meher S, Bruno WH … +1 more , Modi MS
Indian J Surg · 2018 Feb · PMID 29581696 · Full text
We report the "Christmas tree" sign on the magnetic resonance cholangiogram in two patients with left-sided cholangiohepatitis.
We report the "Christmas tree" sign on the magnetic resonance cholangiogram in two patients with left-sided cholangiohepatitis.
Extreme Small Bowel Enteroatmospheric Fistula.
Pandit N, Jaiswal LS
Indian J Surg · 2018 Feb · PMID 29581695 · Full text
Small bowel enteroatmospheric fistula is a serious and devastating complication of open abdomen. We present an interesting image of a 40-year-old gentleman who developed multiple small bowel enteroatmospheric fistulae fo...
Small bowel enteroatmospheric fistula is a serious and devastating complication of open abdomen. We present an interesting image of a 40-year-old gentleman who developed multiple small bowel enteroatmospheric fistulae following open abdomen management for complicated intra-abdominal peritonitis.
Mayer-Rockitansky-Kuster-Hauser Syndrome Presenting as Irreducible Inguinal Hernia.
Verma R, Shah R, Anand S … +2 more , Vaja C, Gaikwad K
Indian J Surg · 2018 Feb · PMID 29581694 · Full text
Inguinal hernia is the most common type of hernia experienced in the surgical OPD due to the muscular anatomy of the region being weak along with the natural weaknesses like deep ring with indirect hernia being more comm...
Inguinal hernia is the most common type of hernia experienced in the surgical OPD due to the muscular anatomy of the region being weak along with the natural weaknesses like deep ring with indirect hernia being more common than direct. Inguinal hernias may have varying unusual sac contents, a case presentation of rudimentary uterus and ovaries as contents of inguinal hernia in an adult female with Mayer-Rokitansky-Kuster-Hauser (MRKH) type II syndrome. This syndrome may be attributed to abnormal development of blastema of cervicothoracic somites and pronephriducts.
Large Solitary Plexiform Neurofibroma of the Penis Without Erectile Dysfunction: a Case Report from Kerala.
Cholakkal S, V C S, Nachiketh G
Indian J Surg · 2018 Feb · PMID 29581693 · Full text
CASE REPORT: Solitary plexiform neurofibroma of the penis is an extremely rare peripheral nerve lesion with only about 20 cases reported all around the world. Here, we are reporting a case of solitary penile plexiform ne...
CASE REPORT: Solitary plexiform neurofibroma of the penis is an extremely rare peripheral nerve lesion with only about 20 cases reported all around the world. Here, we are reporting a case of solitary penile plexiform neurofibroma with sexual dysfunction due to difficulty in penetration. This 47-year-old gentleman presented with a swelling on the dorsal side of the penis. He was aware of the swelling for the last 15 years. The swelling was slow growing and there was no associated loss of sensation or sexual dysfunction. For the last 2 months, he noticed that the tumour is rapidly increasing in size. He was also having difficulty in penetration during sexual intercourse which forced him to seek medical attention. He underwent excision of the swelling from our department. After 18 months of follow-up following excision, there has been no evidence of recurrence of the tumour. CONCLUSION: Penile plexiform neurofibromas are a rare type of lesions and are usually associated with neurofibromatosis. Solitary penile plexiform neurofibromas are extremely rare. Excision, when done properly, gives good results, without erectile dysfunction.
Rupture of Cystic Artery Pseudoaneurysm: a Rare Complication of Acute Cholecystitis.
Praveen Kumar Sunkara PRV, Shah PK, Rakshit K … +3 more , Choudhary SR, Bohidar NP, Dubey SK
Indian J Surg · 2018 Feb · PMID 29581692 · Full text
Pseudoaneurysm (PA) of the cystic artery is rare. Most of the reported cases are iatrogenic and develop secondary to liver biopsy, laparoscopic cholecystectomy, ERCP, and liver transplant. Other reported causes include t...
Pseudoaneurysm (PA) of the cystic artery is rare. Most of the reported cases are iatrogenic and develop secondary to liver biopsy, laparoscopic cholecystectomy, ERCP, and liver transplant. Other reported causes include trauma, malignancy, arteriovenous malformations, and inflammation in the hepatobiliary and pancreatic system. Cystic artery psuedoaneurysm is usually asymptomatic but may also present as vague abdominal pain, intra-abdominal mass, and hemobilia. In the event of rupture, it may present as a catastrophic intra-peritoneal bleeding with hemorrhagic shock. Doppler ultrasound and contrast-enhanced CT scan are useful tools for the diagnosis of this condition. However, selective visceral angiography is confirmatory and offers the opportunity for therapeutic embolization. We report a case which presented with upper right quadrant abdominal pain, vomiting, and hypotension. Abdominal ultrasonography revealed subhepatic hematoma and pericholecystic fluid collection along with acute calculus cholecystitis and sludge in the bile duct. Subsequent contrast-enhanced CT and CT angiography confirmed the presence of ruptured cystic artery psuedoaneurysm with subhepatic hematoma. The patient after resuscitation underwent selective visceral angiography and successful coil embolization of the cystic artery pseudoaneurysm. During the same admission, ERCP and biliary stenting were also performed followed by laparoscopic cholecystectomy. This case reports a rare entity which was successfully treated using a multimodality strategy.
Transmural Migration of Gossypiboma: a Rare Cause of Acute Abdomen.
Agrawal H, Gupta N, Krishengowda U … +3 more , Gupta AK, Naskar D, Durga CK
Indian J Surg · 2018 Feb · PMID 29581691 · Full text
Gossypiboma is the retained foreign body which is generally a cotton sponge/gauze after surgery. Incidence of gossypiboma is around one in 3000 to 5000 surgeries. This low incidence is mainly attributed to a low case rep...
Gossypiboma is the retained foreign body which is generally a cotton sponge/gauze after surgery. Incidence of gossypiboma is around one in 3000 to 5000 surgeries. This low incidence is mainly attributed to a low case reporting due to an associated medicolegal aspect. We are reporting a case of a 38 years old male, who presented with signs and symptoms of peritonitis. The patient had a history of open cholecystectomy 2 years back. A working diagnosis of perforation peritonitis was made, and the patient underwent exploratory laparotomy. Intraoperatively, a surgical sponge was present inside the ileal lumen causing intestinal obstruction with dense adhesion of bowel loops proximal to the site of obstruction with multiple ileal perforations. Even though the incidence of gossypiboma is very low, it should always be kept in mind as a cause of chronic abdominal pain and abdominal discomfort in a patient with previous abdominal surgery.
Mentoring in Surgery-Mentor, Parshuram, Dronacharya, Krishan.
Agarwal BB, Agarwal N, Dhamija N … +1 more , Chintamani
Indian J Surg · 2018 Feb · PMID 29581690 · Full text
Success in any profession has no well-defined predictors. Knowledge, skills, training, and talent come in plenty but fail at times to achieve the universal goal of success. Some attribute it to luck. Apart from the tangi...
Success in any profession has no well-defined predictors. Knowledge, skills, training, and talent come in plenty but fail at times to achieve the universal goal of success. Some attribute it to luck. Apart from the tangible ingredients of a successful career, the intangibles like luck or something ill-defined is a real challenge. The intangibles seem like a chasm, an abyss, or a phantom obstacle. Presence of a guiding spirit who can handhold you to overcome these is essential for success. The aim of a professional is to learn, earn, and yearn for creativity. Practice of surgery is an ideal career to pursue the learning, earning, and yearning. More than any other profession, the guiding handholding spirit is required in surgical profession, the concept of mentoring. Originating from the Greco-Roman times when kind Odysseus left his son Telemachus under the care of his friend, mentor, it has become a universal defining necessity for a successful career in surgery. Indian history replete with such examples of mentorship, good as in the case of Dronacharya to Kaurvas but bad as denied by an able, competent, aspiring student like Eklavya. In the medical profession, there are very few Indian role models of mentorship. One name that comes to our mind is Dr. Krishan Mahajan. The more said is less revealed about him. "Knife before wife" was his commonly spoken advice to all who sought his mentorship. "Hard work is not easy but it is fair" so said a famous boxer, Larry Holmes. It is more than true for our profession as it is better to prepare and prevent, rather than repair and repent.
Synchronous Squamous Cell Carcinoma of the Anorectum and Proctosigmoid-a Case Report.
Madhu YC
Indian J Surg · 2018 Feb · PMID 29581689 · Full text
Primary squamous cell carcinoma of the rectum is extremely rare. Squamous cell carcinoma of the anorectum is a known entity evaluation and treatment protocols have been well defined. The occurrence of squamous cell carci...
Primary squamous cell carcinoma of the rectum is extremely rare. Squamous cell carcinoma of the anorectum is a known entity evaluation and treatment protocols have been well defined. The occurrence of squamous cell carcinoma of rectosigmoid in concurrence with squamous cell carcinoma of the anal canal is extremely rare and the first case to be reported in the literature. A 48-year-old male patient presented with difficulty in passing stools. The clinical examination, colonoscopy, and the histopathology revealed synchronous proctosigmoid and the anorectal neoplasm. A case like this will pose a diagnostic challenges; squamous cell carcinoma of the rectum is not defined in the medical literature; synchronous squamous cell carcinoma will pose both diagnostic dilemmas and treatment challenges like whether to conserve the sphincter or not. Because squamous cell carcinoma of the anorectum can be treated by chemoradiotherapy, even this case is initially thought of treating by neoadjuvant chemoradiotherapy followed by low anterior resection followed by adjuvant treatment. Since there was no medical literature to support this treatment, ultimately multidisciplinary tumor board decision was made for abdominoperineal resection. Patient was treated with abdominoperineal resection and adjuvant chemoradiation. The diagnostic dilemmas and the management issues have been discussed.
Introducing In Vivo Dissection Modules for Undergraduate Level Trainees: What Is the Actual Benefit and How Could We Make It More Efficient?
Sideris M, Papalois A, Theodoraki K … +11 more , Paparoidamis G, Staikoglou N, Tsagkaraki I, Koletsis E, Dedeilias P, Lymperopoulos N, Imprialos K, Papagrigoriadis S, Papalois V, Zografos G, Tsoulfas G
Indian J Surg · 2018 Feb · PMID 29581688 · Full text
Essential Skills in the Management of Surgical Cases (ESMSC) is an international wet lab simulation course aimed at undergraduate students. It combines basic science workshops, case-based lectures and ex vivo skills modu...
Essential Skills in the Management of Surgical Cases (ESMSC) is an international wet lab simulation course aimed at undergraduate students. It combines basic science workshops, case-based lectures and ex vivo skills modules, as well as in vivo dissections using a swine model. This study aims to evaluate the effectiveness of high-fidelity In Vivo Simulation-Based Learning for undergraduate level trainees. Also our goal was to compare the skill-based performance of final year students vs. more junior-level ones. Forty undergraduate delegates at clinical rotation level (male = 28, female = 12, mean age = 23.12, 22-24, SD = 0.69) attended this 2-day course in Athens. = 1 (2.5 %) was year 3, = 4 (10 %) were year 4, = 23 (57.5 %) were year 5 and = 12 (30 %) were year 6. = 30 (75 %) came from Hellenic universities, = 8 (20 %) from the UK and = 2 (5 %) from Germany. = 20 (50 %) attended the in vivo dissections module first, and then the ex vivo one (type A rotation), whereas = 20 followed the reverse training sequence with the ex vivo dissection first, followed by the in vivo one (type B rotation). The mean global rating scores for type A rotation were better in both the in vivo by 0.10 (2.40 vs. 2.30) and ex vivo modules by 0.15 (2.85 vs. 2.70), though it did not reach statistical significance ( > 0.05). Furthermore, the mean improvement of performance, in the laparoscopic skills station for the type A rotation, was better compared to type B by 0.351 (2.00 vs. 1.65, = 0.003). Year 6 students performed better in the laparoscopic station (2.00 vs. 1.75, = 0.059), whereas years 3, 4 and 5 performed better in the in vivo (2.42 vs. 2.16, = 0.157) as well as the ex vivo dissections (2.78 vs. 2.75, = 0.832), though none of those comparisons reached statistical significance. Delegates seemed to appreciate and enjoy the in vivo dissections as reflected in the feedback (8.67/10, min = 6 and max = 10, SD = 1.79). Although medical students seem to appreciate in vivo dissections modules, currently, further evidence is needed to support their recommendation in the undergraduate level. Surgical skills should be part of the undergraduate curriculum to improve final year students' performance in the theatre.
Efficacy of the Evaluation of Inflammatory Markers for the Reduction of Negative Appendectomy Rates.
Yazar FM, Urfalioglu A, Bakacak M … +2 more , Boran ÖF, Bülbüloğlu E
Indian J Surg · 2018 Feb · PMID 29581687 · Full text
Unnecessary appendectomy can cause complications; ways of reducing negative appendectomy rates (NAR) using biochemical and imaging methods are desirable. We retrospectively examined 640 patients who underwent appendectom...
Unnecessary appendectomy can cause complications; ways of reducing negative appendectomy rates (NAR) using biochemical and imaging methods are desirable. We retrospectively examined 640 patients who underwent appendectomy for suspected AA. Patients with histologically confirmed appendicitis were designated the positive appendectomy group ( = 565), whereas those with unconfirmed appendicitis were designated the negative appendectomy group ( = 75). The positive appendectomy group was subdivided into the non-perforated ( = 511) and perforated ( = 54) appendectomy groups according to pathology reports. We compared the age, sex, lymphocyte count, neutrophil percentage, pathologic positivity or negativity for appendicitis, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) of the patients. When the perforated, non-perforated, and negative appendectomy groups were compared, the highest CRP level, NLR, and PLR were evident in the perforated appendectomy group ( = 0.001), whereas the lowest neutrophil percentage was found in the non-perforated appendectomy group ( = 0.001). Multiple logistic regression analysis identified neutrophil percentage, CRP value, and NLR as independent variables and demonstrated that AA could be diagnosed with 88.9 % accuracy using the cutoff values determined. In patients with suspected AA, particularly in rural areas with limited access to advanced imaging modalities, the evaluation of neutrophil percentage, CRP level, and NLR, in combination with the findings of a physical examination, may aid diagnosis and reduce NAR.
The Charlson Comorbidity Index as an Independent Prognostic Factor in Older Colorectal Cancer Patients.
Tominaga T, Nonaka T, Takeshita H … +5 more , Kunizaki M, Sumida Y, Hidaka S, Sawai T, Nagayasu T
Indian J Surg · 2018 Feb · PMID 29581686 · Full text
High-age patients have higher rates of comorbidity that are associated with a poor prognosis. It is important to correctly evaluate their preoperative status to avoid mortality. The aim of this study was to clarify wheth...
High-age patients have higher rates of comorbidity that are associated with a poor prognosis. It is important to correctly evaluate their preoperative status to avoid mortality. The aim of this study was to clarify whether the Charlson comorbidity index (CCI) was useful for predicting postoperative outcomes. This retrospective study collected data from 250 consecutive patients over 75 years of age. The CCI takes into account 19 comorbid conditions. Inflammation-based scores, including the Glasgow prognostic score (GPS) and the platelet to lymphocyte ratio (PLR), are other preoperative scoring systems. The relationships among these scores and postoperative outcomes were evaluated. The patients were classified according to their vital status (dead, = 30 or alive, = 220). Comorbidities, the presence of double cancer, and lymph node metastases were significantly different between the groups ( < 0.01, = 0.01, and < 0.01). In regard to the scoring systems, the CCI, GPS, and PLR were significantly different ( = 0.02, = 0.03, and = 0.05). Multivariate analysis identified CCI ≥ 2 (hazard ratio (HR) = 5.24, 95 % confidence interval (CI) = 1.30-12.1, = 0.01) as a significant determinant of postoperative outcome ( < 0.01). The overall survival tended to be lower in patients with high CCI scores group ( = 0.03). The CCI was useful to predict postoperative outcomes in high-age colorectal cancer patients.
Incidental Findings in Routine Histopathological Examination of Appendectomy Specimens; Retrospective Analysis of 1970 Patients.
Dincel O, Göksu M, Türk BA … +2 more , Pehlivanoğlu B, İşler S
Indian J Surg · 2018 Feb · PMID 29581685 · Full text
Diseases and tumors of the appendix vermiformis are very rare, except for acute appendicitis. This study aimed to examine rare findings in the histopathologic examinations of specimens of patients undergoing appendectomy...
Diseases and tumors of the appendix vermiformis are very rare, except for acute appendicitis. This study aimed to examine rare findings in the histopathologic examinations of specimens of patients undergoing appendectomy due to the diagnosis of acute appendicitis. The files of 1970 patients undergoing appendectomy due to the diagnosis of acute appendicitis between March 2012 and March 2016 were retrospectively investigated. Rare findings were found in 59 (3 %) patients, and these were evaluated in detail. Patients' age, gender, pathology reports, and postoperation follow-ups were recorded. The rare histopathological findings of 59 patients were examined. Of these, 31 were female (52.5 %) and 28 were male (47.5 %). The average age was 33.1 ± 18.2 years. The unusual findings were as follows: 16 fibrous obliteration, 11 , 2 schistosomiasis, 3 appendiceal neuroma, 2 granulomatous appendicitis, 1 Crohn's disease, 3 chronic appendicitis, 1 endometriosis, 2 hyperplastic polyps, 9 mucinous cystadenoma (+mucocele), 8 carcinoid tumors, and 1 lymphoma. All of the malignant tumors were localized in the distal end of the appendix, and all of the patients were treated with appendectomy. Patients with parasitic diseases also underwent anthelmintic treatment, while chemotherapy was administered to the patient with lymphoma. All of the patients diagnosed with malignancy were alive reported no problems at their follow-ups. Although all of the appendectomy samples were normal macroscopically, data from this study suggest that all specimens should be sent for routine investigation.
Robotic Pancreaticoduodenectomy: Single-Surgeon Initial Experience.
Wang M, Cai Y, Li Y … +1 more , Peng B
Indian J Surg · 2018 Feb · PMID 29581684 · Full text
Minimally invasive surgery has gained increasing acceptance over the last few years, which has expanded to pancreaticoduodenectomy. Laparoscopic pancreaticoduodenectomy has been determined to be a feasible, safe, and eff...
Minimally invasive surgery has gained increasing acceptance over the last few years, which has expanded to pancreaticoduodenectomy. Laparoscopic pancreaticoduodenectomy has been determined to be a feasible, safe, and effective procedure in an experienced surgeon's hands, but the adaptations to the clumsy instruments are needed. The improved dexterity of the Da Vinci robotic system provides a good opportunity to perform this challenging procedure in the minimally invasive context. The aim of this study was to share our preliminary experience of totally robotic pancreaticoduodenectomy. From April 2015 to August 2015, four patients were selected to undergo totally robotic pancreaticoduodenectomy in the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. The demographic characteristics, perioperative details, and pathological results were retrospectively reviewed. One female and two male patients underwent totally robotic pancreaticoduodenectomy, while another male patient underwent robotic total pancreatectomy due to the severe atrophy of pancreatic body and tail. The mean age of the four patients was 56.8 years. The average operation time and intraoperative blood loss were 563 min and 228 mL, respectively. No one needed blood transfusion, conversion to open pancreaticoduodenectomy, or postoperative analgesia. The postoperative courses of these patients were uneventful. The mean postoperative hospital stay was 10 days. No one required to be readmitted, and there was no death within 30 days following the surgery. Final pathologic examinations revealed one malignant pancreatic ductal adenocarcinoma, and three benign lesions. Based on this initial study, robotic pancreaticoduodenectomy is safe and feasible, with acceptable oncological outcomes for highly selected patients in experienced surgeons' hands. However, concerns such as long-term outcomes, cost-effectiveness analysis, and learning curve analysis should be fully demonstrated before the popularization of this challenging procedure.
An Analysis of Presentation, Pattern and Outcome of Chest Trauma Patients at an Urban Level 1 Trauma Center.
Narayanan R, Kumar S, Gupta A … +9 more , Bansal VK, Sagar S, Singhal M, Mishra B, Bhoi S, Gupta B, Gamangatti S, Kumar A, Misra MC
Indian J Surg · 2018 Feb · PMID 29581683 · Full text
Chest trauma is an important public health problem accounting for a substantial proportion of all trauma admissions and deaths. It directly account for 20-25 % of deaths due to trauma. Therefore, this study was conducted...
Chest trauma is an important public health problem accounting for a substantial proportion of all trauma admissions and deaths. It directly account for 20-25 % of deaths due to trauma. Therefore, this study was conducted to analyze the presentation, patterns, and outcome of chest trauma in a level-1 urban trauma center. It was a prospective observational study of all patients presented with chest trauma to an urban level 1-trauma center over a period of 3 years. Demographic profile, mechanism of injury, injury severity scores (ISS), associated injuries, hospital stay, etc. were recorded. Morbidity and mortality rates were analyzed and compared with the published literature. Chest injuries comprised 30.9 % of all trauma admissions and the mechanism was blunt in majority (83.5 %) of the cases. Vehicular crashes (59.7 %) followed by assault were the most common modes of injury. Rib fracture was the most common chest injury seen in 724 of the 1258 patients while abdominal visceral injuries were the commonest associated injuries in polytrauma cases. Majority of the patients were managed non-operatively. Inter costal tube drainage (ICD) was the main stay of treatment in 75 % of the cases, whereas, thoracotomy was required only in 5.56 % of the patients. Overall mortality was 11 % and it was found to be significantly higher following blunt chest trauma. We observed that associated extra thoracic injuries resulted in higher mortality as compared to isolated chest injuries. Thoracic injuries can be readily diagnosed in the emergency department by meticulous and repeated clinical evaluation and majority require simple surgical procedures to prevent immediate mortality and long-term morbidity.
Comparing Hemodynamic Symptoms and the Level of Abdominal Pain in High- Versus Low-Pressure Carbon Dioxide in Patients Undergoing Laparoscopic Cholecystectomy.
Mohammadzade AR, Esmaili F
Indian J Surg · 2018 Feb · PMID 29581682 · Full text
The laparoscopic cholecystectomy (LC) is the gold standard to treat gallstone. To view the surgical site in this type of operations better, carbon dioxide is used with a certain pressure. The current study aimed to compa...
The laparoscopic cholecystectomy (LC) is the gold standard to treat gallstone. To view the surgical site in this type of operations better, carbon dioxide is used with a certain pressure. The current study aimed to compare the hemodynamic symptoms and the level of abdominal pain due to using high- and low-pressure carbon dioxide in patients undergoing LC. The current double-blind randomized clinical trial was conducted on 60 patients with the age range of 20-70 years old undergoing LC. The first and second groups experienced PaCO of 7-10 and 12-14 mmHg, respectively. The hemodynamic symptoms, abdominal pain, shoulder-tip pain, nausea and vomiting after the surgery, and the mean of liver function tests were evaluated. Data were analyzed using test, Chi-square test, and repeated measures ANOVA by SPSS 16. Information of 60 patients in two groups was analyzed. There was a significant difference between the groups regarding the mean of systolic blood pressure ( < 0.05). The mean of heart rate was significantly higher in the high-pressure group during surgery and 1 h after that ( < 0.05). The frequency of pain in shoulder-tip and abdomen was higher in the high-pressure group. Frequency of nausea and vomiting 12 h after the surgery between two groups was significant ( < 0.05). The mean of alkaline phosphatase was higher in the low-pressure group than the high-pressure group ( < 0.05). Considering the good performance and low side effects of low-pressure laparoscopic cholecystectomy compared to those of high-pressure, this method can be replaced by high-pressure in LC.
Robot-Assisted Mckeown Esophagectomy is Feasible After Neoadjuvant Chemoradiation. Our Initial Experience.
Goel A, Shah SH, Selvakumar VPP … +2 more , Garg S, Kumar K
Indian J Surg · 2018 Feb · PMID 29581681 · Full text
Neoadjuvant chemoradiation has become the standard of care for esophageal cancer, especially for middle third esophageal lesions and those with squamous histology. Although more and more thoracic surgeons and surgical on...
Neoadjuvant chemoradiation has become the standard of care for esophageal cancer, especially for middle third esophageal lesions and those with squamous histology. Although more and more thoracic surgeons and surgical oncologists have now shifted to video-assisted and robot-assisted thoracoscopic esophagectomy; there is still limited experience for the use of minimal-assisted approaches in patients undergoing surgery after neoadjuvant chemoradiation. Most surgeons have concerns of feasibility, safety, and oncological outcomes as well as issues related to difficult learning curve in adopting robotic esophagectomy in patients after chemoradiation. We present our initial experience of Robot-Assisted Mckeown Esophagectomy in 27 patients after neoadjuvant chemoradiation, from May 2013 to October 2014. All patients underwent neoadjuvant chemoradiation to a dose of 50.4 Gy/25Fr with concurrent weekly cisplatin, followed by reassessment with clinical examination and repeat FDG PET/CT 6 weeks after completion of chemoradiation. Patients with progressive disease underwent palliative chemotherapy while patients with either partial or significant response to chemoradiation underwent Robot-Assisted Mckeown Esophagectomy with esophageal replacement by gastric conduit and esophagogastric anastomosis in the left neck. Out of 27 patients, 92.5 % patients had stage cT3/T4 tumours and node-positive disease in 48.1 % on imaging. Most patients were middle thoracic esophageal cancers (23/27), with squamous histology in all except for one. All patients received neoadjuvant chemoradiation and subsequently underwent Robot Assisted Mckeown Esophagectomy. The average time for robot docking, thoracic mobilization and total surgical procedure was 13.2, 108.4 and 342.7 min, respectively. The procedure was well tolerated by all patients with only one case of peri-operative mortality. Average ICU stay was 6.35 days (range 3-9 days). R0 resection rate of 96.3 % and average lymph node yield of 18 could be achieved. Pathological node negativity rate (pN0) and complete response (pCR) were 66.6 and 44.4 %, respectively. In the initial cases, four patients had to be converted to open due technical reasons or intraoperative complications. The present study, with shorter operative times, similar ICU stay, overall low morbidity, and mortality and optimal oncological outcomes suggest that robot-assisted thoracic mobilization of esophagus in patients with prior chemoradiation is feasible and safe with acceptable oncological outcomes. It has a shorter learning curve and hence allows for a transthoracic minimally invasive transthoracic esophagectomy to more and more patients, otherwise unfit for conventional approach.
Sexuality in Surgically Treated Carcinoma Penis Patients and Their Partners.
Bhat GS, Nelivigi G, Barude V … +1 more , Shastry A
Indian J Surg · 2018 Feb · PMID 29581680 · Full text
Most common treatment offered to carcinoma penis patients is surgery. This results in not only mutilation of the genitals but also affects their sexuality. The treating physician fails to address the issue due to the pau...
Most common treatment offered to carcinoma penis patients is surgery. This results in not only mutilation of the genitals but also affects their sexuality. The treating physician fails to address the issue due to the paucity of the data in this regard. Hence, we decided to evaluate sexuality in these patients after surgical treatment for penile cancer. Most of the times, their partners also face problems of sex and sexuality, regarding which there is no literature. Hence, we decided to include their partners also in the study. We retrieved records of the patients who underwent surgical treatment for carcinoma penis at our institute. After obtaining ethical committee approval, they were invited along with their partners for personal interview. After obtaining written informed consent from each of them, they were administered sexual functioning questionnaire (SFQ). Sexuality was evaluated based on the scores obtained. Performance anxiety was reported by majority of these patients. Their sexual interest, arousal and desire remained almost intact with reduction in satisfaction more so in total penectomised patients. Though the partners had accepted the global reduction in sexuality as their fate, their interpersonal relationship remained little disturbed. The study reveals that sexuality is more than the sexual intercourse alone. Proper pre-operative counselling of these patients and their partners by the treating urologist helps better post-treatment adjustment with regards to sexuality in these patients as well as their partners.
Balloon-Inflated Catheters for Enteral Feeding: a Word of Caution.
Dash NR, Singh AN, Kilambi R
Indian J Surg · 2018 Feb · PMID 29581679 · Full text
Catheters with inflatable balloons such as a Foley catheter may be used for feeding gastrostomy/jejunostomy. The incorrect or improper use of these catheters can have serious consequences. We report 13 cases of feeding j...
Catheters with inflatable balloons such as a Foley catheter may be used for feeding gastrostomy/jejunostomy. The incorrect or improper use of these catheters can have serious consequences. We report 13 cases of feeding jejunostomy with balloon-inflated catheter's malfunction, some referred to our centre and others operated here over a period of 8 years. The most dramatic consequence of such improper use led to rupture of the small intestine due to inadvertent over-inflation (over 100 ml) of the balloon of the catheter during a contrast study. The patient required a laparotomy with resection and anastomosis of the bowel. Three other patients had similar over-inflation of the balloon leading to severe pain and discomfort. In all three patients, timely deflation of the balloon was sufficient to relieve the symptoms. One patient had intussusception with the inflated balloon acting as a lead point. The patient underwent resection of the small bowel with end jejunostomy and distal mucous fistula. All other patients presented with abdominal pain and distension and intestinal obstruction and were managed non-operatively with deflation of balloon either by aspiration, cutting the balloon port or ultrasound-guided puncture of balloon. Healthcare personnel dealing with patients with indwelling catheters must be educated to suspect, detect and manage such problems. The best measure for such unusual complications of otherwise safe devices would be prevention by training and generation of awareness.
Ten-Year Experience of Managing Giant Duodenal Ulcer Perforations with Triple Tube Ostomy at Tertiary Hospital of North India.
Ali WM, Ansari MM, Rizvi SAA … +4 more , Rabb AZ, Mansoor T, Harris SH, Akhtar MS
Indian J Surg · 2018 Feb · PMID 29581678 · Full text
Duodenal ulcer perforations have been known since 1600 AD. It is a common surgical emergency and every surgeon will encounter it. The perforation size of >2 cm has been used as the criteria for defining Giant duodenal ul...
Duodenal ulcer perforations have been known since 1600 AD. It is a common surgical emergency and every surgeon will encounter it. The perforation size of >2 cm has been used as the criteria for defining Giant duodenal ulcers. The management of giant duodenal perforations in hemodynamically unstable patient with comorbid condition is taxing because of high incidence of the postoperative leak and mortality. We have used the simple technique of Triple Tube Ostomy after the primary closure of the defect with encouraging results. It is a retrospective study done at the J. N medical college AMU Aligarh from May 2005 to May 2015. Hemodynamically unstable patients who have presented to the emergency with preoperative diagnoses of giant duodenal ulcer perforation and had undergone triple tube ostomy with primary repair of the perforation were included in the study. There were 34 patients of giant duodenal perforation who presented in shock. All of them underwent triple-tube-ostomy after primary repair of the duodenum. Thirty-two patients recovered with two mortalities (5.8 %). Several definite surgical techniques have been described for the management of giant duodenal ulcer perforation but they are complex, have very high morbidity and mortality rate and require an expert surgeon. A close retrospective scrutiny of the patients suggests that simple triple-tube-ostomy technique which is based on the principle of damage control surgery has good postoperative results Therefore, we recommend it as the procedure of choice in these patients.
Laparoscopic-Assisted Transhiatal Esophagectomy (LATE) for Carcinoma of the Esophagus.
B G V, Nag HH, Varshney V
Indian J Surg · 2018 Feb · PMID 29581677 · Full text
Total laparoscopic approach for the management of carcinoma of the esophagus has not gained much popularity due to its complexity. The aim of this study was to evaluate safety, feasibility, and outcome of laparoscopic-as...
Total laparoscopic approach for the management of carcinoma of the esophagus has not gained much popularity due to its complexity. The aim of this study was to evaluate safety, feasibility, and outcome of laparoscopic-assisted transhiatal esophagectomy (LATE) for patients with carcinoma of the esophagus. This retrospective study involves a total of 26 patients with carcinoma of the esophagus who were considered for LATE by a single surgical team from January 2010 to September 2014. The median (range) age was 55 years (35-72), and male to female ratio was 20:6. The median (range) operative time, blood loss, and hospital stay were 300 min (180-660), 300 ml (100-500), and 11.5 days (8-25), respectively. Pulmonary complications and cervical anastomotic leak (including one patient with conduit necrosis) occurred in eight (30.7 %) and three (11.5 %) patients, respectively. AJCC stage (7th ed.) was IIA in 12 (46.15 %), IIB in 10 (38.46 %), IIIA in 3 (11.53 %), and IIIB in 1 (3.84 %) patient. Surgical resection margin was negative in all but one patient (3.8 %). The median (range) number of lymph nodes (LN) retrieved was 13 (8-28). During a median follow-up 19 months (8-39), five patients (19.23 %) developed recurrence and three (11.5 %) of them died. LATE is a safe and feasible for the management of selected patients with carcinoma of the lower thoracic esophagus.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe