The Indian Journal Of Surgery[JOURNAL]
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200 papers
Surgical Management of Cystic Duct Stump Stone or Gall Bladder Remnant Stone.
Kar A, Gulati S, Mohammed S … +4 more , Valappil MV, Sarala BB, Ghatak S, Bhattacharyya A
Indian J Surg · 2018 Jun · PMID 29973763 · Full text
Retained calculi in the cystic duct or gall bladder remnant can present as a post-cholecystectomy problem. Increased suspicion is necessary to diagnose this condition in a symptomatic post-cholecystectomy patient. Ultras...
Retained calculi in the cystic duct or gall bladder remnant can present as a post-cholecystectomy problem. Increased suspicion is necessary to diagnose this condition in a symptomatic post-cholecystectomy patient. Ultrasonography usually detects this condition, but magnetic resonance cholangiopancreatography is the test of choice for diagnosis as well as for surgical planning. Laparoscopic re-excision of the stump in most cases is feasible and safe. It is increasingly becoming the treatment of choice.
Primary Low-Grade Fibromyxoid Sarcoma of Kidney-an Extremely Rare Entity.
Bhattar R, Aggarwal SP, Yadav SS … +1 more , Tomar V
Indian J Surg · 2018 Jun · PMID 29973762 · Full text
Renal LGFMS is an extremely rare tumor. So far, only four cases have been reported in literature. LGFMS are indolent tumor with distinctive histopathological features with potential for late recurrences and metastasis. T...
Renal LGFMS is an extremely rare tumor. So far, only four cases have been reported in literature. LGFMS are indolent tumor with distinctive histopathological features with potential for late recurrences and metastasis. The diagnosis is made on histopathological examination and supported by immunohistochemical analysis. A 35-year-old young male was presented with flank pain and lump and diagnosed as low-grade fibromyxoid sarcoma after surgery on immunohistochemical analysis. This is the fifth case of renal LGFMS and we presented the review of literature. Radical surgery remains the primary treatment modality. Long follow-up is mandatory.
Gallbladder Metastasis from Renal Cell Carcinoma.
Kitamura H, Kurokawa M, Inaki N … +1 more , Bando H
Indian J Surg · 2018 Jun · PMID 29973761 · Full text
We experienced a rare case of gallbladder metastasis from renal cell carcinoma. A 68-year-old man was admitted for further evaluation of a gallbladder tumor, which had been identified on follow-up computed tomography aft...
We experienced a rare case of gallbladder metastasis from renal cell carcinoma. A 68-year-old man was admitted for further evaluation of a gallbladder tumor, which had been identified on follow-up computed tomography after partial nephrectomy for renal cell carcinoma. Enhanced computed tomography and magnetic resonance imaging showed an enhancing polypoid mass in the gallbladder lumen. Endoscopic ultrasonography demonstrated a homogenous hypo-echoic polypoid lesion, and the outer hyper-echoic layer of the adjacent wall was intact. Blood flow signals in the wall side of the mass were observed on color Doppler endoscopic ultrasonography images. Laparoscopic cholecystectomy was performed and he was uneventfully discharged. Macroscopic examination of the specimen revealed a 12 × 7 × 5 mm pedunculated tumor attached by a thin pedicle to the fundus of the gallbladder. Histology confirmed a metastasis of the renal cell carcinoma that had infiltrated the shallow subserosa but had mainly grown into cavity of the gallbladder. These imaging findings are considered characteristic and may assist preoperative diagnosis in patients with a history of renal cell carcinoma.
Sporadic Desmoid-Type Fibromatosis Occurring at Laparoscopic Trocar Site: An Unusual Entity.
Gupta R, Andley M, Talwar N … +1 more , Kumar A
Indian J Surg · 2018 Jun · PMID 29973760 · Full text
Desmoid-type fibromatosis (DF) or desmoid tumours are rare benign soft tissue tumours of musculo-aponeurotic origin, which have no malignant potential but are locally aggressive and can result in significant morbidity. T...
Desmoid-type fibromatosis (DF) or desmoid tumours are rare benign soft tissue tumours of musculo-aponeurotic origin, which have no malignant potential but are locally aggressive and can result in significant morbidity. They may be hereditary (in association with FAP, i.e. familial adenomatous polyposis syndrome resulting from APC gene mutation) or sporadic, with hereditary cases having a much higher risk of developing DF compared to sporadic ones. Desmoids are known to occur in previous surgical scars. However, previous laparoscopic port site/trocar site is an extremely uncommon site for sporadic desmoids, with only two cases of sporadic laparoscopic trocar site desmoids (occurring in absence of FAP) reported in world literature. We thus describe a case of sporadic DF, occurring at the site of umbilical port 8 months following laparoscopic cholecystectomy for cholelithiasis, treated successfully by margin-negative resection. To the best of our knowledge, this appears to be the first such case in Indian literature and the first being reported after laparoscopic cholecystectomy. In the era of laparoscopic surgery, one must be aware of the existence of such an entity after laparoscopy as it may be confused with conditions such as metastatic deposit, port site tumour recurrence, port site hernia, scar site endometriosis, soft tissue sarcoma etc. and may result in diagnostic dilemma.
Surgery for Blue Rubber Bleb Nevus Syndrome-a Case Report.
Aravindan U, Ganesan R, Thamarai Kannan M
Indian J Surg · 2018 Jun · PMID 29973759 · Full text
Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterised by multiple venous malformations and haemangioma in the skin and visceral organs. The lesion often involves the cutaneous and gastrointestinal tract...
Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterised by multiple venous malformations and haemangioma in the skin and visceral organs. The lesion often involves the cutaneous and gastrointestinal tract. Most common visceral organ affected is the GIT. Most predominant region involved in the GIT is small bowel. However, vascular lesions can occur anywhere from oral mucosa to anal canal. GIT bleed is relatively slow, resulting in minor, chronic and occult blood loss. The syndrome in the GIT may also present with severe complications such as rupture, volvulus, intussusceptions and even death. Cutaneous malformations are usually asymptomatic and do not require treatment. The treatment of GIT lesions is determined by the extent of intestinal involvement and severity of the disease. Most patients respond to supportive therapy such as iron supplementation and blood transfusion. Surgical resection, endoscopic sclerosis and laser photocoagulation have been proposed for more significant haemorrhage and severe complications. Here, we present a case of BRBNS in a 13-year-old girl involving the GIT especially the large bowel, presenting with the complaints of bleeding per rectum and iron deficiency anaemia. Initially, endoscopic sclerotherapy was performed, but to no response. Hence, proceeded with surgical resection.
First Ever Robotic Stage One ALPPS Procedure in India: for Colorectal Liver Metastases.
Krishnamurthy J, Naragund AV, Mahadevappa B
Indian J Surg · 2018 Jun · PMID 29973758 · Full text
Twenty five percent of total liver volume (TLV) is considered as the ideal functional liver remnant (FLR) in major liver resections. In patients with macro-vesicular steatosis, early cirrhosis, and post-neoadjuvant chemo...
Twenty five percent of total liver volume (TLV) is considered as the ideal functional liver remnant (FLR) in major liver resections. In patients with macro-vesicular steatosis, early cirrhosis, and post-neoadjuvant chemotherapy (NACT), hepatocellular injury is common. In such instances, up to 40% of FLR may be required. So in cases of marginal FLR, pre-operative portal vein (PV) embolization or two-stage hepatectomy with PV occlusion is used. Both of which take up to 14 weeks between stages and 30% of patients fail to reach the second resection either due to inadequate FLR growth or disease progression. Associated liver partition and portal vein ligation (ALPPS) procedure has become the gold standard for those cases. A 57-year-old male presented with rectosigmoid growth + multiple right liver and segment 4B metastases. Post-NACT MRI showed interval progression of lesions. Preoperative CT (computed tomography) volumetric scan showed a FLR/TLV (future liver remnant/total liver volume) of 22%. Since patient received 10 cycles of NACT, ALPPS procedure was planned ahead of direct liver resection. Robotic ALPPS stage 1 sparing left lateral segment and 4A + anterior resection was done. We transected the parenchyma between the FLR and the diseased part of the liver with concomitant right portal vein ligation done robotically. CT abdomen done on POD7 showed hypertrophied left lateral segment. Second stage was performed on the eighth post-operative day with FLR/TLV increasing to 37%. Robotic ALPPS procedure for stage one is a safe and feasible technique in experienced centers with advanced robotic skills.
An Assessment Scale for Patients with Postoperative Superficial Incisional Surgical Site Infection: a Cross-Sectional Study.
Anwar MM, Reizian AE, El Kholy AM … +2 more , El Sayed I, Hafez MK
Indian J Surg · 2018 Jun · PMID 29973757 · Full text
Superficial incisional surgical site infection (SSI) is a common postoperative complication in surgical patients. The aim of this study was to assess the predictive power of an assessment scale for identifying patients a...
Superficial incisional surgical site infection (SSI) is a common postoperative complication in surgical patients. The aim of this study was to assess the predictive power of an assessment scale for identifying patients at risk of superficial incisional SSI. A cross-sectional survey was conducted at the Department of Surgery at the Medical Research Institute Hospital, Alexandria University. A sample of 150 adult patients aged from 18 to 65 years, who undergoing general surgeries that had clean sutured surgical wounds, was randomly selected. Forty-six patients (30.7%) had SSI. The total score can significantly discriminate between positive and negative superficial incisional SSI patients with diagnostic accuracy of AUC (SE) = 0.66 (0.048). Each score more than the cutoff point (11.5) will increase the risk of surgical site infection development by 2.5 times (OR (95% CI) = 2.5 (1.26-3.1)). The developed assessment scale can discriminate between patients who are at risk of superficial incisional SSI and those who are not. It can be used as a preliminary screening tool for subsequent investigation for the presence of infection.
Evaluation of the Clinical Use of Robot-Assisted Retroperitoneal Laparoscopy and Preoperative RENAL Scoring for Nephron Sparing Surgery in Renal Tumor Patients.
Xia Y, Wang GX, Fu B … +3 more , Liu WP, Zhang C, Zhou XC
Indian J Surg · 2018 Jun · PMID 29973756 · Full text
The present study aims to compare the operative outcomes following the use of robot-assisted retroperitoneal partial nephrectomy (RARPN) with radius, exophytic/endophytic, nearness to sinus, anterior/posterior, and locat...
The present study aims to compare the operative outcomes following the use of robot-assisted retroperitoneal partial nephrectomy (RARPN) with radius, exophytic/endophytic, nearness to sinus, anterior/posterior, and location (RENAL) scoring or laparoscopic retroperitoneal partial nephrectomy (LRPN) for the treatment of renal tumors. Eighty-three nephron-sparing surgery (NSS) procedures performed between January 2013 and December 2015 were reviewed. The study set consisted of 26 robot-assisted retroperitoneal laparoscopes, of which 3 were high risk (RENAL score ≥10), 11 were medium risk (RENAL score ≥7 < 9), and 12 were low risk (RENAL score <7) and 57 laparoscopic retroperitoneal partial nephrectomy procedures (7 high, 22 medium, and 28 low risk). All surgeries were successful in the absence of conversion or transfusion. Operative times were 96.0 ± 16.9 and 110.0 ± 19.4 min for RARPN and LRPN, respectively ( < 0.05). Warm ischemia times (WITs) were 17.6 ± 3.1 and 22.8 ± 3.5 min, respectively ( < 0.05). Estimated blood losses (EBLs) were 45 ± 15 and 97 ± 25 mL, respectively ( < 0.05). No statistical significance was found in duration of drainage, intestinal recovery time, hospital stay, serum creatinine, and perioperative complications ( > 0.05). RARPN affords significant advantages in outcomes of WIT, EBL, and recovery time over conventional LRPN owing to an increased accuracy in excision and suturing. Patients bearing high-risk renal tumors (RENAL score ≥10) are suitable candidates for RARPN.
The RAQET Study: the Effect of Eating a Popsicle Directly After Bariatric Surgery on the Quality of Patient Recovery; a Randomised Controlled Trial.
Pouwels S, Stepaniak PS, Buise MP … +2 more , Bouwman RA, Nienhuijs SW
Indian J Surg · 2018 Jun · PMID 29973755 · Full text
UNLABELLED: Quality of recovery could be influenced positively if there is less postoperative sore throat (POST). Eating a popsicle might attenuate this sore throat. Especially for bariatric surgery, early recovery is im...
UNLABELLED: Quality of recovery could be influenced positively if there is less postoperative sore throat (POST). Eating a popsicle might attenuate this sore throat. Especially for bariatric surgery, early recovery is important. Adding popsicles to the postoperative protocol could be beneficial. Our hypothesis is that offering a popsicle in the recovery room to patients after bariatric surgery will decrease POST and will increase quality of postoperative recovery. Patients undergoing elective bariatric surgery, between the 23 February 2015 and 3 April, were randomised to either the popsicle group or control group. Primary endpoint was the incidence of POST and secondly if a reduction in POST influences quality of recovery at the first day postoperative measured with the Bariatric Quality Of Recovery (BQoR) questionnaire. One hundred and thirty-three patients were assessed for eligibility. For the final analysis, 44 patients in the intervention and 65 in the control group were available. Eating a popsicle after bariatric surgery had no significant effect on the incidence of POST. Significant effects (in favour of the popsicle group) were seen in muscle pain score ( = 0.047) and sore mouth score ( = 0.012). Popsicle intragroup analysis revealed that eating the whole popsicle (compared to partially eating the popsicle) has positive effects on nausea ( = 0.059), feeling cold ( = 0.008), and mean total comfort score ( = 0.011). Of the patients who became nauseous and/or had to vomit because of the popsicle, = 4 had more severe pain ( = 0.04) and the mean pain score was higher ( = 0.09). The present study demonstrates that offering a popsicle early during recovery after bariatric surgery is feasible without adverse effects, although eating popsicle did not reduce postoperative sore throat. There are possible beneficial effects, such as reduced muscle pains and less sore mouth, that may enhance the quality of recovery. More research is necessary to further substantiate the effect of eating popsicles on the quality of recovery in this patient population. TRIAL REGISTRATION: Registration number: NTR4943 (http://www.trialregister.nl).
Morgagni's Hernia: Analysis of 21 Patients with Our Clinical Experience in Diagnosis and Treatment.
Arikan S, Dogan MB, Kocakusak A … +7 more , Ersoz F, Sari S, Duzkoylu Y, Nayci AE, Ozoran E, Tozan E, Dubus T
Indian J Surg · 2018 Jun · PMID 29973754 · Full text
A Morgagni's hernia is a congenital defect found in the anterior aspect of the diaphragm between the costal and the sternal portions of this muscle. This defect is also referred to as the space of Larrey. It has been rep...
A Morgagni's hernia is a congenital defect found in the anterior aspect of the diaphragm between the costal and the sternal portions of this muscle. This defect is also referred to as the space of Larrey. It has been reported that 70% of patients with Morgagni's hernia are female, 90% of the hernias are right-sided, and 92% of the hernias have hernia sacs. This type of hernia is a rare clinical entity and accounts for 3% of all surgically treated diaphragmatic hernias. There are no large retrospective or prospective studies on this topic. This type of hernia is a rare type among adults without a well-described prevalence and without well-established definitive management strategies. There are also few clinical reports about this clinical entity and its surgical treatment. We treated 21 patients with Morgagni's hernia in a 12-year period, and we report our experience while discussing the surgical treatment of this disease. We performed a retrospective review of the 21 patients who were operated between 2003 and 2015. These patients had undergone surgical repair of Morgagni's hernia. For each subject, demographic data, symptoms of presentation, physical examination findings, preoperative imaging studies and diagnosis, and surgical procedures were documented. Location of the hernia sac and its contents, postoperative complications, and duration of hospital stay were recorded and evaluated. Twelve patients were females and nine were males. The mean age of patients was 63.85 years. Dyspnea was the most prominent symptom in our patients. Morgagni's hernias were located on the right side in 19 patients and on the left side in 2 patients. Chest X-ray in 10 patients and abdominal computerized tomography in 17 patients were the major diagnostic tools. Four patients were operated as emergency while others underwent elective surgery (17 patients). Twelve patients were operated with laparoscopy and the remaining nine were operated with the conventional open abdominal technique. Hernia sacs were observed in all of the patients and removed except in four of them. The omentum and the transverse colon were the most commonly seen organs in hernia sacs. Hernia defects were repaired with primary sutures in four patients (all open cases) and primary closure supported with mesh in six patients (four laparoscopic, two open cases). In the remaining 11 patients, hernia defects were closed with synthetic meshes (eight laparoscopic, three open cases). Mean postoperative hospital stay was 9.8 days. No recurrence was observed in any patients. Only one of our patients died during follow-up. In Morgagni's hernias, surgical intervention is necessary as the hernia may cause complications such as strangulation of the colon or intestines. A laparoscopic approach has increased its popularity in recent years because of the well-known advantages of laparoscopy.
Effect of Varicocelectomy on Serum FSH and LH Levels for Patients with Varicocele: a Systematic Review and Meta-analysis.
Tian D, Huang W, Yan H … +2 more , Zong H, Zhang Y
Indian J Surg · 2018 Jun · PMID 29973753 · Full text
Varicocelectomy can improve the function of testicular Leydig cell for patients with varicocele. We carried out a systematic review and meta-analysis to assess effect of varicocelectomy on serum FSH and LH levels for pat...
Varicocelectomy can improve the function of testicular Leydig cell for patients with varicocele. We carried out a systematic review and meta-analysis to assess effect of varicocelectomy on serum FSH and LH levels for patients with varicocele. A literature review was performed to identify all published randomized preoperation-postoperation clinical trials of assessing serum FSH and LH levels before and after varicocelectomy. The search included the following databases: PUBMED and EMBASE. The reference lists of retrieved studies were also investigated. A systematic review and meta-analysis were conducted. Five studies were selected from 149 studies, including 312 patients. The meta-analysis showed that serum FSH level (95% confidence interval 0.19-0.77, = 0.001) and serum LH level (95% confidence interval 0.25-0.91, = 0.0005) were higher preoperation than postoperation. Serum FSH level decreased by 0.48 ng/dL after varicocelectomy. The mean decrease of the serum FSH was from 0.1 to 4.8 ng/dL. And serum LH decreased by 0.58 ng/dL. The mean decrease of the serum LH was from 0.2 to 2.1 ng/dL. This meta-analysis proves that varicocelectomy perhaps can decrease serum FSH and LH levels in patients with varicocele. And it might be related to the improvement of the function of Leydig cell. But it remains to need a large-scale multicenter randomized controlled study to be further confirmed.
Micro-Incision of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration for Elderly Patients with Choledocholithiasis.
Niu X, Song J, He X … +5 more , Chen J, Xu J, Li Z, Long H, Wei J
Indian J Surg · 2018 Jun · PMID 29973752 · Full text
Common bile duct (CBD) stones are common in elderly patients. The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic...
Common bile duct (CBD) stones are common in elderly patients. The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach. Its safety and efficacy have not been studied in elderly patients with secondary choledocholithiasis. This study evaluates the safety and efficacy of LTM-CBDE in elderly (≥65 years) patients with secondary choledocholithiasis and compares the results with those in younger patients. In this retrospective analysis, 128 patients underwent LTM-CBDE from March 2007 to December 2013. The patients were divided into two groups according to age: the elderly group consisted of 50 patients aged ≥65 years and the younger group consisted of 78 patients aged <65 years. The preoperative morbidity rate, American Society of Anesthesiologists (ASA) score, previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality were compared in both groups. The preoperative morbidity (41 vs. 28) and ASA score (2.5 ± 0.7 vs. 1.8 ± 0.6) were higher in the elderly group ( = 0.000, in both groups). No significant differences in previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality ( > 0.05) were found between the two groups from March 2007 to December 2013. LTM-CBDE is a safe and effective treatment procedure for elderly patients with secondary choledocholithiasis. For suitable patients, we recommend LTM-CBDE as the treatment of choice.
A Review of 2255 Emergency Abdominal Operations Performed over 17 years (1996-2013) in a Gastrointestinal Surgery Unit in India.
Parray AM, Mwendwa P, Mehrotra S … +5 more , Mangla V, Lalwani S, Mehta N, Yadav A, Nundy S
Indian J Surg · 2018 Jun · PMID 29973751 · Full text
There is little information regarding the clinical spectrum and outcome of emergency abdominal operations from specialized units in India. We examined these in our gastrointestinal surgery and liver transplantation unit...
There is little information regarding the clinical spectrum and outcome of emergency abdominal operations from specialized units in India. We examined these in our gastrointestinal surgery and liver transplantation unit from a prospective database maintained between July 1996 and April 2013. Out of 9966 operations performed, 2255 (26%) were emergency procedures (reoperations during the same admission, e.g., for necrotizing pancreatitis were excluded). The primary outcome was 30-day postoperative mortality. The mean age of the patients was 47 years (range 1-107) and included the following age groups: 0-18 years ( = 105, 4.7%); 19-64 years ( = 1766, 78.3%), and >65 years ( = 384, 17.0%). The majority were males (1609, 71%), and there were 646 females (29%). The most common indications were small bowel emergencies (598, 26.5%), followed by pancreatic (417, 18.5%) and colonic (281, 12.5%) emergencies. Pancreatic operations were the second commonest in the adult and middle aged group. Colorectal operations were the second commonest in the geriatric age group (>65 years). Emergency operations for other conditions were: postoperative complications following elective operations 171 (7.5%), gastroduodenal bleeding or perforation in 144 (6.3%), and liver surgery in 93 patients (4.1%) patients. In the small bowel emergencies, 223 patients (37.2%) had primary diagnosis of adhesive obstruction, gangrene in 135 patients (22.5%), perforation in 121 patients (20%), and fistula in 56 patients (9.3%). Mesenteric venous thrombosis was found to be the primary cause of small bowel emergencies, either as a primary cause in gangrene or as a secondary cause in perforations and adhesions. The postoperative mortality after emergencies was 12.6% compared to 2% in elective procedures. Mortality was significantly higher in males (14%) than females (9.6%), < 0.005. Category wise mortality was as follows: pancreatic surgery ( = 86, 20.6%), surgery for postoperative complications ( = 33, 19.3%), duodenal surgery ( = 18, 12.5%), small intestinal surgery ( = 68, 11.4%), and colonic surgery ( = 35, 12.45%). Emergency operations comprise a significant proportion of a GI surgical unit's workload. The mortality is greatest after pancreatic operations followed by those done for postoperative complications. Despite advances in surgical and postoperative care, emergency operations for abdominal emergencies are associated with mortality which is six times higher compared to elective procedures.
Importance of Spontaneous Choledochoduodenal Fistulas Detected During ERCP Procedure.
Akaydin M, Demiray O, Ferlengez E … +3 more , Erozgen F, Ersoy YE, Er M
Indian J Surg · 2018 Jun · PMID 29973750 · Full text
Choledochoduodenal fistula (CDF) is an abnormal passage between the choledochus and duodenum. The most common causes of CDF are cholelithiasis, duodenal ulcer, and tumors. There are mainly two types of fistulas depending...
Choledochoduodenal fistula (CDF) is an abnormal passage between the choledochus and duodenum. The most common causes of CDF are cholelithiasis, duodenal ulcer, and tumors. There are mainly two types of fistulas depending on the location. Type 1 is usually present on the longitudinal fold just close to the papilla. Type 2 is present at the duodenal mucosa adjacent to the longitudinal fold and probably caused by larger stones, duodenal ulcer penetration, impacted cystic duct stones, and as a complication of laparoscopic cholecystectomy. In this study, we investigate the characteristics of our patients those were diagnosed with CDF. This is a descriptive study. We retrospectively obtained the data of 21 patients with spontaneous CDF out of 2430 endoscopic retrograde cholangiopancreaticography (ERCP) patients between 2000 and 2014. We analyzed the laboratory results, demographic and etiological features, major clinical presentations, diagnostic methods, and treatment modalities of the patients. The mean age of the 21 patients was 66.6 ± 2.2 years and a female to male ratio was 12:9. In ten patients, interventional procedures were performed via fistulotomy, not through the papilla. The eventual diagnosis was tumor in five patients and stone or sludge in bile ducts in 14 patients. In the remaining two patients, no reason was found as a cause of CDF. Whipple operation was performed in one patient and stents were placed in three patients for malignacy. Among the 14 patients with sludge or stone in bile ducts, ERCP has been therapeutic in ten. One of the remaining patients has been operated for proximal fistula and underwent choledochus exploration and repair of fistula over a T-tube. In the second patient, stone extraction and T-tube drainage were performed. In patients who had bile duct obstruction and got over of jaundice afterwards, one of the most important reasons of this recovery is the development of spontaneous choledochoduodenal fistula. Even if it is very rare, malignancy can be observed in this area. Therefore, it is extremely important to evaluate the papillary area with ERCP and to conduct biopsy; this will make early diagnosis possible in many patients. In these patients, ERCP can both be diagnostic and therapeutic.
Evaluation of Vocal Cord Function Before Thyroidectomy: Experience from a Developing Country.
Agu KA, Nwosu JN, Akpeh JO
Indian J Surg · 2018 Jun · PMID 29973749 · Full text
Vocal cord palsy (VCP) is a major complication of thyroidectomy. Some patients have preexisting VCP prompting the need for routine or selective preoperative evaluation of the vocal cords. The study aims at ascertaining t...
Vocal cord palsy (VCP) is a major complication of thyroidectomy. Some patients have preexisting VCP prompting the need for routine or selective preoperative evaluation of the vocal cords. The study aims at ascertaining the prevalence of preoperative VCP and making appropriate recommendations. This is a retrospective study of all adult patients who had thyroidectomy at the University of Nigeria Teaching Hospital. Case notes of patients who had thyroidectomy at the hospital from July 2010 to June 2015 were retrieved. Variables studied included biodata, duration of goiter, preoperative hoarseness, outcome of indirect laryngoscopy (IDL), histology of specimen, duration of follow-up, and incidence of postoperative hoarseness. Descriptive statistical analysis was done using SPSS version 20. Of the 91 patients aged 21-70 years (mean 42.08 years, SD 15.40), females outnumbered males with a M:F ratio of 1:10.4. Five patients had preoperative hoarseness, but only three had VCP. IDL was done for 25 (27.4%) patients out of which 22 (88.0%) had normal studies while the remaining three (all from the five with hoarseness) had VCP. Histology of the specimens showed malignancy in 10 (11%), benign in 55 (60.4%), and no report in 26 (28.6%). Five of the malignant histology patients showed normal findings on IDL, three had VCP and two had no preoperative IDL. There was no case of asymptomatic VCP. Vocal cord evaluation is recommended for patients with voice symptoms and those with malignant goiter.
Appendicitis in the HIV Era: a South African perspective.
Gigabhoy R, Cheddie S, Singh B
Indian J Surg · 2018 Jun · PMID 29973748 · Full text
The relationship between HIV infection and the clinical spectrum of appendicitis has not been fully elucidated in the South African context. The aim of this study is to compare the surgical management, histopathology, an...
The relationship between HIV infection and the clinical spectrum of appendicitis has not been fully elucidated in the South African context. The aim of this study is to compare the surgical management, histopathology, and outcomes between HIV-positive and HIV-negative patients undergoing surgery for appendicitis. A retrospective chart analysis was performed of 50 patients who underwent surgery for appendicitis at King Edward VIII Hospital, Durban, South Africa between January 2012 and December 2012. Patients were stratified by HIV serostatus into HIV-positive and HIV-negative groups. Fifty patients underwent surgery for appendicitis during the study period. Of the 50 patients, 14 were HIV-positive (28 %) and 36 were HIV-negative (72 %). Perforated appendicitis was more frequent in the HIV-positive group (50 vs. 25 %, > 0.05). There was a significantly higher laparotomy rate in HIV-positive patients (71 vs. 33 %, < 0.05). Granulomatous inflammation of the appendix was only noted in HIV-positive patients ( = 3). There was no significant difference in the complication rate between the two groups () and no difference in the mean length of hospital stay (7.8 ± 4.89 vs. 5.8 ± 3.94 days, > 0.05). In this retrospective study, perforated appendicitis was seen to be more common in HIV-positive patients resulting in a higher laparotomy rate in this group. Granulomatous inflammation was only found in HIV-positive patients. There was no difference seen in the complication rate, length of hospital stay, and mortality between HIV-positive and HIV-negative patients.
Correction to: Evidence-Based Clinical Practice Points for the Management of Venous Ulcers.
Jindal R, Dekiwadia DB, Krishna PR … +4 more , Khanna AK, Patel MD, Padaria S, Varghese R
Indian J Surg · 2018 Apr · PMID 29916473 · Full text
[This corrects the article DOI: 10.1007/s12262-018-1726-3.].
[This corrects the article DOI: 10.1007/s12262-018-1726-3.].
Tailored Approach to Ventral Hernia-Our Proposed Algorithm.
Baig SJ, Priya P
Indian J Surg · 2018 Apr · PMID 29915492 · Full text
Abstract loading — click title to view on PubMed.
Lateral Internal Partial Sphincterotomy Technique for Chronic Anal Fissure: an Avoidable Risk to the Surgeon's Finger.
Jain BK, Sharma N, Gupta H
Indian J Surg · 2018 Apr · PMID 29915491 · Full text
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My Tryst of Writing and Publishing a Comprehensive Medical Textbook in Vernacular Hindi and New Hindi Medical Terminology.
Goel TC, Goel A, Kumar S
Indian J Surg · 2018 Apr · PMID 29915490 · Full text
In India, although the native language is not English but the medical education is imparted in English. The authors have written a textbook of surgery in Hindi with the intention of promoting the understanding of surgery...
In India, although the native language is not English but the medical education is imparted in English. The authors have written a textbook of surgery in Hindi with the intention of promoting the understanding of surgery and encouraging reflective and deep learning for students whose native language is Hindi. In this article, the authors share experiences of writing such a book, the reasons for the same and also discuss the creation of new medical nomenclature in Hindi.
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