A mesenteric cyst is a rare abdominal tumor that can be found anywhere in the digestive tract, between the duodenum and rectum. It presents nonspecific symptoms like those of other digestive diseases, which can delay the diagnosis. The preferred treatment is surgery and the lesion should be completely removed to avoid recurrence or other complications. We present the case of a patient with pain and palpable abdominal mass, who was diagnosed with a mesenteric cyst and referred for surgical treatment.
{"title":"Presentation of a Case of Mesenteric Cyst","authors":"Garritano C","doi":"10.46889/jsrp.2023.4306","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4306","url":null,"abstract":"A mesenteric cyst is a rare abdominal tumor that can be found anywhere in the digestive tract, between the duodenum and rectum. It presents nonspecific symptoms like those of other digestive diseases, which can delay the diagnosis. The preferred treatment is surgery and the lesion should be completely removed to avoid recurrence or other complications. We present the case of a patient with pain and palpable abdominal mass, who was diagnosed with a mesenteric cyst and referred for surgical treatment.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139227737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Laparoscopic-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP) has gained popularity and was considered the preferred therapeutic option across multiple institutions in managing choledocholithiasis after bariatric surgery. As of recent, a novel procedure, endoscopic ultrasound directed transgastric ERCP (EDGE), has gained popularity across the USA and Europe. We sought to assess and compare the safety and technical success of both procedures. Methods: We conducted a systematic review following the PRISMA guidelines. A total of 925 articles were screened and assessed for inclusions. Two authors independently screend abstracts and titles followed up full-text screening. Articles comparing outcomes between both surgical techniques were included in this study. A meta-analysis was conducted to compare peri-operative outcomes between both procedures. Results: A total of four articles met the inclusion criteria. All four articles were retrospective reviews. The mean age was 52 and the majority were females. When comparing outcomes between both procedures, no difference in adverse events, technical success rates and pancreatitis was detected. Compared to the LA-ERCP cohort, the EDGE cohort had a shorter hospital Length of Stay (LOS) and operative time. Using the Ottawa scale, a moderate risk of bias was assessed across all four articles. Conclusion: Based on the results of this meta-analysis, EDGE was associated with a shorter LOS and operative time with no increased risk of adverse events. Additionally, based procedures had a high technical success rate.
{"title":"EUS-Directed Transgastric ERCP (EDGE) Versus Laparoscopy-Assisted ERCP (LA-ERCP) For Roux-En-Y Gastric Bypass (RYGB) Anatomy: Systemic Review and Metanalysis","authors":"G. Saad","doi":"10.46889/jsrp.2023.4204","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4204","url":null,"abstract":"Objective: Laparoscopic-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP) has gained popularity and was considered the preferred therapeutic option across multiple institutions in managing choledocholithiasis after bariatric surgery. As of recent, a novel procedure, endoscopic ultrasound directed transgastric ERCP (EDGE), has gained popularity across the USA and Europe. We sought to assess and compare the safety and technical success of both procedures.\u0000\u0000Methods: We conducted a systematic review following the PRISMA guidelines. A total of 925 articles were screened and assessed for inclusions. Two authors independently screend abstracts and titles followed up full-text screening. Articles comparing outcomes between both surgical techniques were included in this study. A meta-analysis was conducted to compare peri-operative outcomes between both procedures.\u0000\u0000Results: A total of four articles met the inclusion criteria. All four articles were retrospective reviews. The mean age was 52 and the majority were females. When comparing outcomes between both procedures, no difference in adverse events, technical success rates and pancreatitis was detected. Compared to the LA-ERCP cohort, the EDGE cohort had a shorter hospital Length of Stay (LOS) and operative time. Using the Ottawa scale, a moderate risk of bias was assessed across all four articles.\u0000\u0000Conclusion: Based on the results of this meta-analysis, EDGE was associated with a shorter LOS and operative time with no increased risk of adverse events. Additionally, based procedures had a high technical success rate.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128055266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Faecal Incontinence is a condition that can affect up to 20% of population during their lifetime with female predominance. Sacral Nerve Stimulation (SNS) has been recently shown to have significant benefits in mainly urge incontinence but this has left a large group of patients with passive incontinence without effective management options. The SphinKeeper® (SK) allows treatment of more sizeable defects in the internal or external anal sphincter. Preliminary series have shown some benefit of the procedure in treatment of faecal incontinence. Methods: A single-centre retrospective observational study of SphinKeeper® prostheses was conducted at St Helens and Knowsley NHS trust and we believe this to be one of the largest series of SphinKeeper® in the UK. SphinKeeper® restores sphincter function by using placement of self-expanding prostheses into the inter-sphincteric space. The operation involves implantation of 10 self-expanding sterile prostheses between the internal and the external sphincter, thus creating a third ring around the circumference of the anal canal. Results: Most patients were ASA 2 (n=10). 43% (6/14) patients had previous colorectal surgery – THD and mucopexy (n=3), anorectal fistula surgery (n=1), anterior resection of rectum (n=1) and pelvic floor repair (n=1). EUS was carried out in 6 patients and in all 6 cases identified internal or external anal sphincter defect (IAS n=1, EAS n=3, IAS and EAS n=2). No patient sustained intraoperative complications. 2 patients reattended within 48 hours post op due to severe post-operative pain and were discharged with analgesia. Subjective results were evaluated using Vaizey and Wexner scores and showed significant improvement 4/14 patients, partial improvement in 7/14 patients and no improvement in 3/14 patients. Discussion: Our study evaluated the short-term outcomes of the procedure in 14 patients who had SphinKeeper® surgery between May 2017 and August 2020. Patients who took part in our study had previous treatment for faecal incontinence by a variety of methods (both medical and surgical) and suffered from different types of FI (passive, urge, mixed, associated urinary incontinence). It was promising to see there was a clinically significant improvement in continence indicated by a decrease in Vaizey and Wexner scores (p=0.00377 and p=0.00334 respectively (Wilcoxon test)) with 11 patients improving in scores. It is reasonable to consider Sphinkeeper™ as a safe and minimally invasive surgical intervention to achieve some degree of positive improvement for patients suffering from faecal incontinence.
{"title":"The Use of Sphinkeeper® In Faecal Incontinence","authors":"Kearsey Cc","doi":"10.46889/jsrp.2023.4203","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4203","url":null,"abstract":"Introduction: Faecal Incontinence is a condition that can affect up to 20% of population during their lifetime with female predominance. Sacral Nerve Stimulation (SNS) has been recently shown to have significant benefits in mainly urge incontinence but this has left a large group of patients with passive incontinence without effective management options. The SphinKeeper® (SK) allows treatment of more sizeable defects in the internal or external anal sphincter. Preliminary series have shown some benefit of the procedure in treatment of faecal incontinence.\u0000\u0000Methods: A single-centre retrospective observational study of SphinKeeper® prostheses was conducted at St Helens and Knowsley NHS trust and we believe this to be one of the largest series of SphinKeeper® in the UK. SphinKeeper® restores sphincter function by using placement of self-expanding prostheses into the inter-sphincteric space. The operation involves implantation of 10 self-expanding sterile prostheses between the internal and the external sphincter, thus creating a third ring around the circumference of the anal canal.\u0000\u0000Results: Most patients were ASA 2 (n=10). 43% (6/14) patients had previous colorectal surgery – THD and mucopexy (n=3), anorectal fistula surgery (n=1), anterior resection of rectum (n=1) and pelvic floor repair (n=1). EUS was carried out in 6 patients and in all 6 cases identified internal or external anal sphincter defect (IAS n=1, EAS n=3, IAS and EAS n=2). No patient sustained intraoperative complications. 2 patients reattended within 48 hours post op due to severe post-operative pain and were discharged with analgesia. Subjective results were evaluated using Vaizey and Wexner scores and showed significant improvement 4/14 patients, partial improvement in 7/14 patients and no improvement in 3/14 patients.\u0000\u0000Discussion: Our study evaluated the short-term outcomes of the procedure in 14 patients who had SphinKeeper® surgery between May 2017 and August 2020. Patients who took part in our study had previous treatment for faecal incontinence by a variety of methods (both medical and surgical) and suffered from different types of FI (passive, urge, mixed, associated urinary incontinence). It was promising to see there was a clinically significant improvement in continence indicated by a decrease in Vaizey and Wexner scores (p=0.00377 and p=0.00334 respectively (Wilcoxon test)) with 11 patients improving in scores. It is reasonable to consider Sphinkeeper™ as a safe and minimally invasive surgical intervention to achieve some degree of positive improvement for patients suffering from faecal incontinence.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133288144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I read with great interest this recently published article by Professors Dull RO and Hahn RG [1]. The authors are commended on this review based on evidence from published studies that represent the current understanding of the condition and its scientific basis. The authors have faithfully and factually summarized the evidence based on published reports, including some of the commonly received errors and misconceptions on the scientific foundation that identifying and correcting may help to answer the vitally important question in the title of the report.
{"title":"Hypovolemia With Peripheral Edema: What Is Wrong?","authors":"A. N. Ghanem","doi":"10.46889/jsrp.2023.4201","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4201","url":null,"abstract":"I read with great interest this recently published article by Professors Dull RO and Hahn RG [1]. The authors are commended on this review based on evidence from published studies that represent the current understanding of the condition and its scientific basis. The authors have faithfully and factually summarized the evidence based on published reports, including some of the commonly received errors and misconceptions on the scientific foundation that identifying and correcting may help to answer the vitally important question in the title of the report.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131324743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The precise treatment of ventral hernias is still a topic of considerable debate. The aim of this study was to compare the methods of open retromuscular sublay versus laparoscopic intraperitoneal onlay mesh repair for ventral hernias. Methods: Following approval by the Institutional Ethics Committee, Rohilkhand Medical College and Hospital, Bareilly, 88 patients were randomly divided into two groups in 1:1 allocation ratio, each compromising 44 patients. Patients characteristics, hernia size and postoperative complications were recorded. Results: Mean operative time was significantly (p= <0.001) lower in the SUBLAY group (55.66±8.34 minutes) than in the IPOM group (68.75±10.44 minutes). The post-operative pain(VAS) was significantly (p=0.001) lower amongst patients of the IPOM group (2.36±0.61) as compared to the sublay (4.52±0.66) group. The hospital stay was significantly (p=0.001) lower among patients of the IPOM group (3.61±2.28 days) than the sublay group (6.50±1.68 days). Conclusion: Laparoscopic repair in medium- and large-sized defects is a feasible and safe approach. IPOM compared to SUBLAY significantly reduces postoperative complications and hospital stay.
{"title":"Open Retromuscular Sublay Mesh Repair Versus Laparoscopic Intraperitoneal Onlay Mesh Repair for Ventral Hernias-A Randomized Control Trial","authors":"Awadhesh Pratap Singh Parihar","doi":"10.46889/jsrp.2023.4109","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4109","url":null,"abstract":"Background: The precise treatment of ventral hernias is still a topic of considerable debate. The aim of this study was to compare the methods of open retromuscular sublay versus laparoscopic intraperitoneal onlay mesh repair for ventral hernias.\u0000\u0000Methods: Following approval by the Institutional Ethics Committee, Rohilkhand Medical College and Hospital, Bareilly, 88 patients were randomly divided into two groups in 1:1 allocation ratio, each compromising 44 patients. Patients characteristics, hernia size and postoperative complications were recorded.\u0000\u0000Results: Mean operative time was significantly (p= <0.001) lower in the SUBLAY group (55.66±8.34 minutes) than in the IPOM group (68.75±10.44 minutes). The post-operative pain(VAS) was significantly (p=0.001) lower amongst patients of the IPOM group (2.36±0.61) as compared to the sublay (4.52±0.66) group. The hospital stay was significantly (p=0.001) lower among patients of the IPOM group (3.61±2.28 days) than the sublay group (6.50±1.68 days).\u0000\u0000Conclusion: Laparoscopic repair in medium- and large-sized defects is a feasible and safe approach. IPOM compared to SUBLAY significantly reduces postoperative complications and hospital stay.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"245 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127696657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Blalock-Taussig (BT) shunt was first used to treat the tetralogy of Fallot in 1946. Since then, it has undergone improvements to create a short circuit in the pulmonary artery using an artificial blood vessel. The prognosis after palliative surgery alone is poor; hence, there is a need for radical surgery to improve the long-term prognosis. However, for various reasons, some patients have undergone the Blalock surgery alone without any other therapeutic interventions. In this report, we describe a case of a central shunt surgery performed to improve cyanosis in a patient who had been followed up for a long time without radical surgery after receiving an original BT shunt.
{"title":"Central Shunting for Tetralogy of Fallot After Original Blalock-Taussig Shunt in a 34-Year-Old Woman","authors":"Keisuke Nakanishi","doi":"10.46889/jsrp-2023.4107","DOIUrl":"https://doi.org/10.46889/jsrp-2023.4107","url":null,"abstract":"The Blalock-Taussig (BT) shunt was first used to treat the tetralogy of Fallot in 1946. Since then, it has undergone improvements to create a short circuit in the pulmonary artery using an artificial blood vessel. The prognosis after palliative surgery alone is poor; hence, there is a need for radical surgery to improve the long-term prognosis. However, for various reasons, some patients have undergone the Blalock surgery alone without any other therapeutic interventions. In this report, we describe a case of a central shunt surgery performed to improve cyanosis in a patient who had been followed up for a long time without radical surgery after receiving an original BT shunt.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131732514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Spleen is the most commonly injured solid organ following blunt trauma. Motor vehicle collision account for more than 75% of splenic injuries. In up to 60% of patients, the spleen is the only organ injured, with mortality rates of roughly 8.5%. Some studies quote that more than half of blunt splenic injuries can be managed by non-operative management with morbidity similar to or less than that of operative management. The management of blunt splenic trauma has therefore shifted towards non operative management. Objective: To study the management of splenic injury in blunt abdominal trauma. Material and Methods: A Cross-sectional study was conducted in the department of Surgery, Rohilkhand Medical College and Hospital, Bareilly from 1st November 2020 to 31st October 2021. 36 patients of splenic trauma were included in the study. Result: All grade I and II and 7 out of 10 grade III splenic injuries were managed conservatively. Three patients with grade III splenic damage underwent surgical intervention, with one undergoing splenectomy and two undergoing splenorrhaphy. In Grade IV splenic damage, 6 out of 7 patients were managed operatively, splenectomies were performed in 5 patients and splenorrhaphy was performed in 1 patient. All patients with grade V injuries underwent a splenectomy. Conclusion: In our study, patients with Grade I and Grade II splenic trauma and the majority of Grade III trauma a total of 52.5% of patients could be managed conservatively.
{"title":"Management of Splenic Injury in Blunt Abdominal Trauma- A Cross-Sectional Study","authors":"Rishabh Goel","doi":"10.46889/jsrp.2023.4108","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4108","url":null,"abstract":"Background: Spleen is the most commonly injured solid organ following blunt trauma. Motor vehicle collision account for more than 75% of splenic injuries. In up to 60% of patients, the spleen is the only organ injured, with mortality rates of roughly 8.5%. Some studies quote that more than half of blunt splenic injuries can be managed by non-operative management with morbidity similar to or less than that of operative management. The management of blunt splenic trauma has therefore shifted towards non operative management.\u0000\u0000Objective: To study the management of splenic injury in blunt abdominal trauma.\u0000\u0000Material and Methods: A Cross-sectional study was conducted in the department of Surgery, Rohilkhand Medical College and Hospital, Bareilly from 1st November 2020 to 31st October 2021. 36 patients of splenic trauma were included in the study.\u0000\u0000Result: All grade I and II and 7 out of 10 grade III splenic injuries were managed conservatively. Three patients with grade III splenic damage underwent surgical intervention, with one undergoing splenectomy and two undergoing splenorrhaphy. In Grade IV splenic damage, 6 out of 7 patients were managed operatively, splenectomies were performed in 5 patients and splenorrhaphy was performed in 1 patient. All patients with grade V injuries underwent a splenectomy.\u0000\u0000Conclusion: In our study, patients with Grade I and Grade II splenic trauma and the majority of Grade III trauma a total of 52.5% of patients could be managed conservatively.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"94 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120866678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Haemorrhoidal Disease (HD) is common and impacts negatively on quality of life with high socio-economic costs. Despite international guidelines aimed to indicate appropriate care in HD, treatment of III-degree HD remains controversial due to the wide range of ambulatory or surgical procedures available. We aimed to analyse treatment options for III-degree HD focusing on special cases characterized by large volume and/or circumferential presentation of intermittent prolapse or recurrence after conservative treatments. Methods: In the period January 2017- December 2018 out of 152 patients treated by excisional haemorrhoidectomy, we collected a case series of 29 patients affected by III-degree symptomatic HD. They showed a very large, single prolapse or circumferential one or failure of previous conservative treatments. Results: 14 (48.2%) patients (median age 45 yrs.) of our series were recurrence of HD following Rubber Band Ligation (RBL) (5pts), Dearterialization (DEART) (5pts), Stapled Haemorrhoidopexy (SH) (4pts). Mean operative time was 35 min. Postoperative severe pain (6.8%) and urinary retention (17.2%) were the main postoperative complications which did not affect the length of stay. All patients showed a good outcome without any complication at follow-up. Conclusion: III-degree HD shows the highest variability in anatomical presentation, and proposed treatment. Thus, the choice of a personalized approach must rely upon objective evaluation of volume of prolapse. Intermittent prolapse, if very large or circumferential, associated or not to large external haemorrhoids, makes a special condition III degree HD, suggesting surgical excision, avoiding conservative approaches.
{"title":"A Case Series of Large Volume Iii-Degree Hemorrhoidal Disease: A Special Anatomical Condition Requiring Surgical Treatment","authors":"R. Pietroletti","doi":"10.46889/jsrp.2023.4106","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4106","url":null,"abstract":"Background: Haemorrhoidal Disease (HD) is common and impacts negatively on quality of life with high socio-economic costs. Despite international guidelines aimed to indicate appropriate care in HD, treatment of III-degree HD remains controversial due to the wide range of ambulatory or surgical procedures available.\u0000\u0000We aimed to analyse treatment options for III-degree HD focusing on special cases characterized by large volume and/or circumferential presentation of intermittent prolapse or recurrence after conservative treatments.\u0000\u0000Methods: In the period January 2017- December 2018 out of 152 patients treated by excisional haemorrhoidectomy, we collected a case series of 29 patients affected by III-degree symptomatic HD. They showed a very large, single prolapse or circumferential one or failure of previous conservative treatments.\u0000\u0000Results: 14 (48.2%) patients (median age 45 yrs.) of our series were recurrence of HD following Rubber Band Ligation (RBL) (5pts), Dearterialization (DEART) (5pts), Stapled Haemorrhoidopexy (SH) (4pts). Mean operative time was 35 min. Postoperative severe pain (6.8%) and urinary retention (17.2%) were the main postoperative complications which did not affect the length of stay. All patients showed a good outcome without any complication at follow-up.\u0000\u0000Conclusion: III-degree HD shows the highest variability in anatomical presentation, and proposed treatment. Thus, the choice of a personalized approach must rely upon objective evaluation of volume of prolapse. Intermittent prolapse, if very large or circumferential, associated or not to large external haemorrhoids, makes a special condition III degree HD, suggesting surgical excision, avoiding conservative approaches.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123267134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Fournier’s gangrene is a fatal necrotizing fasciitis of the genitalia and perineum that can lead to infection of the area with various microbes, organ failure, or even death. This study is indented to determine the presence of systemic concomitant diseases, regional risk factors, metabolic problems, early diagnosis, barriers to treatment, and treatment outcomes in Kanyakumari district. Without an accurate diagnosis and prompt treatment, Fournier’s gangrene is a surgical emergency with a high mortality rate. A mortality rate of 15% to 50% has been reported for this polymicrobial necrotizing fasciitis of the vaginal, perianal and perineal regions Aim and Objective: The aim of this study is to determine the age and sex incidence, demographic pattern, predisposing etiologic and risk factors, signs and symptoms, and net patient outcome, and to evaluate the optimal treatment modalities for Fournier’s gangrene. Methods: This study is a prospective observational study conducted in the Department of General Surgery, Kanyakumari Government Medical College from January 2021 to December 2022. A total of 50 cases of Fournier’s gangrene who met the inclusion criteria were included in the study. Demographic data such as age, sex, aetiology, risk factors, clinical features, signs and symptoms, site of infestation, microbial culture, bacterial flora, treatment method used, length of hospital stay, and mortality were examined. Results: A total of 50 patients, 46 men and 4 women, were included in the study. Males outnumbered females in 92% of cases, with a ratio of 11.5:1. Females were found to have vulvar induration and abscess in the perineal or perianal area. In 31 patients (62%), the lesions were located in the scrotum, in 8 patients (16%) in the perineal area, in 6 patients (12%) in the penis, in 3 patients (6%) in the groin, and in 2 patients (4%) in the vulva. Eight individuals in the research group suffered complete scrotal loss. Presentation of symptoms to the hospital was late, averaging 6.8 days after onset. Patients who presented late to the hospital had much more severe morbidity and delayed recovery, requiring multiple debridement and a longer hospital stay. Conclusion: This study suggests that if Fournier’s gangrene is diagnosed early and patients are hospitalized promptly with immediate debridement, metabolic control, and appropriate antibiotics, effective management with a positive outcome is possible. Because the scrotum is a very elastic skin, primary closure and wound healing are possible even after severe necrotic debridement. In patients who have major soft tissue defects after debridement, surgical reconstruction is required, reducing morbidity and hospitalization and allowing patients to return to their normal lives early. Strict metabolic control, proper hygiene, and early treatment are important tools to prevent this devastating disease.
{"title":"Fournier’s Gangrene and Its Management-A Prospective Study","authors":"J. Jayalal","doi":"10.46889/jsrp.2023.4105","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4105","url":null,"abstract":"Background: Fournier’s gangrene is a fatal necrotizing fasciitis of the genitalia and perineum that can lead to infection of the area with various microbes, organ failure, or even death. This study is indented to determine the presence of systemic concomitant diseases, regional risk factors, metabolic problems, early diagnosis, barriers to treatment, and treatment outcomes in Kanyakumari district. Without an accurate diagnosis and prompt treatment, Fournier’s gangrene is a surgical emergency with a high mortality rate. A mortality rate of 15% to 50% has been reported for this polymicrobial necrotizing fasciitis of the vaginal, perianal and perineal regions\u0000\u0000Aim and Objective: The aim of this study is to determine the age and sex incidence, demographic pattern, predisposing etiologic and risk factors, signs and symptoms, and net patient outcome, and to evaluate the optimal treatment modalities for Fournier’s gangrene.\u0000\u0000Methods: This study is a prospective observational study conducted in the Department of General Surgery, Kanyakumari Government Medical College from January 2021 to December 2022. A total of 50 cases of Fournier’s gangrene who met the inclusion criteria were included in the study. Demographic data such as age, sex, aetiology, risk factors, clinical features, signs and symptoms, site of infestation, microbial culture, bacterial flora, treatment method used, length of hospital stay, and mortality were examined.\u0000\u0000Results: A total of 50 patients, 46 men and 4 women, were included in the study. Males outnumbered females in 92% of cases, with a ratio of 11.5:1. Females were found to have vulvar induration and abscess in the perineal or perianal area. In 31 patients (62%), the lesions were located in the scrotum, in 8 patients (16%) in the perineal area, in 6 patients (12%) in the penis, in 3 patients (6%) in the groin, and in 2 patients (4%) in the vulva. Eight individuals in the research group suffered complete scrotal loss. Presentation of symptoms to the hospital was late, averaging 6.8 days after onset. Patients who presented late to the hospital had much more severe morbidity and delayed recovery, requiring multiple debridement and a longer hospital stay.\u0000\u0000Conclusion: This study suggests that if Fournier’s gangrene is diagnosed early and patients are hospitalized promptly with immediate debridement, metabolic control, and appropriate antibiotics, effective management with a positive outcome is possible. Because the scrotum is a very elastic skin, primary closure and wound healing are possible even after severe necrotic debridement. In patients who have major soft tissue defects after debridement, surgical reconstruction is required, reducing morbidity and hospitalization and allowing patients to return to their normal lives early. Strict metabolic control, proper hygiene, and early treatment are important tools to prevent this devastating disease.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"29 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120819756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: A case series demonstrating the use of a tibia intermedullary nail placed in a retrograde fashion through the calcaneus and talus as a Tibiotalocalcaneal (TTC) arthrodesis salvage technique in three separate patients. Case Presentation: The first case, an 80-year-old female with a previous Total Knee Arthroplasty (TKA) and ipsilateral open tibia shaft fracture developed a septic non-union with hardware failure. Given her multiple comorbidities, she was treated with a long TTC arthrodesis using a retrograde tibial nail to preserve her soft tissue and encourage earlier mobilisation. The second case, was a 55-year-old male with an open right pilon fracture and multiple surgeries due to non-union of his fracture, including failed TTC with hindfoot nail, he was salvaged with a TTC arthrodesis using a long TTC arthrodesis with a retrograde tibial nail. The last patient, a 30-year-old male who fell 25 feet and suffered a right open pilon fracture required multiple surgeries due to septic non-union, and eventually achieved union after a TTC arthrodesis with osteotomy for deformity correction, both of which were stabilized using a retrograde tibial nail. Conclusion: In this case series, the patients underwent revision surgery for non-union using a long TTC arthrodesis construct with a retrograde tibial nail ultimately achieving union. We found that for select patients, a retrograde tibial nail for TTC arthrodesis was a useful option to reduce complications, achieve union, and help to encourage early mobilization and return of function.
{"title":"Retrograde Tibia Intramedullary Nailing in Tibiotalocalcaneal Arthrodesis","authors":"R. Jenkinson","doi":"10.46889/jsrp.2023.4104","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4104","url":null,"abstract":"Background: A case series demonstrating the use of a tibia intermedullary nail placed in a retrograde fashion through the calcaneus and talus as a Tibiotalocalcaneal (TTC) arthrodesis salvage technique in three separate patients.\u0000\u0000Case Presentation: The first case, an 80-year-old female with a previous Total Knee Arthroplasty (TKA) and ipsilateral open tibia shaft fracture developed a septic non-union with hardware failure. Given her multiple comorbidities, she was treated with a long TTC arthrodesis using a retrograde tibial nail to preserve her soft tissue and encourage earlier mobilisation. The second case, was a 55-year-old male with an open right pilon fracture and multiple surgeries due to non-union of his fracture, including failed TTC with hindfoot nail, he was salvaged with a TTC arthrodesis using a long TTC arthrodesis with a retrograde tibial nail. The last patient, a 30-year-old male who fell 25 feet and suffered a right open pilon fracture required multiple surgeries due to septic non-union, and eventually achieved union after a TTC arthrodesis with osteotomy for deformity correction, both of which were stabilized using a retrograde tibial nail. \u0000\u0000Conclusion: In this case series, the patients underwent revision surgery for non-union using a long TTC arthrodesis construct with a retrograde tibial nail ultimately achieving union. We found that for select patients, a retrograde tibial nail for TTC arthrodesis was a useful option to reduce complications, achieve union, and help to encourage early mobilization and return of function.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134565414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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