Indian Journal of Surgery最新文献

Bleeding jejunal diverticula is a rare cause of lower gastrointestinal bleeding. We describe a case of rectal bleeding secondary to jejunal diverticula disease and outline our experience of managing bleeding jejunal diverticula in current practice.

Superior mesenteric artery occlusion (SMAO) can present as acute mesenteric ischemia (AMI) with bowel necrosis or as mesenteric vascular narrowing with collateral formation, resulting in chronic mesenteric ischemia (CMI). The diagnosis is often delayed due to a low clinical index of suspicion, leading to a high mortality rate. We aimed to characterize the clinical and radiological features of SMAO. This retrospective study included 39 patients with SMAO reported on CT for 3 years. We compared the clinical features from medical records with imaging and intraoperative findings. The CT features of vessel occlusion, status of collaterals, bowel changes, and other intra-abdominal findings apart from involvement of other vessels (celiac, renal, aortic, neck vessels) were analyzed. Out of 39 patients, 12 had acute SMAO, and the remaining 27 patients had chronic SMAO and were sub-classified into Takayasu (n = 13) and non-Takayasu (n = 14) sub-groups. The acute group had proximal and distal occlusions equally and bowel gangrene changes but without collaterals, whereas chronic group had mainly proximal stenosis/occlusion and no bowel changes with well-formed collaterals. Involvement of other abdominal and peripheral vessels was noted in the chronic group (both Takayasu and non-Takayasu) but less in acute group patients. Early surgery in the acute group was associated with a better prognosis and CT-detected bowel ischemia changes correlated well with intraoperative findings. Acute and chronic SMAO have distinct features in terms of level and type of occlusion, bowel ischemic changes and collaterals. Takayasu arteritis may be a subset of chronic SMAO with associated changes, which warrant further elucidation.

This study assessed the feasibility and efficacy of hysteroscopic mesh resection in managing presacral mesh infection following sacrocolpopexy. A retrospective analysis was conducted on three cases of presacral mesh infection treated with hysteroscopic total mesh resection between January 2020 and December 2021. The cases were classified and diagnosed using category-time-site (CTS) coding for complications, and perioperative indicators were evaluated. The mean age of the patients was 61.67 years (SD 4.44). Surgical time averaged 37.33 min (SD 5.11), with an intraoperative bleeding volume of 13.33 ml (SD 4.44). The hospitalization cost was 12,436.43 yuan (SD 2281.79), and the postoperative hospitalization duration was 6.25 days (SD 0.88). The preoperative frailty index was 0.18 in two out of three cases, indicating favorable surgical tolerance. There were no 30-day unplanned readmissions. At 3 months post-operation, the Patient Global Impression of Improvement (PGI-I) score was 100%, indicating good outcomes with a subjective cure rate of 100%. These findings indicate that hysteroscopic mesh resection could be a viable and effective treatment modality for presacral mesh infection following sacrocolpopexy.

Transoral robotic surgery (TORS) has transformed the management of oropharyngeal tumors with its precise and minimally invasive techniques. However, its role in identifying primary sites in carcinoma of unknown primary with secondary neck nodal metastasis remains understudied. Here, we present a case series of 18 patients who underwent ipsilateral radical tonsillectomy and tongue base mucosal wedge biopsy using transoral robotic surgery (TORS) at a tertiary care institute. This study offers a concise overview of the surgical steps and instrumentation employed in the procedure, focusing on patient positioning, robotic arm placement, optical dilation, tissue dissection, hemostasis, and closure. By elucidating the technical nuances of the surgical procedure, this study aims to promote the adoption of minimally invasive approaches in head and neck surgery, thereby advancing patient care.

A 70-year-old diabetic female presented to emergency with complaints of severe pain in right loin region, fever with chills, and burning micturition since last 1 week. X-ray abdomen was suggestive of emphysematous pyelonephritis which was confirmed by contrast CT abdomen. She recovered after percutaneous nephrostomy with broad spectrum antibiotic coverage.

The rise in stoma creation after emergency laparotomy has surged significantly in recent years, contrasting sharply with earlier practices of resection and anastomosis. Despite advances in management, which were expected to reduce this trend, it has instead escalated, imposing a burden on healthcare costs and impacting the quality of life for stoma patients. This study seeks to examine the factors influencing the necessity for enteric stomas during emergency laparotomies for acute abdominal conditions. This descriptive observational study was conducted in the Department of General Surgery at a Medical College & Hospital, from November 2022 to January 2024, analyzing data from March 2019 to March 2021. It included 70 patients aged 18 to 60 who underwent enteric stoma creation during emergency laparotomy. Data were collected retrospectively from medical records and analyzed using descriptive statistics. The study included 70 patients with an average age of 43.7 ± 14.4 years; 43 males and 27 females. The primary indications for stoma creation were obstructing colonic cancer (38.5%), non-traumatic small bowel perforation (14.2%), and sigmoid volvulus (11.4%). Ileostomies were predominant (58.5%), with double-barrel ileostomy being the most common (31.4%). Short-term complications occurred in 28.5% of patients, with surgical site infections being the most common (55%). The study highlights a paradoxical increase in enteric stoma creation despite advancements in surgical care. The findings underscore the need for further research into the factors influencing the decision to create a stoma, beyond immediate surgical considerations.

Raman spectroscopy discovered by Nobel laureate Sir Chandrasekhara Venkata Raman from India in 1928 changed the history of Oncosurgery and gave a new direction and dimension to the diagnosis, management, screening, and treatment of cancer. The amalgamation of laser and artificial intelligence in spectroscopy made this invention of Raman an extremely useful non-invasive tool in cancer surgery and management. Apart from intraoperative guidance, early detection, and tumor classification, Raman spectroscopy was found to be useful in the assessment of residual disease, therapeutic monitoring of chemotherapy drugs and radiotherapy, biomarker invention, drug delivery monitoring, and cancer screening. While Raman spectroscopy shows great promise in cancer research and diagnosis, it is still a developing field, and further research is needed to fully understand its potential.

Introduction: The association between vitamin D level and gastric cancer has not been studied in our population despite the high prevalence of vitamin D deficiency and gastric cancer. Patients and Methods: This was a 26-month case series analysis study in which 59 patients with histologically confirmed gastric cancer and age and sex-matched 60 patients with suspicion of Helicobacter Pylori infection were taken as controls to find out any association between low 25 hydroxy vitamin D level and malignancy. Results: The mean age of the cases and controls was 57 SD (standard deviation)10 and 56 SD 9 years, respectively. The mean vitamin D levels in cases and controls were 20.15 ng/ml and 32.21 ng/ml, which was statistically significant (p < 0.0001). Only 3 (5%) controls showed vitamin D deficiency (< 20 ng/ml), compared to 30 (50.84%) cases, which was statistically significant (p < 0.001). The mean vitamin D levels in well differentiated, moderately differentiated and poorly differentiated adenocarcinoma were 26.10, 23.25 and 14.88 ng/ml, respectively, which was statistically significant (p < 0.001). Stage III gastric adenocarcinoma (50.8%) was the most common, followed by stage II (42.4%), stage I (5.08%) and stage IV (1.7%); however, vitamin D levels did not statistically differ among these stages. All these patients except stage IV underwent surgery, were followed for two years, and had a survival rate of 90 percent. Conclusion: There was a positive association between vitamin D deficiency and the occurrence of gastric cancer. Vitamin D levels were significantly associated with different tumour differentiation grades but not with clinical staging.

Urogenital dysfunction after rectal surgery is associated with neurovascular bundle (NVB) injury. We compared urinary and sexual functions after transanal total mesorectal excision (taTME) and laparoscopic total mesorectal excision (laTME), and analysed the impact of the differences in NVB injuries on the functional outcomes of these treatments. Overall, 187 patients with rectal cancer who underwent taTME (n = 94) or laTME (n = 93) at the Shengjing Hospital of China Medical University between March 2018 and June 2021 were included. Ninety-seven patients (taTME, n = 52; laTME, n = 45) with NVB injuries were classified as bleeding subgroups and the others as non-bleeding subgroups. Urinary function was compared 6 and 12 months postoperatively using the International Prostate Symptom Score (IPSS). Sexual function was compared 12 months postoperatively using the five-item International Index of Erectile Function (IIEF-5). The IPSS of all groups at 6 months postoperatively was higher than that preoperatively. All postoperative scores in the bleeding subgroup of the taTME group were significantly higher than the preoperative scores. The bleeding subgroup of the taTME group had higher IPSS and significantly lower IIEF-5 scores than the non-bleeding subgroup of the taTME group and the bleeding subgroup of the laTME group postoperatively. The IIEF-5 scores of all groups at 12 months postoperatively were lower than those preoperatively. This study confirmed impaired urinary and sexual functions after taTME and laTME, and patients with NVB injuries in the taTME group had worse urinary and sexual dysfunction.