Indian Journal of Surgery最新文献

Breast conserving therapy is now considered the preferred option for early invasive and in situ ductal (DCIS) breast carcinoma. In an attempt to decrease positive margin and local recurrence, various methods for margin delineation have been described. Our team at AIIMS New Delhi have developed a new technique of injecting methylene blue at the sonographically determined margin of tumour to delineate the margin of excision for breast cancer. We perform this procedure after immobilization of tumour with a transparent Ioban/Opsite adhesive sheet applied over the breast. The injection of blue dye at sonographically determined margins facilitates the lumpectomy with free margins.

A 39-year-old lady with Down’s syndrome presented with right iliac fossa pain to the emergency department. Computed tomography abdomen pelvis revealed a foreign body in the right lower anterior abdominal wall. We report the first case of using laparoscopic totally extraperitoneal (TEP) approach to remove an ingested foreign body that likely perforated through the gastrointestinal tract and subsequently migrated to the anterior abdominal wall. Granted, the laparoscopic TEP approach is more widely used in inguinal hernia mesh repairs and increasingly prostatectomies; we believe that the TEP approach could also be used in a novel fashion as in this case.

The initial accounts of gallstone disease, a widespread ailment, were documented in the 15th century. However, historical records from preceding epochs remain scarce. This study aimed to examine the occurrence of gallbladder disease and cholelithiasis within ancient Mesopotamian cuneiform texts. As the primary resource for accessing Mesopotamian cuneiform documents and identifying relevant texts, Scurlock’s 2005 book was utilized. Six texts, believed to be connected to gallbladder disease, were selected. These texts underwent evaluation based on the presence of the terms ZÉ.GİG, ZÉ (denoting gallbladder disease), Pašittu (indicating cholelithiasis), and the five principal symptoms of gallbladder disease. The findings reveal an important relationship between Mesopotamian cuneiform texts and gallbladder disease, and date the historical timeline of gallstone disease and cholelithiasis back to the 1st millennium BC.

Global surgery is a rapidly developing multidisciplinary field. This editorial chronicles the beginnings of GS, highlighting its evolution, milestones, challenges, and gazes in to the future as it becomes evident that global surgery has the potential to play a transformative role in achieving global health equity.

Abstract

We present a case report of an incarcerated paraesophageal hernia containing a duodenal perforation managed with surgery. The patient is a 65-year-old female with super morbid obesity (BMI 67) and severe malnutrition (albumin 2.9) found to have a large paraesophageal hernia with free air and fluid in the chest and abdomen. On presentation, the patient was in septic shock, and she was taken emergently to the operating room for exploratory laparotomy. Operative findings included an incarcerated paraesophageal hernia with a 3-cm posterior duodenal perforation. A distal gastrectomy with Billroth-II reconstruction and gastropexy were performed. The patient ultimately recovered well and was discharged home. We report a positive outcome in a rare and dangerous case of an incarcerated paraesophageal hernia associated with duodenal perforation and septic shock.

Transanal minimally invasive surgery is a relatively new diagnostic and therapeutic approach for removing pathological lesions localized in the mid-rectum and its distal third. The availability of laparoscopic equipment and its low cost made this procedure dominant over others. A total of 12 patients underwent afore-mentioned procedure at the Clinical Hospital Center of Zemun. Patients were diagnosed with either benign adenomas or early rectal carcinoma, all verified by histopathological analysis, which could not be removed using endoscopic methods. During the research, we examined the procedure’s feasibility, the margin’s negativity, length of hospital stays, and early complications. The average distance of lesions from the anocutaneous line was 8.1 cm. Mucosectomy was most often performed, followed by full-thickness resection of the rectal wall and resection of the rectal wall with part of the mesorectal tissue. The average size of polypoid lesions was 3 cm. We had positive margins in only one case. The postoperative hospital stay was average 1.8 days. Regarding early postoperative complications, we had one case of postoperative bleeding, which was treated with endoscopic hemostasis. All transanal resection techniques aim to obtain adequate, negative margins of resected pathological lesion. A high percentage of patients with negative margins and a low level of postoperative complications make this procedure applicable in modern practice. This procedure has proven to be a safe, effective and reproducible technique. With the development of the surgical technique, it will be increasingly used to perform more complex colorectal operations in our center.

Port site infection causes significant morbidity in patients undergoing laparoscopic cholecystectomy. The umbilicus, the most common location for creating pneumoperitoneum, frequently harbours resident microflora, which can render a patient susceptible to subsequent port site infections. Umbilical hygiene and its role in preventing surgical site infections have not yet been studied. Our study aimed to bridge this gap by proposing a method for umbilical hygiene. Five hundred two patients planned for laparoscopic cholecystectomy were randomised. In the intervention arm, the umbilicus was cleaned with 2–3 drops of coconut oil and patients were instructed to take a bath, with an emphasis on umbilicus cleaning. Patients in the control group were asked to bathe before surgery, without applying coconut oil. In both arms, the abdomen was painted using chlorhexidine, and a standard laparoscopic cholecystectomy was done with the gall bladder being extracted through the epigastric port. Eight (or 1.5%) of the 480 patients had port site infections. Five of them had infections at the umbilical port site, of which four (p = 0.200) belonged to the control group. Our study showed no statistically significant association between preoperative umbilical hygiene and port site infection. This might be due to the fact that patients in both arms bathed prior to the surgery and had their abdomen painted and deep cleaned with chlorhexidine. Hence, we would like to emphasise the significance of deep cleaning of the umbilicus with chlorhexidine during the painting of the abdomen. Further studies with a larger sample size are needed.

Medication-related osteonecrosis of the jaw (MRONJ) is a condition of persistent exposure of bone or an introral/extraoral fistula through which the bone can be probed for more than 8 weeks in a patient who is under treatment with antiresorptive or antiangiogenic agents (bisphosphonates, denosumab, antiangiogenic agents, tyrosine kinase inhibitors, and monoclonal antibody targeting vascular endothelial growth factors) in the maxillofacial region without any previous history radiation therapy to the jaws or obvious metastatic disease to the jaws. High index of suspicion is required to identify this entity and treat them accordingly. We hereby present a case report where we highlighted the methods to establish the diagnosis of medication-related osteonecrosis of the jaw and its complex management from medical management to surgical management with debridement using piezosurgical device along with the incorporation of autologous platelet concentrate and review the literature of this entity.

To evaluate the recovery of vital lung tissue after organ restoration decortication procedure open or video endoscopically, an objective parameter was required. Hitherto, less described multidetector computed tomography (MDCT) scan-based assessment of volumetric parameters in patients of chronic empyema thoracis was done before and after surgery. A total of 35 patients of chronic tubercular empyema thoracis were studied. MDCT-based various volumes diseased pleura in pre- and postoperative period were measured. Spirometric findings (FEV1, FVC, FEV1/FVC) before and after intervention were also compared. In this study, there were 35 patients (men = 25, women = 10), with a mean age of 27.91 SD 8.18 years. Mean value of increase in volume of lung from preoperative 493.57 SD 79.47 cc to postoperative was 845.21 SD 40.83 cc (71.24% increase) with a p-value < 0.001. The mean value of decrease in thickness of diseased lung pleura from preoperative 52.60 SD 12.69 mm to postoperative was 3.82 SD 1.59 mm (93.80% decrease) with a p-value < 0.001. Mean value of decrease in the volume of diseased lung pleura from preoperative 335.52 SD 108.07 cc to post-intervention was 9.51 SD 5.74 cc (97.31% decrease) with a p-value < 0.001. MDCT scan from preoperative to postoperative period is additional tool to objectively assess recovery and correlates well with spirometric lung volume measurements.

We report a case of anomalous course of the ascending posterior segmental artery (Asc. A²) to the right upper lobe detected by three-dimensional computed tomography image reconstruction. The knowledge of vascular anomalies is useful to avoid intraoperative complications during pulmonary lobectomy.