Indian Journal of Surgery最新文献

Bleeding and perforation are the commonly encountered complications of duodenal ulcer (DU), and gastric outlet obstruction (GOO) is uncommon. At the same time, choledochoduodenal fistula (CDF), stricture common bile duct (CBD), and strictured pancreatic duct (PD) are extremely rare. We report a series of three such unheard cases as the “Thatte Syndrome.” The first and second cases were the trio of GOO, CDF, and CBD stricture (Thatte Syndrome). In the third case, this trio was further complicated by PD stricture (quartet). All three patients were successfully treated and had a symptom-free, long follow-up.

Based on the Bethesda Thyroid Cytopathology Reporting System 2017, the risk of non-diagnostic (ND) cytology malignancy was reported to be 5–10%. The present study aimed to determine the non-diagnostic rates in patients who underwent thyroid fine needle aspiration biopsy due to thyroid nodules, to investigate the factors affecting thyroid cancer diagnosis in patients whose fine needle aspiration biopsy result was non-diagnostic, to determine the malignancy rates in patients with the non-diagnostic cytological result, and to compare them with the literature. Patients who underwent thyroid fine needle aspiration biopsy under the guidance of thyroid ultrasonography (USG) between January 2011 and January 2020 and whose results were non-diagnostic were included in this study. Patients whose fine needle aspiration biopsy results turned out to be non-diagnostic were retrospectively screened in the automation system of our hospital. In our research, the malignancy rate of thyroid nodules whose fine needle aspiration biopsy result was non-diagnostic at baseline was 2.7% (23/846). Of the 846 patients with non-diagnostic cytological diagnosis included in our study, 114 (13.4%) underwent surgery. Of the 114 patients who underwent surgery, 23 (20.1%) had malignant pathology results. In our study, T4 level (p = 0.003), age (p < 0.001), and microcalcification (p < 0.001) were statistically associated with malignancy. The findings showed that the presence of microcalcification, low age, and low T4 level increases the risk of malignancy in patients whose fine needle aspiration biopsy cytology result was non-diagnostic. Clinicians may consider these findings as complementary markers for patient management protocols whose repeated fine needle aspiration biopsy results were non-diagnostic.

Gynecological cancer originating in the female reproductive tract is one of the most common cancers among women, and its incidence is increasing every year in India. This results in high mortality, poor survival outcomes, and psychological effects. Several theoretical and empirical investigations examined gynecological cancer and its varied influences. However, no bibliometric attempts were performed to screen these publications to comprehend the most recent developments and trends in gynecological cancer research in India. Thus, this study aimed to examine the recent development of gynecological cancer research using bibliometric analysis of 3378 research articles collected from the Web of Science database from 2003 to 2022. The study used the Bibliometrix and VOSviewer software to inspect the performance and the science mapping analysis. The performance analysis findings indicate an increase in publication trends after 2008 in India. In scientific production, India collaborated with 116 countries worldwide. The most productive journal, author, and institution are Plos One, Rengaswamy Sankaranarayanan, and All India Institute of Medical Sciences, respectively. By using keywords, intellectual structure, and conceptual structure, the analysis indicates that future studies could focus on cervical carcinoma, ovarian cancer, human papillomavirus, and epithelial ovarian cancer. In light of the overall findings, it is recommended that academicians and practitioners interested in gynecological cancer-based research deliver an overview of the field by providing readers with essential papers, authors, universities, concepts, and sources. These outcomes will also help scholars in gaining a better understanding of current developments, trends, and issues in gynecological cancer research.

Complex ventral hernia which is large with wide defect requires multiple strategies to expand the abdominal wall. We have combined open perforator preserving anterior component separation technique with peritoneal flap hernioplasty in patients with large incisional hernias. We have described the indication, technique, and intraoperative and postoperative outcomes of this combined technique. To the best of our knowledge, this is the first report of this combined procedure. The surgeries were performed between May 2022 and January 2024. The patient had large midline hernias with more than 10-cm defect width. The patients were evaluated for operative time, postoperative pain, surgical site infection, seroma, hematoma, skin necrosis, recurrence, pseudo-recurrence (bulge), 90-day readmission, chronic pain, and Clavien-Dindo score. We operated six patients with this technique. All were women, and the mean age was 35 years (range 15–50). The mean BMI was 24 kg/mt² (range 21–28). All were midline incisional hernias, and one had twice recurrence. The mean defect width was 14 cm (range 11–18), and the mean operative time was 147 min (range 130–160). There was one superficial surgical site infection (Clavien-Dindo 3a). In the postoperative period, none of the patients had seroma, hematoma, skin necrosis, recurrence, pseudo-recurrence, or chronic pain. The patients were followed for 8 months mean (range 3–22). In patients with large midline ventral hernia, perforator preserving anterior component separation technique can be combined with peritoneal flap hernioplasty to achieve tension-free fascial closure. However, more studies with large sample size and long follow-up period are needed on this.

Many women with benign breast disease seek consultations at tertiary referral centres in our country. This study aimed to investigate the clinicopathologic profile and the reasons of referral of such patients to a tertiary care hospital. This study (January 2020–February 2022) enrolled 245 women aged ≥ 18 years attending our outpatient clinic with a referral diagnosis of benign breast disease prospectively. During the first visit, each woman was given a questionnaire which consisted of 21 questions, including (1) general questions regarding patients’ profiles, (2) questions specific to benign breast disease, and (3) previous medical consultations and reasons for visiting our centre. The mean age of patients was 34.5 years, and 75.5% were premenopausal. The majority (45.3%) belonged to rural areas. Mastalgia was the most common presenting symptom (51.4%). Forty-five percent of patients had visited a public hospital earlier, and 42.4% consulted > 1 doctor before visiting our centre. Most had ≥ 1 investigation performed, including breast ultrasonography (76.3%) and mammography (22.9%). Ninety percent had received some form of medication. The dominant reasons for visits to our centre were the fear of malignancy (46.5%) or dissatisfaction (45.7%) with counselling regarding breast cancer risk. But only 43% accepted that they would have been satisfied if they were emphatically told that they did not have an increased risk of breast cancer. Counselling of benign breast disease patients needs to be centred around alleviating fear of malignancy. More insight among treating physicians is needed to address the patient’s concerns.

The objective of this study was to establish a nomogram model for predicting survival outcomes in patients with testicular germ cell tumors (TGCTs). Data of patients with TGCTs were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox analyses were used to identify the independent predictors. A nomogram was constructed to predict overall survival (OS), and verified by concordance index (C-index), calibration curve, and decision curve analysis (DCA). The analyzed population comprised 12,008 patients with TGCTs. The nomogram showed a high C-index of 0.844, and the calibration plots were adequately fitted. Decision curve analysis indicated the clinical usefulness of the nomogram, which outperformed the tumor-node-metastasis (TNM) stages. This study built and verified a nomogram for predicting OS of TGCT patients, with higher clinical value compared to TNM stages. Our nomogram will assist clinicians in the appropriate management of patients with TGCTs.

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has demonstrated significant survival benefits in peritoneal carcinomatosis (PC) across diverse cancer types, including gastrointestinal, ovarian, mesothelioma, and pseudomyxoma peritonei (PMP). However, variations in morbidity and mortality rates necessitate a comprehensive evaluation. This study aims to present concise insights into the short-term outcomes of CRS and HIPEC, drawing from a single institute experience. Patients who underwent CRS and HIPEC between November 2018 and August 2021 were identified, and their data were meticulously analyzed. The focus encompassed the clinical spectrum, surgical particulars, postoperative complications, and perioperative morbidity and mortality. Throughout the study period, 54 patients underwent CRS and HIPEC, with colorectal cancer accounting for the majority (46.3%), followed by ovarian cancer, gastric cancer, PMP, and malignant peritoneal mesothelioma. The average peritoneal cancer index stood at 14, with complete cytoreduction achieved in 79.6% of cases. Notably, 9.2% of patients experienced grade III and IV complications. Progression-free survival (PFS) demonstrated a median duration of 16.07 months (95% confidence interval, 8.59–23.54). The 1-, 2-, and 3-year survival rates were observed at 74%, 63%, and 43%, respectively. CRS and HIPEC are safe and feasible PC treatments for various cancers and should be recognized as important tools in advanced cancer therapy to achieve curation in a selected patient population.

Introduction

Laparoscopic cholecystectomy, a widely performed procedure globally, often results in post-operative pain, which impacts the length of hospital stay and imposes financial burdens. This randomised controlled trial aimed to compare the effects of pre-emptive versus post-operative local anaesthetic infiltration at port-site incisions on post-operative pain in laparoscopic cholecystectomy patients.

Patients and methods

This double-blinded study, conducted at a tertiary care hospital, included 50 patients scheduled for laparoscopic cholecystectomy and were divided into two groups: Pre-emptive analgesia (group A) and post-operative analgesia (group B). Randomization was performed with sealed envelopes, and patients were evaluated preoperatively. Pain scores, shoulder pain incidence, hospital stay duration, analgesic requirements, and return to normal activity were compared between the groups.

Results

Baseline demographic profiles were comparable. Pre-emptive analgesia demonstrated significantly lower Visual Analogue Scale scores at 1, 3, 6, 12, 24 h, and 7 days post-operatively with no significant difference in shoulder pain incidence. Pre-emptive analgesia correlated with a markedly shorter hospital stay reduced analgesic requirements, and an earlier return to normal activity. Only 10% of patients from the post-operative analgesia group required additional analgesia.

Conclusion

Pre-emptive local anaesthetic infiltration at port sites yielded significant benefits, including reduced pain, lower analgesic requirements, shorter hospital stays, and earlier resumption of routine activities compared to post-operative infiltration.

Trial Registration

This project is registered under the Clinical Trial Registry-India (CTRI) CTRI Number: CTRI/2023/08/056175 [Registered on: 07/08/2023]—trial registered prospectively

Medical teachers are facing many problems today—clinical load, patient care, administrative work, mandatory research and publication, professional jealousy of co-workers, unruly students, disobedient ministerial workers, and frequently changing norms and transfers. Add to this the financial strains, the lifestyle changes, and the family woes. In order to succeed as a teacher they should know the subject and its recent advances, and they should be able to convey it in the simplest possible way so that it is crystal clear to every student. They should have the ability to make the teaching material interesting and relevant, and they should harbor a deep-seated responsibility and respect for the students. With the number of medical colleges and medical students on the rise, scarcity of talented teachers, and constant comparison with lecturers on YouTube and the internet, their jobs are getting tougher by the day. With expectations like life should be fair, everyone should like them, people should agree with them and change according to them, they must be popular, respected, and well understood, and they must do well in life and be duly rewarded for their efforts, they are sitting over a pile of desires, which may or may not get fulfilled. Learning to accept what is, rather than what should be, is powerful. That is the paradox, which can be sometimes hard to grasp. Only by practicing this day by day can we start to experience and understand the freedom in letting go of unrealistic expectations and embracing gratitude and the present. Teaching is a great job and teachers are nation builders. If we stop chasing our expectations and cultivate a sense of gratitude for the opportunity that has been bestowed upon us we can all be happy.