Indian Journal of Surgery最新文献

Difficult laparoscopic cholecystectomy is a condition that every general surgeon has once faced during surgery. There have been various propositions regarding the aetiology and criteria for difficult cholecystectomy. As a whole, it has been associated with abnormal anatomy, frozen Calot’s triangle, difficult exposure, post endoscopic retrograde cholangio-pancreatography, requiring more than 90 min, need for open conversion, etc. There are various preoperative and intraoperative predictors of difficult cholecystectomy described in the literature. However, history of severe pelvic inflammatory disease preoperatively has not been described in the literature as a predictor of difficult cholecystectomy. In our case report, a 31-year-old lady presented to us with biliary colic. Ultrasonography revealed a normal wall gall bladder, with multiple calculi. Diagnosis of symptomatic cholelithiasis was made. Based on clinical history and intraoperative findings, a diagnosis of Fitz-Hugh-Curtis syndrome was made, which is a sequelae of pelvic inflammatory disease.

Biofilms commonly develop in indwelling medical devices such as contact lenses, central venous catheters, mechanical heart valves, peritoneal dialysis catheters, urine catheters and drains. Drains are used extensively in all types of surgeries for various purposes. With the potential benefits, they are prone to develop biofilms and increase the risk of surgical site infections. However, there are not many studies correlating the presence of biofilms in drains with surgical site infections and other factors. This prospective observational study was conducted on 143 patients who had 183 surgical drains placed intra-operatively and underwent various surgeries. Drains were tested for the presence of biofilms and correlated with the type of surgery, duration of drain kept in the site and incidence of surgical site infections. There was a significant association between the presence of biofilms in drains with the type of surgery (p = 0.014), duration of the drain in place (p = 0.087) and the incidence and the grades of surgical site infections (p = 0.001). The type of drains was also significant (p = 0.005). Surgical drains are prone to develop biofilms. Drains placed in patients with contaminated and dirty surgeries, increased duration in situ, and non-vacuum abdominal drains had higher incidence. Judicious use of drains with early removal will decrease the biofilm development and may reduce surgical site infections.

WEE1 G2 checkpoint kinase/mammalian target of rapamycin expression levels are implicated in increasing mortality risk in triple-negative breast cancer patients, and we investigated their expression patterns and clinical significance in triple-negative breast cancer. A total of 67 triple-negative breast cancer patients were selected as the subjects of this case series analysis, with cancer/normal adjacent tissues, clinical baseline, and pathological data collected. WEE1 G2 checkpoint kinase/mammalian target of rapamycin expression levels in cancer/normal adjacent tissues were assessed. The impact of WEE1 G2 checkpoint kinase/mammalian target of rapamycin levels on triple-negative breast cancer patient survival and prognosis and the independent risk factors for death were evaluated. WEE1 G2 checkpoint kinase/mammalian target of rapamycin expression levels in triple-negative breast cancer tissues were distinctly higher than normal adjacent tissues. Significant differences in Tumor Node Metastasis staging, modified Scarff-Bloom-Richardson grading, and axillary lymph node metastasis were observed between patients with WEE1 G2 checkpoint kinase low expression and high expression/mammalian target of rapamycin low expression and high expression. Dead patients showed higher WEE1 G2 checkpoint kinase/mammalian target of rapamycin levels than alive patients during follow-up. Both WEE1 G2 checkpoint kinase high expression and mammalian target of rapamycin high expression increased mortality risk, with their simultaneous high expression causing higher mortality risks in triple-negative breast cancer patients than any of them alone. Simultaneous high expression of WEE1 G2 checkpoint kinase and mammalian target of rapamycin increased mortality risks and was an independent risk factor for death in triple-negative breast cancer patients.

Suturing techniques have been evolving since the surgery started. Various suturing techniques are classically used to get better results in different situations. Here, the author described a novel technique, which is a modification of the horizontal mattress suture and has many advantages over conventional suturing techniques, and emphasized its need for every surgeon who is tackling problems of tension suturing and wound approximation.

Benign bile duct stricture (BBS) can lead to recurrent cholangitis, biliary cirrhosis, hepatic failure, and death if untreated. Although excellent outcomes can be achieved by Roux-en-Y hepaticojejunostomy (RYHJ), in the majority of patients with BBS, a subset of patients can have recurrent anastomotic site strictures requiring revision Roux-en-Y hepaticojejunostomy (rRYHJ). This study is a review of patients undergoing revision Roux-en-Y hepaticojejunostomy. Case series analysis of retrospective data from patients undergoing rRYHJ from January 1989 to December 2020 was conducted. Their demographic, preoperative, intraoperative, and postoperative outcomes were analyzed. A total of 44 (6.98%) patients had recurrent anastomotic site strictures among 630 patients who had undergone RYHJ (Roux-en-Y hepaticojejunostomy) for benign biliary stricture following bile duct injury at a minimum follow-up of 3 years. Among 44 patients, 36 patients (81.8%) underwent rRYHJ (revision Roux-en-Y hepaticojejunostomy). Their mean age was 48.5 years, and the majority were women with 26 (59%) of the patients. The mean duration between primary (RYHJ) and revision (rRYHJ) was 5.5 years. Thirty-two (88.8%) patients presented with cholangitis, and one patient (2.7%) had cirrhosis. Twenty-four (75%) patients underwent preoperative biliary drainage. Types of re-strictures (on the basis of intraoperative assessment) according to bismuth classification included type I 1 (2.78%), type II 3 (8.3%), type III 20 (55.5%), type IV 10 (27.8%), and type V 2 (5.5%). Twelve patients (33%) had postoperative complications, and the most common complication was surgical site infection (n = 8, 22.2%). There was no mortality. Two patients had postoperative bile leakage, managed conservatively (Clavien-Dindo (CD) grade I). On long-term follow-up (mean 5.5 years), satisfactory outcomes (A and B McDonald’s grade) were observed in 31 (86%) patients, 3 (8.3%) patients had grade C outcomes, and 2 (5.5%) patients had grade D outcomes. Overall, 29.5% (13) of cases, including 6 cases of bile duct stricture after the first RYHJ and 5 cases of re-stricture after revision r-RYHJ, were managed successfully with balloon dilation and ring biliary catheter, showing better long-term outcomes. Our study has shown that the overall post-revision Roux-en-Y hepaticojejunostomy (rRYHJ) long-term outcome was satisfactory in 86% of patients according to McDonald’s grading. A multidisciplinary approach in high-volume center is paramount important to obtaining a good long-term outcome.

We present a case series of preoperative embolizations of a massive thyroid mass. Preliminary results show that preoperative embolization reduces blood flow, blood loss, and operative time. Preoperative embolization is a safe adjunctive procedure that should be considered in selected patients.

The escalating cost of attending a surgical conference by the postgraduate trainee is proving to be a bane for many with the impending financial implications which are slowly becoming detrimental and challenging. There is an urgent need for cost-cutting and making these surgical conferences economical so that the young generation of surgeons can learn the latest from their peers and get the opportunity to interact with the topmost professionals in the specialty. The conferences should attract surgeons across without feeling the pinch in the pocket by making it hybrid and providing support to postgraduates, especially those from economically poor background.

This meta-analysis was conducted to compare the effectiveness of the non-mesh Desarda technique (DT) with the mesh-based Lichtenstein technique (LT) for the repair of unilateral inguinal hernia. A meta-analysis was performed on the Desarda group (DG) and Lichtenstein group (LG) studies. A detailed literature search was conducted on PubMed, Scopus, and Google Scholar for comparative studies between Lichtenstein and Desarda techniques for the repair of unilateral inguinal hernia. The data for the primary outcomes and one secondary outcome, i.e., time taken to return to normal gait, was reported in the form of mean difference with 95% confidence interval, and inverse variance was used as the statistical method. For the remaining secondary outcomes, Mantel–Haenszel was used as the statistical method. The effect measure was reported as a risk ratio at a confidence interval of 95%. There was no significant difference in seroma formation, recurrence, postoperative infection, scrotal edema formation, hematoma formation, time taken to return to normal gait, and foreign body sensation between the two groups. A significant difference was seen in the duration of hospital stay (MD = − 0.97, p < 0.00001, I² = 95%), intraoperative time (MD = − 8.75, p < 0.00001, I² = 100%), and time taken to return to normal activities (MD = − 2.19, p < 0.00001, I² = 92%), all in the favor of DG. DT was found to be superior to LT in terms of reducing duration of hospital stay, intraoperative time, and time taken to return to normal activities. For the remaining outcomes, there was no significant difference between the two groups.

Sclerotherapy is a frequently employed technique for treating vascular malformations. Bleomycin is a sclerosant that has demonstrated efficacy and safety in this particular approach. The aim of this study is to investigate the efficacy of bleomycin sclerotherapy in treating vascular malformations. In this study, we reviewed all the studies that fit the subject of our research with the keywords bleomycin and vascular malformations in the title and abstract in PubMed from 2004 to June 12, 2023, to prevent selection bias. Most studies support bleomycin’s efficacy and safety as a sclerosant agent. A few studies have observed its distressing side effect, pulmonary fibrosis. The variety of vascular malformations and the lack of a unique classification system appear to hinder the accurate measurement of this method’s efficacy.

The prognostic nutritional index (PNI¹) has been widely used for the prediction of surgical risk in patients with gastrointestinal malignancy. The aim of this study was to evaluate PNI values to predict the outcome in various categories of abdominal surgery with the objective of identifying the patients at risk in order to avoid morbidity and mortality. One hundred patients undergoing surgical interventions for abdominal conditions both in emergency and elective settings in the age group of 10–80 years of either sex were included in this prospective study. The PNI of each patient was calculated as 10 × albumin (g/dl) + 0·005 × total lymphocyte count (per mm³). The patients were grouped into low PNI (PNI < 45) and high PNI (PNI > 45) groups. The chi-square test or Fisher exact test was applied for statistical analysis and a p-value of < 0.05 was considered significant. The PNI level was found to be low in female patients (p-value 0.017). There was a high incidence of co-morbidities amongst patients with low PNI (p-value 0.001). More patients in the PNI < 45 group needed ICU care (p-value 0.021). The length of hospital stays (p-value 0.001) and the mortality rate were found to be high (p-value 0.016) in the PNI < 45 group. The PNI has been found to be a simple and useful biomarker which can define the baseline risk and predict postoperative complications and long-term outcomes in abdominal surgery.