Indian Journal of Surgery最新文献

The article is devoted to the results of the first clinical trials of a new domestic mesh implant with a composite coating Niprocel®. According to the declared properties of the mesh prosthesis, an increase in the quality of its engraftment was noted with a decrease in the frequency of specific prosthetic complications. The hemostatic properties of the composite coating have been proven, which were manifested by leveling the risk of wound hematoma formation. Another important property of the implant was a decrease in the reaction of surrounding tissues to a foreign body due to the composite coating, which, together with the hemostatic and, accordingly, lymphostatic effect, provided a reduction in the risk of exudative manifestations from the wound, as well as the development of inflammatory infiltration. These properties made it possible to reduce the overall incidence of local wound complications in the early period after allohernioplasty.

Patient education is essential for managing conditions like acute appendicitis, cholecystitis, and hydrocele, as it empowers patients to seek timely medical intervention, which can dramatically improve outcomes. Artificial intelligence tools are increasingly integral in healthcare, enhancing the delivery and accessibility of patient education. This study aims to compare the effectiveness of ChatGPT and Google Gemini in creating patient education guides on acute appendicitis, cholecystitis, and hydrocele. In this cross-sectional study, we generated patient education brochures for three diseases using two AI tools, ChatGPT and Google Gemini. The responses were evaluated based on several variables including word count, sentence length, readability (assessed with the Flesch-Kincaid Calculator), similarity (analyzed using Quillbot), and reliability (measured by the Modified DISCERN Score). Statistical analyses were performed using unpaired t-tests and Pearson’s correlation coefficients. The analysis revealed that there were no significant differences in readability scores, word counts, sentence lengths, or reliability scores between the materials produced by ChatGPT and Google Gemini. Additionally, correlation analyses indicated a positive correlation for ease scores and a negative correlation for reliability scores between the tools, though these findings were not statistically significant. The study concludes that ChatGPT and Google Gemini are equally effective in producing patient education materials for acute appendicitis, cholecystitis, and hydrocele. The absence of significant differences between the two AI tools suggests their potential utility as educational resources in healthcare settings.

Liver abscess is a rare complication associated with the ingestion of foreign bodies such as fish bone, which migrates to the liver through gastrointestinal tract. Here, we are reporting one such case of fish bone induced liver abscess that presented with acute small intestinal obstruction. On preoperative imaging, there was evidence of left lobe liver abscess with distal ileal transition point for obstruction and ascites. However, intraoperatively to our surprise, a foreign body, i.e., fish bone, was retrieved from liver abscess cavity, apart from ruptured liver abscess, and adhesive small bowel obstruction in distal ileum. This foreign body was identified later on revisiting the contrast-enhanced computed tomography abdomen post-operatively. We are reporting rare incidence to discuss presentation and adequate management.

With the development of laparoscopy and refinement of the surgical instruments and technology, multiple surgeries, in the same sitting, can be safely handled which needs evaluation in the terms of feasibility and validation. The study is a case series analysis of prospectively collected data on concomitant (≥ 2) laparoscopic procedures done, over 7 years (2016–2023) at the Department of General Surgery, of two tertiary medical care institutes, by a single surgeon. All such 139 patients on accrual with coexisting benign surgical pathologies amenable to laparoscopy were included after formal consent. The data were analysed in terms of operative time, visual analogue scale (VAS) for pain at 24 h, hospital stay, surgical feasibility, post-operative complications and cost. The outcomes were compared against the single procedures (as component of concomitant surgeries) done by same surgeon/or other modalities possible, in the same duration. A total of 139 registered cases underwent surgery, of which 61 were different procedures combined with laparoscopic cholecystectomy. Rest 78 cases included single incision bilateral TAPP, TEP for bilateral inguinal hernias, bilateral transperitoneal pyelolithotomy, laparoscopic pyelolithotomy with pyeloplasty and Meckel’s diverticulectomy with appendectomy. The results of concomitant surgeries, i.e. operative time and hospital stay, were significantly less, and the respective VAS values were nearly equal to the VAS in a single procedure, with no significant difference. With the developed expertise of surgeon, skill enhancement and establishment of a good infrastructure and surgical team, it is well feasible to carry concomitant laparoscopic surgeries with early return to activity and sufficient cost saving. It saves both out-of-pocket expenses of the patient, trouble of second anaesthesia and surgery and reduces provider’s cost and burden as well.

Although traumatic injury has been the foremost reason for hospitalization and a common cause of in-hospital mortality, Sri Lanka lacks a defined prehospital trauma management protocol, an accredited trauma care hospital network, or an integrated trauma system. Further, there has been a shortage of clinical outcome data following major trauma care, precluding the identification of overall lapses. Wild elephant attack-related human injury has been a subdomain of traumatic injury, which has never been evaluated from the surgical point of view. In such a background, the demographics of the cases, socio-environmental details of the incidents, prehospital care specifics, injury severity classification, treatment details, and clinical outcome data with disability status of the victims of elephant attacks were studied at a rural base hospital in Sri Lanka for 18 months from July 2022. Among 54 eligible cases (males, 37 (68.5%); mean age, 45.4 (range 23–75) years), there had been 13 (24%) fatalities. Polytrauma with intracranial, thoracic, or abdominopelvic injuries has been the main cause of death. For 47 cases brought alive to the hospital, the median transportation duration was 65 min (range 20–125). Among them, six out of 15 patients with class III/IV hemorrhagic shock had crystalloid resuscitation, 10/23 with tachypnoea or pulse oximetry < 94% had received prehospital oxygen treatment, and none of 9 patients with Glasgow Coma Scale ≤ 8 had protected airway as prehospital care. Among 41 survivors, 13 (25%) had suffered major injuries with a revised trauma score ≤ 5. The average hospital stay had been 25.2 days (range 6–79) for major injury survivors and 7.2 days (range 2–26) for survivors with a revised trauma score > 5. Eleven patients (27% of survivors) had a long-term disability, and 20 (49%) had a short-term disability. Seventy-five percent of the attacks have happened during vulnerable time periods (4 am–8 am or 4 pm–8 pm), and 93% have happened in the vicinity of human habitats. Human injuries caused by wild elephant attacks have led to high injury severities, disabilities, and fatalities. Therefore, to reduce the overall negative outcomes of these injuries and to decrease the health economic burden, all possible steps have to be taken for the primary prevention of human injuries caused by wild elephant attacks. The majority of the victims in the cohort have not received prehospital care after the elephant attacks and have been transferred to the surgical facility, with an average transport time of over an hour. With such inferences, this study has highlighted several deficiencies in initial trauma care management in rural areas of Sri Lanka, signifying the need to have an improved prehospital trauma care structure for better outcomes. The development of a streamlined trauma system and a dedicated trauma care hospital network equipped with adequate infrastructure and human resources would be the sustainable answer to this ongoing conce

Several patients present with bilateral renal and ureteric stones with or without hydronephrosis and preserved renal functions. Simultaneous bilateral laparoscopic pyelolithotomy (SBLP) is hitherto, not performed and patients are operated metachronously. Here, we report 3 cases of transperitoneal SBLP in adult and paediatric patients. A 30-year-old gentleman had a recurrent large pelvic stone in the left kidney and a small one in the right; a 40-year-old man had left solitary pelvic calculus with small lower calyceal calculus and broken calcified stent parts in the renal pelvis and upper ureter on the other side. An 8-year-old boy had bilateral solitary renal pelvic stone. All 3 subjects had preserved calyces, mild hydronephrosis, moderate size extra-renal pelvis and preserved renal functions. SBLP under general anaesthesia was performed. Meticulous pyelotomy closure was done using Polygalactin suture 3–0 with intra-corporeal suturing after DJ stent insertion. Single abdominal drain FG 20 was placed in the pelvis in all subjects. Two out of three patients underwent successful removal of all stones on both sides. In the third patient (40-year man), multiple small calculi (< 5 mm) in the left kidney were left behind and the part of calcified broken stent was removed using a ureteroscope. The operative time was 2 h and 25 min on an average in these cases. The blood loss was minimal on an average less than 50 ml. The 3 illustrative cases have paved the path and the confidence to undertake simultaneous bilateral laparoscopic pyelolithotomy and uretero-lithotomy more frequently in other units at our institute. Laparoscopic nephrolithotomy in intra-renal pelvis may be more difficult and is being attempted in single side stones. To start with SBLP may be tried in extra-renal pelvic stones. Second side should only be proceeded on after timely and successful completion on one side.

Gossypiboma is a common iatrogenic complication following abdominopelvic surgeries and has medicolegal implications. Common complications of retained surgical gauze/sponge include abscess formation, granuloma formation, etc. Transluminal migration of gossypiboma is rare and occurs by long-standing necrosis of the bowel wall. We report the case of a lady who presented with vague complaints following trans-abdominal hysterectomy and was found to have a gossypiboma inside one of the ileal loops on computed tomography. The radiologic findings were confirmed intra-operatively.

Male endometriosis is a rare condition whose exact cause remains elusive, with only a handful of cases (17 cases) documented in literature. In the instances reported previously, endometriotic lesions were frequently observed affixed to the urinary bladder, in the inguinal region, and within the lower abdomen. Proposed explanations for its origin point to a hyper estrogenic environment, possibly linked to prolonged estrogen treatment, cirrhotic liver disease, or chronic surgical inflammation.

We report here a rare case of male endometriosis in a 52-year-old diabetic man, who exhibited unusual hematuria and was subsequently diagnosed to have a mass related to the urinary bladder on investigation. Surgical removal and histopathological examination validated the diagnosis. Notably, known etiological factors of male endometriosis were not present in this patient. It is conceivable that persistent embryonic remnants or latent non-alcoholic fatty liver disease in the context of Type II diabetes or obesity may have contributed in the development of endometriosis.

Glutaraldehyde is used in the hospital setup for high-level disinfection of heat-sensitive instruments like endoscopes, bronchoscopes, and arthroscopes. Notwithstanding the occupational hazards, glutaraldehyde is still being used in the third-world countries to facilitate rapid turnover in between cases. The adverse effects of glutaraldehyde spill inside the peritoneal domain have been reported sparingly and highlighted only exceptionally. The authors have shared their experience with inadvertent intra-peritoneal glutaraldehyde-spill during uneventful laparoscopic surgery in a child. The blind spot during laparoscopy, preventive safeguards, and therapeutic outcomes have been highlighted.

Dr. David Coston Sabiston is a pioneer surgeon and an innovator in cardio-thoracic surgery. An image of excellence among surgical trainees across the globe. As chairman of the department of surgery at Duke University, he was reputedly one of the greatest surgeons who ever lived. In 1962, he grafted a vein from a patient’s leg to feed blood past a blocked coronary artery, very first coronary artery bypass grafting (CABG), and promptly known as a moderniser of cardiac surgery. He was the president of all the principal surgical societies in America.