Indian Journal of Surgery最新文献

The AJCC 8th edition has included depth of invasion as per the new CAP guidelines as an independent measure of T staging irrespective of tumour size. This aim of this study was to look at the correlation between depth of invasion measured by the new guidelines and neck nodal positivity rate in cases of carcinoma of the tongue. We performed a case series analysis of 131 cases of carcinoma tongue who underwent wide excision and neck dissection at a tertiary cancer care centre in North Kerala, India. Depth of invasion was reported as per the new CAP/AJCC guidelines and its correlation with lymph node positivity rate was assessed. We also looked at the upstaging caused by the addition of depth of invasion to T staging in the AJCC 8th edition. Lymph node positivity correlates well with depth of invasion, and the coefficient of correlation was 0.89 in our study. The lymph node positivity rate exceeded 15% when the depth of invasion exceeded 4 mm. 59.5% of T1 tumours and 28.5% of T2 tumours were upstaged when AJCC 8th edition TNM staging was used instead of 7th edition. Depth of invasion correlates well with lymph node positivity and the addition of depth of invasion in AJCC 8th edition results in upstaging compared to AJCC 7th.

Cattle injuries are common in India. An injury by cattle is more common in rural and agriculture-dependent regions of the country. Injuries can be related to domesticated or stray cattle. This case series presents a detailed analysis of cattle-related injuries in the northern hilly regions of India. The study was conducted in the General Surgery department of a newly established medical college and hospital in the hilly areas of northen India. Mechanisms, anatomical sites, and patterns of injuries were systematically categorized. The findings shed light on the unique challenges and risks posed by interactions with cattle in these regions along with recommendation to make a law for the safety of human beings and animals to prevent life-threatening events from a preventable cause.

Bariatric surgery has become an effective method for treating severe obesity and its related complications. While the effectiveness and safety of BS have been widely confirmed, micronutrient deficiency has emerged as a long-term complication after surgery. Literature was collected through online searches of PubMed, Cochrane Library, Web of Science, and Embase databases, as well as manual searches. A total of 15 studies, with a sample size of 2993 cases, were included. The studies found that the risk of zinc deficiency increased gradually at 6 months, 1 year, and 2 years after surgery compared to pre-surgery levels. Subgroup analysis revealed that serum zinc levels decreased by 9.40% (95% CI − 16.44%, − 2.36%) at 1 year after laparoscopic sleeve gastrectomy, 9.33% (95% CI − 10.73%, − 7.92%) after Roux-en-Y gastric bypass and one-anastomosis gastric bypass, and 22.30% (95% CI − 30.14%, − 14.46%) after biliopancreatic diversion/duodenal switch. Meanwhile, the total prevalence of zinc deficiency at 1 year after surgery was 26.1%. In conclusion, zinc deficiency worsens and serum zinc levels decrease after bariatric surgery. It is recommended that patients undergoing weight loss surgery undergo regular monitoring of serum zinc levels and receive timely zinc supplementation therapy.

Artificial intelligence (AI), once integrated into medicine, has transformed its role from a mere statistical tool to a sophisticated system capable of guiding surgical procedures and predicting outcomes. AI algorithms utilize machine learning (ML), deep learning, and neural networks to analyze large datasets and identify patterns, ultimately making accurate predictions about patient outcomes. Through continuous learning, adaptation, and updating, these systems assist healthcare professionals in the diagnosis and offer real-time guidance during surgical interventions, reducing surgical error and postoperative complications. This evolution marks a paradigm shift, enhancing precision, efficiency, and, ultimately, patient care in surgery. This review article explores the critical role of AI in predicting surgical complications and discusses associated challenges and ethical considerations.

The increasing number of patients have been electing to undergo breast-conserving surgery via immediate, one-stage direct-to-implant breast reconstruction. Conventionally, this implant-based breast reconstruction is conducted utilizing a surgical methodology in which the pectoralis major muscle is incised to create two distinct planes. However, achieving satisfactory implant coverage remains a significant challenge, primarily due to the supplementary financial implications associated with the use of an acellular dermal matrix patch. There is a pressing necessity to discover an innovative surgical technique to address this limitation. The primary objective of this research is to investigate the potential advantages of employing a flap comprising the pectoralis major and serratus anterior muscle fascia for implant coverage during the process of breast reconstruction. The implant was encapsulated within a lateral tissue pocket, crafted from the fascia of the pectoralis major and serratus anterior muscles. This novel surgical technique maintained the original boundaries of the pectoralis major and serratus anterior muscles and substituted the high-cost acellular dermal matrix with an autologous fascial flap. After the operation, all patients exhibited a diminished rate of complications, with no occurrences of severe post-operative issues. Patient satisfaction surveys were administered to evaluate the esthetic effects of the reconstructed breast shape. All patients successfully underwent the surgical procedure. The aggregate complication rate, specifically for seroma and hematoma, was observed to be a minimal 5.41%, with no instances of capsular contracture recorded. Feedback obtained from the administered BREAST-Q questionnaires indicated good satisfaction and aesthetic outcomes among all the patients with reconstructed breasts. The utilization of a flap composed of the pectoralis major and serratus anterior muscle fascia to craft a lateral tissue pocket encapsulating the implant represents a reliable, secure, and economically efficient surgical methodology. Moreover, this technique can yield aesthetically pleasing outcomes.

To introduce an experience of an anterolateral thigh flap combined with an ilioinguinal flap (ALT-SCIA) for treating severe skin trauma. Retrospective cohort data of 13 cases with complicated lower leg wounds admitted between June 2017 and October 2018 who underwent the ALT-SCIA were studied. The conjoined flap was designed according to the descending branch of the superficial circumflex iliac artery and the lateral circumflex femoral artery. The baseline data and operative details were collected from electronic medical records. These enrolled cases included eleven men and two women, aging from 24 to 55 years old. They underwent an average follow-up of 26.3 months. All flaps survived during the first stage and had good blood circulation, a plump appearance, soft texture, similar color to the receiving area, and no pigmentation. The eventual review presented those four cases acquired bone grafting treatments due to bone defect. The ALT-SCIA method provides adequate composite soft tissue coverage of large defects in the lower leg. Our study found that the flaps could provide abundant tissue and a relatively well-concealed donor area, and showed a relatively good clinical efficacy.

We report a case of appendico-vesical fistula (AVF) in a 12-year-old boy presenting with a 2-month history of solely recurrent painless macroscopic haematuria. Ultrasound and MRI scans were suggestive of an urachus remnant with a calculus in the bladder dome. Cystoscopy showed a bladder diverticulum with mucosal inflammation. Open laparotomy eventually revealed the AVF, as a complication of a clinically ‘silent’ acute appendicitis. AVF is a rare complication of acute appendicitis. A literature review identified 17 further paediatric cases. Whilst faecaluria and pneumaturia are pathognomonic for AVF, these were present in only 24% of patients. Most patients presented with recurrent urinary tract infections or urinary symptoms, and most had a history of abdominal pain and vomiting. Imaging studies and cystoscopy were often inconclusive, and most diagnoses were made at surgery. A high index of clinical suspicion helps to guide diagnosis and treatment.