Indian Journal of Surgery最新文献

Kienbock’s disease refers is avascular necrosis of lunate bone also called lunato malacia. It is a rare disease with a prevalence of about 0.0066% Golay [1]. The disease was first described by Austrian radiologist Kienbock in 1910 Wagner and Chung [2]. The disorder usually limits wrist movements may cause pain-swelling in the wrist and is rarely seen in both wrists. It most commonly affects men between the ages of 20 to 40 years [3, 4]. The aetiology of the disease is not very clear but main factors which can be attributed are:- trauma, uneven bones in forearm, irregular lunate bone, underlying medical condition like lupus, sickle cell anaemia and cerebral palsy.

Breast conservation surgery is the standard of care for patients with early breast cancer. Although most surgeons perform oncoplasty for closure of defect, there is no randomised evidence for its favour as compared to simple closure of breast defect. We compared the cosmetic outcomes of patients treated by oncoplasty versus simple closure with 1-cm vs. 2-cm margin of excision. One hundred and four patients with breast cancer were randomised to four groups: excision with 1-cm margin with simple closure or excision with 2-cm margin with simple closure; excision with 1-cm margin and oncoplasty; and excision with 2-cm margin oncoplasty. Fifty-two patients underwent oncoplasty and 52 patients had simple closure of breast defect. There was no significant difference in the cosmetic outcomes in patients undergoing oncoplasty compared to simple closure. Excision with 2-cm margin compared to 1 cm did not worsen the cosmetic outcome. The margin positivity and re-excision rates were higher with 1-cm margin and oncoplastic closure group (p-value 0.018). There was no significant difference in complications between oncoplasty compared to simple closure, and 1-cm vs. 2-cm margin of excision. Simple closure demonstrated similar cosmesis as compared to oncoplasty.

Median arcuate ligament syndrome (MALS) and superior mesenteric artery syndrome (SMAS) are well known abdominal vascular compression syndrome, but coexistence of these is rarely described in literature. We report a patient presenting with chronic abdominal pain, occasional emesis and weight loss and was diagnosed as having coexistent MALS and SMAS. The patient underwent release of celiac artery compression with posterior gastrojejunostomy with good outcome. Coexistent MALS and SMAS is a rare entity.

Introduction

We describe a tissue-based repair technique for primary ventral hernia. We use the anterior rectus sheath as a flap from across the opposite side to cover and strengthen the suture repair in patients with small primary ventral hernia.

Patients and Methods

Patients with primary ventral hernias of 1 to 3 cm defect width were included in this series. We created a rectangle-shaped anterior rectus sheath flap (ARS). The ARS flap was rotated medially to cover the closed hernia defect. The patients operated with this technique were evaluated for postoperative pain, surgical site infection, seroma, hematoma, skin necrosis, hospital stay, readmissions, chronic pain, and recurrence.

Results

We studied eight patients (six men and two women), seven of whom had an umbilical hernia and one epigastric hernia. Two patients had chronic liver disease with ascites and infected hernia. One was an obstructed hernia. The mean defect width was 2.1 cm (range 1.2 to 2.5), and the mean operative time was 40 min (range 30–50 min). The mean pain score on a scale of 1 to 10 on postoperative day one was 2 (range 1–3). The median follow-up period was 14 months (range 12–47). In the postoperative period, none of the patients had surgical site infection, seroma, hematoma, skin necrosis, readmission, chronic pain, or recurrence.

Conclusion

The anterior rectus sheath flap repair gives strength to the simple suture closure in patients with small primary ventral hernia. It is suitable for repair when the mesh is not desired. However, further studies are needed to throw more light on this promising technique.

Abstract

This study is to evaluate intraoperative and postoperative outcomes of hand-assisted laparoscopic colectomy (HALC) and open colectomy in the management of patients needed to removal total colon or colorectum. A systematic literature search with no limits was performed in PubMed and the Cochrane Library. Estimated blood loss, operative time, length of hospital stay, and post-operation complications including ileus, wound infection and leak were extracted. Six researches reporting a total number of 271 patients who underwent HALC or open surgery within restorative proctocolectomy (RPC) or total abdominal colectomy (TAC) were included. There was a significant difference between HALC and open surgery groups in the estimated blood loss (mean difference (MD) = 93.44, 95%CI [51.33, 135.54], p < 0.0001), operative time (MD = − 41.17, 95%CI [− 54.41, − 27.94], p < 0.00001) and length of hospital stay (MD = 1.56, 95%CI [0.24, 2.88], P = 0.02). In the terms of post-operation complications, the incidence of ileus (OR 1.27, 95% CI [0.55, 2.95], P = 0.57) and wound infection (OR 1.21, 95% CI [0.53, 2.79], P = 0.66) were similar between the two groups. HALC could have more effect and safety over open surgery in patients underwent RPC and TAC.

Primary tracheal tumour is a relatively rare condition. Resection of tracheal tumours is challenging as airway is shared between anaesthesiologist and surgeon for providing maximal surgical access while ensuring patent airway and oxygenation at the same time. We report a case of tracheal mass located below the vocal cord almost occluding the tracheal lumen. Awake fibreoptic-guided flexometallic endotracheal tube was placed for initial ventilation; subsequently, another flexometallic endotracheal tube was placed through an incision in the trachea below the tumour for ventilation during resection of tumour. The patient was successfully managed under general anaesthesia through our meticulous preparation and keen vigilance.

Free fibular flap has been widely used for head and neck reconstruction. However, studies on donor-site complications after free fibular flap are lacking. This study aims to systematically review the morbidity of early and late donor-site complications following FFF transplantation for head and neck reconstruction. A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE databases until April 2023. Weighted means was calculated to pool the morbidity of complications. Finally, 34 studies were included. The weighted mean morbidity of common early donor-site complications was wound dehiscence (8%), necrosis (4%), delayed healing (27%), infection (6%), total skin graft loss (1%), and partial loss (11%). Late donor-site complications included chronic pain (14%), limited range of ankle motion (16%), ankle instability (6%), reduced muscle strength (24%), toe weakness (24%), claw toe (19%), gait abnormality (19%), sensory deficit (26%), numbness (28%) and limitations in walking (19%), running (31%), and upstairs (20%). High morbidity of early and late donor-site complications following FFF surgery was observed. Thorough preoperative assessment and flap design are crucial to minimize complications risk. Further studies are warranted to investigate other potential influencing factors and provide more specific treatment suggestions.

There are quite a lot of studies investigating preoperative factors that might be used to predict postoperative hypocalcemia (PH) in thyroidectomized patients; however, there are less studies in parathyroidectomized patients, especially in patients who underwent single parathyroid adenoma excision by using the focused surgical approach. In this study, our aim was to determine whether any preoperative clinical, laboratory, or ultrasonographical feature anticipates PH in parathyroidectomized patients due to primary hyperparathyroidism (PHPT). All patients who operated for PHPT between 2019 and 2021 were retrospectively evaluated. Patients undergoing single parathyroidectomy by using the focused surgical approach were included in the study. Demographic, clinical, ultrasonography, and histopathology results were noted and compared in patients with and without early PH within 4 days after surgery. Of 181 parathyroidectomized patients, 98 underwent focused parathyroidectomy for single parathyroid adenoma. PH was observed in 36 (36.7%) patients. Patients with PH were younger compared to without PH (p = 0.018). Gender distribution and the presence of osteoporosis were comparable. Nephrolithiasis was less prevalent in the hypocalcemia group (p = 0.034). Preoperative levels of calcium, phosphorus, magnesium, parathyroid hormone, alkaline phosphatase, and 25 OH vitamin D were similar in the two groups. Fractional excretion of calcium (FECa) was lower in the PH group (p = 0.045, p = 0.001). Ultrasonographic and histopathologic diameters and volumes of parathyroid lesions were not different in both groups (p > 0.05 for all). In the multivariate analysis, only being 50.5 years old or younger and without nephrolithiasis were found to be associated with PH (p = 0.016, p = 0.026). Patients younger than 50.5 age and without nephrolithiasis might require closer follow-up for the development of early PH.

Anomalous low insertion of cystic duct (LICD) is present in 10.4% of cases. Its preoperative detection is possible with MRCP (95% accuracy). Commonly they present as post-cholecystectomy cholangitis ( Mirizzi's syndrome). Only few small case reports are available in the literature to serve as a guideline for its management. We present the management of 35 cases of LICD done by a single surgeon in the last 10-year period. Thirty four out of 35 cases were post cholecystectomy. We streamlined our surgical management depending on biliary dilatation (cut off 1 cm). Open or laparoscopic CD clearance after slitting CD vertically and obliterating the CD pouch with sutures including the common wall + / − choledocho-duodenostomy if bile duct is more than a centimetre. We did open surgery in 20 cases and laparoscopic in 15. Our follow up duration was 2 months to 3 years with a serial ultrasound and LFT yearly. No recurrence of symptom and/or stricture was noted in all cases except one case had pancreatic duct stones in ampulla that required ERCP. Our 30-day mortality was 1/35 cases (3%) due to severe CRE sepsis. LICD presenting as Mirizzi’s syndrome is a complex surgical problem. We recommend MRCP in all cases. With our surgical approach either open or laparoscopic, by obliterating the CD pouch + / − biliary bypass can cure this problem forever, but we need much larger studies to establish a care pathway for LICD.

The Supreme Court of India has directed the National Medical Commission to find out the rationality of conducting live surgical workshops during medical conferences several times without any clear guidelines or directives. Whilst live surgical workshops are great learning tools for young surgeons, there exists a risk of a breach of patient confidentiality and safety. Do the pros outweigh the cons is to be addressed. The time may be ripe to explore other options like live operations on simulators with the scenario manipulated by Artificial Intelligence (AI), to make it more a real, challenging experience for surgical trainees.