Showing papers in "International Surgery Journal in 2021"

Study of the efficacy of trauma and injury severity score to predict survival in patients of polytrauma

Abstract: Background: Trauma is one of the major cause of mortality and morbidity in both developed and developing countries. Polytrauma patients present particular challenges as profile of the patient varies with different types and severity of injuries. Prediction of survival in trauma patients is an essential requirement of trauma care. Trauma and injury severity score (TRISS) have been considered as a standard of the quality of trauma care. Study was carried out to evaluate the performance of TRISS in predicting survival in patients of polytrauma.Methods: Prospective observational study was conducted in emergency department of a tertiary care centre. 100 patients were evaluated in the study for a period of 18 months between November 2019 and April 2021. Patient demographics, details of trauma, pattern of injuries and physiological status were recorded. Overall outcome were studied and data analysis was done on the basis of TRISS. Statistical analysis was performed using statistical package for the social sciences (SPSS) program for windows, version 25.0 (SPSS Chicago, Illinois).Results: Young patients with mean age of 34.54 were most commonly affected in polytrauma with male preponderance. Road traffic accidents were the most common mode of trauma followed by fall from height. Blunt trauma was the most common type of injury. TRISS strongly predicted survival in polytrauma patients (AUC 0.926 CI 95% 0.868-0.985). TRISS has high sensitivity 97.62% and specificity 62.50% at a cut off of 64.50%.Conclusions: TRISS is an effective method for predicting survival of polytrauma patients and thus can be utilized to evaluate and compare trauma care.

Breast fibroadenoma and its clinical perspectives: a prospective observational study

Abstract: Background: To study the patterns of breast fibroadenoma in females and to co-relate them with the pathological findings.Methods: Sixty six females who attended the Surgery Department in Darbhanga Medical College, Bihar, a tertiary centre in rural area, with benign breast lump during the period Bihar during period of November 2009 to November 2011, were studied. Early diagnoses by doing a triple assessment like a clinical examination, FNAC or a core needle biopsy and imaging methods like ultrasonography or mammography. The clinical diagnoses were compared with the cytological or histological findings wherever possible and their accuracies were evaluated.Results: Out of the 66 confirmed fibroadenoma female patients who were studied, most patients presented as a painless lump which is need to be differentiated from carcinoma. Most of the patient (63%) presented within 6 months of development of breast lesion showing increasing awareness in females of rural India. The maximum number of patient presented (55%) is of 2nd to 3rd decade. It was found that maximum number of patients have upto three children due to early marriage in rural background.Conclusions: Fibroadenoma is a common cause for breast lump even in rural background. Triple assessment provided a quick diagnosis and it alleviated unnecessary anxiety from the patients about breast cancer. The clinical diagnosis of a breast lump, as confirmed by cytology and histology, was accurate in most of the cases.

Bacteriological profile of diabetic foot

Abstract: Foot infections in patients with diabetes mellitus are a major cause of morbidity, can lead to gangrene and ultimately amputation of the limb. Aim of the study was to determine the type of microorganisms isolated from the Diabetic foot ulcer and antibiotic resistance pattern. We have included 50 patients having diabetic foot ulcers of Wagner's grade 1 or above in our study. Debrided tissue, pus, or swabs from the base of the ulcers were subjected to aerobic and anaerobic culture. The organisms were identified, and further antibiotic sensitivity was conducted. Seventy-two aerobic and 13 anaerobic organisms were isolated. Among the aerobic and anaerobic bacteria isolated, most predominant organisms were S. aureus and Bacteroides spp.; respectively. Of the S. aureus , 77.8% were methicillin resistant, while 42.1% of gram-negative Enterobacteriaceae were extended spectrum beta-lactamase (ESBL) positive. Klebsiella spp. was the highest ESBL producer. Acinetobacter spp. was the highest MBL producer. Most sensitive drugs for S. aureus were linezolid, vancomycin and amikacin. Gram-negative bacteria were mostly sensitive to piperacillin-tazobactam and amikacin. Pseudomonas spp. were usually sensitive to meropenem, piperacillin -tazobactam. Acinetobacter spp. was sensitive to colistin, tigecycline. As diabetic ulcers are often infected by multidrug-resistant bacteria, a knowledge of the common bacterial pathogens implicated as well as their sensitivity pattern helps the clinician to choose the proper antibiotic for a timely treatment.

East surgical ward enteric perforation score: a new statistically valid scoring criteria for decision between repair or ileostomy in patients with peritonitis due to enteric perforation

Abstract: Background: Enteric fever leading to enteric perforation is very common surgical emergency in the developing nations. The two surgical solutions used worldwide are to repair or exteriorize the perforation as ileostomy. The aim of the study was to setup and validate a statistically reliable scoring system for decision between repair and ileostomy in patients with peritonitis due to enteric perforation.Methods: It was an observational cross-sectional study done at East Surgical Ward of Mayo Hospital, Lahore. 256 patients were selected by consecutive non-probability sampling after ethical approval. The duration of study was 2 years from 1st August to 2018 to 30th July 2020. Patients with age more than 13 years presented in emergency department with diagnosis of peritonitis due to enteric perforation were included. A preformed scoring criterion named as East surgical ward enteric perforation (ESWEP) score was set by giving each variable a score of 1 to 3. Cut-off value between repair and ileostomy was observed.Results: 142 (55.4%) patients were male and 114 (44.5%) were female. Male to female ratio was 1: 1.24. The average age of patients is about 37 years with SD of ±9.67 years. ROC curve showed cut-off of pre-operative ESWEP score of 4 (sensitivity78%, specificity of 88%), per operative score of 7 (sensitivity 96%, specificity of 85%) and total ESWEP score of 11 (sensitivity 94%, specificity of 88%).Conclusions: ESWEP score is new score which helps in standardization of operative procedure done for the patients with peritonitis due to enteric perforation.

A successful delivery of giant bladder stone by obstetric forceps: a case report

Abstract: Bladder stones are the most common form of lower urinary tract stone and are frequently seen in elderly men. Most cases develop as a result of infravesical obstructions such as prostatic hyperplasia and neurogenic bladder. Giant bladder stone on the other hand is a rare phenomenon. In current urological practice, giant bladder stones weighing over 100 grams are rarely seen. Giant bladder stones which cause obstructive uropathy and acute renal failure are even less common. Retrieval of bladder stone during open surgery is usually uncomplicated except in some cases. Obstetric forceps have been described to successfully deliver giant bladder stones in such cases.

Inferior pedicle with inverted-T procedure for bilateral reduction mammoplasty provided satisfactory surgical and aesthetic outcome

Abstract: Background: The objective of the study was to evaluate surgical and aesthetic outcomes of bilateral reduction mammoplasty (RM) through the inferior pedicle with inverted-T approach (PO). Methods: 23 women with bilateral symptomatizing macromastia underwent preoperative breast measurements, calculation of breast volume (BV), determination of quality of life (QoL) and self-esteem scorings using the breast reduction assessed severity scale (BRASS) and the Rosenberg self-esteem scale (RSES). RM was performed and intraoperative and PO data were collected. At 3-m PO, aesthetic outcome was evaluated using the ABNSW score, which assesses breasts asymmetry and shape, nipple deformation, skin condition and wound scar, and QoL outcome and overall satisfaction were determined. Results: Mean operative time was 240.4±39.7 min and mean weight of excised breast tissue was 2778.3±307.7 gm. Minor PO complications were managed conservatively and no patient required revision surgery. PO breast measurements were significantly improved with decreased BV and increased breast projection. Median ABNSW score was 10 and PO median BRASS and RSES scores were 9 and 17 with significant change in comparison to preoperative data. Preoperative BRASS score was negatively correlated age and body mass index, while RSES score was positively correlated with age. Nine women were highly satisfied by aesthetic outcome, 10 women were satisfied and 16 women were highly satisfied with overall outcome. Conclusions: RM significantly improved women QoL, aesthetic appearance and psychological status. Inferior pedicle with inverted T-mammoplasty is a safe, and applicable pattern of mammoplasty, allow significant reduction of BV with improved breast measurements and projection and provide satisfactory aesthetic outcome.

Assessment of immediate postoperative complications in patients undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis with pre-existing co-morbid conditions

Abstract: Background: Elective laparoscopic cholecystectomy done by experienced surgeon continues to be a vary safe operation however from surgical point of view, presence of co-existing clinical conditions offer independent complication risk but the influence of these clinical conditions such , diabetes, hypertension, respiratory etc. has not been emphasized enough. This study is an effort to determine the influence of co-existing clinical conditions on morbidity and mortality following laparoscopic cholecystectomy.Methods: This prospective observational study was conducted over a period of 1.8 years from August 2017 to April 2019. On the basis of selection criteria patients with symptomatic cholelithiasis were divided into two groups cases and control group. The evaluation of morbidity was done in terms of any wound infection, chest infection, cardiac complications, cholangitis, deep vein thrombosis, septicemia, etc.Results: Distribution of complications was comparable between cases and controls. (Nil: 90% versus 92.50% respectively. Proportion of patients with complications was significantly lower in patients without history of previous attack as compared to with history of previous attack. Distribution of complications were comparable between diabetic and non-diabetic.Conclusions: The presence of co- morbid conditions in the form of diabetes mellitus and hypertension does not in-crease the risk of immediate post operative complications. However, history of previous attack of acute cholecystitis can increased chances of intra-operative adhesions around calots triangle prolonging the duration of surgery which in turn can increase the risk of post operative complications.

Pattern of illnesses presenting as acute abdomen: surgical study in 118 patients

Abstract: It is a term used to describe a symptom complex; of which, pain in the abdomen is a predominant feature. There may be associated symptoms like vomiting, anorexia, constipation, abdominal distension and fever. It has sudden onset or onset over a short period of time, can persist for several hours to days and is associated with a wide variety of clinical features specific to underlying disease. Such disease may be surgical, medical or gynaecological condition. Psychogenic pain may also present in the same manner. The clinical course may develop over a variable time period and may not have fully evolved by the time of presentation.

Increasing antimicrobial resistance is not inevitable: in reply to microbiological and antibiotic profile of osteomyelitis tertiary care hospital

Abstract: Notably, the authors report that for Staphylococcus aureus, the most commonly isolated pathogen, 75% of isolates were resistant to gentamicin, 81% to ciprofloxacin and 50% were methicillin resistant Staphylococcus aureus (MRSA). With regard to gram negative isolates the predominant species were Pseudomonas aeruginosa and Acinetobacter baumanii. Both pathogens are intrinsically highly antibiotic resistant, however a high number of the isolates reported in this study were in addition resistant to carbapenems (42.9% meropenem resistant Pseudomonas, 54.5% meropenem resistant acinetobacter). The authors report rising rates of antimicrobial resistance which they regard as inevitable, as a result of extensive antibiotic use. They advocate surveillance to monitor these changes in infection aetiology.

A comparative study to assess the post-operative complications between laparoscopic cholecystectomy versus open cholecystectomy

Abstract: Background: Cholelithiasis is a common problem these days. Earlier it was considered the health problem of the female only. But now it is quite common in the males also. The prevalence of gallbladder stone disease (GBSD) in female to male is 3:1 in 18-65 years age group. In the developed countries GBSD is common and occur in 7% in male and 15% in female with an overall prevalence of 11%. Cholecystectomy is one of the most common operation carried out in general surgery. Methods: Our study was conducted on 60 patients divided in 2 groups of 30 each to compare post-operative complications between laparoscopic cholecystectomy and open cholecystectomy. Results: As per findings of the present study duration of pain, rate of complications and total hospital stay were significantly lower in laparoscopic group. There was early removal of drainage tube, early stitch removal in laparoscopic group. Conclusions: Laparoscopic cholecystectomy can be recommended as first choice operative treatment for patients with cholelithiasis as it provides better cosmetic results, lesser pain, early removal of drainage tube, lesser post-operative hospital stay and fewer incidence of surgical site infection. It should be an available option for all patients requiring elective cholecystectomy.

The orthopedic patient and limb amputation: impact of traditional beliefs on acceptance in Port Harcourt, Nigeria

Abstract: The relationship between belief systems and health has been severally documented, especially as health implies a state of complete physical, mental, social, (and spiritual) wellbeing and not only the absence of disease or infirmity. Also, the impact of education and sociocultural orientations on individual acceptance of intended forms of treatment has been reported. Acceptance of surgical limb amputation will therefore be affected by similar factors depending on the society. Surgical limb amputation is a form of treatment recommended in conditions of dead, dying, dangerous limb or damn nuisance, in which the appendage is removed surgically and permanently from the rest of the body. A lot of emotions are known to be involved due to profound ABSTRACT

Gangrenous bowel ischemia-a complication of COVID-19: a case report

Abstract: In December 2019, various digestive symptoms have been frequently reported in the patients infected with virus. A multicentre study in Hubei, China found that nearly 50% of the patients of COVID-19 had symptoms associated with gastrointestinal system in the form of lack of appetite, diarrhoea, vomiting or abdominal pain. Coagulation abnormalities in form of raised D-dimer and fibrinogen levels were also found in such cases. Fibrin formation and polymerization may predispose to thrombosis and corelate with worse outcome such as ischemia of the organ. Ischemia colitis, a condition that results from a lack of arterial blood supply to the colon, has been linked to hypercoagulable states.

Comparative study between POMPP score versus Boey score to predict morbidity and mortality in peptic perforation peritonitis

Abstract: Background: Peptic ulcer disease (PUD) results from an imbalance between stomach acid-pepsin and mucosal defense barriers. It affects 4 million people worldwide annually. Peptic ulcer perforation is one of the most common surgical emergencies and is associated with a high rate of morbidity and mortality. This is due to presence of various risk factors among the population like H. pylori infection, long term NSAID use, alcohol ingestion, smoking and steroid use. Peptic ulcer perforation peritonitis usually requires an emergency surgical intervention and hence the need for this study, to compare POMPP and Boey scores as predictors of morbidity and mortality in patients with peptic perforation peritonitis. Methods: This prospective observational study was conducted in the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020. All patients above 18 years with features of hollow viscus perforation with per-operative finding of perforated peptic ulcer were included in the study. Patients with histopathology suggestive of malignancy were excluded. Results: A total of 65 patients were included in the study. On analysis of the data by Chi-square test, P value of both POMPP and Boey scores was found to be 24 hours, age >65 years and pre-operative shock. Conclusions: Both scoring systems are easy to use and can assist in accurate and early identification of high-risk patients and are important in predicting mortality and morbidity in patients with peptic ulcer perforation.

Spectrum of urological procedures in Yobe State University Teaching Hospital: an initial experience in a young west African hospital

Abstract: Background: In auditing the surgical procedures of a hospital, services rendered to patients are reviewed using the data generated from the procedures, hence the outcome is used as a framework for improvement in future and capacity building. Objectives of the study were to analyze the indications for Urological procedures with the procedures performed at Yobe State University Teaching Hospital (YSUTH) and share our experience, with recommendation for future improvement . Methods: Retrospective hospital-based study on patients who had urological procedures done in YSUTH between March 2018 to April 2020. Urology patients that have not undergone any urological procedure were excluded from the study. Data obtained from the records in the operation theatre, emergency unit and medical record department of the hospital. Results: There were 185 patients with indications for surgery, constituting 41.0% of all general surgery patients. Male to female ratio was 8.7:1 and the median age range was 70-79 years. A sum of 212 urology procedures performed. Benign prostate hyperplasia (BPH) and prostatectomies were the commonest diagnoses and elective procedures respectively, while urethral stricture and bladder cancer were the 2 nd and 3 rd diagnose respectively. Urethral catheterization for urine retention in BPH was the commonest emergency procedure. Cystoscopy was the commonest day case and the commonest among endo-urology procedures. Conclusions: BPH, followed by urethral strictures and bladder cancers were the commonest diagnoses and indications for surgery. Urine retention in BPH is the commonest emergency requiring urthral catherization. Creation of dedicated day surgery unit and employment of permanentt consultant urologists and more health personnels relevant to urology, will improve the quality and quantity of services rendered.

Laparoscopic management in hydatid disease of liver: a series of 35 cases

Abstract: Background: The purpose of this study is to analyse the sociodemographic factors & clinical features of hydatid disease of liver and to emphasize on the safety, efficacy and the role of laparoscopy in its management in the present scenario. Methods: A prospective observational study was done for 35 patients who were diagnosed with and later underwent surgical intervention laparoscopically for hydatid disease of liver over a duration of 3 years from January 2017 to December 2019. Diagnosis was based on the history, clinical examination, ultrasonography of abdomen (USG) and contrast enhanced computed tomography scan of abdomen (CECT). Results: A slight female preponderance with most cases in the 4th decade of life and belonging to rural areas and low socio-economic status. A single cyst in the right lobe of the liver was most common lesion. The most common surgery performed was laparoscopic de-roofing of the cyst with omentoplasty. The most common complication was intra-operative spillage of cyst contents followed by post-operative biliary leak. Conclusions: In the present era laparoscopic surgery is safe, efficacious and plays a crucial role in the management of hepatic hydatid disease with its proven benefits over the conventional surgeries including less morbidity and mortality and reduced rate of recurrence.

Is limberg flap better than excision and primary closure for treatment of sacrococcygeal pilonidal sinus: a prospective randomised study of 30 cases

Abstract: Sacrococcygeal pilonidal sinus is a common presentation to the office of both the General Surgeon and Coloproctologist. Over time various treatment modalities have evolved for the same. Older methods such as excision with or without closure have been associated with higher complications in the post-operative period, recurrence rates and hospital stay. Flap procedures have a longer operative period and a steep learning curve but a better overall post-operative course and lower recurrence rates. Our study was done to compare the outcomes of primary excision and closure to a Limberg flap for treatment of sacrococcygeal pilonidal sinus. The objective of the study was to determine whether Limberg flap was superior to excision and primary closure for treatment of pilonidal sinus. 30 patients presenting with chronic pilonidal sinus where randomly assigned to two groups of 15 patients each. Both the groups were compared in terms of age of presentation, sex prediliction, duration of surgery, post-operative resumption of work, complications and recurrence. We concluded that Limberg flap is superior to excision and primary closure for treatment of pilonidal sinus.

Why are we still using antibiotic prophylaxis in elective laparoscopic cholecystectomy for the low-risk groups? a review of literature

Abstract: Gallstone disease is one of the most common gastrointestinal conditions requiring surgery and more than 90% of cholecystectomies are done laparoscopically. Since 1990 LC has been stamped as the gold standard approach for uncomplicated gallstones and other benign gallbladder conditions and the reasons behind that are less postoperative pain, smaller incision and shorter hospital stay. Though LC achieved the gold standard level it is not spared with complications. The major complications of LC are major bleeding, Bile duct injury, and wound infection or surgical site infection (SSI). Before LC become the gold standard the incidence of SSI, related to open cholecystectomy (OC) was between 3 to 47%. In LC the incision site is smaller and due to the use of the trocar, wound exposure and contamination are less common as compared to the OC resulting in a significant reduction in SSI.

Microbiological and antibiotic profile of osteomyelitis in tertiary care hospital

Abstract: Background: Osteomyelitis has been continuing as the most important cause of morbidity among patients with bone infections. Constant change in the trend of organisms involved and resistance pattern has made management of osteomyelitis cases difficult. With this background present study aimed to look for the changing trends of microorganisms involved in osteomyelitis and their antimicrobial susceptibility pattern. Methods: A total of 100 cases studied over a period of two years. Samples collected were processed by standard microbiological techniques and antimicrobial testing was done as per the clinical and laboratory Standards Institute guidelines. Results: Among 100 cases, 62 were males and 38 were females, with the mean age of all the patient was 51.6±12.32 years. 64% of the patient were diabetic patients. Long bones are most involved with trauma (45%) as risk factor. Staphylococcus aureus (24.2%) predominant pathogen isolated followed by Pseudomonas aeruginosa (21.2%) and Acinetobacter baumannii (16.7%). Antibiotic sensitivity testing of gram positive organisms showed hundred percent sensitivity to vancomycin and gram negative bacteria showed highest sensitivity to cefoperazone+sulbactam, piperacillin+tazobactam, meropenem and imipenem. Conclusions: Osteomyelitis caused by methicillin resistant staphylococcus aureus and carbapenem resistance gram negative bacteria is a serious concern. Since multidrug resistant strains have emerged in osteomyelitis cases, emphasis should be given for hygiene and targeted antibiotherapy.

Comparative study between clinical diagnosis using modified Alvarado score and ultrasound imaging in decreasing negative appendectomy rate

Abstract: Acute appendicitis is the acute inflammation of appendix which is the most common cause of acute surgical emergencies. It has a lifetime risk of about 8.6% in males and 6.7% in females. It may progress to perforate which is associated with higher morbidity and mortality. Hence, surgeons are more inclined to operate when diagnosis is probable rather than wait till it is certain. Rate of appendectomy for appendicitis is at 10 per 10,000 patients per year. Appendicectomy for appendicitis is the most commonly performed emergency operation in the world. Despite the increased use of ultrasonography, computed tomography and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%) as has the rate of appendicular rupture. Experienced clinicians accurately diagnose appendicitis based on a combination of history, physical examination and laboratory studies about 80% of the time. Removing normal appendix is an economical burden both on patients and health resources. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis. A scoring system described by Alvarado was designed to reduce negative appendicectomy rate without increasing morbidity and ABSTRACT

Efficacy of haemorrhoidectomy versus haemorrhoidectomy with internal sphincterotomy in treatment of haemorrhoids: a retrospective randomized controlled trial study

Abstract: Background: Role of internal sphincterotomy along with hemorrhoidectomy in reducing the pain among the cases with hemorrhoids is still a debate among most of the surgeons. Hence this study was conducted to compare the efficacy of haemorrhoidectomy with or without internal sphincterotomy in reducing the post-operative pain among the patients with haemorrhoids. Methods: A hospital based randomized controlled trial study was conducted among the patients with haemorrhoids undergoing surgical intervention for the same in department of general surgery in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, during the study period from July 2017 to December 2019. A total of sixty cases with haemorrhoids were included in the study. Patients in group A (n=30) underwent haemorrhoidectomy alone and group B (n=30) underwent haemorrhoidectomy along with internal sphicterectomy. Data entry was done using Microsoft excel and data was analyzed using Statistical Package for Social Sciences (SPSS) version 17. Results: In the present study, mean pain scores on first three post-operative days and the duration required to resume the normal activities was found to be low in the group who underwent haemorrhoidectomy with internal sphincterectomy compared to the group who underwent haemorrhoidectomy alone. Duration of surgical procedure and the complications were found to be similar in both haemorrhoidectomy with internal sphincterectomy group and haemorrhoidectomy alone, group. Conclusions: Haemorrhoidectomy with lateral Internal Sphincterotomy is better in terms of less pain but the complications were similar in both groups.

Problems and impact of use of private owned theatre wears as seen by theatre users

Abstract: Background: The surgical theatre wear or attire include but are not limited to surgical caps, surgical scrubs, theatre aprons, and theatre foot wears. The basic principles in the care and maintenance of theatre wears are aimed at ensuring safety and infection prevention and control. Aim was to explore the problems associated with private owned theatre wears (scrubs, boots and aprons); and examined the impact of semi-closed mode of procurement and maintenance of theatre wears on theatre users in the tertiary healthcare setting. Methods: A cross-sectional descriptive study was done among theatre users in a tertiary healthcare center using self-administered semi-structured questionnaires. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: One hundred and twenty-nine (60.6%) respondents affirmed that the mode of care of theatre scrub was not standard. 133 (62.4%) of the respondents asserted that there were problems associated with the semi-close mode of care. Nearly half (42.3%) of the respondents stressed that bad smell and contamination were their worries, and most respondents call for a change in the model of procurement and care of theatre wears. Conclusions: There were problems associated with the semi-closed system as revealed in this study, which bothers on safety of the theatre staff. Most respondents were negatively impacted, rated the current practice below standard, and call for a change in policy.

Comparative study between BISAP score and Ranson score in predicting severity of acute pancreatitis

Abstract: Background: Acute pancreatitis has widely variable clinical and systemic manifestations spanning the spectrum from a mild, self-limiting episode of epigastric pain to severe, life-threatening, multi-organ failure. Since the morbidity and mortality of acute pancreatitis differ markedly between mild and severe disease (mild <5% versus severe 20–25%), it is very important to assess severity as early as possible. To assess the accuracy of the BISAP scoring system versus Ranson scoring system in predicting severity in an attack of acute pancreatitis. Methods: It is a prospective and retro prospective study that was conducted, from August 2018 to November 2019. All surgical units in the headquarters hospital, Ooty. BISAP score and Ranson’s score is calculated in all such patients based on data obtained within 48 hours of hospitalization. Results: Ranson’s score of more than 3 and the BISAP score of less than or equal to 3 had the best accuracy of predicting the severity of acute pancreatitis. Both Ranson’s score and BISAP score showed higher sensitivity in the prediction of systemic complications than that of local complications. Conclusions: From this study, we can conclude that the BISAP scoring system is not inferior to Ranson’s scoring system in predicting the severity of acute pancreatitis. BISAP scoring system is very simple, cheap, easy to remember and calculate. BISAP scoring system accurately predicts the outcome in patients with acute pancreatitis.

Thyroid function and gallstone disease: is there an association?

Abstract: The disorders associated with biliary tract stones dates way back to the 21 Egyptian dynasty and not just in the modern era. Around 2000 years ago, young Egyptian women had gallstones, during the period of The Roman Empire, as suggested by archaeological evidence. The core process involved in this chronic hepatobiliary disease, Cholelithiasis, is impaired cholesterol, bilirubin and bile acid metabolism, resulting in the formation of gallstones in the hepatic duct, common bile duct or gallbladder. In the western population, majority of the Gallstones are cholesterol stones. Around 6.12% of the adult Indian population is affected by Cholelithiasis. The incidence has increased these days, partly because to the wide use of ultrasonography in the last two decades and also due to the changing socio-economic conditions and other epidemiological factors including diet. Some of the non-modifiable risk factors for cholesterol gallstone formation are ethnicity, increasing age of the patient, female gender and a family history of gallstones. On the contrary, the modifiable risk factors for the formation of cholesterol stones include sedentary lifestyle, obesity and rapid loss of weight. Diseases like cirrhosis, chronic haemolysis and Crohn's disease have been identified as risk factors for the formation of black pigment stones. Gallstone disease in children is rare and has been found to have an association with risk factors which are similar to those in adults, particularly obesity.

A comparative study to evaluate milligan morgan hemorrhoidectomy versus pile suture method in management of haemorrhoids

Abstract: Haemorrhoids are by far one of the commonest afflictions for surgeon consultations in the present times. Worldwide, the overall prevalence of hemorrhoids in the general population is estimated to be 4.4%. The management of haemorrhoids is multivariate out of which Milligan Morgan Open Hemorrhoidectomy is commonly used procedure but, it is associated with many complications such as prolonged post operative pain, increased hospital stay and increased time taken to return to routine work. The surgical technique for hemorrhoidectomy has been modified in an attempt to lessen postoperative complications and allow earlier patient discharge. Therefore less invasive techniques such as band ligation, injection, sclerotherapy, radiofrequency ablation and staplers hemorrhoidopexy were introduced. These are less destructive but cost and availability outcast them too . In 1978 Farag introduced the pile suture technique for the treatment of hemorrhoids which he reported to give better clinical impact than the conventional ligation and ABSTRACT

A comparative study on outcome of surgical management of varicose veins with and without venous stripping

Abstract: Background: Varicose veins are dilated, elongated and tortuous veins. Though not a very fatal disease the morbidity caused by this disease is more. The treatment modalities available are conservative, surgical and endovenous therapies. In this comparative study, the outcome of surgical management of varicose veins with and without venous stripping is compared and analyzed. Methods: During the period of September 2017 to November 2018. 92 cases of varicose veins were operated in all surgical units in the headquarters hospital, Ooty. A thorough clinical examination in good light will give the maximum information about the varicosities. To avoid recurrence due to anatomic variations in the leg veins and to mark the exact site of incompetent vessels for easy surgical approach with minimal incisions and to rule out deep vein thrombosis (DVT) imaging studies are now routinely done. Results: The hematoma formation in the thigh was seen in 28% of patients who underwent venous stripping whereas it was seen in 4% who underwent Trendelenburg procedure alone without venous stripping. These wounds were examined in the postoperative period. 4% of patients in each group had delayed wound healing. Conclusions: Concerning wound healing, hospital stay, and pain relief there is no significant difference between the two procedures. So, as for as the variables observed, the Trendelenburg procedure with incompetent perforators ligation without venous stripping appears to be better than Trendelenburg procedure with incompetent perforators ligation with venous stripping.

Intraoperative strategies to overcome difficulties in laparoscopic cholecystectomy for chronic calculous cholecystitis

Abstract: Background: Surgery in chronic cholecystitis is very challenging because of inability to hold the gall bladder, dense adhesions, frozen Calot’s triangle and difficulty in applying clips. Precise and meticulous dissection is required to establish critical view of safety. There is no consensus among surgeons about appropriate intraoperative steps in difficult gall bladder (GB) surgery. The authors aim to present various intraoperative difficulties and strategies to overcome them. Methods: A prospective study of 81 patients of chronic cholecystitis was done in our institution. They were divided in two groups. Group A in which surgery could be done easily. Group B in which surgery was difficult and different intraoperative strategies were applied to overcome them. Results: Total 42 patients were included in group A and 39 patients in group B. Various difficulties encountered while performing laparoscopic cholecystectomy in group B were adhesions (53.8 %), inability to grasp the fundus of GB (15.3%), frozen Calot’s triangle (15.3%), inability to grasp the Hartmann’s pouch (12.8%) and cystic duct edema (2.5%). Conclusions: Intraoperative technique of identification of Rouviere′s sulcus first, followed by high peritoneal incision on the GB body. Subsequently blunt dissection of Calot’s triangle using gauze piece and hydro dissection by suction irrigation canula ventral to the sulcus. It created a retro gall bladder tunnel safely. It established the critical view of safety in all our cases.

Computed tomography severity index and serum CRP concentration for predicting the severity of acute pancreatitis

Abstract: Acute pancreatitis is highly variable in clinical presentation and severity. In the majority of patients, the course is mild and self-limiting, but in 20% of patients it may become fulminant and progress to multisystem organ failure and death. Because of this potential for catastrophic deterioration, the stratification of injury severity is essential. It is necessary to manage these patients in an intensive care unit with early and aggressive treatment in order to improve outcome.

Multiple spontaneous jejunal and ileal perforations: a diagnostic challenge

Abstract: Spontaneous multiple small bowel perforations are rare. Perforations of jejunum and ileum contribute to around 0.4% of patients presenting with acute abdomen. While the diagnosis of hollow viscus perforation is relatively straight forward, the site of perforation is often made only after laparotomy. The cause of small bowel perforation, in India, is often due to infections – typhoid fever and tuberculosis. In the Western countries, trauma forms the leading cause, followed by closed loop obstructions, malignancy, jejunal diverticula and tumours. Less common causes of small bowel perforations include Crohn’s disease, ischaemia, iatrogenic manipulations, and drugs such as potassium chloride and steroids.

Acute appendiceal diverticulitis diagnosed in the postoperative context of appendectomy

Abstract: Acute appendiceal diverticulitis is a rare cause of acute abdomen that is commonly interpreted as acute appendicitis until definitive histological result We herein present two cases of patients of distinct age groups and gender who presented to the emergency department with right lower quadrant abdominal pain Laboratory and imaging studies led to the diagnosis of acute appendicitis In both cases, intraoperative findings were compatible with the initial diagnosis and therefore appendectomy was performed Later pathological exam showed diverticulitis of the vermiform appendix Although appendiceal diverticulitis is associated with a higher risk of perforation and neoplasms, both patients had linear postoperative period, without complications or dysplastic findings Despite its similarities to the acute appendicitis, appendiceal diverticulitis presents itself as a distinct entity and should be suspected in patients with right lower abdominal pain in older age and with longer duration of symptoms

Extensive post-covid mucormycosis salvaged by old fashioned negative pressure wound therapy

Abstract: Mucormycosis represents a group of life threatenening infections caused by fungi of the order Mucorales. Mucorales are ubiquitous environmental fungi that grow well in moist and damp conditions. They can invade arteries to cause thrombosis and infarction. These fungi cause infection primarily in patients with diabetes, neutropenia, elevated levels of free iron and those who are on glucocorticoid therapy, which supports fungal growth in serum and tissues. Recently the incidence of mucormycosis was found to have increased in patients previously infected with coronavirus (COVID-19). Here we presented a 52 year old lady who was previously infected by coronavirus, was administered glucocorticoids as a part of empirical treatment for COVID-19 pnemonitis. She recovered uneventfully within a few days, but, around a month later presented with erythematous papule over the anterior chest wall. The papule developed into a large fungating ulcer over a period of 10 days. KOH mount and culture confirmed it to be mucormycosis. Cutaneous mucormycosis can be highly invasive, penetrating into muscle, fascia and even bone. These are molds that grow well in moist and damp conditions. But depriving them of moisture and oxygen can help control their spread. This could be achieved by thorough debridement and applying negative pressure to the wound. The results achieved are remarkable and satisfactory.