Academia Journal of Surgery

Assessment of Usefulness of CRP, PMN Elastase, PCT and Il- 6 as Prognostic Factors in Patients with Acute Pancreatitis

2021-01-11T07:28:46+00:00

Background: Acute pancreatitis is an inflammatory disease of the exocrine pancreas with rapid onset. The present study was conducted to assess the usefulness of CRP, PMN elastase, PCT and IL- 6 as prognostic factors in patients with acute pancreatitis. Subjects and Methods: The present study comprised 53 patients who presented with a diagnosis of Acute Pancreatitis. CRP was estimated by turbidimetric immunoassay using CRP/U2A-000 kit. PMN-Elastase was estimated by solid-phase enzyme immunoassay. Procalcitonin was estimated by the immuno- chromatographic test. IL-6 was estimated by Immuno-enzymatic assay. Results: There were 47 males and 6 females in the present study. The mean SD CRP in patients with mild pancreatitis was 44.35 53.04 and in severe pancreatitis was 174.80 14.55, PCT was seen in 4 in mild pancreatitis patients and 12 in severe pancreatitis patients, PMN- elastase level was 3.89 1087 in mild pancreatitis and 3.99 2.75 inn severe pancreatitis patients, IL-6 level was 129.63 319.08 in mild pancreatitis and 1166.76 818.06 in severe pancreatitis patients. The difference was significant (P< 0.05). CRP had higher (100) specificity as compared to PCT (81), PMN- E (10) and IL- 6 (90), Specificity found to be 88, 81, 97 and 94 respectively, PPV was 84, 74, 67 and 90 respectively, NPV was 100, 87, 62 and 94 respectively, accuracy was 92, 81, 62 and 92 respectively, AUC was 0.97, 0.81, 0.43 and 0.95 respectively. Conclusion: Authors found that CRP is the single best predictor of the severity of acute pancreatitis. IL-6 and PCT also are reliable predictors. PMN-Elastase needs to be assessed in patients with acute pancreatitis presenting early in the course of the illness.

Assessment of the Role of Laparoscopic Management in Patients with Complicated Appendicitis

2021-01-11T07:30:22+00:00

Background: Present research aimed to evaluate the wellbeing and the effectiveness of laparoscopy for managing complicated appendicitis. Subjects and Methods: Present descriptive research was carry out on 50 patients at tertiary care institution of Gujarat for the period of 1 year. This study is including patients of complicated appendicitis undergoing laparoscopic management. Parameters studied included Age, Gender, WBC count, wound infection and hospital stay. Results: There was increase of total leucocytic count (leukocytosis) in most of the patients; Mean WBCs was 12.71 5.37. 33 patients had pus free IPF collection and perforated appendicitis (PA), 11 patients had turbid free IPF collection with AA (highly inflamed appendix), 2 case was mucocele of the appendix, 2 cases of appendicular abscess (3.3%) and 2 cases of gangrenous appendix. Conclusion: management of complicated appendicitis laparoscopically is practicable, secure and can present a small occurrence of infectious impediments, fewer post-operative pain, fast revival and improved cosmesis on the cost of extended operating time than OA.

A Rare Case: Gall Stone Induced Acute Pancreatitis with Normal Amylase and Lipase Levels

2021-01-11T07:31:48+00:00

Acute pancreatitis (AP) is most commonly diagnosed by increased values of serum amylase and lipase. Acute pancreatitis where value of serum amylase and lipase is normal is very rare. This is a case of gall stone induced AP where levels of serum amylase and lipase are normal but the clinical suspicion and imaging are strongly confirming pancreatitis.

Direct Vision Internal Urethrotomy (DVIU) and Regular Clean Self Intermittent Catheterization (CSIC) For Short Bulbar Urethral Strictures: A Durable Solution

2021-01-11T07:32:58+00:00

Background: To evaluate durability of DVIU results and recurrence of stricture if the CSIC was done regularly up to one year and weekly thereafter. Subjects and Methods: This retrospective study was conducted in the Department of Urology at tertiary care teaching hospital of Rajasthan, India. Files of all patients operated between January 2015 and July 2018 for single bulbar urethral strictures of less than 1-1.5cm size in length, iatrogenic, idiopathic, traumatic or inflammatory origins were evaluated. Patient with multiple or complicated strictures of post urethroplasty, post hypospadias repair, previous radiation or multiple DVIU were excluded from the study. Data of all patients who were on CSIC following direct vision internal urethrotomy were evaluated at 3, 6, 12 and 24 months. Results: Mean age of patients was 41.13 years with range in between 26-74 years. Most common cause of urethral strictures were idiopathic 66 (58.92%) followed by iatrogenic 27 (24.11%) causes. After 24 months of follow up 95 (84.82%) patients maintained urethral caliber up to 16 Fr. Failure or recurrence was found in 17 (15.18%) patients who required intervention. Conclusion: Direct vision internal urethrotomy (DVIU) with regular clean intermittent self-catheterization (CSIC) was found good success rate in bulbar urethral strictures upto 1 cm in selected patients.

Eﬀect of CO2 Pneumoperitoneum on Liver Function Following Laparoscopic Cholecystectomy

2021-01-11T07:33:58+00:00

Background: Laparoscopic provides access to abdominal cavity for both diagnostic and therapeutic surgical interventions which were previously only possible through laparotomy. Recent studies have shown marked rise in serum liver enzymes after laparoscopic surgeries which is considered to be related to the impaired liver and splanchnic perfusion. The present study has been carried out with the aim to comprehend changes in liver enzymes after laparoscopic vs conventional cholecystectomy and the effects of these on outcomes of surgery. Subjects and Methods: Between January 2018 and June 2019, 100 patients with symptomatic gall stones which were eligible for cholecystectomy were enrolled in this prospective clinical observational trial. Randomisation to laparoscopic or open cholecystectomy was performed by using a sealed envelope technique just before surgery. All cases were operated by the same consultant surgeon with a standard anaesthetic protocol. Liver function tests were performed before surgery, at 24 hours and day seven postoperatively. Results: In the laparoscopic group, a statistically significant rise in liver enzymes both aspartate aminotransferase and alanine aminotransferase was observed after 24 hrs of surgery as compared to preoperative values (p<.001) and then again touching normal serum level on 7^th day postoperatively. Whereas in open cholecystectomy patients, only a slight variation in the liver enzymes was observed, which was not significant compared to preoperative level (p>.05). No statistically significant changes in serum level of GGT, ALP and bilirubin was seen in either group. No mortality or bile duct injury was observed in this study. Conclusion: Transient elevation in level of liver enzymes occurs after cholecystectomy in both open and laparoscopy group but more in laparoscopic arm attributed to CO2 pneumoperitoneum with possibly some other factors contributing to this. These changes return to normal in a week time after the procedure, and no major complication is generally seen in these patients with normal preoperative liver function, but these temporary derangements at times may be of concern to surgeons for its implication to the integrity of biliary tract.

Comparative Study of Role of Laparoscopic Vs Conventional Management in Peritonitis

2021-01-11T07:35:04+00:00

Background : A very commonly encountered case in the field of general surgery is peritonitis. In our study, we analyse 100 cases of acute peritonitis due to various causes, being managed conventionally and laparoscopicaly. Subjects and Methods: The observational, continuous, prospective, single centre study was carried out at Gujarat Adani Institute of Medical Science at GK General Hospital Bhuj. The study was conducted for a total duration of 27 months from October 2017- December 2019 (Patients were enrolled in the study and followed up till the day of admission to the day of the discharge). Total 100 patients are enrolled in the study but there were no intervention done. We compare the outcomes in terms of postoperative pain, removal of ryles tube, urinary catheter, drains, early ambulation and duration of hospital stay. Results: Maximum patients were diagnosed as having pre pyloric peptic (pyloric with antral perforation) perforation (45%) followed by jejunal perforation (17%). successful laparoscopic surgery without conversion was done in 92%. study total 4 cases of laparoscopic managed group needed to convert in open including 2 duodenal perforation cases, 1 sigmoid colon perforation case and 1 ascending colon perforation. Conclusion: Laparascopic intervention to be better of the two provided availability of skill and setup.

Eﬃcacy of Single Dose versus Multiple Dose of Pre-Operative Antibiotic: Teaching Hospital Based Study

2021-01-11T07:36:33+00:00

Background: The major crisis in any type of surgery is understood to be Surgical Site Infection (SSI). Although laparoscopic cholecystectomy is a nominally invasive procedure, there is a dominant prevalence of SSI in patients. It is also believed that prophylactic antibiotic has major impact in reducing SSI. Subjects & Methods: Seventy cases were enrolled in this study with knowledgeable consent. The study was carried out over a time period of ten months. The subjects acknowledge for elective laparoscopic cholecystectomy were incorporated in our study. Results: Out of the 70 randomized patients, 35 were allotted in single dose (SD group) while 35 patients were allotted in multiple doses (MD group), who got planned treatments and were then investigated. Of the 70 patients, female patients were 58(82.9%) and males were 12(17.1%). Total 43.62 12.18 years was the mean age of patients having symptomatic cholelithiasis, with 18 years as minimum and 77 years as maximum age. The peak of disease was documented in the age group of 30 to 39 years (28.6%). Conclusion: Utility of single antibiotic dose before anesthesia induction in laparoscopic cholecystectomy was likewise efficient as the use of multiple antibiotics doses in surgical site infection of postoperative periods.

Prevalence of Peptic Ulcer Disease among the Patients with Abdominal Pain at Tertiary Care Institute of Gujarat

2021-01-11T07:37:51+00:00

Background: To establish the occurrence of peptic ulcer disease amid the Subjects with abdominal pain at tertiary care institute of Gujarat. Subjects and Methods: present research was performed at the Department of Surgery, tertiary care institute of Gujarat, for the period of one year in 200 patients with abdominal pain and diagnosed with peptic ulcer disease. Information was composed utilizing pre-designed questionnaire. Results:The majorities of participants was females, most were aged between 18 to 25 years. Around 97% had pain in the epigastric region. Gastric ulcers preponderate for 65% patients in current research, except refused during the later existence of the epoch, as the occurrence of duodenal ulcers stayed stable, however amplified rather the later phase. Conclusion: An extensive diversity of subjects with abdominal pain was documented amid the subjects. On the other hand, the socio-economic situation and educational levels of the Subjects with the illness were below par.

To Study the Biochemical Markers for the Prediction of Fistula Formation after Pancreatic Resection Surgery in the Post Operative Period

2021-01-11T07:39:58+00:00

Background: To study and assess the potential laboratory biomarkers for foreseeing postoperative pancreatic fistula (POPF) after pancreatic resection medical procedures. Subjects and Methods: 64 patients were studied from Jan 2008 to Dec 2018. All patients undergoing Pancreatic resection surgeries like Pancreaticoduodenectomy (PD), distal Pancreatectomy (DP) for tumors of the periampullary region, Pancreatic body or chronic pancreatitis Clinical data of the patients, surgical approach, pancreatic parenchymal tissue consistency, histopathology of the specimen, white blood cell count and blood amylase levels tube Drain fluid amylase were recorded and analyzed. Correlations between these parameters and postoperative pancreatic fistula (POPF) were assessed. Results : 22 out of the 64 (34.37%) patients developed POPF. The fistula was graded according to the ISPG classification. It was Grade An of every 10 (45.45%) patients, grade B in 8 (36.36%), and grade C in 4 (18.18%),.On univariate and multivariate strategic relapse investigations, higher amylase levels in the stomach waste liquid on a postoperative day (POD)1 and higher serum amylase levels on POD4 indicated a critical relationship with fistula arrangement in the post-operation period (POPF) (P < 0.05). On ROC (recipient working trademark bend) examination, amylase cut-off degree of 2270.67 U/L in the stomach waste liquid was related with a 76.6% affectability and 82% particularity [area under the bend (AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 53.2 U/L was related with a 74.6% affectability and 72.9% explicitness (AUC: 0.784; P = 0.05). Conclusion: Post-operative channel liquid amylase levels on day 1 and serum amylase level on day 4 speak to interesting biomarkers related to POPF improvement after the pancreatic medical procedure.

To Compare the Role of Topical Platelet Administration with Normal Saline Dressing (NS) in Chronic Diseases

2021-01-27T09:14:41+00:00

Background: The ulcer is deemed chronic if it lasts for longer than 6 weeks. It has a significant effect on the quality of life. They can cause sub- stantial morbidity and injury and their propensity for causing extreme physical or psychological trauma for patients is generally underestimated. The objective is to the aim of the study was to compare the role of topical platelet administration with normal saline dressing in chronic ulcers. Design: This was a Randomized Controlled study. Duration: One year i.e. 2017 to 2018. Participants: The study included 80 patients comprising men and women with non-healing ulcer diagnosis who were admitted for intervention in the surgery department of Mahatma Gandhi Memorial Hospital. Subjects andMethods: Two random groups, Group A and Group B, comprising of 40 patients each group. Comprehensive history and clinical evaluation were conducted in both groups and all details were collected. The original condition of the ulcer has been identified and appropriate wound debrided in both groups, if necessary. The dressing and examination of the patients is preceded by observations. Data was recorded almost every 5th day from the date of entry to 10th day. The effectiveness measurement was dependent upon the size of the ulcer as well as the presence of epithelization at the wound area. Results: group A patients showed wound area contraction rate of 1.8 mm² per day. Group B patients showed wound area contraction rate of 0.8mm²per day. P value for wound contraction rate was less than 0.001. In group A epithelization was noted between 5^th day and 10^thday and mean period was 6.2 days. In group B epithelization was noted between 5^th day and 10^thday and mean period was 8.5 days. Conclusion : It can be concluded that PRP dressing can be used as a safe adjunct in wound healing.

Comparative Analysis Between Ranson and Bisap Score in Predicting Severity of Acute Pancreatitis

2021-01-27T09:17:08+00:00

Background: A spontaneous inflammation of the pancreas is acute pancreatitis that may be mild or life-threating. It is a highly common disease that poses a huge surgical risk to surgeons globally. The objective is to research was undertaken to compare the Ranson and BISAP scores for predicting the severity of acute pancreatitis. Design:This was a hospital based prospective study. Participants: 100 patients both males & females with acute pancreatitis. Subjects and Methods: Patients having history of inflammation and clinical findings of acute pancreatitis and presence of large oedema pancreas in the abdomen identified via USG or CT. The BISAP and Ranson scores were used to predict severity. Results: In this study, acute pancreatitis was 10 times higher in men than women. The average age was 41.18. In this study, the average age of non-survivors was 60, relative to 41.23 years of survivors. In this study, alcohol was the most common etiological factor (59 percent). Conclusion: In patients with acute pancreatitis BISAP findings are also useful in assessing the risk of serious and predictive mortality as in Ranson’s score.

Single Center Experience of Laparoscopic Management of Pediatric Gall Stone Disease

2021-01-27T09:19:07+00:00

Background: The aim of this retrospective study is to analyze the result of pediatric gall stone disease at a large volume single center. Subjects and Methods: This is a retrospective study, where patients operated at a single center between august 2007 to august 2020 were evaluated for presenting clinical features, cause of gall stone disease, surgery performed, intra op & post op complications and outcome at the time of discharge from hospital from clinical case files. Results: Total 253 patients underwent laparoscopic cholecystectomy between august 2007 and august 2020. Three patients were converted to open due to complications and were removed from the final analysis. Age distribution was 3 years to 12 years. Pain abdomen was most common feature as a clinical presentation. Hemolytic anemia was documented in only 10 patients. Twenty five patients were obese with BMI > 2SD. Standard 4 port laparoscopic cholecystectomy was done in all the patients. Stone was absent in 32 cases and only sludge was found on gross examination, twenty two cases has single stone & rest had multiple stone. Duration of surgery was 30 minutes to 45 minutes with median of 35 minutes. Two patients out of 250 had CBD injury. All patients were discharged within 7 days of surgery. Conclusion: Gall stone disease is increasingly common in patient presenting with repeated pain abdomen. Hemolytic anemia is not a common cause of pediatric gall stone disease. Laparoscopy is well tolerated in children with very few complications in experienced hands.

Assessment of Eﬀect of Lump Size and Nodal Status on Prognosis of Invasive Breast Carcinoma

2021-01-28T10:10:21+00:00

Background: Latest report on national cancer registry website in India suggest breast cancer to be leading cancer in females in a population based survey, surpassing cervical cancer, at both urban and rural locations across India. The present study was conducted to assess effect of lump size and nodal status on prognosis of invasive breast carcinoma. Subjects & Methods: The study was done in Department of General Surgery for a period of six months from September 2019 to February 2020 in a tertiary care hospital among 45 women with invasive breast carcinoma was recorded. In all patients, side and location of tumour and histological types, tumour size, histological grade, skin, nipple and areola invasion was recorded. Results: Group I had 6, II had 8, III had 4, IV had 5, V had 2, VI had 6, VII had 7, VIII had 3 and IX had 4 patients. Location was upper outer quadrant (22), upper inner quadrant (5), lower outer quadrant (4), lower inner quadrant (3), center quadrant (9) and multifocal tumour (2). The difference was significant (P< 0.05). Conclusion: The size of the primary tumour and the number of positive lymph nodes has an inverse linear relationship with prognosis.

Assessment of Single Incision Laparoscopic Assisted Appendectomy Cases

2021-01-28T10:12:10+00:00

Background: Acute appendicitis represents the most common indication of emergency nontraumatic abdominal surgery in the world. The present study was conducted to assess the cases of single incision laparoscopic assisted appendectomy. Subjects & Methods: The present study was done in Department of General Surgery for a period of one year in a tertiary care hospital among 142 patients of acute appendicitis of both genders underwent single incision laparoscopic assisted appendectomy was performed. This technique was evaluated for operative time, post-operative pain, post-operative length of stay and complication rate. Results: Out of 142 patients, males were 80 and females were 62. Common clinical features were abdominal pain in 136, vomiting in 70, constipation/diarrhea in 45 and anorexia in 59 cases. The mean age of the patients was 45.6 years, post –operative pain (VAS) after 12 hours was 6.2, after 1 day was 4 and after 2 days was 1.4. The difference was significant (P< 0.05). Mean hospital stay was 1.4 days. Conclusion: Single incision laparoscopic assisted appendectomy found to be effective in cases of appendicitis with less post- operative pain.

Role of Prophylactic Neck Dissection in Node Negative Carcinoma of Tongue

2021-01-28T10:14:14+00:00

Background: To ascertain the role of prophylactic neck dissection in cN0 tongue cancers. To assess the role of tumour thickness as a guide for the choice type of neck dissection in tongue cancers. Subjects and Methods: A single institutional study by the Department of Surgical Oncology in a teritiary care centre. Biopsy of the tumour site has been done and biopsy proven carcinoma tongue cases have been included in the study. A total of 110 cases of carcinoma tongue were recorded. 50 cases out of the 110 cases were cN0. All the cases were operated by wide local excision of primary tumour and modified radical neck dissection. After the histopathological assessment tumours were divided into two categories, tumours with thickness more than 4mm and those with thickness less than 4mm. Pathological node positivity in both these categories is studied. All the cases were followed up and those with positive nodes were advised post-operative radiotherapy. Results: Among 110 cases studied 50 cases have no clinical nodes at presentation and 60 had cervical lymph node metastases at presentation. Among the 50 cases with no clinical nodes at presentation, histopathology showed that 20 cases (40%) had primary tumour less than 4mm and 30 cases(60%) had primary tumour more than 4mm. 10 of the 20 cases(50%) with tumour thickness less than 4mm had lymph node metastases on pathological assessment and 24 of the 30 cases(80%) with tumour thickness more than 4mm had lymph node metastases on pathological assessment. Among the the category of tumor thickness less than 4mm, 4 cases (20%) had lymph node metastases to level 1, 3 cases (15%) had lymph node metastases to level 2, 3 cases (15%) had lymph node metastases to level 3, 1 case (5%) had lymph node metastases to level 4. Among category of tumour thickness more than 4mm, 10 cases (33.3%) had metastases to level 1, 9 cases (30%) had metastases to level 2, 5 cases(16.6%) had metastases to level 3, 3 cases(10%) had metastases to level 4 and 4 cases (13.33%) had metastases to level 5. Conclusion: The role of neck dissection is the most important step in the management of carcinoma tongue. Prophylactic neck dissection has a definitive role in clinically node negative tongue cancers. Type of neck dissection based on our results showed supraomohyoImid neck dissection would be sufficient for tumours less than 4mm and modified radical neck dissection for tumours more than 4mm thickness. Even most advanced imaging techniques like PET scan and SLNB could not completely derail the need for prophylactic neck dissection in carcinoma tongue.

Determination of Role of Hyaluronan in Recurrent Renal Stone Formation

2021-01-28T10:16:32+00:00

Background: Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) are now widely used to eradicate stones. The present study was conducted to determine role of hyaluronan in recurrent renal stone formation. Subjects and Methods: The study was conducted at Department of Urology, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore between November 2019 to August 2020 on 45 patients of both genders were classified into 3 groups. Group I were normal (15), group II (15) were stone formers and group III (15) were post- treated stone formers. The total urinary glycosaminoglycans, hyaluronan and the proportion of HA in total GAGs were recorded. Results: There were 8 males and 7 females in group I, 6 males and 9 females in group II and 10 males and 5 females in group III. The total urinary glycosaminoglycans (GAGs) concentration in group I was 235.4 µg hexuronate/ mmol creatinine, in group II was 142.3 µg hexuronate/ mmol creatinine and in group III was 108.2 µg hexuronate/ mmol creatinine. The mean hyaluronan level in group I was 812.4 µg hexuronate/ mmol creatinine, in group II was 1725.4 µg hexuronate/ mmol creatinine and in group III was 672.4 µg hexuronate/ mmol creatinine. The mean HA in total GAGs was 0.26% in group I, 0.74% in group II and 1.04% in group III. The difference was significant (P< 0.05). Conclusion: Increased HA production during inflammation of renal epithelial cells in SF do enhance the risk of renal stone formation and an higher HA proportion in total GAGs of both SF and Post-SF indicated that they have a higher risk for the occurrence and recurrence of kidney stone disease.

A Comparative Study of Diﬀerent Treatment Modalities of Inguinal Hernia

2021-02-27T03:50:49+00:00

Background: Hernia is mainly defined as a protrusion, bulge or projection of an organ or a part of an organ through the body wall that normally contains it. The present study compared different treatment modality of inguinal hernia. Subjects and Methods: 80 cases of lingual hernia of both genders were divided into 2 groups of 40 each. Group I patients underwent Lichtenstein’s hernioplasty and group II patients underwent preperitoneal meshplasty. Parameters such as time taken for surgery, early complications were recorded. Results: Group I had 22 males and 18 females and group II had 25 males and 15 females. The mean time of surgery in group I was 46.2 minutes and in group II was 55.2 minutes. The early complication was seroma 2 each in group I and 1 in group II, wound infection 3 cases in group I and 2 in group II, pain 2 in group I, mesh infection 3 in group I and 1 in group II and testicular atrophy 1 in group I. The difference was significant (P< 0.05). Conclusion: Inguinal hernias were effectively managed with both techniques.