Academia Journal of Surgery

The Prognosis of Early Recurrence in Patients with Colorectalcancer and Risk Factors for Early Recurrence

2021-06-17T12:03:00+00:00

Background: Because predicting recurrence intervals and patterns would allow for appropriate therapeutic strategies, we evaluated the clinical and pathological characteristics of early recurrence of colorectal cancer and the survival in the recurrence patients. Methods: Patients who developed recurrence after undergoing curative resection for colorectal cancer stage I–III between July 2017 to june 2020 were identified. Analyses were performed to compare the clinicopathological characteristics in the recurrence patients followed by detecting the overall prognosis. Subjects and Methods: Four patients had cancer recurrence of consecutive 48 patients who underwent surgical resection for colorectal cancer from 2017 to 2018. Patients who underwent curative resection were enrolled in this study. The mean follow-up period of the patients was 26+-7 months. Among 4 patients with early relapse, All four were advanced T-stage, 03 (75%) had elevated postoperative CEA and 03 (50%) had venous invasion. T-Stage, postoperative CEA levels and venous Invasion were statistically significant. Among four recurrence patients, three (75%) recurrences were within 9 months. Among these patients, metastasis alone within the liver was one patient (25%), metastasis to peritoneum and liver was one patient (25%), and local recurrence in two patients (50%) respectively. The initial diagnosis of patients with early recurrence was done by CEA tumor marker as it rose (75%) and clinical parameters. Definite diagnosis was done by CT, and by alternative methods like PET-CT. two patients underwent surgery for recurrent lesions, two patients received chemotherapy only. In the follow up period two patients with distant metastasis died and one patient with Low anterior resection who had recurrence was followed by chemoradiation and APR. Result: In this study, only four (04) patients (8.3%), including two (02)with colon cancer (6.6%) and two (02)with rectal cancer (11.1%) had post operative recurrence within the time period . Among four patients with post operative recurrence, All patients were advanced T - Stage, three(75%) had elevated post operative CEA levels and three (50%) had venous invasion. We found no differences in the factors like sex, age, primary tumor site, operative method, tumor size, type of histopathology, the degree of lymphatic or neural invasion,preoperative CEA levels in the patients with recurrence. Conclusion: patients with high postoperative CEA levels, advanced T-Stage and venous Invasion after surgery should be examined by the abdominal CT scan or as early as possible after surgery as the prognosis of these patients is not good.

A Comparative Study of Early Vs Delayed Laparoscopic Cholecystectomy

2021-06-17T12:15:59+00:00

Background: To compare early and delayed laparoscopic cholecystectomy. Subjects & Methods: Eighty four patients age ranged 20-60 years of both genders with complaint of acute cholecystitis reported to the Department of General surgery at Pt. Jawahar Lal Nehru Government Medical College and Hospital Chamba from April 2019 to March 2020 were divided into 2 groups of 42 each based on lottery system. Group A was early laparoscopic cholecystectomy and group B was delayed or late laparoscopic cholecystectomy. Parameters such as operative time, conversion to open cholecystectomy, Adhesions, biliary duct injury, wound infection and hospital stay was recorded. Results: Common clinical features were fever seen in 20 in group A and 23 in group B, pain abdomen in all patients in both groups, vomiting in 18 in group A and 12 in group B, jaundice in 3 in group A and 1 in group B and 23 in group A and 25 in group B were febrile. A significant difference was found between both groups. Multiple GB calculi was seen in 34 in group A and 36 in group B, pericystic fluid collection 22 in group A and 28 in group B, GB wall thickening 7 in both groups, conversion to open surgery was seen in 8 in group A and 12 in group B, adhesions 5 and 11, bleeding in 4 and 16, GB perforation in 2 and 3, bile duct injury in 1 and 3 in group A and B respectively. The mean duration of surgery in group A patients was 78.2 minutes and in group B was 118.2 minutes and hospital stay was 3.1 days in group A and 6.4 days in group B. A significant difference was observed (P< 0.05). Post op wound infection was seen in 3 in group A and 8 in group B, post op bile leak in 2 in group A and 5 in group B and post op jaundice in 1 and 4 in group A and B respectively. A significant difference was found between both groups (P< 0.05). Conclusion: Early cholecystectomy group had better results in terms of shorter hospital stay, less conversion to open surgery, less post- operative complications and duration of surgery.

A Prospective Randomized Trial of Polypropylene Mesh Compared with Nylon/Prolene Darn in Inguinal Hernia Repair

2021-06-20T11:10:39+00:00

Background: The outcome of the hernia repair has been studied extensively. The high recurrence rate which was seen when surgery was performed using fascia for inguinal hernia or when the suturing was done under tension resulted in the development od various other structures which can be used for the repair. As a result of it Nylon darn with minimal tension was developed later on polypropylene mesh was developed to strengthen the posterior wall of inguinal canal during hernia repair. The objective is to compare the two techniques commonly employed in the treatment of inguinal hernia repair i.e. Polypropylene mesh and Prolene darning. Subjects and Methods: The present Randomized control study was done in the department of surgery at Dr B R Ambedkar Medical College and K C General Hospital from January 2003 to January 2005 for a period of Two years. During this period 40 cases of inguinal hernia were studied, 20 cases were managed by polypropylene mesh repair and 20 cases were managed by Prolene darning technique. Results: In the present study study subjects were between 18 to 70 years of age with majority (30%) of them between 41 to 50 years of age, 20% between 51 to 60 years of age.Among the late complications neuralgia was seen in 10% of study subjects in mesh group and 15% in Prolene darn group. Scar tenderness was seen in only one subjects in Prolene Darn group. The Recurrence was seen in only one subject among Mesh Group at the end of 12 months of follow up period. Conclusion: Polypropylene mesh repair has no added advantage over prolene darn with respect to early postoperative pain complications or return to normal activities. Patients experienced mild-to-moderate pain irrespective of type of repair.

Assessment of Postoperative Complications in Abdominal Surgeries by Clavein-Dindo Classiﬁcation System in the Indian Hospital Setting

2021-07-24T09:39:41+00:00

Background: Complications occur in every surgical department, there is no surgery without any complication. So surgical complications need to be classified and evaluated. When a new surgical procedure is introduced or when several surgical approaches exists for one procedure, there is a need to compare outcomes and complication for each specific approach in a sound and reproducible way. A new classification was initiated by Clavien and dindo which has been updated regularly. This classification is based on the type of therapy needed to correct the complication. The principle of the classification was to be simple, reproducible and applicable irrespective of the cultutral background. The objective is aim of our current study is to critically evaluate this classification and to correlate the classification grades in each patient and each procedure and test the easy usability in the Indian hospital setting. Subjects and Methods : A total of 100 cases diagnosed as abdominal pathology admitted in general surgical ward of Narayana Hospital which required elective laparotomy were studied. This evaluation provides strong evidence that the cassification is valid and applicable worldwide in many fields of surgery. No modification in the general principle of classification is warranted in view of its use in ongoing publications and trials. Results: This classification system helps in the exact analysis of each and every individual surgical postoperative complication by grading the complications and hence, lowering the occurrence of similar complications in the future surgical work. Conclusion: The Clavien-Dindo classification represents an objective and simple, way of reporting all complications in patients undergoing major abdominal surgeries. This classification system allows us to distinguish a normal postoperative course from any deviation and it satisfactorily distinguishes the severity of complications. Finally, according to our experience, this classification system seems to be of particular interest in comparing the various complications between different surgeries.