International Surgery Journal https://mail.ijsurgery.com/index.php/isj <p>International Surgery Journal (ISJ) is an open access, international, peer-reviewed surgery journal. The journal's full text is available online at http://www.ijsurgery.com. The journal allows free access to its contents. International Surgery Journal (ISJ) is dedicated to publishing research on all aspects of surgery. International Surgery Journal (ISJ) focuses on General Surgery, Robotic Surgery, Orthopedic Surgery, GI Surgery, Neurosurgery, Plastic Surgery, Cardiothoracic Surgery, Vascular Surgery, Urology, Surgical Oncology, Radiology, Ophthalmology, Pediatric Surgery, Anaesthesia, Trauma Services, Minimal Access Surgery, Endocrine Surgery, ENT, Colorectal Surgery, Laparoscopic and Endoscopic techniques and procedures, Preoperative and postoperative patient management, Complications in surgery and new developments in instrumentation and technology related to surgery. International Surgery Journal (ISJ) is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, editorial, case reports, short communications, point of technique, correspondence and images in surgery. It is published <strong>monthly</strong> and available in print and online version. International Surgery Journal (ISJ) complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 12 per year</strong></p> <p><strong>Email:</strong> <a href="mailto:medipeditor@gmail.com" target="_blank" rel="noopener">medipeditor@gmail.com</a> / <a href="mailto:editor@ijsurgery.com">editor@ijsurgery.com</a></p> <p><strong>Print ISSN:</strong> 2349-3305</p> <p><strong>Online ISSN:</strong> 2349-2902</p> <p><strong>Publisher:</strong> <a href="http://www.medipacademy.com/" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix:</strong> 10.18203</p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="http://www.crossref.org/" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Surgery Journal accepts manuscript submissions through <a href="https://www.ijsurgery.com/index.php/isj/about/submissions" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>Registration and login are required to submit manuscripts online and to check the status of current submissions.</p> <ul> <li><a href="https://www.ijsurgery.com/index.php/isj/user/register" target="_blank" rel="noopener">Registration</a></li> <li><a href="https://www.ijsurgery.com/index.php/isj/login" target="_blank" rel="noopener">Login</a></li> </ul> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="mailto:medipeditor@gmail.com" target="_blank" rel="noopener">medipeditor@gmail.com</a> / <a href="mailto:editor@ijsurgery.com">editor@ijsurgery.com</a></p> <p><strong> </strong></p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int Surg J.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The International Surgery Journal is indexed with </p> <p><strong><a href="https://journals.indexcopernicus.com/search/journal/issue?issueId=all&amp;journalId=31390" target="_blank" rel="noopener">Index Copernicus</a></strong> </p> <p><a title="https://www.scilit.net/journal/325414" href="https://www.scilit.net/journal/325414" target="_blank" rel="noopener"><strong>Scilit (MDPI)</strong></a></p> <p><strong><a href="https://imsear.searo.who.int/handle/123456789/156148" target="_blank" rel="noopener">Index Medicus for South-East Asia Region (WHO)</a></strong></p> <p><a href="https://www.journaltocs.ac.uk/index.php?action=browse&amp;subAction=pub&amp;publisherID=3072&amp;local_page=1&amp;sorType=&amp;sorCol=1&amp;pageb=1" target="_blank" rel="noopener">JournalTOCs</a></p> <p><a href="http://www.crossref.org" target="_blank" rel="noopener">CrossRef</a></p> <p><a href="http://www.journalindex.net/visit.php?j=9595" target="_blank" rel="noopener">Journal Index</a></p> <p><a href="http://scholar.google.co.in/" target="_blank" rel="noopener">Google Scholar</a></p> <p><a href="http://jgateplus.com/" target="_blank" rel="noopener">J-Gate</a></p> <p><a href="http://www.directoryofscience.com/site/4548839" target="_blank" rel="noopener">Directory of Science</a></p> <p><a href="http://journalseeker.researchbib.com/view/issn/2349-3305" target="_blank" rel="noopener">ResearchBib</a> </p> <p><a href="http://www.icmje.org/journals-following-the-icmje-recommendations/" target="_blank" rel="noopener">ICMJE</a></p> <p><a href="http://www.sherpa.ac.uk/romeo/journals.php?id=2295&amp;fIDnum=|&amp;mode=simple&amp;letter=ALL&amp;la=en" target="_blank" rel="noopener">SHERPA/RoMEO</a> </p> <p> </p> en-US medipeditor@gmail.com (Editor) editor@ijsurgery.com (Editor) Fri, 27 Jan 2023 15:01:02 +0000 OJS 3.3.0.13 http://blogs.law.harvard.edu/tech/rss 60 Fat grafting: an adjunct in management of chronic leg ulcers https://mail.ijsurgery.com/index.php/isj/article/view/9258 <p>Chronic leg ulcers (CLU’s) are one of the most challenging medical conditions, mostly resistant to conventional therapy. Several treatment modalities are present but none have become standard of care. Autologous fat contains adipose derived stem cells (ADSC’s) which is believed to have abundant growth factors (GF’s) required for its regenerative and reparative properties. Our observational study was conducted to see the feasibility and efficacy of fat grafting in management of CLUs with complete wound healing as final outcome. 14 patients with CLUs (any etiology, &gt;3 months and multiple ulcers were counted as individual cases if &gt;3 cm apart) were included with coagulopathies, uncontrolled diabetes mellitus (Hba1c&gt;9 mmol/mol) being the exclusions. Fat was harvested using standard Coleman’s technique. Study was conducted from December 2015 to December 2017 in tertiary care hospital and patients were followed up for next 24 months. All cases were evaluated clinically. Average age of wounds before intervention was 33.34 months, average wound size 16.46 cm<sup>2</sup> and 4.9 cc of average fat was transferred underneath the ulcer. 11 out of 14 wounds healed completely within average 27.4 days and final outcome was not achieved in 3. Pain assessed using visual analogue scale (VAS) in immediate post operative period till 48 hours (telephonically). Patients were evaluated at 1 week, 1 month, 3 months and 6 months after procedure for pattern of wound healing and related complications. Fat grafting is easy, safe, effective and a minimally invasive OPD procedure with short recovery time for managing CLUs.</p> Ravi Saroha, Vijay Langer, S. K. Singh Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9258 Fri, 27 Jan 2023 00:00:00 +0000 Accidental acid ingestion in children: case series and literature review https://mail.ijsurgery.com/index.php/isj/article/view/9341 <p>Acid ingestion in children is a common problem in developing countries. Immediate complications of acid ingestion are oesophageal perforation, laryngeal trauma, bleeding and fistula formation but stricture is a delayed complication. Gastric outlet obstruction is known complication of acids and surgery is the mainstay of treatment. Heineke-Mikulicz pyloroplasty was done in five cases without complications and the outcomes were satisfactory.</p> Bijay Kumar Suman, Ram Jeewan Singh, Amit Kumar Sinha, Bindey Kumar, Shweta Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9341 Fri, 27 Jan 2023 00:00:00 +0000 Non-Meckel's small intestine diverticulitis presenting with obstruction and perforation https://mail.ijsurgery.com/index.php/isj/article/view/9266 <p>Small bowel diverticulosis (excluding Meckel's diverticulum) is a rare condition, which predominates in older adults. It is theorized that irregular intestinal contractions lead to increased segmental intraluminal pressure, favouring diverticula formation. This diverticulum may develop life threatening complications. Clinical record of a patient who attends the emergency service of an IMSS hospital in Ciudad Juárez, including clinical symptoms, imaging, surgical management and pathological anatomy. Patient presented to the emergency room with a clinical and imaging picture of intestinal obstruction. An exploratory laparotomy was performed, finding a diverticular disease of the small intestine complicated by diverticular perforation, which was confirmed by histopathological study. Due to its high morbidity and mortality, non-Meckel's diverticulitis of the small intestine is a pathology that should be considered as a differential diagnosis in adults over 70 years of age with abdominal pain.</p> David E. Ayala-Garcia, Kathya Itzel Porras Doran, Goretti Yáñez Ochoa, Kevin Armando Herrera Doñez Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9266 Tue, 10 Jan 2023 00:00:00 +0000 Acute acalculous cholecystitis as a rare cause of gastric outlet obstruction https://mail.ijsurgery.com/index.php/isj/article/view/9306 <p>Gastric outlet obstruction (GOO) is a condition that classically presents with upper abdominal pain and post-prandial vomiting due to mechanical obstruction secondary to luminal, intraluminal or extraluminal disease. Our case report, the first of its kind in the literature to our knowledge, describes GOO secondary to acalculous cholecystitis in a 58-year-old male who presented to the emergency department with abdominal pain and nausea. This unusual case highlights the need for clinicians to consider uncommon differentials in patients presenting with common symptoms such as abdominal pain and nausea.</p> Gamze Aksakal, Enoch Wong Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9306 Tue, 17 Jan 2023 00:00:00 +0000 Pyogenic liver abscess following endoscopic retrograde cholangiopancreatography procedure for choledocholithiasis https://mail.ijsurgery.com/index.php/isj/article/view/9338 <p>Pyogenic liver abscess (PLA) is a condition in which there is pus accumulation in the liver. It usually develops in the context of portal pyemia, through hematogenous seeding as well as via biliary disease. PLA is a rare, but important complication following biliary instrumentation such as endoscopic retrograde cholangiopancreatography (ERCP). We report a case of a 44-year-old man who initially presented with clinical features of ascending cholangitis. Laboratory investigations revealed leukocytosis as well as hyperbilirubinemia. Diagnosis of choledocholithiasis was then confirmed with an ultrasound examination, showing a 1×1 cm stone in the common bile duct. ERCP was performed and achieved stone clearance. However, the patient returned 1 month later with similar symptoms of right upper quadrant pain, fever and jaundice. Suspecting recurrent choledocholithiasis, an emergency ERCP was performed and showed pooling of radio-opaque contrast in the extra-biliary space. There were also multiple CBD stones seen. An urgent CT Abdomen was done and revealed multiple liver abscesses in bilateral liver lobes, with the largest measuring 4.5x5.9x2.1cm. The patient was treated conservatively with Augmentin and repeat ultrasound at 4 weeks interval showed no residual liver abscess.</p> Juin Yeen Ooi, Ramamoorthy Velayutham Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9338 Fri, 20 Jan 2023 00:00:00 +0000 Perforated appendicitis after blunt abdominal trauma: a case report https://mail.ijsurgery.com/index.php/isj/article/view/9403 <p>Cases of acute appendicitis due to blunt abdominal trauma (BAT) are rare, and usually regarded as two separate entities. Although the exact mechanism of acute appendicitis after BAT is unknown, several literatures reported their causal relationship. Suspicion of appendicitis should be raised in presentation of abdominal pain after BAT. We present a case report of two patients who developed acute perforated appendicitis following BAT.</p> Kah Ling Yu, Aida Nadhirah Nor Azizan, M. Ammar Ahmad Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9403 Fri, 27 Jan 2023 00:00:00 +0000 A rare case of Amyand hernia with acute appendicitis in a 7-day-old child https://mail.ijsurgery.com/index.php/isj/article/view/9343 <p>Amyand hernia is an extremely rare type of inguinal hernia where the vermiform appendix resides within the hernial sac. We presented a case of a 7-day-old male patient who presented to the ER with an irreducible right congenital inguinal hernia for 6 hours. The patient underwent surgical correction for the hernia where a thick, elongated, and inflamed appendix was identified within the hernia sac, ligated and excised to be sent for histopathological evaluation. Amyand hernia, as well as acute appendicitis in neonates, is an extremely rare condition, and in most cases, the diagnosis is established intraoperative because it's nearly impossible to be diagnosed by radiological imaging.</p> Mohammad A. Abo El Naga, Islam E. Abd Elhady, Yomna H. Elwan, Shereen O. Abdo, Nervana M. Khalil Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9343 Fri, 27 Jan 2023 00:00:00 +0000 Peritoneal carcinomatosis as a pathway of metastatic dissemination in a patient with gastroesophageal junction cancer: case report and review https://mail.ijsurgery.com/index.php/isj/article/view/9309 <p>The oesophageal adenocarcinoma is an increasing pathology in the last decade, predominantly in the western population. A characteristic of esophageal cancer (EC) and esophageal-gastric junction cancer (EGJC) is the high percent of metastatic disease at the time of diagnosis one of the main causes of death in these patients. The present case is about a 78-year-old man, diagnosed with Barrett's esophagus with high-grade dysplasia and stenosis of distal third of esophagus, during surgery we found peritoneal carcinomatosis with implants in gut and no resectably disease.</p> José Á. Tovar Ramírez, R. Lucano Valdés Ramos, Miguel Á. Nava Jiménez, Obed H. Grajeda Chávez, Luis Arturo Camarillo R. , Mariano Tovar Ponce, Emmanuel Gómez García, Mauricio Martínez Hurtado, Daniela Rodríguez Ramírez, Ludwigvan A. Bustamante S. Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9309 Fri, 27 Jan 2023 00:00:00 +0000 A novel approach for weight reduction after Roux-en-Y gastric bypass https://mail.ijsurgery.com/index.php/isj/article/view/9315 <p>Diabesity constitutes coexistence of both diabetes and obesity has become a modern epidemic now. It can be linked with insulin resistance and hyperinsulinaemia by various pathophysiological mechanism. Bariatric and metabolic surgery is a safe and effective treatment option for those affected by severe obesity and with its comorbidities like hypertension, diabetes mellitus, sleep apnoea, knee problems etc. These same procedures have also been recognized for their impact on metabolic or hormonal changes that play a major role in hunger (the desire to start eating) and satiety (the desire to stop eating) as well as improvement and/or resolution of conditions like diabetes mellitus, hyperlipidaemia which is associated with severe obesity. Bariatric surgery is a recognized and accepted approach for both weight-loss and many of the conditions that occur as a result of severe obesity.</p> Birbal Kumar, Dipankar S. Mitra Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9315 Fri, 27 Jan 2023 00:00:00 +0000 A rare case of a giant vesical diverticular calculus managed successfully by endoscopy https://mail.ijsurgery.com/index.php/isj/article/view/9208 <p>Vesical diverticula occur in the setting of bladder outlet obstruction (BOO) and neurogenic vesicourethral dysfunction. Vesical diverticular calculi are rare, especially for minimally invasive endoscopic lithotripsy treatment. A male patient of around 80 years presented with complaints of urinary intermittency and dribbling for 3 to 4 days. On investigation, the patient was found to have a calculus within a diverticulum in the urinary bladder. After counselling, cystolithotripsy + transurethral resection (CLT+TURP) of the prostate under spinal anaesthesia was performed. Usually, open surgery is recommended for the management of vesical diverticular calculi. However, CLT+TURP was the best option, in this case, keeping in mind the patient’s age and comorbidities. Simultaneous endoscopic resection of the prostate gland would help to treat the cause.</p> Santosh Patil, Vinay S. Kundargi, Siddanagouda B. Patil, Basavesh S. Patil, Saurabh M. Thakkar Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9208 Fri, 27 Jan 2023 00:00:00 +0000 Pancreatico-duodenectomy in a blunt trauma abdomen: a rare case report https://mail.ijsurgery.com/index.php/isj/article/view/9288 <p>Abdominal trauma, a very common occurrence, especially in a country like India with an abundance of road traffic accidents. However, very few of such patients present with pancreatic or duodenal injury. At times such an injury requires the complex and intricate procedure of pancreatico-duodenectomy. Such a procedure requires highly trained surgeons as well as extensive post operative monitoring. In the scenario that these are available, this major surgery becomes a lifesaving procedure. This case report describes one such successful outcome. Early presentation to the hospital, the availability of skilled surgeons and a good tertiary care set up have made the once rarely performed surgery called Whipple’s procedure (pancreatico-duodenectomy) into a live saving surgery which can be used for abdominal trauma cases as well.</p> Navin R. Kasliwal, Kruttika Singh, Soorya C. Sekar, Chaitanya K. Parupally Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9288 Fri, 27 Jan 2023 00:00:00 +0000 A rare case of primary gastrointestinal stromal tumour of the stomach presenting as perforation peritonitis https://mail.ijsurgery.com/index.php/isj/article/view/9294 <p>Presentation of gastrointestinal stromal tumours (GISTs) as perforation peritonitis is a rare entity with only few cases reported in literature. Here we present a case of a 50-year-old male with acute abdomen and signs of peritonitis. Abdominal radiography revealed dilated small bowel loops in the absence of any free intraperitoneal air. Exploratory laparotomy revealed a growth arising from the stomach wall at the distal part of the body along the greater curvature. Wide excision of the lesion was done with rent closure. Histopathological examination further confirmed the diagnosis of a GIST of the stomach. Post operatively patient received Imatinib therapy and is doing well on follow up. Although rare, GISTs should be considered in the differential diagnosis of perforated GI lesions.</p> Harekrishna Majhi, Arsha Santhosh, Suraj Ethiraj, Sailesh Nayak, Debi Prasad Chattarjee Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9294 Fri, 27 Jan 2023 00:00:00 +0000 Role of progressive preoperative pneumoperitoneum in the management of giant inguinoscrotal hernia-case report https://mail.ijsurgery.com/index.php/isj/article/view/9295 <p>Managing a giant inguinal hernia/ incisional/ ventral hernia had its own complications. The overtime adaptation of peritoneal cavity to a lower abdominal pressure was one of the most important factors responsible for these complications. Surgical repair is also quite a challenge because of the massive contents in sac, adhesions and concomitant fibrosis. In order to reduce the complications like intra-abdominal hypertension, cardiorespiratory problems and to increase the abdominal wall compliance, many techniques were described. Progressive preoperative pneumoperitoneum is a well described technique for the repair of giant inguinal hernia/ incisional/ ventral hernia with loss of domain which helps in conditioning the abdominal wall in the preoperative period, increasing the likelihood of primary closure and decreasing the incidence of compartment syndrome.</p> Sabari Girieasen M., Vijayalakshmi V., Mohamed Farook M. Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9295 Fri, 27 Jan 2023 00:00:00 +0000 An unusual presentation of coexisting parathyroid carcinoma and papillary carcinoma thyroid: a case report and literature review https://mail.ijsurgery.com/index.php/isj/article/view/9303 <p>Parathyroid carcinoma is the rarest endocrine cancer with aggressive behaviour. It may be presented as a feature of severe hypercalcemia, musculoskeletal involvement and a neck mass. There should be a high clinical suspicion if there is marked hypercalcemia, very high parathyroid hormone levels, palpable neck mass, recurrent laryngeal nerve palsy due to invasion and severe bone and renal symptoms. Thyroid pathology has been seen in 15-70% of patients with primary hyperparathyroidism (PHPT) especially with parathyroid adenoma. Medullary thyroid carcinoma is common with PHPT as in MEN 2 syndrome and rarely co-existed with non-medullary thyroid carcinoma. Parathyroid carcinoma and papillary thyroid carcinoma is extremely rare. Only 16 cases are reported in the literature.</p> Pradeep Puthen Veetil, Shikhil Puzhakkal, Niya Narayanan, Anju Chakko Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9303 Fri, 27 Jan 2023 00:00:00 +0000 Valentino’s syndrome: a formidably deceptive tale of peptic ulcer https://mail.ijsurgery.com/index.php/isj/article/view/9308 <p>The incidence of peptic ulcer disease (PUD) has steadily declined with the advent of H2 blockers and proton pump inhibitors (PPIs). The combined use of PPIs and endoscopic treatment has further decreased the need for emergency surgeries. Perforated ulcers are a rare cause of abdominal pain, and may not even be considered when the patient presents with right lower quadrant (RLQ) pain. In this article we report a case of 50-year lady, who presented with symptoms and signs of appendicitis accompanied by elevated inflammatory markers. Proper history taking, explicit knowledge regarding differentials, accurate radiological diagnosis and skilful surgical repair is paramount in its management and to prevent morbidity and mortality.</p> Gagandeep Reddy Komatreddy, Poojitha Reddy Gangam Venkat, Katra Sai Teja, Sridhar Punyapu Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9308 Fri, 27 Jan 2023 00:00:00 +0000 Meckel's diverticulum presenting with intestinal occlusion due to internal hernia https://mail.ijsurgery.com/index.php/isj/article/view/9361 <p>Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal system. Its incidence is approximately 0.3% to 3% of the population. It is located between 30 and 150 cm from the ileocecal valve. Up to 4% present with complications such as haemorrhage, diverticulitis, perforation, and intestinal obstruction. Clinical record of a patient admitted to the emergency room of an IMSS hospital in Ciudad Juárez, including clinical symptoms, imaging, surgical management and pathological anatomy. Patient presented to the emergency room with a clinical and imaging picture of intestinal obstruction. An exploratory laparotomy was performed, finding an internal hernia secondary to adhesions generated between a Meckel's diverticulum to the right mesocolon. Meckel's diverticulitis is a differential diagnosis to consider in young patients presenting with intestinal obstruction, since its early treatment reduces morbidity.</p> David E. Ayala-Garcia, Kathya Itzel Porras-Doran, Agustin Fraga-Ramos, David Aguirre-Baca Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9361 Tue, 10 Jan 2023 00:00:00 +0000 Intussusception in a mid-age female https://mail.ijsurgery.com/index.php/isj/article/view/9318 <p>Intussusception in adults is a rare entity, especially caused by benign lesions like lipoma. The clinical picture of intussusception in adults is subtle making the diagnosis tenuous. Gastrointestinal lipomas are rare benign tumors and the present report describes one such clinical entity.</p> Rishabh Raj, Anshuman Deo, Pranjal Prem, Prem Kumar Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9318 Fri, 27 Jan 2023 00:00:00 +0000 Dermatofibrosarcoma protuberans - an atypical tumor with a typical diagnostic dilemma: a case report https://mail.ijsurgery.com/index.php/isj/article/view/9326 <p>Dermatofibrosarcoma protuberans (DFSP) is a rare tumor of dermal fibroblast. Diagnosis poses a challenge to every surgeon. Its propensity to recur can be attributed to its characteristic finger-like projections, misdiagnosis, and incomplete excision. Wide local excision with adequate margins may lead to functional defects and cosmetic blemishes. Most cases undergoing second surgery warrants reconstructive procedure which might further complicate the management. We report a case of DFSP, initially misdiagnosed and underwent incomplete excision, later presented with recurrence and atypical features. High-grade suspicion is of paramount importance for ascertaining the diagnosis of DFSP and its appropriate treatment.</p> Manoj Kumar, Rohit Gupta, Manoj Kumar, Ashesh Jha Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9326 Fri, 27 Jan 2023 00:00:00 +0000 Surgical correction of mid gut volvulus presenting as acute intestinal obstruction and multiple jejunal diverticula with sealed off perforation-a case report https://mail.ijsurgery.com/index.php/isj/article/view/9337 <p>Multiple diverticulosis of the jejunum is an uncommon pathology of the small bowel. The incidence of diverticulum of small intestine varies from 0.3 to 1.2%, out of which duodenal diverticula are common that jejunal. This rare jejunal diverticula is usually asymptomatic in course, which made it more difficult in establishing this diagnosis. This may rarely lead to complications such as perforation, haemorrhage, obstruction which may be due to adhesions, volvulus, and intussusception. We herein report a case of a 72-year-old female patient with no comorbidities presented to ER with complaints of abdominal distention, lower abdominal pain, vomiting for 3 days. Pre-op evaluation revealed midgut volvulus with intestinal obstruction. Explorative Laparotomy revealed multiple diverticula in jejunum. Midgut volvulus was operated by resection and anastomosis of small bowel.</p> Raju Badipati, Kushal Gunturu, Samali Maity, Muralidharsai Maddasani, Farha N. Khatoon, Lakshmi D. Kasinikota, Geetha V. Panchakarla, Siyonu K. Sardena, Mounika Valluri Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9337 Fri, 27 Jan 2023 00:00:00 +0000 A rare case of delayed presentation of post traumatic diaphragmatic hernia presented with intestinal obstruction https://mail.ijsurgery.com/index.php/isj/article/view/9342 <p>Traumatic diaphragmatic injuries are rare complications resulting from a thoracic-abdominal blunt or penetrating trauma. Diaphragmatic injury is a rare entity and clinically difficult to be diagnosed as symptoms are often masked due to associated injury in poly trauma case. There are no specific signs and symptoms for diagnosing diaphragmatic rupture. High degree of clinical suspicion is needed in all cases of thoroco-abdominal injury to diagnose a case of diaphragmatic rupture. Left sided diaphragmatic injuries are more commonly reported in literature.</p> <div><em> </em></div> Hiral D. Chaudhary, Jatin G. Bhatt, Ajay M. Rajyaguru, Nilesh V. Vaniya Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9342 Fri, 27 Jan 2023 00:00:00 +0000 Condyloma acuminata on the breast: a case report https://mail.ijsurgery.com/index.php/isj/article/view/9321 <p>Condyloma acuminatum (CA) is a benign tumor primarily caused by infection with human papillomavirus (HPV) type-6 or type-11, lesions of which are most frequently found on the genital and perianal squamous mucosa and skin. CA outside the genitals is not common. The woman underwent successful surgical excision and reconstruction for breast nipple condyloma. Breast nipple condyloma pose a management dilemma. It is possible that the pathogenesis of these lesions is through both direct contact spread as well as haematogenous dissemination of the human papillomavirus.</p> Birbal Kumar, Balkishan Gupta, Dipankar S. Mitra Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9321 Fri, 27 Jan 2023 00:00:00 +0000 Challenges and prospects of neurosurgical services in Bauchi, north-east Nigeria https://mail.ijsurgery.com/index.php/isj/article/view/9244 <p><strong>Background:</strong> Nigeria has few neurosurgeons and her population has little or no access to neurosurgical services. Neurosurgical care has become the vital components of tertiary health care delivery. Within the last three (3), we have pioneered the neurosurgical services in our centre though with lack of materials and manpower. Our objectives was to recount our previous experiences and challenges.</p> <p><strong>Methods:</strong> A retrospective observational study of all in-patient neurosurgical cases managed from September 2018 to September 2021. Descriptive data analysis was used for the data obtained.</p> <p><strong>Results:</strong> A total of 1714 patients were managed with male:female ratio of 2.5 to 1.74% were age 40 years and below. Trauma is the leading cause of admission accounted for 83% while vascular lesions accounted for the least (0.06%).</p> <p><strong>Conclusions:</strong> Pioneering a neurosurgical service is a herculean task, it takes a huge sacrifice. There is an urgent need to deploy materials and manpower to sustain and improve these services. Collaborative effort among public, private and donor agencies will brighten our future neurosurgical practice.</p> Olabisi O. Ogunleye, Jeneral D. Alfin, Oluchukwu B. Ogunleye, Abdulkadir A. Jauro Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9244 Fri, 27 Jan 2023 00:00:00 +0000 Demographics and outcomes of ventral wall hernia repair at Sultan Qaboos University Hospital https://mail.ijsurgery.com/index.php/isj/article/view/9298 <p><strong>Background:</strong> Ventral abdominal wall hernias are one of the most common encountered surgical cases. Currently most repairs are done using a mesh either in an onlay or sublay method. The high burden of ventral abdominal wall hernias, there is a need to determine the most common predictive factors for their occurrence and the complications associated with their repair so that the best preventive measures can be taken.</p> <p><strong>Methods:</strong> A retrospective cohort study was conducted at Sultan Qaboos University Hospital during the period between 1<sup>st</sup> January 2014 to 30 June 2019. All patients underwent ventral hernia repair were included and pediatric patients were excluded.</p> <p><strong>Results:</strong> The total number of included patients were 383. Previous abdominal wall surgery was the most common risk factor (218 of the patient) followed by pregnancy (132). There was a significant correlation between age of patients and duration of admission (P value 0.003) however no significant correlation between gender and duration of admission was found. The percentage of recurrence in open surgery was 4.69% and 12.50% in laparoscopic repair. There was insignificant correlation between the use of mesh and recurrence rate. It was reported that 73 patients developed post operative complication with higher rate for seroma and hematoma.</p> <p><strong>Conclusions:</strong> Addressing risk factors and educate the population is an important step that should be taken to decrease the incidence hernia and its complication. As the sample size was small and majority of patient are from one region, a large multicentre study will be considered for better analysis and results.</p> Ali H. Al Sharqi, Safiya K. Al Khrusi, Maather H. Al Farsi, Shamsa H. Al Ghafri, Ola H. Al Hamdani, Abdulmajeed Al Balushi, Mayisa Al Mujaini, Hani A. Al Qadhi Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9298 Fri, 27 Jan 2023 00:00:00 +0000 Bladder exstrophy: surgical management in older children and young adults: review of 29 cases in sub-Saharan surgical facility https://mail.ijsurgery.com/index.php/isj/article/view/9379 <p><strong>Background:</strong> Bladder exstrophy is a challenge to every surgeon in the world but it is more challenging in developing world. The condition is highly varied in nature and so are the procedures. Though rare it is associated with severe disability not to be able to have continence of urine and affect normal reproduction.</p> <p><strong>Methods:</strong> We retrospectively retrieved documents from hospital records</p> <p><strong>Result: </strong>We describe 29 cases of Bladder extrophy where 10 of which were treated with uretero-sigmoidostomy diversion. Bladder closures were done for 19 cases with 2 cases of bladder wall dehiscence. We also reported use of paraexstrophy skin to augment the contracted bladders in 9 older children.</p> <p><strong>Conclusions: </strong> Because of lack of awareness in the community, bladder exstrophy cases come late in the childhood or in adulthood. This has affected the result where many of them offered only diversion. In One third (9 cases) we used paraexstrophy skin to augment bladder capacity where we observed better outcomes.</p> Gashaw M. Getahun, Andinet Desalegn Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9379 Fri, 27 Jan 2023 00:00:00 +0000 Retrospective evaluation of outcome of percutaneous nephrolithotomy at a tertiary care center in eastern Nepal https://mail.ijsurgery.com/index.php/isj/article/view/9420 <p><strong>Background:</strong> Percutaneous nephrolithotomy (PCNL) is considered as the standard treatment for renal tract stones. It is a successful procedure with low complication rate. Objective was to evaluate the outcome measures in large renal stone including stone free rates and complications in patients underwent PCNL.</p> <p><strong>Methods:</strong> A retrospective study was conducted in 120 patients who underwent PCNL for renal stone size 2 to 2.5 cm, between 2019 and 2021. Ethical clearance was obtained from the institutional review committee (IRC/2430/022). The data were collected from the records available in the medical record section. The data were analyzed for patient demographics, investigations, site of puncture, stone-free rates (SFRs), type of nephroscope, use of nephrostomy tube, blood transfusion, hospital stay and complications.</p> <p><strong>Results: </strong>Out of 120 cases, 64 (53.3%) were males and 67 (55.8%) presented with renal stone on the right kidney. Renal stone was in pelvis in 47 (39.2%) patients. In 47 (39.2%) cases puncture was made in the lower pole. Stone free clearance rate was 92.5% and 4.2% patients required blood transfusion. There was no statistical difference in intraoperative complication like bleeding in supracostal puncture group and subcostal puncture group [25% vs 13.2%; p=0.13] and in tube group and tubeless group (43.9% vs 3.8%; p&lt;0.001). There was significant difference in length of hospital stay and duration of Foley’s catheter removal between supracostal group vs subcostal group and tube group vs tubeless group (p&lt;0.05). Postoperative complications like fever were seen in 14 (23.0%) and four (6.8%) patients with standard nephroscope group and mini nephroscope group respectively and it was statistically significant (p&lt;0.05).</p> <p><strong>Conclusions:</strong> Mini and tubeless PCNL had a good success rate with minimal complication. The total stone clearance rate in our study was 92.5%.</p> Rikesh Jung Karkee, Samir Chaudhary, Awaj Kafle, Shailesh Maharjan, Inzmamul Haque Raque, Karun Devkota, Deependra Prasad Sarraf Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9420 Fri, 27 Jan 2023 00:00:00 +0000 Epidemiology of hand surgical cases operated in tertiary referral centers in Dhaka https://mail.ijsurgery.com/index.php/isj/article/view/9336 <p><strong>Background:</strong> Hand surgical cases in Bangladesh are managed both by orthopedic and plastic surgeons. There are very limited number of hand surgeons available in the country. Tertiary referral centers especially in the city of Dhaka cater for most of the hand surgery patients treated in the country. Objective were to understand the needs of the community for hand surgery.</p> <p><strong>Methods:</strong> This rretrospective study spanning July, 2017 to June, 2018- used data from the operation register of the Burn and Plastic surgery department, DMCH (Dhaka medical college and hospital) and hand surgery department, NITOR (National institute of traumatology and orthopedics).</p> <p><strong>Results:</strong> Of the sample of 2000 cases, 1000 data were collected from Dhaka medical college hospital, of which 670 (67%) were routine cases and 330 (33%) were emergency department cases. Of the 1000 cases from NITOR including 317(31.7%) routine cases and 683 (68.3%) cases from emergency department. Demography of the population 76% male and 24% female cases from DMCH; and 80% male and 20% female from NITOR. In Burn and Plastic surgery department of DMCH the percentage of diagnosed cases-acute burn (55%), acute trauma (9.5%), PBSC (21.5%), post trauma deformity (9%), and congenital cases (5%) and in NITOR- acute burn (1%), acute trauma (68%), PBSC (9%), post trauma deformity (20%), and congenital cases (2%) respectively.</p> <p><strong>Conclusions: </strong>This study shows the needs of the community for hand surgery and the portfolio of cases performed would be guide for an evidence-based approach to the development of services and training of hand surgeon in Bangladesh.</p> Sharmin Akter Sumi, Raquib Mohammad Manzur, Shuva Debnath, Subrata Sharkhar Kar, Sajedur Reza Faruquee, Abul Kalam, Vaikunthan Rajaratnam Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9336 Fri, 27 Jan 2023 00:00:00 +0000 Post operative effect of bile spillage in laparoscopic cholecystectomy https://mail.ijsurgery.com/index.php/isj/article/view/9357 <p><strong>Background: </strong>Most common disease of gall bladder and biliary tree is cholelithiasis. Laparoscopic cholecystectomy is now gold standard treatment. Gall bladder contents can be spilled during both in open and laparoscopic cholecystectomy, but these contents are eliminated usually through direct removal, copious irrigation and mopping in open operations. Right shoulder tip pain is a common short term complaint. Aims and objectives were to study right shoulder tip pain, its duration and severity in post-operative period of patients having spillage versus non spillage of gall bladder contents.</p> <p><strong>Method: </strong>It is a hospital based prospective comparative study was conducted in KPC medical college and hospital, Jadavpur, Kolkata. Time frame was April 2021- July 2022. Sample size was 100.</p> <p><strong>Result: </strong>Our study showed that, less number of patients had right shoulder tip pain (in numerical rating scale) and requirement of rescue analgesia in case compared to control group.</p> <p><strong>Conclusions: </strong>Right shoulder-tip pain, which may occur post-laparoscopic cholecystectomy, is variable in duration, severity and character and is more in spillage group.</p> Rajeev Ranjan, Anindita Bhar, M. D. Parvej, Tamoghna Das Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9357 Thu, 12 Jan 2023 00:00:00 +0000 Comparative study of early versus delayed laparoscopic cholecystectomy in acute cholecystitis and its associated complications https://mail.ijsurgery.com/index.php/isj/article/view/9140 <p><strong>Background:</strong> Acute cholecystitis is a common surgical problem and was usually treated with conservative management followed by surgery after an interval of 6/8 weeks. The aim of the study was to compare the efficacy of immediate with delayed laparoscopic cholecystectomy.</p> <p><strong>Methods:</strong> Randomized controlled trial in RRMCH from January 2019 to June 2019 was conducted on patients diagnosed to have acute cholecystitis. The 25 patients underwent immediate laparoscopic cholecystectomy within 24-72 hours of admission and 25 patients underwent DLC.</p> <p><strong>Results:</strong> In the early surgery group intraoperative complications noted were adhesions, bleeding, GB perforation and bile duct injury. Although the percentage of complications was high in delayed group no statistical significance could be derived between the groups</p> <p><strong>Conclusions:</strong> Early laparoscopic cholecystectomy (ELC) surgery had similar intra and postoperative complications compared to delayed surgery in acute cholecystitis but was associated with a shorter surgery and lesser stay in hospital.</p> Madhura G., Deepthi R., Neetha V., Venkatesh S. Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9140 Fri, 27 Jan 2023 00:00:00 +0000 Analysis of the histopathological findings of lymph node biopsies at a tertiary care centre https://mail.ijsurgery.com/index.php/isj/article/view/9327 <p><strong>Background:</strong> Lymph nodes are spread throughout the body and are routinely checked for abnormalities. These lymph nodes have the potential to become infected or malignant. The swelling of lymph nodes and the nodes which are abnormal in terms of size and/or number is commonly known as lymphadenopathy. One of the most common causes of lymphadenopathy observed is reactive lymphadenitis followed by granulomatous lymphadenitis. For diagnosis of lymph node biopsies, excisional biopsy and histopathological analysis are considered as the ‘gold standard’.</p> <p><strong>Methods:</strong> This is a retrospective, descriptive and a cross-sectional study of all the patients with lymph node biopsies seen in Bhaktivedanta Hospital and Research Institute from January 2018 till March 2022. Histopathology reports of lymph node biopsies of patients required at Bhaktivedanta Hospital and Research Institute were included in the study.</p> <p><strong>Results:</strong> The most common diagnosis is of tuberculous lymphadenitis which accounted for 251 (53.2%) of the total 469 cases. Tuberculous lymphadenitis was most commonly observed in females (68.92%) as compared to males (31.07%). Cancer cases which accounted for 83 (17.70%) cases formed the second most common diagnosis in which females (53.01%) accounted for most cases as compared to males (46.99%).</p> <p><strong>Conclusions:</strong> Enlarged lymph nodes should undergo fine needle aspiration cytology (FNAC), truecut biopsy and/or excisional biopsy for correct diagnosis. The diagnostic spectrum ranges from benign reactive to TB and also malignancies.</p> Bimal Shah, Sarang Degloorkar, Sanjay Parab, Mita Shah, Ria Vijay Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9327 Fri, 27 Jan 2023 00:00:00 +0000 Gall bladder perforation: critical analysis of management at tertiary care centre https://mail.ijsurgery.com/index.php/isj/article/view/9213 <p><strong>Background:</strong> Gall bladder perforation (GBP) is a rare complication of acute cholecystitis. Despite considerable advancements in diagnostic and therapeutic modalities, morbidity and mortality continues to be high, owing to delay in diagnosis and ill-defined treatment protocols.</p> <p><strong>Methods:</strong> We reviewed demographic profile, diagnosis and management strategies employed in 28 patients at our centre from Jan 2018 till Jul 2020. Patients were classified based on Niemeier classification.</p> <p><strong>Results:</strong> A total of 28 patients were identified but 3 excluded due to paucity of data. There were 21 patients of Niemeier type II perforation and 02 each of type I and III. Diagnosis of GBP was based on CECT in 18 patients. In patients with type II perforation, 03 underwent emergency laparoscopic cholecystectomy (LC) though one required conversion. Twelve patients were managed conservatively followed by interval cholecystectomy after mean duration of 14 weeks. Of these 08 successfully underwent LC and 03 were converted to open surgery. One patient underwent open radical cholecystectomy due to intraoperative suspicion of carcinoma. 06 patients of type II perforation underwent percutaneous drainage of collection followed by LC after mean duration of 23 weeks. Histopathology revealed chronic cholecystitis in 16 patients, acute cholecystitis in 05, carcinoma in 02 and xantho-granulomatous cholecystitis in one patient.</p> <p><strong>Conclusions:</strong> CECT should be employed early for diagnosis in suspected cases and percutaneous intervention should be used in cases unresponsive to conservative measures alone. There are higher chances of success in performing LC after 14 weeks leading to better outcomes.</p> Sanjay Sharma, Vikram Trehan, Priya Ranjan, Amit Singh Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9213 Fri, 27 Jan 2023 00:00:00 +0000 Evidence based diagnostic protocol and management for pain in right iliac fossa https://mail.ijsurgery.com/index.php/isj/article/view/9228 <p><strong>Background:</strong> Right iliac fossa pain is most common clinical presentation encountered in surgical OPD. Usually during evaluation, diagnosis is uncertain in some cases and patient suffers a lot. Clinical symptoms usually not involved during evaluation of patient this also makes diagnosis more difficult. Therefore, aim of the study was that how we would proceed in this case.</p> <p><strong>Methods:</strong> This was prospective study and total 30 patients were analyzed. Study was done at tertiary centre. All patients suspected with pain in right iliac fossa included in this study. First evaluated clinically then biochemical and radiological investigated. Histological and acid-fast bacilli culture was not included.</p> <p><strong>Results:</strong> Out of 30 cases, acute appendicitis were in 15 cases (50%), followed by appendicular lump (7 cases, 23%), irritable bowel disease (3 cases, 10%), tubercular lesion (2 cases, 6.7%), carcinoma of caecum (1 case, 3.33%), appendicular abscess (1 case, 3.33%), both appendicitis with tubercular lesion were also present (1 case, 3.33%). All cases of acute appendicitis, appendicular lump, carcinoma of caecum were managed surgically while appendicular abscess and ilieocaecal tuberculosis was managed conservatively.</p> <p><strong>Conclusions:</strong> The diagnosis of right iliac fossa pain is very difficult. Be very cautious during clinical evaluation. Even if CT scan is still unclear about the diagnosis and till date no definite diagnostic protocol has made. Before validate this protocol, a large data must be needed.</p> Jitendra Kumar Saroj, Ajeet Singh, Abhay Bhatnagar, Abdul Majid Wani Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9228 Fri, 27 Jan 2023 00:00:00 +0000 Comparative study of complications using electrocautery versus conventional scissors for raising flap in modified radical mastectomy https://mail.ijsurgery.com/index.php/isj/article/view/9300 <p><strong>Background:</strong> In the current scenario of rapid advancement in the field of surgery, the intraoperative and post-operative complications have reduced drastically by the use of effective surgical techniques in the modified radical mastectomy. Previously scissors were used for raising flap, today electrocautery is used by most of the surgeons for raising flap in modified radical mastectomy. Now electrocautery and conventional scissors are the two most widely used technique for raising flaps in modified radical mastectomy.</p> <p><strong>Methods:</strong> The study was conducted on 60 patients admitted in surgical wards of Sri Guru Ram Das institute of medical sciences and research with carcinoma breast. The study will be conducted to identify the complications using electrocautery versus conventional scissors for raising flap in modified radical mastectomy. The study participants were divided into two groups.</p> <p><strong>Results:</strong> Seroma and flap necrosis consequences were comparable in both research groups; however, electrocautery surgery took less time than scalpel dissection. Seroma development after four weeks of surgery and flap infection complications were comparable.</p> <p><strong>Conclusions:</strong> Dissection in MRM by scissors took longer operative period and drain output was more and the patient had longer hospital stay.</p> Ruby Aheer, Gurpreet Singh Bhangu Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9300 Fri, 27 Jan 2023 00:00:00 +0000 A comparative study between the outcomes of various surgical procedure in management of ileal perforation of tertiary care in central India https://mail.ijsurgery.com/index.php/isj/article/view/9304 <p><strong>Background: </strong>This study was done to establish the outcomes of surgical procedure in management of ileal perforation.</p> <p><strong>Methods: </strong>This study included 70 patients admitted to surgical emergency with acute abdomen. These patients were divided into 3 groups group A, group B, group C. The surgical management was done as primary repair (group A) and resection and anastomosis (group B) and primary repair with ileostomy (group C); Comparative study was done between all procedure. Study centre was L. N. medical college and hospital and research centre, Bhopal, Madhya Pradesh<em>. </em>Study duration was from March 2021 to September 2022.</p> <p><strong>Results:</strong> This study highlights the life-saving role of loop ileostomy for postoperative intestinal leakage in cases of primary repair of perforation. It is recommended that whenever intestinal leakage is suspected in the postoperative period, urgent exploratory laparotomy must be undertaken and the continuing peritoneal contamination should be controlled by exteriorizing the site of intestinal leak as loop ileostomy.</p> <p><strong>Conclusions:</strong> In our study we have found that, for a single perforation, primary repair is the procedure of choice and for multiple perforation with good systemic support, resection anastomosis is procedure of choice. For patient with poor systemic support, loop ileostomy is preferred procedure as it decreases the mortality.</p> Puneet Agrawal, Krishnanand Anand, Rahul Khare, Amit Sahu Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9304 Fri, 27 Jan 2023 00:00:00 +0000 Thickness of subcutaneous fat in the right iliac fossa as a predictor of surgical site infection in open appendicectomy- a single centre prospective study https://mail.ijsurgery.com/index.php/isj/article/view/9161 <p><strong>Background:</strong> Acute appendicitis is the acute inflammation of appendix accounting to 7-10% of acute abdomen cases. The complications vary from surgical site infection to enterocutaneous fistula and stump appendicitis. The surgical site infections after appendicectomy are postoperative nosocomial infections affecting the incision site, deeper tissues and organs at the operative site within 30 days of surgery. The study was aimed at predicting subcutaneous fat thickness causing surgical site infection in open appendicectomy wounds.</p> <p><strong>Methods:</strong> This prospective study was conducted in Trichy SRM Medical College Hospital and Research Centre, Tamil Nadu from January to June 2021 in 82 patients. Patients who underwent open appendicectomy for uncomplicated acute appendicitis were included. Patients underwent preoperative Ultrasound abdomen to measure the subcutaneous fat thickness in right iliac fossa and was correlated with post operative surgical site infection for 1 month. The subcutaneous fat thickness was divided into three groups; I- 5.5 mm and below, II- 5.5 to 7.5 mm and III- more than 7.5 mm.</p> <p><strong>Results:</strong> The results show that there was an increased association of surgical site infection in patients with increased subcutaneous fat thickness at incision site with mean of 6.25 and SD of 1.49.</p> <p><strong>Conclusions:</strong> The study showed that subcutaneous fat thickness is a predictor for development of surgical site infection in open appendicectomy wounds. The subcutaneous fat thickness association in causing surgical site infection in open appendicectomy wounds is of linear association.</p> Lakshmi Kandhan L., P. Karthick, Mohamed Arsath Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9161 Fri, 27 Jan 2023 00:00:00 +0000 Histopathological analysis of appendix biopsies in patients at a tertiary care centre https://mail.ijsurgery.com/index.php/isj/article/view/9329 <p><strong>Background:</strong> One of the most common problems associated with the abdomen is appendicitis. The acute cases of appendicitis are generally treated with appendectomy. The surgical process of removal of appendix, that is, appendectomy, helps in diagnosis of appendicitis. However, the appendix which looks normal macroscopically can actually harbour pathological findings when histopathological assessment is done. Appendiceal tumours or any type of parasitic function can occur in a normal looking appendix.</p> <p><strong>Methods:</strong> This is a retrospective, descriptive and a cross-sectional study of all the patients with appendix biopsies seen in Bhaktivedanta Hospital and Research Institute from January 2018 till March 2022. Ethical approval from the Institutional Ethics Committee was obtained for this study. Histopathology reports of appendix biopsies of patients required at Bhaktivedanta Hospital and Research Institute were included in the study.</p> <p><strong>Results:</strong> Out of the total 359 cases of appendix biopsies, 209 (58.2%) cases of acute appendix were found to be the most common. Males accounted for 216 (60.17%) cases of appendix biopsies which are in majority in comparison to 143 (39.83%) cases of female appendix biopsies. Based on age grouping, the age group of 11-20 showed majority (25.1%) cases of appendix biopsies.</p> <p><strong>Conclusions:</strong> All appendix specimens should be sent for histopathological analysis to document the removal of appendix, to know the pathology diagnosis and to rule out malignancy in the appendix.</p> Bimal Shah, Sanjay Parab, Sarang Degloorkar, Mita Shah, Ria Vijay Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9329 Fri, 27 Jan 2023 00:00:00 +0000 An observational study to evaluate efficacy and safety of ultrasound guided foam sclerotherapy for treatment of varicose veins https://mail.ijsurgery.com/index.php/isj/article/view/9331 <p><strong>Background:</strong> There are various minimally invasive techniques for varicose veins. Tessari has invented simple method to create sclerosant foam that has become popular nowadays as treatment for varicose veins. Aim was to describe the efficacy and safety of ultrasound guided foam sclerotherapy for treating varicose veins.</p> <p><strong>Methods:</strong> The observational study was carried out in 50 patients between July 2020 to June 2021. Sclerosant foam was made by Tessari method using polidocanol was introduced under ultrasound guidance in to affected veins. After 3 days looked for any residual varicosities and complications. All patients were followed up at 3 days, 1 month, 3 month and 6 months after treatment.</p> <p><strong>Results:</strong> 37 patients were treated with 3.0% of polidocanol. Rest 13 patients (26.0%) were treated with 1.0% of polidocanol. Six (12.0%) and eight patients (16.0%) received three and four sessions of sclerotherapy respectively. After 1 month, 41 patients (82.0%) achieved complete occlusion, in 5 patients (10%) partial occlusion was seen. After 3 months, 47 patients (94%) achieved complete occlusion without any symptom and three patients (6.0%) had partial occlusion. At the end of 6 months 48 patients (96.0%) achieved complete occlusion without any symptoms. Four patients (8.0%) developed SVT blurred vision in 3 patients (6.0%) and pain with redness at injection site was observed in one patient (2.0%).</p> <p><strong>Conclusions:</strong> Ultrasound guided foam sclerotherapy is safe and effective in obliterating varicosities of lower limb including perforators using polidocanol sclerosant agent with less complication, low recurrences and good cosmetic outcome.</p> Ashlesh Bhavsar, Girish P. Bochiya, Jenish V. Modi, Mitesh Trivedi Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9331 Fri, 27 Jan 2023 00:00:00 +0000 Post-mastectomy breast reconstruction: an overview of the state of the art, challenges, and prospects https://mail.ijsurgery.com/index.php/isj/article/view/9305 <p>Breast cancer, which affects approximately 12% of women worldwide, is a leading cause of death and morbidity, and the majority of cases are treated surgically. The loss of one or both breasts to cancer can be devastating and it often has negative physical and psychological impact on women. In order to maintain an outward breast contour, some women turn to temporary solutions, such as breast pads, which are often unsatisfactory. Over the years, patients' perceptions of their bodies, self-esteem levels and quality of life have all improved as a result of less radical breast cancer surgeries and the growing popularity of post-mastectomy breast reconstruction. Therefore, it is recommended that women undergoing breast cancer surgeries be given the choice of breast reconstruction. Nevertheless, accessibility, acceptability, and affordability of breast reconstruction still pose a challenge. Although these limitations exist globally, they are most noticeable in low- and middle-income nations. This article gives an overview of the various considerations and surgical options for breast reconstruction after breast cancer surgery. In addition, it examines some of the challenges to breast reconstruction faced worldwide and discusses recent and future trends which are bound to improve post-mastectomy breast reconstruction techniques and outcomes globally.</p> Ismat D. Ghazal, Chimdi Eleweke, Francisca O. Aladesanwa, Bayowa O. Onabajo Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9305 Fri, 27 Jan 2023 00:00:00 +0000 Do postgraduate research degrees contribute to positive outcomes for surgical doctors? An evaluation of relevant literature https://mail.ijsurgery.com/index.php/isj/article/view/9322 <p>Doctorates as part of surgical training are gaining popularity and diversity within the global market. The costs of these degrees need weighed against anticipated benefits for the individual and healthcare systems. This review considers the drivers, impact and future of higher research degrees in surgery.</p> Matthew F. Flynn Copyright (c) 2023 International Surgery Journal https://mail.ijsurgery.com/index.php/isj/article/view/9322 Fri, 27 Jan 2023 00:00:00 +0000