Surgery Journal最新文献

{"title":"Fistulotomy versus Fistulectomy for Fistula-in-Ano: A Randomized Prospective Study.","authors":"Srikantaiah Chandra Sekhariah Hiremath,&nbsp;Rakesh Patil","doi":"10.1055/s-0042-1758633","DOIUrl":"https://doi.org/10.1055/s-0042-1758633","url":null,"abstract":"<p><p><b>Background</b>  Fistula-in-ano is common surgical ailment yet challenging to treat. Current management remains majorly dependent on two conventional surgical options (fistulotomy and fistulectomy), surgeon's preference, and their experience. <b>Methods</b>  This prospective, randomized study was conducted to compare fistulotomy with fistulectomy in the management of patients with simple fistula-in-ano. Fifty patients were recruited and randomized into two groups each containing 25 patients: group I was managed by fistulotomy and group II was managed by fistulectomy. The outcomes of the study include operating time, postsurgery hospital stay, wound healing time, postoperative pain, and postoperative complications. <b>Results</b>  Of the 50 patients, 11 (22%) were female and 39 (78%) were male with a mean age of 40.62 ± 12.86 years. The operating time in patients in the fistulotomy group was 21.96 ± 1.90 minutes and in the fistulectomy group was 31.32 ± 2.99 minutes ( <i>p</i> ≤ 0.001). The mean postsurgical hospital stay in the fistulotomy group was 1.32 ± 0.47 days and in the fistulectomy group was 2.32 ± 0.69 days ( <i>p</i> ≤ 0.001), respectively. Mean Visual Analog Scale score was higher in fistulectomy when compared with the fistulotomy at 6 hours and at discharge ( <i>p</i> ≤ 0.05). Postoperative complications were also found to be less in fistulotomy patients compared with patients who underwent fistulectomy. <b>Conclusion</b>  In comparison to a fistulectomy, fistulotomy has a slight edge in terms of operating time, postsurgery hospital stay, wound healing time, postoperative pain, and postoperative complications. Fistulotomy yielded better results than fistulectomy and we recommend fistulotomy procedure as a treatment of choice in patients with simple low lying fistula-in-ano.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e336-e340"},"PeriodicalIF":0.9,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9681539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40510672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominoperineal Approach to Uterovaginal Anastomosis in Cervical Dysgenesis: A Case Report and Review of Literature.","authors":"Ajay Halder,&nbsp;Shweta Patel,&nbsp;Pankhuri Dubey","doi":"10.1055/s-0042-1757555","DOIUrl":"https://doi.org/10.1055/s-0042-1757555","url":null,"abstract":"<p><p>Genital outflow tract obstruction due to cervical agenesis is an uncommon Mullerian duct anomaly, increasingly being treated with conservative surgery by creation of an outflow tract by drilling or coring into the cervical remnant or by uterovaginal anastomosis. A 19-year-old woman with cervical dysgenesis in the present case underwent a successful uterovaginal anastomosis to relieve the obstructive menstrual symptoms and preserve the future reproductive function. The neouterovaginal canal was created over a mold of Foley's catheter by anastomosis anterior surface of the uterine corpus to the vaginal vault, bypassing the dysgenetic cervix and using the fibrous band of cervix as support. Normal cyclical menses were restored. Steps of the procedure are detailed in this case report.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e297-e301"},"PeriodicalIF":0.9,"publicationDate":"2022-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Irrigation with Bupivacaine at the Surgical Bed for Postoperative Shoulder Tip and Abdominal Pain Relief after Laparoscopic Cholecystectomy.","authors":"Affan Iqbal,&nbsp;Amir Khodavirdipour,&nbsp;H R Ravishankar","doi":"10.1055/s-0042-1758141","DOIUrl":"https://doi.org/10.1055/s-0042-1758141","url":null,"abstract":"<p><p>Gallstones in western countries are primarily composed of cholesterol. However, mixed or pigment stones, which contain a higher proportion of bilirubin, are more frequently seen in developing nations and Asia than in western countries. Abdominal and shoulder tip pains (STPs) are common complaints following the standard laparoscopic cholecystectomy procedure. To date, all pain management modalities have proven variable outcomes. This prospective randomized study included 82 patients who underwent elective laparoscopic cholecystectomy. The control group received 20 mL of normal saline, whereas the study group received a 20-mL instillation of 0.5% bupivacaine at the gallbladder bed after surgical resection. The Visual Analog Scale (VAS) was used to analyze abdominal pain and STP. The mean age ranged from 20 to 80 years. Abdominal VAS at 6, 12, 18, 24, 30, 36, and 48 hours were statistically insignificant. The majority were discharged on postoperative day 1 (32 studies, 37 control). Follow-up VAS after 1 week for STP VAS and abdominal pain VAS in both groups were statistically insignificant. Even with small numbers of a well-conducted randomized trial, we demonstrated that bupivacaine irrigation at the gallbladder bedpost laparoscopic cholecystectomy does not affect pain relief.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e312-e315"},"PeriodicalIF":0.9,"publicationDate":"2022-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-appendicular Abscess in a Spigelian Hernia.","authors":"Rany Aoun,&nbsp;Rhea Akel,&nbsp;Roger Noun,&nbsp;Ghassan Chakhtoura","doi":"10.1055/s-0042-1758044","DOIUrl":"https://doi.org/10.1055/s-0042-1758044","url":null,"abstract":"<p><p><b>Background</b>  Spigelian hernias are a rare type of lateral ventral abdominal hernia and their content can include any of the intra-abdominal organs. Many cases have described the presence of a variety of abdominal organs in Spigelian hernias, but only few cases report the presence of an incarcerated appendicitis. Imaging is an important step in the diagnosis to avoid the lack of knowledge in such cases. Surgical treatment can be through open or laparoscopic approach, with or without using a mesh according to the size of the defect. <b>Case Report</b>  We report a case of an 82-year-old patient who presented with an acute appendicitis with peri-appendicular abscess strangulated in a right Spigelian hernia. The patient was successfully treated by a laparoscopic appendectomy, a surgical drainage of the abscess, and direct muscle approximation without using of mesh due to inflammation. <b>Conclusion</b>  Spigelian hernias with acute appendicitis in their content are a very rare condition. Clinical diagnosis is usually difficult and challenging and computed tomography scan is the imaging modality of choice. The treatment is surgical.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e308-e311"},"PeriodicalIF":0.9,"publicationDate":"2022-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramural Jejunal Hematoma Causing Intermittent Bowel Obstruction-A Rare Manifestation of Warfarin Toxicity.","authors":"Arun S Patil,&nbsp;Shriya Shriya,&nbsp;Nikhil Dhimole,&nbsp;Jalbaji More","doi":"10.1055/s-0042-1755223","DOIUrl":"https://doi.org/10.1055/s-0042-1755223","url":null,"abstract":"<p><p>Patients with thromboembolic disorders are commonly on anticoagulants; hence, they are susceptible to bleeding episodes such as ecchymosis, gingival, subconjunctival bleeding, and rarely can have intramural hematoma of small bowel causing patient to present with intestinal obstruction. It is a rare cause of mechanical bowel obstruction requiring a nonsurgical management. Our patient was a 55-year-old male, a known case of thromboembolism on warfarin medication, presented with abdominal pain and vomiting. Patient's laboratory reports reflected anemia and deranged coagulation profile with prothrombin time and international normalized ratio, both being elevated. Intramural hematoma of jejunum was diagnosed by abdominal contrast-enhanced computed tomography. Conservative management was done, warfarin was stopped and vitamin K was administered. Patient received fresh frozen plasma and packed cell blood. It is important to suspect warfarin toxicity in patients on the medication who come with such presentation to avoid surgical management, which could be catastrophic due to excessive bleeding. It is important for regular monitoring of coagulation profile of such patients and to reduce prescribing other medications that can interact with warfarin. It is worth noting that novel oral anticoagulants, such as dabigatran and rivaroxaban, are associated with fewer side effects and do not require close laboratory monitoring.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e290-e292"},"PeriodicalIF":0.9,"publicationDate":"2022-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapunzel Syndrome: A Case of Trichobezoar with Small Bowel Complications.","authors":"Ramakrishna Narra,&nbsp;Anusha Guntamukkala,&nbsp;Chanda Bhaskara Rao,&nbsp;Tanveer Begum","doi":"10.1055/s-0042-1757777","DOIUrl":"https://doi.org/10.1055/s-0042-1757777","url":null,"abstract":"<p><p><b>Introduction</b>  Rapunzel syndrome is characterized by a large trichobezoar in the stomach with a tail extending beyond the pylorus into the small bowel, causing mechanical obstruction of the small bowel. A 7-year-old girl presented to the emergency room with severe epigastric pain. Computed tomography suggested trichobezoar causing jejuno-jejunal intussusceptions, bowel wall thickening, and dilated small bowel loops proximal to the obstruction. On laparotomy, two concealed perforations were noted at the duodenojejunal (DJ) junction and 40 cm distal to the DJ junction. An enterotomy incision was given at the antimesenteric border of the distal jejunal perforation site, and the mass was successfully extracted. Primary repair was done at the DJ perforation site, and resection was followed by an end-to-end anastomosis at the distal jejunal perforation site. Surgery confirmed a complex mass of tangled hair within the gastric cavity with a tail extending into the pylorus of the stomach and small intestine, consistent with trichobezoar. <b>Conclusion</b>  Computed tomography is superior to other radiological imaging modalities for diagnosing trichobezoars as it helps diagnose and demonstrate mechanical bowel complications.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e293-e296"},"PeriodicalIF":0.9,"publicationDate":"2022-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical View of Safety in Laparoscopic Cholecystectomy: A Word of Caution in Cases of Aberrant Anatomy.","authors":"Maria Ioanna Antonopoulou,&nbsp;Dimitrios K Manatakis","doi":"10.1055/s-0042-1744154","DOIUrl":"https://doi.org/10.1055/s-0042-1744154","url":null,"abstract":"Introduction  To avoid vasculobiliary injuries, the Critical View of Safety (CVS) technique is strongly recommended during dissection of the hepatocystic triangle. It entails three basic steps as follows: (1) complete clearance of the hepatocystic triangle of fibrofatty tissue, (2) separation of the lower part of the gallbladder from the cystic plate, so that (3) two and only two structures are seen entering the gallbladder. Case History  In this video vignette, we present the case of an aberrant hepatic artery, coursing subserosally parallel to the gallbladder wall. Despite presumably achieving all three CVS requirements, the surgeon did not proceed to clipping and dividing the two structures, preventing a major vascular injury. Due to its unusually large caliber, the artery was carefully dissected, and multiple smaller branches to the gallbladder were ligated instead, until it was definitively identified entering into the hepatic parenchyma of segments IVb–V. Discussion  The CVS approach was originally conceived as a means for the conclusive recognition of the cystic duct and artery to prevent misidentification errors. However, in such cases of extreme anatomical variations, the CVS may indeed have certain limitations. Therefore the surgeon should always maintain a high degree of suspicion and a low threshold for alternative bail-out options.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e157-e161"},"PeriodicalIF":0.9,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40647949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraluminal Migration of a Penrose Drain Presented with Hematochezia, after Lower Gastrointestinal Surgery.","authors":"Roza Mourelatou,&nbsp;Christos Liatsos,&nbsp;Angeliki Bistaraki,&nbsp;Efstathios Nikou","doi":"10.1055/s-0042-1757603","DOIUrl":"https://doi.org/10.1055/s-0042-1757603","url":null,"abstract":"<p><p><b>Background</b>  Although surgical drains are widely used after lower gastrointestinal (GI) procedures, complications may occur. Specifically, sporadic cases of drain migration into a hollow viscus, most commonly regarding active drains and treated with surgical removal, have been reported. Herein, we present a case of a passive drain (penrose) migration into the colon, after segmental sigmoidectomy with primary anastomosis, presented with hematochezia. <b>Methods</b>  A 37-year-old male patient suffering from colovesical fistula, due to sigmoid diverticulitis, underwent resection of the fistula, the involved sigmoid segment and the bladder opening, followed by primary anastomosis of the colon and primary closure of the bladder. A penrose catheter was positioned near the anastomosis. <b>Results</b>  On 8th postoperative day (POD) the patient had three episodes of hematochezia and blood in the drain collection bag, followed by relative improvement. On 15th POD gas was observed on the drain's collection bag and a new episode of hematochezia led him to sigmoidoscopy. The endoscopy revealed the presence of the penrose drain intraluminally, protruding via an ulcer at the level of the anastomosis. The penrose repositioned outside the lumen and metallic clips were used to approximate the defect. The patient was then fully recovered, discharged, and the drain removed on follow-up. <b>Conclusion</b>  To our knowledge this is the first report of drain migration presented with hematochezia, after lower GI surgery, avoided reoperation, and resolved with removal of the drain under direct endoscopic vision.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e279-e282"},"PeriodicalIF":0.9,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9550314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33503108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of COVID-19 on Orthopaedic Trauma Admissions and Operating in a London District General Hospital.","authors":"Ubaid Zahoor,&nbsp;Catherine Malik,&nbsp;Hassan Raja,&nbsp;Sruthi Ramaraju,&nbsp;Kesavan Sri-Ram","doi":"10.1055/s-0042-1757883","DOIUrl":"https://doi.org/10.1055/s-0042-1757883","url":null,"abstract":"<p><p><b>Background</b>  The coronavirus disease 2019 (COVID-19) has presented orthopaedic departments around the world with unprecedented challenges across all aspects of health care service delivery. This study explores the effect of the COVID-19 lockdown on trauma admissions and trauma theater utilization at a London District General Hospital. <b>Methods</b>  Data was collected retrospectively from electronic patient records for 4 weeks from the initiation of two lockdown periods beginning March 16, 2020 and December 23, 2020. Results were compared with a comparable time period in 2019. Patient age, date of admission, time of admission, date of operation, length of stay, length of operation, type of operation, and length of anesthesia were analyzed. <b>Results</b>  Fewer patients were admitted during the COVID-19 period for trauma (108 in 2019 vs. 65 in March 2020 and 77 in December 2020). In addition, there was a significant shift in patient demographics, with the mean age of patients being 55.6 years in 2019 and 64.1 years in March 2020 and December 2020 ( <i>p</i>  = 0.038). The most common mechanism of injury in both years was due to falls; however, the proportion of injuries due to falls fell from 75% in 2019 to 62% March 2020, but not significant change from pre-COVID baseline in December 2020 (77% falls). The duration of anesthesia was significantly longer in March 2020 (136 minutes) compared with in 2019 (83 minutes) ( <i>p</i>  < 0.00001). There was no statistically significant difference in operation length for each operation type, but there was an overall increase in median operation length of 13.6% in March 2020 from the previous year. Finally, although overall length of stay was roughly constant, the time between admission and operation was significantly reduced in March 2020 (1.22 vs. 4.74 days, <i>p</i>  < 0.0000001). <b>Conclusion</b>  Orthopaedic trauma remains an essential service which has always had to overcome the challenges of capacity and resources in busy cities like London. Despite the reduction in trauma volume during the COVID-19 lockdown there have still been significant pressures on the health care system due to new challenges in the face of this new disease. By understanding the effects of the lifestyle restrictions brought about by the lockdown on trauma services as well as the impact of COVID-19 on service delivery measures such as length of surgery and stay, health care managers can plan for service delivery in the future as we attempt to return to nonemergency orthopaedic services and move lockdown restrictions are eased.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e283-e289"},"PeriodicalIF":0.9,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9550317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33504025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extra-Gastrointestinal Stromal Tumor (EGIST) in the Pelvis Mimicking Retroperitoneal Sarcoma.","authors":"Etienne El-Helou,&nbsp;Linda Chamma,&nbsp;Houssam Bashir Mazraani,&nbsp;Delivrance Sebaaly,&nbsp;Omar Georges Chamma,&nbsp;Jessica Naccour,&nbsp;Marwan M Haddad,&nbsp;Dani Lichaa,&nbsp;Houssam Alam","doi":"10.1055/s-0042-1757335","DOIUrl":"https://doi.org/10.1055/s-0042-1757335","url":null,"abstract":"<p><p>Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors accounting for less than 1% of total gastrointestinal tumors. They tend to be aggressive and have a poor prognosis. Unfortunately, there is a lack of data or controversial data due to its scarcity. Therefore, we report a case of pelvic EGIST misdiagnosed as retroperitoneal sarcoma. We opted for surgical management followed by adjuvant oral chemotherapy with imatinib.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":" ","pages":"e266-e269"},"PeriodicalIF":0.9,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9512592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40381403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}