New Indian Journal of Surgery

Paraurethral cyst or Skene’s duct cyst is a rare disorder which occurs due to the obstruction of Skene’s duct adjacent to the external urethral orifice. We experienced a 28 years young lady with acquired paraurethral cyst for 2 months just to the left and posterior aspect of urethral orifice and compressing it toward the right side. There is no standardized treatment guideline for this cyst till now. In this case report, we discuss the surgical management and histopathological findings of this lady with paraurethral cyst.

Testicular abscess is a rare surgical entity scrotal region. E Coli is the commonest causative organism. A total number of eight cases of testicular abscesses had been reviewed for a period of one year. It was seen that, the cases mainly present with complaint of acute scrotum with discharging pus. Mean age of the patients under study is around 45 yrs. Ultrasonography used for diagnosis. It was found that identifying bacterial pathogens are found in eight cases. E coli were found to be the commonest pathogen in culture isolate. One patient of testicular abscess; pus culture revealed AFB to be causative bacteria. Only a single case of acute testicular abscess was found to have seropositivity for Hbsag .broad spectrum antibiotics were used as mainstay of treatment.

Tumor lysis syndrome (TLS) is characterized by hyperkalemia, hyperuricemia, hyperphosphatemia and hypocalcemia. TLS can be Spontaneous TLS, Lab TLS, and Clinical TLS.Germ cell tumors presenting with spontaneous TLS is uncommon. But obstructive uropathy causing similar picture is reported.

Intussusception is commonly seen in pediatric age group and is rare in adults. Adults with intusussusception present with non specific symptoms and diagnosis is made by imaging. Most of the times the treatment requires resection of the involved bowel.

Most of the cases occur during during puberty. It is benign proliferation of male breast glandular tissue. It is a common presentation in the primary care setting and mostly benign. Treatment is towards the specific etiology when identified. In majority of cases of gynaecomastia observation and reassurance are the main therapy.

Our study aims on the management of pyogenic liver abcess, on the line management, choice of treatment. A case series of our experience with clinical and pathological correlation and type of drainage. The first line of management for liver abcess in intravenous antibiotic and imaging of the abcess and depending on the collection size and involved lobe of liver choice of intervention is taken. Either percutaneous needle aspiration or catheter drainage. Liver abcess is an emergency condition the choice of therapy depends on the patient status, for the management combined team work is needed from surgical and radiological side

Present study aims to investigate characteristics, diagnosis and treatment of accessory breast. All patients with swelling in axilla. All the patients undergone excision for the swelling. The follow-up period for the patients ranged from 6 months to 2 years. In all four cases no evidence of disease is found till now. Accessory swelling is a swelling in the axilla causing anxiety to the female. For management a comprehensive treatment strategy is required.

Aim of the Study: 1. This study was undertaken to evaluate the efficacy of primary reduction of nasal fractures and to study the need for secondary septorhinoplasty for the management of residual nasal deformity. 2. To study the demography of the nasal trauma.

Materials and Methods: Medical records of all patients with nasal fractures were collected and plan of management by the department of surgery and ENT were evaluated and post OP follow up done for one year. Cases between June 2016 to 2017 were collected. Inclusion Criteria: All cases of Nasal trauma.

Exclusion Criteria: Facial trauma associated with head injury and those associated with comorbidities like DM, immunosuppression.

Results: Out of total 100 patients, 10 patients met the inclusion criteria. Four patients underwent closed reduction of nasal bones and septum within 1 week of injury. Six patients could not be included because of multisystem injury or comorbidities. All 10 cases were followed up to determine the efficacy of the initial treatment modality as well as the need for secondary septorhinoplasty. All 4 cases who underwent closed reduction had no residual deformity or the need for secondary septorhinoplasty. Out of 6 untreated cases, 1 case underwent secondary septorhinoplasty. Follow up period ranged from 1 month to 10 months. All patients who were treated primarily were pleased with the results and one patient who underwent secondary septorhinoplasty also had satisfaction.

Conclusion: Closed reduction of nasal fractures appears to be an effective method of treatment with good patient compliance, reduced hospital stay and good cosmetic outcome. Best results are obtained if the surgery is done within 1 week of injury and the factors that affect the outcome are timing of surgery, status of the nasal septum, delay in treatment and associated injuries.

Background: Veins varicose are the most common condition which affects the 30% of the adult population. This can be seen more in males than females. The present study aim is to see the efficacy of foam slerotherapy in treating truncal and perforator reflex in varicose patients.

Materials and Methods: This study was conducted in the Department of surgery, 2008-2010 for the period of 2 years. Patients came to the surgery OPD with veins varicose was included based on the inclusion and exclusion criteria. The entire patient’s demographic and clinical data was collected. A total of 56 patients were included in the study. All the patients subjected to the foam sclerotherapy and observed for 1 year. This study was ethically cleared from Institutional Human Ethics Committee (IHEC). All patients were explained detailed procedure and inform consent was obtained from each patient.

Results: In this study males were more than females. 50 patients was in the primary treatment and 6 patients showed recurrent/residual varicose. In primary treatment maximum number of patients showed SFJ incompetence. 7 patients showed pain along the injected site. Thrombophebilites is the major complication after the surgery.

Conclusion: Foam sclerotherapy has its own advantages compared to the other procedures patients with veins varicose. It reduced the economic burden and patients in abolishing the truncal reflex as well the waiting list for surgery.

Background: Laparoscopic cholecystectomy is now accepted worldwide as the gold standard surgical technique for cholecystitis. But it is not without difficulties especially in a/c cases.Here we discuss about our experience in difficult cholecystectomy which we managed with fundus first method especially when it is difficult to dissect out cystic artery and duct at calot’s triangle due to dense adhesions. After dissecting fundus, body and neck catgut loops were used to tie the cystic pedicle.

Methods: 100 cases of laparoscopic cholecystectomy done in patients presented with abdominal pain and USG diagnosis of cholecystitis. The cases were analysed prospectively with data sheets and video recordings over a period of 18 months. The period of study and the 100 cases were selected for statistical significance. Among those 28 cases were done with fundus first technique and out of these 22 cases were with catgut loop tie technique.

Results: Conversion rate was 0% and there was no CBD injury. On follow up two cases had problems one with retained stones in CBD and other in the cystic duct. One case was managed with endoscopic sphincterotomy and the other case with laparoscopy.

Conclusion: Fundus first method with catgut loop tie of cystic pedicle with frozen calot’s and thickened cystic duct stump is an alternative technique for conversion to open surgery in difficult cholecystectomy. It is a safe technique with decreased post–operative morbidity.

Introduction: We assessed the correlation between the International Prostate Symptom Score (IPSS), patient age and postoperative urinary retention in patients undergoing inguinal hernia repair.

Methods: 84 male patients admitted for inguinal hernia repair between January 2016 and December 2016 were included. Preoperatively patients were scored by the IPSS (0–35) according to the severity of their urinary symptoms. Patients were categorized into three symptom groups (mild, moderate and severe based on scores of 0–7, 8–18 and >18 respectively) and 2 age groups (<50 and > 50 years). All patients with postoperative urinary retention were catheterized per urethra.

Results: 16 (19.04%) patients needed catheterization postoperatively. The average (median) IPSS value in non-catheterized patients were 4 whereas in catheterized patients were 9. 87.5% of catheterized patients had an IPSS > 8. Statistical analysis showed significant association between moderate IPSS (>8) and catheterization risk in male patient (chi square p<0.005). There was also a significant relation between age (>50 years) and incidence of catheterization (chi square p<0.05).

Conclusion: Considering our results, it seems that IPSS score is useful in the prediction of those patients who are likely to develop postoperative retention after inguinal hernia repair.

Introduction: Pilonidal sinus is a common chronic, benign disease of young adulthood. Pilonidal disease is an infection under the skin in the gluteal cleft. ‘Pilonidal’ mean tuft of hair. Known risk factors include family history, local trauma, sedentary occupation and obesity. The management of pilonidal sinus has remained controversial.

Aims and Objectives: To study the clinical presentation, predisposing factors, of pilonidal sinus in the study sample, and compare the effectiveness of two surgical treatment methods, namely, excision of sinus tracts with primary closure, and the excision of the sinus with closure of the defect with limberg flap, in terms of the duration of hospital stay, post operative wound infection and recurrence.

Methodology: All patients presenting with the Pilonidal sinus to Victoria hospital were admitted, and the demographic data like their age, sex, occupation etc were recorded. The patients were divided in to two groups, one group of 35 patients, were treated by excision of sinus tract and primary closure of the resulting defect. Another group of 35 subjects were treated by excision of sinus tract and Limberg Flap closure. The study subjects in both the groups were followed up and data regarding duration of hospital stay, the post operative wound infection, and the recurrence were collected and analyzed.

Results: A total of 40 patients [57.14%] out of 70 patients belonged to age group between 21-30yrs. Disease was more common among male (85.71%) than females(14.28%). Pilonidal sinus was found to be common among Drivers (42.85%). 35 pateints underwent excision and primary closure while remaining 35 underwent excision of sinus tract and Limberg flap repair of the defect. Recurrence after primary closure was 25.71% in our study and 5.71% after Limberg flap. Hence Limberg Flap closure of the defect following exicion was a better procedure than Primary Closure.

Background: Incisional hernia is a common surgical condition with a reported incidence of 2-11% of patients subjected to abdominal operations.

Aim: This is a prospective study which was under taken to study the differences in the post-operative events of the onlay mesh repair between the transverse and the midline vertical incision approach in our setup.

Methods: This is a prospective study of 55 cases of incisional hernia that were operated in the department of general surgery, Govt. medical college, Omandurar govt. estate, Chennai, India from Nov 2016 to June 2017. Patient’s history, clinical finding, investigations, operative findings, operative procedures and postoperative complications were all recorded in a proforma specially prepared. All patients underwent onlay mesh repair. The approach of the repair was based on the preference of the operating surgeon & the ease to proceed with surgery. Patients were followed up for immediate post-operative complications. The two groups were compared using appropriate statistical tests.

Results: Most of the patients presented with incisional hernia in the infraumbilical region. 30 patients were approached with transverse incision & 25 patients with midline vertical incision. Pain score & duration of drainage were significantly higher in the transverse approach group. Postoperative complications were also higher among the transverse group than in the midline vertical incision group, but none of them were statistically significant.

Conclusion: The study showed that the post-operative complications were higher in the transverse incision group, but none of them were statistically significant, for onlay mesh repair of incisional hernia.

Introduction: Peptic ulcer is one of the most common disease leading to perforations. Only by early diagnosis and treatment, it is possible to reduce the still relatively high mortality. The perforation and resultant peritonitis are immediate threats to the life. The therapeutic priorities are the treatment of peritonitis and securing the closure of perforation with a surgical procedure. Even with the better understanding of the disease, effective resuscitation and prompt surgery under modern anesthesia techniques, there is high morbidity and mortality. Aim and Objectives: The main aim of my study is to study multiple factors causing a peptic ulcer and its perforation and outcome of various surgical techniques of the closure of peptic perforation.

Material and Methods: In the present study, a total of 180 patients admitted with peptic perforations at tertiary care center were included during December 2012 to August 2014. A detailed history was recorded. Other data like the condition of the patient at the time of admission, the duration of symptoms and surgery and mode of treatment were recorded. Those patient managed conservatively i.e placement of drains, were not included in this study. After confirmed diagnosis, resuscitation, the patients underwent simple closure without any definitive surgery by various techniques like Grahm’s patch (omentopexy), Figure of eight, Laparoscopic closure of perforation and Omental plugging.

Results: The peak age incidence 51.11% was seen in the age group of 41 to 60 years. All the 180 patients of peptic perforation presented with pain in the abdomen and vomiting was present in 120 cases. Distension was present in about 135 patients, mostly in those presented after 24 hrs and 48 hrs of symptoms. Mortality was higher in patients coming late. i.e. after 48 hrs. The incidence of peptic perforation was more in smokers, alcoholics and NSAIDS users. Majority of the patients 140 (77.77%) were operated through Grahm’s patch technique for all sizes of perforation, 33 (18.33%) patients were operated through the figure of eight suture and 7 patients were operated laparoscopically. In majority 60 (33.33%) of cases wound complications was a major complication. The oral feeding starting day in Grahm’s patch was 5.2 days, for the figure of 8 stitch was about 4.3 days and for laparoscopy 4 days. The hospital stay for Grahm’s patch technique was for about 11 days while for laparoscopy was about 8.3 days.

Conclusion: In the present study, it could be concluded that peptic ulcer perforation still remains one of the most common causes of abdominal catastrophe. After careful review of published data and numerous discussions, we hope that figure of 8 stitch can be a better alternative to Grahm’s surgery, as it is associated with fewer complications and mortality rate with less operative time. While though laparoscopy technique shows promising results, it requires expensive set up with surgical expertise with more operative time.

Background and Aim: The swellings in head neck region are of great clinical significance. The athology of swellingsmay vary from cysts, benign tumours and malignancy to metastatic tumours. So, these neck swellings are a great dilemma to surgeon for diagnosis and treatment. The aim of present study is to diagnose the different types of cysts out of total head neck swellings because these cysts are commonly present in head neck region.

Materials and Methods: In this study 100 patients of different cystic neck swelling were studied over a period of five years from 2014-2016 to compare the findings withclinical diagnosis, FNAC and histopathological report for itsdiagnostic reliability. This study was done in surgerydepartment of mcgann teachin hospital and Medical College Hospital shimogha. Patients of 1-70 yrs age were taken for study. History of patients was taken; clinical examination of swelling was done followed by FNAC and histopathology examination of postoperative specimen of neck swelling.

Results: The analyzed data was presented by various tables. Out of these 100 cases of neck swellings 40 cases were of various cysts. 16 were males and 24 were females.The male, female ratio was 1:1.5. Age range was 1–70 years with maximum frequency in the 1- 30yrs of age. Clinical, cytological and histopathological diagnosis was done in all the cases. Out of the cases studied 50% were thyroglossal cyst, 25% were Epidermoid cyst, 15% were dermoid, 10 % of total were brachial cyst, retention cyst and ranula.

Conclusion: It is concluded that head and neck swellings are very common conditions encountered. Our study found that simple clinical examination followed by FNAC and histopathology is simple, quick, inexpensive and minimally invasive technique to diagnose different types of head and neck swellings. In this study out of different head and neck cystic swellings thyroglossal cyst was most common followed by dermoid cyst.

Cellulitis is an inflammation of skin and subcutaneous tissue following a trivial trauma to the skin. Lower limb cellulitis is the commonest site for this inflammation. Cellulitis can occur anywhere on the body, but is most commonly encountered on the lower legs, especially near the shins and ankles. Under normal circumstances, the skin provides an effective barrier against invasion by micro-organisms that live on the skin or that are present in the environment. Methods: In our study, we studied 50 patients of cellulitis admitted to our hospital. Patients of cellulitis were diagnosed and given the standard treatment protocol. admission to hospital, All routine investigations, USG of the affected limb, Abdomen where necessary. Conservative management. In one case, patient had to be shifted to ICU and surgical intervention. Results: In this study of 50 patients, 35 were male and 15 were female patients. Out of these 50 patients 47 patients presented with lower limb cellulitis, 2 patients with upper limb cellulitis and 1 patient with abdominal wall celllulitis. Out of 50 patients 45 patients had co-existing Diabetes mellitus, 17 patients were grossly anaemic and 16 patients were found to have hypoproteinemia. 48 patients were treated conservatively, 2 required surgical debridement. 1 patients developed necrotizing fasciitis and needed ICU management. No fatalities were recorded. Conclusion:Cellulitis is more common in lower limbs. In the lower socio-economic strata, anaemia and hypoproteinemia add to the development of cellulitis. Diabetes is a major comorbid condition that predisposes to cellulitis after trivial trauma. Conservative management helps if

Thromboangiitis obliterans (TAO), also known as Buerger’s disease or von Winiwarter-Buerger syndrome, is a chronic, inflammatory, thrombotic, nonatherosclerotic, segmental, obliterative, tobaccoassociated vasculopathy primarily involving infrapopliteal and infrabrachial medium-sized and small arteries of predominantly young male smokers, occurring prominently in young male smokers, predominantly affecting small and medium sized vessels and veins in the upper and lower extremities. The aetiology of TAO is unknown but there is a strong association with heavy tobacco use. This study was undertaken to study the mode of presentation of TAO,evaluation of the patient in order to assess the severity and effects of various modalities of treatment. It has a strong and positive association with smoking the cessation of which can bring about remission.

Background: Perforation Peritonitis is one of the common and Life Threatening Surgical Emergency all over the world. The outcomes in India and in our region i.e., Udaipur, Rajasthan are no exception to it. The most common etiology in our region is perforation of diseased Viscera, which is different from western world [2, 5]. The present study was carried out to evaluate the etiology, pathology, site of perforation, and surgical management, post operative complications and mortality.

Objective: Hirschsprung’s disease is one of the common causes of obstruction in children. Transanal endorectal pull-through represents the latest development in the concept of the minimally invasive surgery for Hirschsprung’s disease. In this study, we present our early experience with single stage transanal pull through in children diagnosed with Hirschprung’s Disease on radioimaging.

Design: Retrospective study of children with single stage transanal pull-through done for Hirschsprung’s disease in our institute from Oct 2013 to January 2016.

Material and Method: 12 boys with age remaining 1 month to 2 years who presented with Hirschsprung’s disease were studied. The selection criteria included radiological transition zone at rectosigmoid , no evidence of enterocolitis or sepsis and no associated major anomaly. Pre-operative bowel preparation was done using warm saline until effective decompression of the bowel was achieved .Single stage transanal endorectal pull-through was done in these patients. The follow-up period ranged from 6 months to 2 years.

Results: 12 male patients with a mean age of 8.7 months (range 1 month to 2 years) underwent transanal endorectal pull through. The mean operating time was 73 min (range 60 to 120 min). The average length of bowel resected was 15.5 cm (range – 10 to 18 cm). Post-operatively patients passed first stool between 2nd and 3rd day. Oral feeding was resumed on 5th to 6th post-operative day. The average post-operative duration of stay in hospital was 10 days.The first rectal examintion was performed under anaesthesia three weeks after the operation for the assessment of anastomotic site for any stricture, stenosis or any pus discharge. There after patients were followed up every 15 days for 3 months and assessed for pattern of stooling, enterocolitis and weight gain. After 3 months follow up was done at monthly interval. No mortality occurred in the series.

Conclusion: Advancement in pediatric anaesthesia, availability of pediatric surgical expertise, improvement in preoperative and post-operative management and nursing care has made single stage transanal pullthrough in children a feasible option. The early results are comparable to single stage or multistage surgery in older children.

Background/aim: Use of electrocautery in surgery for the skin incisions is rapidly gain popularity but still most surgeons are in doubt and fear of complications like scarring of tissues, post operative pain, wound infection and poor Cosmesis. Aim of this prospective study was to compare the outcome of electrocautery incisions versus scalpel incisions in open inguinal hernia surgery with regard to early postoperative pain, postoperative wound infection rate and scar assessment. 

Material and Methods: A prospective randomized study of 50 patients with inguinal hernia undergoing mesh repair was carried out over a period of one year. Patients were divided equally in to two groups. In Group A skin incision was taken with electrocautery, and in Group B incision was taken with scalpel. Postoperative pain, wound complication and requirement of analgesic and Cosmesis were compared between the two groups.

Results: The post-operative pain is significantly less in electrocautery group. The requirement of analgesics dose were (mean 1.08 and 2.6) in electrocautery and scalpel group respectively which is significantly more with scalpel group. Only one case of seroma was noted in scalpel group while electrocautery group didn‘t had any complications, the difference was not statistically significant. Cosmesis was better in electrocautery incisions; Manchester scar score was higher in the group II.

Conclusion: Electrocautery incision is safe, less time consuming with less blood loss during inguinal hernia surgery and produces less postoperative pain no postoperative wound infection and better in term of Cosmesis.

Background: Breast cancer is a common cancer among women in Kerala. Though the state has high literacy rate, still many breast cancer patients are being diagnosed in a later stage as locally advanced breast cancer mainly due to delayed diagnosis.

Aims: To find out any relation between low education and low socio economic status with delayed diagnosis resulting in locally advanced breast carcinoma.

Settings and Design: We conducted a comparative study between locally advanced and early breast carcinoma patients admitted in general surgery ward in Govt. TD Medical College, Alappuzha for two years to know if low education and socio economic status is a reason for delayed presentation resulting in locally advanced breast carcinoma.

Materials and Methods: We collected data from July 2014 to June 2016 by personal interview with locally advanced and early breast cancer patients admitted in general surgery ward of Govt. TD Medical College, Alappuzha. Thus obtained data was used to analyse our aims.

Results and Conclusion: We had total 100 patients, 50 with locally advanced and 50 with early breast carcinoma in two year study period. Our study shows that low education and socioeconomic status is associated with delayed presentation leading to delayed diagnosis resulting in locally advanced pattern of breast carcinoma.

Background: Liver abscess was one of the high mortality diseases prior to the availability of percutaneous drainage techniques. Usg guided percutaneous drainage of liver abscess has been gained increased acceptance nowerdays in combination with parenteral antibiotics and is the choice of procedure in most cases. Patients who failed to respond and with poor compliance are candidates for surgical drainage.

Aim: To compare the therapeutic effectiveness of intermittent needle aspiration and pigtail catheter drainage in manegment of liver abscess.

Methods: A comparitive study was carried out among 60 subjects attending Department of Surgery, K.R. Hospital, Mysuru over a period of 12 months. Subjects of either sex with diagnosed cases of pyogenic and amoebic liver abscess were included in the study. Patients with poor compliance, ruptured liver abscess, uncertain diagnosis, terminal disease and liver malignancy were excluded from the study.

Results: The mean age group of the study subjects was 44.6 (range 38-84) years. The gender distribution showed a higher number of males (53) as compared to females (7). Needle aspiration procedure showed a better outcome statistically as compared to pigtail drainage. Two patients in catheter drainage groups required surgery due to persistent sepsis and inadequate drainage.

Conclusions: Percutaneous intermittent needle aspiration is easier, simpler and less expensive preffered method of drainage as compared to pigtail catheter drainage approach for liver abscess.

Context: Mechanical bowel preparation (MBP) is a medical process involving evacuation of bowels with the use of laxatives before surgery involving the colon and ano-rectum to cleanse the bowels. MBP is shown to reduce the rates of infectious postoperative complications. Sodium picosulphate is a stimulant laxative commonly used orally for bowel preparation before gastrointestinal (GI)or anorectal surgery. There is scarcity of Indian data on role of sodium picosulphate in bowel preparation needed in patients undergoing gastrointestinal and anorectal surgery.

Aims: To evaluate the efficacy, tolerability, safety of sodium picosulphate in bowel preparation needed in patients undergoing GI or ano-rectal surgery. Settings and Design: Prospective, non-comparative interventional study.

Methods and Material: 100 patients (55 males and 45 females) between 18 to 65 years of age and posted for GI or ano-Rectal surgery who requires bowel preparation as per PI discretion (elective procedure) and willing to sign the written informed consent form are enrolled in this study. These patients were prescribed 2 tablets of Sodium Picosulphate 10 mg at night before the procedure. The efficacy outcomes were the efficacy of bowel preparation assessed by the surgeon intraoperatively on a 4-point likert scale of 1 = poor (large solid stool), 2 = satisfactory (particulate formed stools), 3 = good (fluid and gas filled), and 4 = excellent (colon/ano-rectum empty and collapsed); clean operative field, difficulty in bowel handling during surgery, and patient satisfaction for bowel evacuation assessed on a scale of 0 = not satisfied at all, 1 = somewhat satisfied, and 2 = completely satisfied. The tolerability and safety was assessed based on the adverse events reported and the symptoms of nausea, vomiting, abdominal pain/cramps, bloating and weakness assessed on a 0-10 visual analogue scale (VAS). Statistical Analysis Used: Descriptive statistics are presented for the study outcomes.

Results: Of the 100 patients enrolled the study (median age of 44.22 years) 54 were males and 45 were females. 44 patients underwent GI surgery while 55 patients underwent anorectal surgery. Efficacy of Bowel preparation (in perprotocol dataset, N=99) as assessed by surgeon intraoperatively was rated as Excellent in 40.41%, Good in 48.48%, Satisfactory in 10.1%, and Poor in 1.01% patients. Operative field as assessed by surgeon during the procedure as “clean” in 98% patients. Difficulty in handling the bowel was reported as “no” in 99% patients. Bowel evacuation satisfaction as assessed by patients was rated as ‘Completely satisfied’ by 73.74%, ‘somewhat satisfied’ by 25.25% were and ‘not satisfied’ by 1.01% patients. Therapy with sodium picosulphate was well tolerated, mild intensity adverse events of weakness, bloating, abdominal cramps, nausea and vomiting were reported by few patients.

Conclusions: Sodium picosulphate can be considered as a good therapeutic armamentarium to surgeons for its use in bowel preparation needed in patients posted for GI or anorectal surgeries and further studies can be considered to substantiate these findings.

Aim: The aim of this study is to study the efficacy of single point (ZF) fixation in selected cases of Tripod fractures of zygoma in achieving anatomical reduction of the zygomatic bone complex in restoration of normal function & aesthetics.

Materials and Methods: This prospective clinical study was conducted in the department of Plastic & Reconstructive Surgery, Gandhi Medical College & Hospital, Secunderabad, Andhra Pradesh. Total of 13 patients who reported in the Department of Plastic & Reconstructive Surgery with clinical and radiological evidence of unstable and displaced tripod fracture of zygoma. Inclusion Criteria: Displaced tripod fracture of zygoma as seen clinically and radiologically (3D CT). Tripod fracture of zygoma with or without associated maxillofacial fractures. Patients above 18 years of age. Presentation within 15 days of injury were included in the study. Exclusion Criteria: Associated fractures of maxilla, frontal bones which can destabilise mid facial skeleton. Bilateral displaced fractures of zygoma. Comminuted fractures of zygoma. Zygoma fractures with visual disturbances. Patients medically unfit for surgery to undergo general anaesthesia. Foreseeable missing opportunity of follow up examination were excluded in the study.

Results: Road traffic accidents were the common cause of fracture zygoma. Most of the patients were between 18-25 yrs age group. Associated fractures were noticed in less than 23% (3cases) of patients in our group. 50% (7cases) of the fractures were compound. 3Dimensional computed Tomography was used to identify the pattern of fracture. Group 3 fracture was noted in 7% (1) patient. Group 4 fracture was noted in 53% (7) patients. Group 5 fracture was noted in 23% (3) patients. Group 6 fracture was noted in 15% (2) patients. Single point fixation done using 2 holed, 1.5 mm plate & 8mm screws in 23% (3) of patients. Single point fixation done using 3 holed, 1.5 mm plate & 8mm screws in 69% (9) of patients. Single point fixation done using 4 holed, 1.5 mm plate & 8mm screws in 7% (1) of patients. Malar symmetry obtained in 47% (6) of patients. Grade 2 malar symmetry obtained in 38% (5) of patients. Grade 3 malar symmetry obtained in 15% (2) of patients. Enophthalmos was noticed in 30% (4) of patients. All patients achieved >3cm mouth opening towards the end of 2 months. None of the patients developed clinical infra orbital step. 5 (38%) patients had radiologically detectable infra orbital step. None of the patients developed post operative infection. Dental occlusion was normal in all patients.

Conclusion: It can be concluded that single point fixation has a definite place in the management of tripod fractures of zygoma with minimal to moderate displacement of infraorbital margin.

Telemedicine is becoming an important tool in today’s modern clinical practice. With the help of advanced network facilities, low cost gazettes and smart phones, practice of telemedicine is possible even at places having minimum available infrastructure. Health care centres with advanced facilities may not be available for poor patients living in remote areas. Use of advanced technology by medical person in remote areas can provide the same quality of medical care as given to urban population. Organisation of ‘tele camps’ is an initiative taken by our department to provide facilities of a tertiary care centre in remote areas. We found it as an easy, effective and relatively low cost modality. As telemedicine is actively being practised in our department, once the patients are enrolled in the digital data base of the camp they can contact any time by using our telemedicine facilities without actually waiting for next camp.

Background: Lower limb varicose veins are the commonest of all vascular disorders. It is one of the important vascular conditions that affect 25 million people in western civilizations. The most important underlying cause for primary varicose veins is incompetence of the great saphenous venous system, most commonly due to reflux at the sapheno-femoral junctional valve. These varicose veins can be treated by either open surgery or new modalities like endovascular surgeries. Conventional surgery (open surgery) involves sapheno-femoral disconnection at the sapheno-femoral junction and stripping of the great saphenous vein above the knee, which may be accompanied by phlebectomies of minor varicosities.

Aim: To compare the short term outcome between open surgery versus endovenous radiofrequency ablation with sclerotheraphy for great saphenous varicose veins in terms of post operative pain, duration of surgery, duration of hospital stay, early return to activities, complications such as hematoma, wound infection, and patient satisfaction.

Methods: A comparitive study was carried out among 60 subjects attending Department of Surgery, K.R. Hospital, Mysuru over a period of 12 months. Patients with symptomatic varicose veins who belong to CEAP classification 2-6 due to great saphenous vein incompetence with perforator incompetence were included in the study. Descriptive statistics reported using mean and standard deviation for continuous variable, numbers and percentage for the categorical variable and chi-square test or fisher’s exact test and for continuous variable Independent t-test or Mann Whitney u-test were used to analyse the results.

Results: Endovenous radiofrequency ablation is a better option in terms of less morbidity, less postoperative pain, requirement of analgesia, and it resulted in lesser hospital stay, and early return to normal activities than conventional surgery.

Conclusion: Endovenous radiofrequency ablation performed quicker and safer and resulted in a significantly better early outcome than conventional surgery.

Introduction: Acute pancreatitis is characterised by sudden onset of abdominal pain. Gallstones disease, alcoholism are the commonest causes of acute pancreatitis. Material Method: The study was carried to judge the outcome and efficacy of pancreatitis. Patients presenting with acute pain abdomen with clinical presentation of pancreatitis proven with investigation were managed conservatively. Results: 28 patients were studied who were between 35- 47years. There were no mortalities. 3 patients developed pseudocyst and 3 patients developed pancreatic necrosis. Conclusion: Conservative management is preferred treatment of acute non infective pancreatitis.

Application of skin graft to cover the raw area is on of the commonest procedure done in plastic surgery. Skin graft can be either split thickness or full thickness, depending amount of dermis harvested. Donor site is always a concern for the patient as well surgeon. Hence it is chosen from hidden areas. Donor site complications are sometimes more cumbersome for the patient. As it is surgically created raw area hence every attempt should be taken to provide good healing without any complications. A successful skin graft surgery not only involves good take of the graft but also well healed donor site. Various techniques have been described for optimizing the donor site healing. Autologous Platelet Rich Plasma (APRP) and collagen dressing are popular methods. But comparative studies are not done to prioritize a single modality. Through this paper we would like to highlight the comparison between APRP and collagen dressing in improving donor site healing.

Liver abscesses have plagued mankind from times immemorial with well-documented reference of the abscess since the time of Hippocrates (400 B.C.). The two common causes of liver abscess are pyogenic and amoebic. Amoebic liver abscesses are more common in our series as compared to pyogenic. There is a third entity, namely Fungal Live Abscess is rare. In our series of 61 patients, the most common cause was amoebic abscess and it was seen more often in alcoholic patients.

Context: Thyroid surgeries comprise one of the more commonly performed procedures by a general surgeon. Today most of the complications of thyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerve injury (RLN), bleeding etc.

Aims: This study intends to examine the incidence, natural history and the factors contributing to the various complications following thyroidectomy and the effect of timely and prompt recognition and intervention in minimizing morbidity.

Material and Methods: This randomized prospective study included 100 consecutive patients undergoing various thyroidectomy procedures and meeting the inclusion criteria, after presenting to the surgical OPDs attached to Victoria Hospital, Bangalore Medical College And Research Institute. All cases were followed up for a period of 10 postoperative days.

Results: 44% of the patients were seen to be in the fourth decade of life with the male: female ratio being 0.8:9.2. Total thyroidectomy was the procedure done in roughly half the patients and multi nodular goitre was the most common diagnosis. The incidence of post-operative hypocalcemia was 18 %, and that of RLN paralysis, wound infection, haematoma and seroma were 4%, 4%, 4% and 2% respectively. The incidence of bleeding, airway obstruction, superior laryngeal nerve (SLN) paralysis and thyroid storm was nil.

Interpretation and Conclusion: An adequate pre-operative preparation, thorough knowledge of anatomy and operative steps with meticulous attention to hemostasis and dissection is essential in ensuring an uneventful postoperative recovery.