New Indian Journal of Surgery

Introduction: Acute biliary pancreatitis (ABP) caused by gallstones and biliary sludge1 is the most important cause of Acute Pancreatitis (AP). Aim: Effect of early cholecystectomy in mild acute biliary pancreatitis. Methods: This was a hospital based observational study, by convenience sampling recruited 60 patients of mild acute biliary pancreatitis eligible as per inclusion criteria within study duration of one year reported at Department of Surgery, Sardar Patel Medical College, PBM Hospital, Bikaner. Results: mean age was 44.76±9.88 yr (range 30- 70), 60% were female, 51.67% had pain & nausea as chief complaint, 71.66% patients had Cholelithiasis on MRCP. 6.68% had 3 CT severity score preoperatively whereas 1.66% had 3 CT severity score postoperatively. 56.67% cases had surgery after 72-96 hr. Success rate of early cholecystectomy was 98.33%. 56.67% cases had surgery after 72-96 hr mean 101.6± 14.89 hr. Only one case had recurrence on 3 months follow up. Conclusion: Early Cholecystectomy for patients with acute mild gallstone pancreatitis was found to be a safe procedure when performed during the index admission. Keywords: Early Cholecystectomy; Biliary pancreatitis. Introduction Acute biliary pancreatitis (ABP) caused by gallstones and biliary sludge1 is the most important cause of Acute Pancreatitis (AP), accounting for up to 75% of cases.2 Although most cases of ABP are mild and Self-limiting, a small group (20%) of patients may develop severe pancreatitis, which is associated with high morbidity and mortality.3 Commonly, after resolution of the initial attack of APB, patients may experience a recurrent attack (40% to 60%) within 2 weeks or other gallstonerelated complications such as biliary colics, acute cholecystitis, acute cholangitis or common bile duct (CBD) obstruction. Acute pancreatitis is a common disease in the emergency room with an annual incidence rangin

he quality of skin wound healing can be improved by the application of collagen scaffolds as biological dermal substitutes. Dermal extract helps to improves wound healing and quality of the scars. They serve as a scaffold into which cells can migrate and repair the injury. In the current scenario where in many biological and cellular engineering skin substitutes are available, wound management is a multimodality treatment with use of multiple available methods to augment wound healing at various levels. An excellent dermal substitute should be affordable, long-lasting, ready-to-use, analgesic, durable, flexible, non-antigenic, stops water loss, conforms to uneven wounds, anti-microbial, and may be applied in one sitting. In this study, we attempted to mimic the same technique in our two-layered regenerative scaffold, which is created locally and is cost-effective.

he quality of skin wound healing can be improved by the application of collagen scaffolds as biological dermal substitutes. Dermal extract helps to improves wound healing and quality of the scars. They serve as a scaffold into which cells can migrate and repair the injury. In the current scenario where in many biological and cellular engineering skin substitutes are available, wound management is a multimodality treatment with use of multiple available methods to augment wound healing at various levels. An excellent dermal substitute should be affordable, long-lasting, ready-to-use, analgesic, durable, flexible, non-antigenic, stops water loss, conforms to uneven wounds, anti-microbial, and may be applied in one sitting. In this study, we attempted to mimic the same technique in our two-layered regenerative scaffold, which is created locally and is cost-effective.

Background: Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty.

Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication.

Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups.

Results: Total number of complications in group A were 11(42.3%) and most common complications were skin necrosis (n=7, 26.9%) and urethrocutaneous fistula (n=6, 23.1%). Total number of complications in group B were 7(26.9%) while Chordee and preputial edema (n=6, 23.1% each) were among the most common complications. 9(34.6%) patients developed complications in group C and most common complications were penile torsion (n=6, 23.1%) and urethrocutaneous fistula (n=4, 15.4%).

Conclusion: We have seen in our study that TV flap is a good option as second cover with lesser complications especially in terms of fistula related complications while Durham smith onlay cover found to be equally better option as it showed no skin complications and other complications were almost comparable to TV flap cover.

Background and Aim: Understanding the natural history of venous thrombosis is important for optimal management of this condition. Once risk factors are recognized it is possible to avoid these risk factors or to use active prophylaxis to reduce the morbidity and mortality. This study is targeted at identifying the risk factors of deep vein thrombosis in our set up, the role of Heparin in prophylaxis and to do a comparative study of low molecular weight Heparin with unfractionated Heparin in treatment of deep vein thrombosis of lower limb in Guru Gobind Singh Government hospital, Jamnagar. Material and Methods: Study population consisted of 50 consecutive patients with deep vein thrombosis, admitted to Guru Gobind Singh hospital, Jamnagar. We have studied 50 patients above 18 years of age with proven deep venous thrombosis by Doppler ultrasound. A complete clinical history was taken to assess risk factors, level of immobility if present and thorough physical examination was done. Routine investigations such as hemogram, haematocrit, blood indices, and liver and renal function tests were done. Diagnosis of deep vein thrombosis was detected by radiographic imaging like Doppler ultrasonography. Results: In our study, most of patients presented with complaints of swelling (70%) and pain (48%) of the affected lower limb. Few patients (4%) had symptoms of breathlessness (SOB), chest pain and orthopnea suggestive of pulmonary embolism. 34 patients in our study were having reasonably good level of haemoglobin while rests of all were having anaemia of different degree4 patients had haemoglobin below 8gm/dl and that needed separate treatment also. Leukocytosis was present in 16 patients. 16 patients had smoking as associated risk factor along with other acquired risk factors and 5 patients had obesity along with other risk factors. The most common complication of DVT is pulmonary embolism which occurs due to dislodgement of thrombus. Conclusion: Even though it is grievous, DVT can be prevented and treatable. Better and regular availability of drugs like LMWH and safer oral anticoagulants in the smallest possible region of the country can do wonders to save lives. Larger studies focusing more on coagulation cascade, molecular biology and genetics will be even bigger help to mankind.

In recent years, there has been a greater emphasis on providing high-quality medical treatment to ensure patients’ safety through improving recovery after surgery (ERAS), reducing postoperative stress, and restoring normal function quickly. Negative pressure wound care has revolutionized the way acute and chronic wounds are treated. The incision site is usually covered with an occlusive or semiocclusive covering after primary wound closure. It is thought that using closed incisional negative pressure therapy on surgical wounds improves wound healing by better distributing shear stresses on wound edges and promoting the evacuation of wound fluids such subcutaneous seroma and hematoma

Introduction: In a country like ours, the increased number of surgical emergencies presenting to a hospital diverts majority of the resources towards the emergency department. Understanding this growing need makes it important to study and evaluate the distribution of these patients which shall help in developing a more efficient department. Material and Methods: We conducted a prospective study of patients undergoing emergency surgeries from December 2019 to November 2021. Total 300 patients included and study was carried out in the Department of Surgery, S.P. Medical College and P.B.M Hospital, Bikaner. Results: Majority of patients were from 21 to 40 years age group (43.66%). There were 208 males and 92 females. The male to female ration in our study was 2.26:1. Out of 300 patients, 82 patients (21.33%) had acute appendicitis 50 patients (16.66%) had hollow viscus perforation and 40 patients (13.33%) had intestinal obstruction. Most common surgical intervention done was exploratory laparotomy followed by appendectomy. The average hospital stay in our study was 6.6 days. Surgical site infection

Background: Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty. Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication. Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups.