Department Of General Surgery Research Articles

Laparoscopic Versus Open Mesh Repair of Inguinal Hernia for Military Personnel

Background: An organ or fatty tissue, like the colon, might abnormally emerge through the wall of the cavity in which it normally dwells, a condition known as a hernia. Inguinal hernia repair is among the most frequently done procedures by surgeons worldwide. Treatment includes pure tissue repairs to prosthetic repairs under open or laparoscopic approach. Though so many options are available but none is superior to others. Aim of the study is to compare the effectiveness of laparoscopic hernia repair with open mesh hernia repair. Methods: The study was a comparative cross-sectional study. The study, which took place between 2016 and 2018, involved 100 cases in the General Surgery department of Combined Military Hospital (CMH), Savar (30 cases of laparoscopic hernioplasty and 70 cases of open hernioplasty). Purposive sampling technique was used to collect data. Data were collected during follow up of patients by using a semi-structured questionnaire. Data were analysed by using Statistical Package for the Social Sciences (SPSS) version 26.0. Informed written consent were obtained from the patients and ethical issues were duly addressed. Results: There were 100 patients in the study, 30 of whom were assigned to group A (the laparoscopic group) and 70 to group B (the open group). In group A, the mean operating time was 103.67±23.57 minutes, while in group B, it was 50.26±2.57 minutes. In group A, there was a decrease in pain scores, with 90% of patients reporting 1-2 (mild discomfort). Three people are in excruciating pain. Conclusion: Inguinal hernia repair is a frequently performed general surgery treatment. Because of the large socio-economic impact of inguinal hernia repair, it is the responsibility of the surgeon to consider the most advantageous approach in each given situation. For all patients needing elective hernioplasty, laparoscopic, non-randomized, pre-peritoneal mesh repair for inguinal hernias is a safe, effective method that has clear advantages over open mesh repair. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 17-23

Importance of multimodal resident education curriculum for general surgeons: perspectives of trainers and trainees

PurposeSatisfaction should be prioritized to maximize the value of education for trainees. This study was conducted with professors, fellows, and surgical residents in the Department of general surgery (GS) to evaluate the importance of various educational modules to surgical residents.MethodsA questionnaire was administered to professors (n = 28), fellows (n = 8), and surgical residents (n = 14), and the responses of the three groups were compared. Four different categories of educational curricula were considered: instructor-led training, clinical education, self-paced learning, and hands-on training.ResultsThe majority of surgeons regarded attending scrubs as the most important educational module in the training of surgical residents. However, while professors identified assisting operators by participating in surgery as the most important, residents assessed the laparoscopic training module with animal models as the most beneficial.ConclusionsThe best educational training course for surgical residents was hands-on training, which would provide them with several opportunities to operate and perform surgical procedures themselves.

Postpartum Surgical Emergency, in the General Surgery Department of the District Hospital of the Commune IV/ Bamako

Introduction: Postpartum is a period of physical and psychological upheaval with the possibility of surgical complications. Objective: To analyze the epidemiological-clinical, therapeutic and prognostic profile of postpartum surgical emergencies. Methods: This was a descriptive, cross-sectional study over 8 months (from August 2022 to March 2023) including all patients admitted to the general surgery service for acute surgical abdomen in the postpartum period. Result: Seven patients were retained with an average age of 28.33 6.89years. We found 4 cases (57.1%) of post-operative peritonitis, 1cas (14.3%) of appendicular abscess and 1 case (14.3%) of strangled white line hernia. Clinical signs were dominated by abdominal pain, conjunctival pallor and fever. Anemia was confirmed in 5 (71.4%) patients and we found leukocytosis in all patients. Laparotomy associated with hysterectomy was performed in 2cas, laparotomy avively of the banks and uterine suture in 2 cases, washing of the peritoneal cavity associated with abdominal drainage in 1 case, hernia cure in 1cas, an appendectomy in 1cas and a sigmoidectomy in 1cas; abdominal drainage was performed in all our patients. Conclusion: The occurrence of an abdominal surgical emergency in postpartum is serious and may involve the obstetric and vital prognosis of the patient. The involvement of all actors (surgeon, obstetrician and anesthesiologist resuscitator) in the management, remains essential to secure the periartum period.

Clinical and history features of patients with recurrent deep endometriosis: A retrospective study

Aim. To identify clinical and history features of patients with recurrent deep endometriosis (RDE). Materials and methods. A retrospective study of clinical and history data of 200 patients with DE undergoing surgical treatment at the Department of General Surgery of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology in 2020–2021. Group 1 included 80 patients with RDE, group 2 included 120 patients with newly diagnosed DE. All patients underwent surgical treatment followed by immunohistochemical examination and DE confirmation. Results. An association was found between the young age of the patient at the time of the first surgery and the type of endometriosis. It was found that women with a history of endometriosis surgery in early reproductive years (29.22±5.3 years) are at risk of recurrent endometriosis. Two or more surgeries were reported in 33.7% of RDE patients. In 90.2% of patients, endometriosis recurred with clinical manifestations; in 9.8%, it was asymptomatic and diagnosed on pelvic ultrasound. The group of RDE patients showed a longer period of infertility (5.432±3.53 years) than the group with newly diagnosed DE (2.953±1.29 years). It was found that the surgeries performed in RDE patients were longer, more complex, and associated with more blood loss. Intestinal resection, ureterolysis, adhesiolysis, and salpingectomy were significantly more common in the RDE group than in patients without a history of endometriosis surgery. Conclusion. In most cases, RDE is clinically manifested, rarely asymptomatic and diagnosed by visualization methods. Patients with a history of surgery at a younger age are at risk of RDE, and their surgical interventions are more complicated with more blood loss. Currently, surgical treatment of DE is the optimal method; however, it has serious disadvantages with severe and even life-threatening postoperative complications.

TIMING OF THE STOMA REVERSAL, WHAT IS THE SAFE PERIOD?: A RETROSPECTIVE OBSERVATIONAL STUDY

Objective: The objective of the study is to determine the most suitable timing for the reversal of enteric stomas and to investigate the complications associated with the presence and reversal of stomas among different age groups and genders. Methods: This was a retrospective study conducted in the Department of General Surgery of a tertiary care medical institute. The institutional ethical committee approved the study. We reviewed the digitally recorded data of patients who had undergone both the creation and reversal of stomas at our institution over various time intervals spanning from January 2017 to December 2022. Beyond the electronically stored clinical data encompassing patient demographics, stoma type, and complications encountered between stoma insertion and reversal, we conducted a thorough review of the database containing information on outpatient follow-ups for a month. The gender and age distribution, indications for surgery, type of stoma, and its correlation with age and gender were analyzed. Duration from surgery to stoma reversal and complications were also analyzed. Categorical data were presented as frequency and percentage, whereas quantitative data were summarized using the mean and standard deviation. Closure of the stoma after surgery was compared based on age and sex, employing an independent t-test. Results: In this study 82 patients undergoing stoma surgery, 68.29% were male and 31.71% were female. The mean age of male and female patients was found to be 44.26 and 35.96 years, respectively. Males had a higher median duration for ileostomy and jejunostomy reversals at 14 and 17 weeks, respectively, whereas females showed longer durations for ileostomy at 15 weeks. Common indications for surgery included intestinal obstruction (32.9%) and peritonitis (20.7%). Post-stoma closure 50% of the patients experienced complications, with 24% occurring within 1 month of reversal. Major complications occurred in 41% of cases, including parastomal hernia and suspected anastomotic leaks. Minor complications were observed in 28 patients, representing 35% of all surgeries. Conclusion: Stoma reversal between 8 and 12 weeks post-surgery is recommended for minimizing complications and avoiding psychological burden. While early closure may reduce hospital stay, it increases the risk of infections. Optimal timing for stoma closure is complex, requiring personalized, collaborative decision-making.

Establishment and evaluation of a prognostic model for patients with unresectable gastric cancer liver metastases

BACKGROUND Liver metastases (LM) is the primary factor contributing to unfavorable outcomes in patients diagnosed with gastric cancer (GC). The objective of this study is to analyze significant prognostic risk factors for patients with GCLM and develop a reliable nomogram model that can accurately predict individualized prognosis, thereby enhancing the ability to evaluate patient outcomes. AIM To analyze prognostic risk factors for GCLM and develop a reliable nomogram model to accurately predict individualized prognosis, thereby enhancing patient outcome assessment. METHODS Retrospective analysis was conducted on clinical data pertaining to GCLM (type III), admitted to the Department of General Surgery across multiple centers of the Chinese PLA General Hospital from January 2010 to January 2018. The dataset was divided into a development cohort and validation cohort in a ratio of 2:1. In the development cohort, we utilized univariate and multivariate Cox regression analyses to identify independent risk factors associated with overall survival in GCLM patients. Subsequently, we established a prediction model based on these findings and evaluated its performance using receiver operator characteristic curve analysis, calibration curves, and clinical decision curves. A nomogram was created to visually represent the prediction model, which was then externally validated using the validation cohort. RESULTS A total of 372 patients were included in this study, comprising 248 individuals in the development cohort and 124 individuals in the validation cohort. Based on Cox analysis results, our final prediction model incorporated five independent risk factors including albumin levels, primary tumor size, presence of extrahepatic metastases, surgical treatment status, and chemotherapy administration. The 1-, 3-, and 5-years Area Under the Curve values in the development cohort are 0.753, 0.859, and 0.909, respectively; whereas in the validation cohort, they are observed to be 0.772, 0.848, and 0.923. Furthermore, the calibration curves demonstrated excellent consistency between observed values and actual values. Finally, the decision curve analysis curve indicated substantial net clinical benefit. CONCLUSION Our study identified significant prognostic risk factors for GCLM and developed a reliable nomogram model, demonstrating promising predictive accuracy and potential clinical benefit in evaluating patient outcomes.

Impact of one-anastomosis gastric bypass and laparoscopic sleeve gastrectomy on metabolic parameters in morbidly obese patients: A comparative review.

Objective: To compare one-anastomosis gastric bypass and laparoscopic sleeve gastrectomy in morbidly obese patients in terms of frequency of dyslipidemia, mean AST, mean ALT, mean HbA1C and mean FPG. Study Design: Randomized Controlled Trial Setting: Department of General Surgery, Allied Hospital, Faisalabad. Period: October 20, 2022, to June 20, 2023, Methods: Morbidly obese individuals were randomly assigned to either undergo laparoscopic sleeve gastrectomy (Group A) or one-anastomosis gastric bypass (Group B). The study, led by a consultant with 3 years of post-fellowship experience, conducted comprehensive patient assessments, including BMI calculations and metabolic profiling. Monthly follow-ups continued until the 6th month, after which lipid profiles, alanine transaminase (ALT), aspartate transaminase (AST), hemoglobin A1C (HbA1C) and fasting plasma glucose (FPG), results were obtained from the hospital pathology lab. The comparative analysis revealed superior outcomes in Group B, the one-anastomosis gastric bypass cohort, as compared to Group A (laparoscopic sleeve gastrectomy), spanning multiple parameters. Results: The mean FPG in Group A was 5.52±0.26, compared to 5.56±0.25 in Group B. Mean HbA1c was 6.65±0.24 in Group A and 6.26±0.19 in Group B. AST levels were comparable, with 24.13±3.31 in Group A and 24.23±3.48 in Group B, yielding a p-value of 0.896. Similarly, ALT levels showed no significant difference between the groups (24.55±3.46 in Group A and 23.92±3.35 in Group B, p-value=0.414). Conclusion: One-anastomosis gastric bypass demonstrated superior efficacy over laparoscopic sleeve gastrectomy in morbidly obese patients, showcasing favorable outcomes in terms of dyslipidemia, AST, ALT, HbA1C, and FPG.

Abstract PO4-07-07: The construction and clinical research value of the prediction model of sentinel lymph node metastasis based on indocyanine green fluorescence quantification in breast cancer

Abstract Objective: To establish a prediction model of sentinel lymph node metastasis by quantitative indocyanine green fluorescence analysis in breast cancer. Methods: From May 2023 to June 2023, 20 patients with breast cancer underwent modified radical mastectomy in the General Surgery Department of Jiangsu Provincial People's Hospital were chosen for research and analysis. Sentinel lymph node were taken from all the patients. The sentinel lymph nodes were located by using the double staining method of subcutaneous injection of Methylene blue and intravenous injection of indocyanine green. The postoperative pathology is used as the standard for evaluating the presence or absence of metastatic cancer in lymph nodes. At the same time, the transcutaneous fluorescence of sentinel lymph node was recorded and the peak time of fluorescence intensity curve was plotted. To establish a logistic diagnostic prediction model and fluorescence threshold, the sentinel lymph node was incised during operation and the fluorescence of sentinel lymph node was recorded again. The criteria for ICG positive determination are determined by the Youden index, which was used to judge the lymph nodes above the threshold in the Logistic diagnostic prediction model. Lymph nodes below the threshold determined in the Logistic diagnostic prediction model are the criteria for ICG negative determination. Cases with less than 3 sentinel lymph node were excluded. Results: 19 cases were ultimately selected. Methylene blue staining data was taking as the judgment standard of sentinel lymph node. Fluorescence imaging was 100% in 14 patients, 66.7% (2/3) in 1 patient, and 125%-150% (5/4-6/4) in 4 patients. Fluorescence quantification values below 2.91 are negative lymph nodes, and values above 4.69 are positive lymph nodes. Moreover, caution is required between 2.91 and 4.69. Combining with the fluorescence dynamic attenuation curve, the positive group has a plateau curve, while the negative group mostly has a decline curve. Combining fluorescence quantification with fluorescence dynamic attenuation curve, the diagnostic rate of positive lymph nodes has a lower false negative rate compared to simple fluorescence quantification and fluorescence dynamic attenuation curve. Conclusion: The quantitative difference value of indocyanine green fluorescence angiography can be used to predict the positive metastasis of sentinel lymph node in breast cancer, making it an attempt to exempt sentinel lymph node biopsy. Citation Format: Yang Wu, Wei Zhang, Jinhai Tang. The construction and clinical research value of the prediction model of sentinel lymph node metastasis based on indocyanine green fluorescence quantification in breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-07-07.

Primary Retroperitoneal Tumors: A Report of 08 Cases at the General Surgery Department of The Mohamed VI University Hospital in Marrakech

Primary retroperitoneal tumors are a rare and heterogeneous group of neoplasms arising within the retroperitoneal space, excluding the kidneys, urinary tract, adrenal glands, major blood vessels, and adjacent viscera. Treatment involves surgical resection, often requiring sacrifices of adjacent organs, with adjuvant chemotherapy considered in some cases. Histologically, mesodermal tumors were most common, with myxoid liposarcomas being predominant. Long-term outcomes vary, with some cases showing favorable evolution but others experiencing recurrence or mortality post-surgery. This study aims to provide insights into the clinical presentation, diagnostic approach, treatment modalities, and long-term outcomes of primary retroperitoneal tumors based on a retrospective analysis of cases treated at the general surgery department of the Mohamed VI University Hospital in Marrakech. By elucidating the characteristics and management of these tumors, this study seeks to contribute to the understanding of primary retroperitoneal tumors and guide future diagnostic and therapeutic strategies to improve patient outcomes.

Outcome and Factors Related to Isolated Liver Metastasis due to Breast Cancer.

To determine the associated risk factors for isolated liver metastasis in breast cancer patients and to detect the prognostic factors related to survival. Analytical study. Place and Duration of the Study: Department of General Surgery, The University of Health Sciences, Istanbul, Turkiye, from January 2011 to November 2020. Patients with breast cancer liver metastasis who experienced surgery were retrospectively analysed for breast cancer and metastases-related characteristics. Descriptive statistical methods were used in the evaluation of data. Survival analyses were estimated by the Kaplan-Meier method. Log-rank and univariable Cox regression tests were utilised to search for prognostic factors' impact on survival. Out of 12 patients, 11 had recurrent disease after a median of 36 months of disease-free survival (DFS) and one patient had de novo metastasis. Grade 3 tumours and increased expression of Ki-67 had a negative effect on DFS. The median follow-up period was 66 months. Survival analysis showed 2- and 3-year progression-free survival (PFS); overall survival rates were 82%, 69%, 92%, and 82%, respectively. Development of liver metastasis in 3 years following breast cancer treatment was linked to worse PFS (p = 0.040). Long-term survival is possible for breast cancer survivors with liver metastasis. Disease-free interval is an important determinant. Longer progression-free survival was detected in patients who had developed metastasis after three years of breast cancer treatment. Breast cancer, Liver metastasis, Hepatic surgery.

Left-Sided Pneumothorax in a Potential Kidney Transplant Recipient—A Surprise in the Surgical Ward: Case Report

The risk of morbidity and mortality in the group of people qualified for kidney transplantation is high. Although currently, the qualification for kidney transplantation is very extensive and detailed, the final examination and assessment at the transplant center is crucial for the success of the transplantation. A 50-year-old woman with end-stage kidney disease was admitted to the Department of General, Vascular, and Transplant Surgery on July 21, 2023, for kidney transplantation. A month earlier, she had undergone surgery to create an arteriovenous fistula on the left forearm. The regional anesthesia was performed. Apart from temporary pain and cough, the postoperative course was uncomplicated. Upon admission to the Department, the patient was in good general condition, and only a dry cough was noted during the physical examination. Chest X-ray revealed pneumothorax on the left side with partial lung atelectasis. The patient was temporarily disqualified from kidney transplantation and the pneumothorax was cured. She is currently on the active list waiting for a kidney transplant. The analysis of the above case emphasizes the importance of a physical examination and final qualification at the transplant center. Detailed examination and evaluation at the above center can improve patients' quality of life and survival.

Clinical Application of ERCP Concurrent Laparoscopic Cholecystectomy in the Treatment of Cholecystolithiasis Complicated with Extrahepatic Bile Duct Stones

ObjectiveTo compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration and lithotomy (LCBDE) in the treatment of cholecystolithiasis combined with bile duct stones. MethodsFrom September 2018 to January 2022, 195 patients with cholecystolithiasis complicated with extrahepatic bile duct stones from Department of Department of General Surgery, Shanghai Jiading Central Hospital met the inclusion criteria, including 60 cases in the LC group and 86 cases in the LCBDE group. The general condition, operation success rate, complications and residual stone rate of the two groups were retrospectively analyzed. ResultsIn the simultaneous operation group, 58 patients successfully performed ERCP, and the indwelling rate of the abdominal drainage tube (41.7% vs. 95.3%) was significantly better than that in the LCBDE group. There was no significant difference in the conversion rate to open surgery, operation time, and intraoperative blood loss between the two groups. In the simultaneous surgery group, 4 patients (6.7%) developed pancreatitis after ERCP, which was cured by conservative treatment. The pain score at 6 hours after operation was significantly lower than that in the LCBDE group (3.9±1.6 vs 6.5±2.4). There were no significant differences in biliary leakage (1.7% vs. 4.7%), postoperative cholangitis (5.0% vs. 5.8%), incision infection (3.3% vs. 3.5%), and bile duct stone residue rate (5.0% vs 3.5%) between the two groups. There was no severe pancreatitis, second operation or death. The duration of hospital stay was shortened in the concurrent operation group (5.1±2.3d vs 7.9±3.7d), and the operation cost was significantly higher than that in the LCBDE group (48839.9±8549.5 vs 34635.9±5893.7 yuan). ConclusionERCP combined with LC and LCBDE are both safe and effective methods for the treatment of cholecystolithiasis combined with extrahepatic bile duct stones. The simultaneous operation group has certain advantages in patient comfort and rapid rehabilitation, which can be popularized in qualified units.

CASE REPORT ON OBSTRUCTED OBTURATOR RICHTER HERNIA MANAGED BY OPEN PREPERITONEAL MESH REPAIR

Introduction: Obturator hernia is rare abdominal hernia.It occurs when part of the pelvic contents protrude through the obturator foramen adjacent to Obturator vessels and nerve.It is a diagnostic challenge in the emergency department since the signs and symptoms are non-specific and the risk of strangulation is high in such hernias. It often occurs in elderly, emaciated and thin lean body mass women.The patient may present with intestinal obstruction with diffuse abdominal pain, nausea and vomiting and constipation,because of diagnostic difficulty they often present late and most of them are diagnosed introperatively. Case report: A 60 years old female patient presented to emergency General Surgery Department of GMERS Medical College Himmatnagar with pain in Right Groin region and diffuse pain abdomen and vomiting associated with constipation since 3 days,k/c/o Hypertension on medication Tab Amlodipine 5mg 1-0-0.On examination -Abdomen distended,tenderness present in Right groin region Abdominal girth 72 cm . Abdomen Xray revealed multiple air fluid levels ,USG Abdomen and pelvis suggestive of Right Groin Hernia and multiple dilated bowel loops with diameter of 3.5 mm suggestive of Intestinal Obstruction (Usg picture is uploaded in fig 2) and as patient was not affordable for CECT Abdomen and pelvis CECT Abdomen and pelvis was not done Discussion: Emergency lower midline exploratory laparotomy under General Anaesthesia was done and intraoperatively was diagnosed as Obstructed Obturator Hernia as the bowel was found to be protruding into Obturator foramen adjacent to Obturator vessels and Obturator nerve and the bowel was reduced from foramen and was found to be healthy ,single suture was taken over the coopers ligament and obturator foremen and peritoneum was closed as there was no bowel contamination preperitoneal space was created and 15X15 cm Macroporous light weight polypropylene Mesh was placed and fixed covering all the defects to prevent recurrence and any future groin and Inguinal hernia. Conclusion: Obturator Hernia is a rare form of abdominal hernia but can cause a severe Intestinal Obstruction if it not diagnosed and treated early bowel might result into ischemia and necrosis which can turn into a fatal complication.The elderly female with lean body mass and multiparous women presenting with diffuse pain abdomen and pain in Groin region with vomiting and constipation obstructed Obturator hernia and femoral hernia should always be kept as probable diagnosis.Radiological imaging may yield the diagnosis but in this case as patient was not affordable so ,CECT Abdomen with pelvis was not done and as patient Abdomen Xray had multiple air fluid levels .Emergency lower midline Exploratory laparotomy can be done and if obstructed bowel is found to be healthy then Preperitoneal mesh repair can be done and this procedure has got a good outcome increases the abdominal strength and has got a less recurrence chances.

Outcome of stapled haemorrhoidopexy versus open haemorrhoidectomy in grade third and fourth haemorrhoids

Background: Haemorrhoids are one of the most common benign anorectal problems worldwide. Methods: This study was conducted in the department of General Surgery, Sher e Kashmir Institute of Medical Sciences and SKIMS Medical College from April 2021 to October 2022. The study included 80 patients which were randomly divided into two groups. Group A was offered Stapled Haemorrhoidopexy and Group B underwent open hemorrhoidectomy. All relevant data was collected and final inferences were drawn Results: In our study there were 80 patients with mean age of 45 years with male preponderance. Majority of patients were having duration of symptoms for 6-12 or >12 months. The most common presenting complaint was prolapsed mass, followed by bleeding per rectum. 50 patients had grade 3, 30 patients had grade 4 haemorrhoids. Mean operative blood loss, operative time, wound healing time and mean duration of hospital stay was less in MIPH group. Post procedure complications were present in 12 patients in group A and 32 patients in group B. Most common complication in group B was urinary retention. There was no recurrence in both groups up to 6 months. Post-operative pain was significantly less in MIPH group. Conclusions: Stapled Haemorrhoidopexy has less, post-operative pain, operative time, hospital stay, complications and less wound healing time. However, there is no significant difference in long term complications when compared with Miligan-Morgan technique. Cost of Stapler gun used for MIPH may be a limiting factor.

Multiple spinal schwannomas of multiple intradural extramedullary tumors: a case report

We describe the case of a 30-year-old male patient who was brought to the hospital's general surgery department with a four-month history of low back pain, numbness, and paraesthesia in both legs, history of weakness in both legs is also present. Magnetic resonance imaging revealed multiple Intradural extramedullary tumors at the C3/C4, D1-D2, D4, and D8 levels- likely nerve sheath tumors (schwannomas). The patient underwent surgery for the removal of tumors. The diagnosis was validated by histopathological examination. Post-operative recovery was uneventful and the patient improved gradually and recovered fully in 10-15 days.

One-step approach by enterolithotomy as surgical treatment of biliary ileus associated with bridle: case report and literature review

Gallstone ileus is a rare cause of intestinal obstruction, more common in adults and in the context of late complications due to gallbladder stones. The pathophysiology describes long-term inflammatory processes of the gallbladder, with biliodigestive fistula development and passage of the gallstone into the intestine, impacting the terminal ileum in most cases. It manifests with data of intestinal obstruction in patients with a chronic history of gallbladder lithiasis. The ideal imaging study is a computed tomography (CT) scan of the abdomen to identify pneumobilia, intestinal obstruction and the lithiasis impacting on the bowel. The surgical approach depends on the context of each patient through laparoscopy or laparotomy in order to perform enterotomy and extraction of the stone or by performing also the management of the fistula and cholecystectomy at the same surgical time. Management must be individualized for each patient. We present the case of a patient in her tenth decade of life with a history of recurrent biliary colic without management, who was admitted to the general surgery department with data of probable intestinal occlusion. Imaging studies were performed, with radiographic evidence of distension of the small bowel loops and tomography with findings suggestive of biliary ileus. Due to the clinical context and comorbidities of the patient, laparotomy with enterotomy and extraction of the stone was performed.

Evaluating the Surgical Treatment of Mechanical Icterus in the General Surgery Department of the Hopital Ntional Ignace Deen, Chu De Conkry

<i>Introduction</i>: The aim of this study was to report our experience in the surgical management of mechanical jaundice. <i>Methods</i>: This was a 10-year retrospective descriptive study (January 2011 to August 2022), carried out in the general surgery department of the Hôpital National Ignace Deen. Patients admitted for surgery for mechanical jaundice were included. <i>Results</i>: We collected 22 cases of mechanical icterus out of a total of 4739 surgical procedures performed during the study period. The mean age was 46 years, with extremes of 9 and 80 years. All our patients were seen at the frank icterus stage. Ultrasound was performed in all patients. Etiologies were dominated by tumors of the pancreatic head (54.54%), and lithiasis of the main bile duct (18.18%). The average consultation time was 5.04 months, with extremes of 9 years and 80 years. Cholecystectomy was performed in over half the cases (54.54%), including three cases associated with stone extraction (13.63%). Bilio-digestive shunts were performed in 11 cases (50%), of the choledochoduodenal (13.63%) and cholecysto-jejunal (13.63%) types. Post-operative management was straightforward in 81.81% of cases, with 4 deaths (18.18%). <i>Conclusion</i>: Palliative bypass, due to the delay in consultation, allows remission of the signs of cholestasis, but does not change the natural course of the pathology. Mortality depends on the etiology.

Frequent Presentation of Counterfeit Gunshot Wounds in a Tertiary Care Hospital in North India: A Case Series

Introduction: Self-inflicted wounds, or wounds produced by another acting in accord with him, are wounds inflicted by a person on his own body. The purpose of fabricating injuries is to file a false claim of assault against an opponent, to alter the appearance of a minor injury in order to attract more attention and a harsher punishment for the alleged accused. Someone may also pretend these as defence wounds, so as to conceal homicide.Result: In a short period of 1 year, i.e. from August 2020 to July 2021 in a single unit of Department of General Surgery, 8 cases of Counterfeit Gunshot Wounds are there which depicts that the foul play is at large scale and these gunshot wounds are not present over the vital organs of the body.Conclusion: The combined efforts of all investigating authorities and doctors can help to avoid injury fabrication, which will not only decrease wasteful litigation in the courts, but will also help to avoid harassment of innocent individuals.

Drug utilization and prescribing pattern in the treatment of urolithiasis: a perspective on World Health Organization recommendations

Background: Drug utilization research (DUR) is essential in promoting rational use of medicine, aimed at understanding the patterns of prescription, administration, and utilization of medications. It provides valuable insights into the actual drug usage patterns for specific disease conditions. To evaluate the current utilization pattern of drugs in patients of urolithiasis in the Department of General Medicine and Surgery at Integral Institute of Medical Science and Research Hospital, Lucknow. Methods: Following the approval of the institutional ethics committee, a prospective observational study was conducted at Integral Institute of Medical Science and Research Department of general medicine and surgery over a six-month period. Urolithiasis patients’ prescriptions were analyzed to study the prescribing patterns. Information about patient demographics, co-morbidities, and the number and types of medications prescribed were collected and analyzed. Results: Out of 102 patients studied, a female preponderance over male patients was observed. The co-morbidities that are encountered most commonly were hydronephrosis, cystitis, and renal cyst. There is averaged 7 medicines per prescription, 15.25% of medicines written by the generic name, 83.33% of patients receiving antibiotics, 54.70% of patients receiving injections, and 83% of drugs prescribed are mentioned in the essential medicine list. Analgesics, antibiotics, nutritional supplements, antiemetic, alkalizing agents, and antispasmodics were among the class of medicines given. Conclusions: This study highlights the current use of medicines and drug utilization in urolithiasis management. The findings show important insights for healthcare professionals to enhance medication therapy, encourage cost-effective healthcare delivery and improve quality of patient in urolithiasis management.

Comparison of 1-stage and 2-stage Managements for Common Bile Duct Stones and Gallstones (CBDS): A Retrospective Study.

The aim of this study was to evaluate the efficacy, safety, and surgical outcomes of 2-stage management, namely preoperative endoscopic retrograde cholangiopancreatography (ERCP) + laparoscopic cholecystectomy (ERCP+LC) or LC + postoperative ERCP (LC+ERCP), as well as 1-stage management, LC + laparoscopic common bile duct exploration (LCBDE) for treating patients with gallstones and common bile duct stones (CBDS). This retrospective study analyzed the data of 180 patients with common bile duct stones (CBDS) who were admitted to the Department of General Surgery at Tongji Hospital, Tongji University, between January 2019 and June 2021. The study included 3 groups: ERCP+LC (group 1), LC+ERCP (group 2), and LC+LCBDE (group 3), each consisting of 60 patients. Clinical metrics of the patients were collected and compared among the groups. Group 3 had the shortest operation duration and hospital stay compared with group 1 and group 2. In addition, group 3 had the lowest long-term postoperative complications, particularly the recurrence rate of CBDS. The total cost was also the lowest in group 3. Furthermore, patients in group 3 had the lowest postoperative amylase levels. All patients in the study achieved successful stone clearance. There were no significant differences in the conversion to other procedures rate, postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and mortality among the three groups (P > 0.05). Both 1-stage management and 2-stage management are effective treatments for CBDS. The LC+LCBDE management is a safe treatment option, offering shorter hospital stays and operation duration, lower costs, and fewer complications.