Department Of General Surgery Research Articles

Comparison of robotic versus laparoscopic surgery for visceral obesity in mid-low rectal cancer: a propensity-matched analysis.

Obesity is becoming more and more common, and measuring visceral fat area (VFA) is a useful diagnostic technique for visceral obesity (VO). The purpose of this research is to compare the surgical results of robotic versus laparoscopic rectal surgery, with a focus on assessing the benefits of the latter method for treating both VO and mid-low rectal cancer. Patients receiving laparoscopic or robotic anterior rectal excision at Northern Jiangsu People's Hospital's general surgery department were included in the retrospective analysis. 242 people in all took part in the study; 121 cases were assigned to the robotic surgery (RS) group and another 121 cases to the laparoscopic surgery (LS) group. In comparison to LS, our results show that RS led to a shorter period for the recovery of bowel function (p = 0.03), a shorter hospital stay (p < 0.001), a smaller intraoperative blood loss (p < 0.001), and a shorter time until the commencement of oral intake (p = 0.041). However, there were no statistically significant differences between the two groups in terms of the indices of histopathologic specimens, the proportion of temporary loop ileostomy, and the incidence of early postoperative problems (p > 0.05). When patients with VO undergo surgery for rectal cancer, RS has the added benefit of accelerating patient recovery while producing results that are similar to LS in the near run.

Double Postbulbar Block in the Prevention of Postmanipulation Pancreatitis

Abstract The problems of preventing postmanipulation pancreatitis (PMP) remain the subject of debate and a lot of research from leading scientific clinics around the world. The article is devoted to the assessment of prevention methods of PMP in patients with lesion of the pancreaticobiliary zone who underwent transpapillary interventions. Aim of the study Evaluation of the effectiveness of the author’s method of preventing PMP.Material and methods A prospective two-center randomized study included 545 patients treated in the Department of Liver Surgery and General Surgery in 2020–2022, who underwent ERCP and endoscopic papillosphincterotomy. There were 146 (26.8%) male patients, and 399 (73.2%) female patients, aged from 18 to 92 years, the mean age 62.7±7.4 years. Patients were divided into 3 groups according to the method of preventing PMP: in the 1st group, standard drug premedication was supplemented with two postbulbar blocks with a solution of lidocaine 0.5% 10 ml before and after the intervention (RF Patent No. 2779221, 09/05/2022), in the 2nd group standard premedication was combined with placebo was used, and in the comparison group 3 no submucosal injections were performed. The monitoring of clinical manifestations of PMP and the level of amylase was carried out every 12 hours until the parameters normalized. Statistical processing was carried out using program STATISTICA 6.1 for Windows.Results The frequency of mild pancreatitis, corresponding to the criteria for PMP, did not exceed 18% in groups 1 and 3 (p=0.3408), but was lower with pseudo postbulbar block, 9% (χ2=2.83, р=0.0926), the difference was not statistically significant. The incidence of severe pancreatitis was significantly lower in group 1 with double postbulbar block where there were no cases of pancreatic necrosis among 143 patients (χ2=6.19, р=0.0129). The mortality did not differ significantly among groups (χ2=0.15, р=0.7004). The duration of the hospital period had significant differences between groups (Student’s t-test 1.973, p=0.001). The hospital period with double postbulbar block turned out to be significantly shorter.Conclusion 1. Double postbulbar blockade significantly reduces the risk of developing severe postmanipulation pancreatitis, regardless of existing risk factors. 2. Double postbulbar block significantly reduces the duration of the hospital period after endoscopic papillosphincterotomy. 3. Pseudo postbulbar block using saline requires further evaluation as a possible way to prevent mild pancreatitis.

Establishment of a prognostic model for gastric cancer patients who underwent radical gastrectomy using machine learning: a two-center study.

Gastric cancer is a prevalent gastrointestinal malignancy worldwide. In this study, a prognostic model was developed for gastric cancer patients who underwent radical gastrectomy using machine learning, employing advanced computational techniques to investigate postoperative mortality risk factors in such patients. Data of 295 patients with gastric cancer who underwent radical gastrectomy at the Department of General Surgery of Affiliated Hospital of Xuzhou Medical University (Xuzhou, China) between March 2016 and November 2019 were retrospectively analyzed as the training group. Additionally, 109 patients who underwent radical gastrectomy at the Department of General Surgery Affiliated to Jining First People's Hospital (Jining, China) were included for external validation. Four machine learning models, including logistic regression (LR), decision tree (DT), random forest (RF), and gradient boosting machine (GBM), were utilized. Model performance was assessed by comparing the area under the curve (AUC) for each model. An LR-based nomogram model was constructed to assess patients' clinical prognosis. Lasso regression identified eight associated factors: age, sex, maximum tumor diameter, nerve or vascular invasion, TNM stage, gastrectomy type, lymphocyte count, and carcinoembryonic antigen (CEA) level. The performance of these models was evaluated using the AUC. In the training group, the AUC values were 0.795, 0.759, 0.873, and 0.853 for LR, DT, RF, and GBM, respectively. In the validation group, the AUC values were 0.734, 0.708, 0.746, and 0.707 for LR, DT, RF, and GBM, respectively. The nomogram model, constructed based on LR, demonstrated excellent clinical prognostic evaluation capabilities. Machine learning algorithms are robust performance assessment tools for evaluating the prognosis of gastric cancer patients who have undergone radical gastrectomy. The LR-based nomogram model can aid clinicians in making more reliable clinical decisions.

Diagnostic Efficacy Study Comparing Tzanakis Scoring System With Alvarado Scoring System in Effective Diagnosis of Acute Appendicitis.

Objective Among the common causes of abdominal emergencies, acute appendicitis ranks at the top, particularly in the young population. While negative appendectomy is not uncommon, the risk of appendicular perforation is substantial if the diagnosis is missed or delayed. This study evaluated the diagnostic efficacy of the Tzanakis scoring system for acute appendicitis, comparing it with the Alvarado scoring system, considering the histopathological finding as the gold standard. Materials and methods This prospective observational study, conducted in the General Surgery department in a tertiary care hospital in India, included clinically diagnosed acute appendicitis cases posted for open or laparoscopic appendicectomy. Results The mean age for the 60 participants included in the study was30.97±13.44, and the median was 24.5 yrs. The sensitivity ofultrasonography (USG)in diagnosing histopathological positive acute appendicitis was 89%, and the specificity was 50%. The sensitivity, specificity, positive, and negative predictive values of the Tzanakis score were 87%, 50%, 96%, and 22%, respectively, and those of the Alvarado score were 54%, 75%, 96%, and 10%, respectively. Conclusion The receiver operator characteristic (ROC) curve for the Alvarado and Tzanakis scores showed that the area under the curve (AUC) was greater for the Tzanakis scoring system (0.670) than for the Alvarado scoring system (0.598). Differences between the AUCs were not statistically significant. Although the Tzanakis scoring system is more sensitive than the Alvarado scoring system in diagnosing acute appendicitis, studies with larger samples are needed to show the superiority of this scoring system over the Alvarado scoring system.

A qualitative study on the adoption of the new duty hour regulations among medical residents and faculty in Korea.

Duty hour regulations (DHRs) were enforced in 2017 in Korea to prevent the detrimental effects of excessively prolonged working hours among medical residents. We investigated the adoption of and implications of the new DHRs among medical residents and faculty members. Semi-structured interviews were conducted with 15 medical residents and 9 faculty members across general surgery, internal medicine, obstetrics-gynecology, and pediatrics departments at Chonnam National University Hospital. Based on the constructivist grounded theory, we developed themes from the data by concurrent coding and analysis with theoretical sampling until data saturation. In addition, respondent validation was used to ensure accuracy, and all authors remained reflexive throughout the study to improve validity. The methods of DHRs adoption among residents and faculty members included the following 4 themes: DHRs improved work schedule, residents have more time to learn on their own, clinical departments have come to distribute work, organization members have strived to improve patient safety. Residents have undertaken initial steps towards creating a balance between personal life and work. Teamwork and shift within the same team are the transitions that minimize discontinuity of patient care considering patient safety. Teaching hospitals, including faculty members, should ensure that residents' work and education are balanced with appropriate clinical experience and competency-based training.

Assessing Residents in the Department of Surgery at a Tertiary Care Centre Using Mini-Clinical Evaluation Exercise (Mini-CEX).

This study aimed to introduce, sensitize, and train our postgraduate students and faculty of the department of general surgery with the use of mini-Clinical Evaluation Exercise (mini‑CEX) and to assess the perception of students and faculty towards it. A cross‑sectional observational study was conducted over a period of four months. Ten surgery residents in the department were asked to volunteer to participate and five professors conducted the session. Five sessions of mini‑CEX(nine points) were conducted for each resident in different settings of the out‑patient department (OPD) and in‑patient department (IPD). A total of five skills were tested. Feedback from faculty and residents regarding the perception of mini‑CEX was alsotaken. A statistically significant difference in mean scores of all domains was observed comparing the first and last assessment (p<0.05). Hundred percent of the residents scored superior category (7-9) in the final assessment in all domains, whereas the maximum was in a satisfactory scoring grade in 1st assessment. The time taken for the assessment significantly reduced from 1st assessment to the last assessment in OPD and IPD settings (p=0.001). The mini-CEX assessment tool got 100% feedback from faculty in terms of skill improvement, method, attitude of residents, and ability to identify gaps in knowledge. However, one assessor thought that "time given for assessment" was inadequate and more effort was required than the usual traditional assessment methods. The most identified problem faced by residents was that the "time given during assessment" was less (50%); however, overall residents also found it valid, effective, and helpful in identifying knowledge gaps and improving clinical and communication skills. Mini‑CEX improves the learning environment in residency and also leads to improvement in medical interviewing skills, physical examination skills, humanistic qualities/professionalism, and counseling skills. So, it can be used for residency training in clinical departments.

To 110th anniversary of cardiac surgeon and researcher Igor N. Meshalkin

Igor N. Meshalkin (1913–1996) was Soviet cardiac surgeon, Dr. Sci. (Medicine). He was a graduate of the 2nd Moscow State Medical Institute (2nd MSMI, now the N.I. Pirogov Russian National Research Medical University). He was a participant in the Great Patriotic War. Igor N. Meshalkin began his professional career as a medical resident and an assistant of the clinic of faculty surgery in the 2nd MSMI since 1947; then as a medical resident of the Main Military Hospital of the Armed Forces of the USSR since 1951 and an assistant of the general surgery department of the pediatric faculty in the 2nd MSMI since 1954. In 1958–1963, he headed the Department of Acquired Heart Diseases in the Institute of Experimental Biology and Medicine (now the E.N. Meshalkin National Medical Research Center). In 1963–1977, Igor N. Meshalkin was the head of the department in the Central Clinical Hospital of the 4th Main Directorate of the USSR Ministry of Health. His research interests were focused on urgent abdominal surgery, thoracic surgery, mitral stenosis surgery. Igor N. Meshalkin was the author of 55 scientific works including two monographs. Received 8 November 2023. Accepted 14 November 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article. Acknowledgment: The authors would like to thank Marina, daughter of Igor N. Meshalkin, for providing personal documents and photographs.

Economic impact of outpatient follow-up using telemedicine vs in-person visits for patients in general surgery: A secondary analysis of a randomized clinical trial

IntroductionInnovation in internet connectivity and the Covid 19 pandemic have caused a dramatic change in the management of patients in the medical field, boosting the use of telemedicine. A comparison of clinical outcomes and satisfaction between conventional face-to-face and telemedicine follow-up in general surgery, an economic evaluation is mandatory.The aim of the present study was to compare the differences in economic costs between these two outpatient approaches in a designed randomized controlled trial (RCT). MethodsA RCT was conducted enrolling 200 patients to compare conventional in-person vs. digital health follow-up using telemedicine in the outpatient clinics in patients of General Surgery Department after their planned discharge. After a demonstration that no differences were found in clinical outcomes and patient satisfaction, we analyzed the medical costs, including staff wages, initial investment, patent’s transportation and impact on social costs. ResultsAfter an initial investment of 7527.53€, the costs for the Medical institution of in-person conventional follow-up were higher (8180.4€) than those using telemedicine (4630.06€). In relation to social costs, loss of productivity was also increased in the conventional follow-up. ConclusionThe use of digital Health telemedicine is a cost-effective approach compared to conventional face-to-face follow-up in patients of General Surgery after hospital discharge.

EFFECTIVENESS OF DOUBLE-GLOVING METHOD ON PREVENTION OF SURGICAL GLOVE PERFORATIONS AND BLOOD CONTAMINATION: A PROSPECTIVE STUDY

Objectives: To evaluate efficacy of double gloving to provide mechanical barrier against communicable diseases and also to evaluate different parameters affecting glove perforation rate. Methods: This prospective study was performed in department of General Surgery at tertiary care teaching hospital of Gujarat. This study involved a group of surgeons and operation theatre nursing staff. Randomization of the participants was done with the closed envelope method in two groups: single gloving and double gloving. Glove perforation rate and hand contamination rate was calculated and compared between both the groups. Participants of double gloving groups were also asked for discomfort using double gloves and compromised tactile sensations. Results: There was no statistically significant difference in the glove perforation rate between single gloves and double outer gloves. (p=0.55) But, the glove perforation rate was significantly low in double inner gloves than single gloves. (p=0.004) The hand contamination rate was significantly lower amongst perforated double gloves than perforated single gloves. (p=0.00001) Awareness of glove perforation was absent in majority of the participants in both the groups. All the participants in the double gloving group were comfortable with using double gloves and their tactile sensations were not compromised. Conclusion: This study concluded that double gloving efficiently prevented hand contaminations during a surgery. There was no significant difference noted in glove perforation rates in both single and double gloving groups. Double gloving is recommended for the surgeons and nursing staff to protect them from blood borne infections and eliminate the chances of surgical site infections in the patients.

Analysis of the differential expression of serum miR-21-5p, miR-135-5p, and miR-155-5p by Bifidobacterium triplex viable capsules during the perioperative stage of colorectal cancer.

In this study, we investigated the impact of perioperative administration of Bifidobacterium triplex viable capsules on the serum levels of circulating miR-21-5p, miR-135-5p, and miR-155-5p in patients with colorectal cancer (CRC). The purpose of this study is to provide a foundation for future research on the use of Bifidobacterium triplex viable capsules to enhance postoperative recovery in patients with CRC. A total of 60 patients with primary CRC admitted to the Department of General Surgery at Shanxi Bethune Hospital between June 2020 and December 2020 were selected and randomly divided into two groups: 20 cases in the control group and 40 cases in the experimental group. The experimental group was administered oral Bifidobacterium triplex viable capsules during the perioperative period, while the control group was administered oral placebo. Before and after the perioperative period, the expression levels of miR-21-5p, miR-135-5p, and miR-155-5p were compared in the serum of both groups of patients. Furthermore, we established the prognostic value of these three miRNAs in CRC patients. After surgery, the expression levels of miR-21-5p, miR-135-5p, and miR-155-5p decreased in both groups of patients (P < 0.05). Significantly greater differences were observed between miR-21-5p and miR-135-5p (P < 0.001). Expression levels of serum miR-21-5p (P = 0.020) and miR-135-5p (P = 0.023) decreased significantly more in the experimental group than in the control group. The levels of the above three miRNAs after surgery did not correlate with 3-year OS (HR = 4.21; 95% CI 0.37-47.48; log-rank P = 0.20) or 3-year DFS (HR = 1.57; 95% CI 0.32-7.66; log-rank P = 0.55) in two groups. Radical surgery reduces the levels of serum miR-21-5p, miR-135-5p, and miR-155-5p expression in patients with CRC. The use of Bifidobacterium triplex viable capsules assists in achieving quicker perioperative recovery from radical surgery in CRC patients, and this underlying mechanism may be associated with the regulation of serum miR-21-5p, miR-135-5p, and miR-155-5p expression levels.

Role of Procalcitonin for Early Discrimination Between Necrotizing Fasciitis and Cellulitis of the Extremities.

Introduction Necrotizing fasciitis (NF) is a grave and life-threatening infection of the soft tissues. It is defined by the gradual necrosis of the fascia and subcutaneous tissue, which spreads along the fascial planes. Cellulitis, a prevalent skin infection, has led to suggestions that procalcitonin could serve as a diagnostic tool to distinguish it from other inflammatory skin conditions that resemble cellulitis. The study aims to assess the procalcitonin (PCT) levels in individuals with NF and cellulitis and determine its effectiveness in early differentiation between these two conditions. Methods After obtaining clearance from the institutional ethical committee, the study was conducted in the Department of General Surgery, Sri Devaraj Urs Medical College, over six months. Informed consent was obtained from all 30 patients included in this study. The study compared PCT levels in patients diagnosed with NF and cellulitis. Statistical analysis was performed using SPSS version 22 software (IBM Corp., Armonk, NY, USA). Results The mean age of subjects was 53.23 ± 8.78 years. Among patients, 21 (70%) were diagnosed with cellulitis and 9 (30%) were diagnosed with NF. The mean PCT levels were 0.34 ± 0.32 and 4.89 ± 1.98 among the cellulitis and NF groups, respectively. There was a significant difference (p<0.05). PCT had a sensitivity of 100% and a specificity of 100%, in differentiating cellulitis and necrotizing fasciitis. Conclusion PCT levels were notably elevated in cases of NFcompared to cellulitis. Despite the study's limited sample size, it represents the first report highlighting the value of PCT as an early diagnostic tool for identifying necrotizing fasciitis.

MARKERS OF COMPLICATIONS AFTER LAPAROSCOPIC GASTRIC BYPASS IN PATIENTS WITH OBESITY

Introduction. Bariatric surgery is one of the most effective methods of treating morbid obesity, which allows for a long-lasting result. Along with the increase in the number of operative methods of obesity treatment, the relevance of issues related to postoperative complications is increasing. In recent years, the issue of using special checklists after surgery has been actively investigated. This will help optimize the process of monitoring patients' condition in the postoperative period.&#x0D; The aim of the study: to develop a check-list model to prevent the detection of complications after laparoscopic gastric bypass in obese patients.&#x0D; Materials and methods. On the basis of the developed checklist, a study of the condition of obese patients, who underwent laparoscopic gastric bypass during 2019-2023, was conducted on the basis of the Department of General Surgery No. 2 of the Bogomolets National Medical University. The checklist included the following criteria: the level of pain on the VAS scale, the level of nausea, eating, mobility, whether there is a desire to be discharged home, abdominal muscle tension, pain in the calf muscles, heart rate, oxygen saturation in the blood, the number drainage discharge within 24 hours, temperature, systolic blood pressure, central venous pressure, laboratory diagnosis, decrease in hemoglobin concentration, leukocyte level after surgery, C-reactive protein level after surgery, blood procalcitonin level, erythrocyte sedimentation rate level, the presence of a shift in the leukocyte formula to the left. The presence of complications was assessed, the parameters of the checklist were analyzed using univariate logistic regression and ROC analysis for early detection of complications and determination of the chance of complications in the future.&#x0D; Results. Complications occurred in 18/218 (8.2%). The most frequent complication was bleeding in 6/18 (33.3%). Reoperation was performed in 12 cases of 12/18 (66.6%), endoscopic treatment was performed in 1 case, and conservative methods were used in 5 cases. According to the checklist, 31.81% had a positive predictive value (PPV) and 99.56% had a negative predictive value (NPV). The optimal cut-off point of the total score of the checklist was 6. Patients with a positive prognosis of the checklist have a higher chance of developing complications of VSH – 4.5 (95% CI 1.8-9.72), p &lt;0.001.&#x0D; Conclusions. The complication rate was 18/218 (8.2%). According to the checklist, heart rate, systolic blood pressure and mobility are very good predictors of postoperative complications. The checklist is the best option for determining the readiness of patients to be discharged from the hospital due to a high prognostic negative result. Due to the low prognostic positive result, the evaluated checklist needs additional modification and optimization taking into account the results already obtained.

Outcomes of Purse-string versus Conventional Linear Suture Closure of the Skin Wound following Ileostomy Reversal

Background: Intestinal stomas are made in a variety of settings and their reversal is also a routine surgery. Due to their clean, contaminated nature, there is a high risk of surgical site infection post-operatively. The objective of this study is to determine the difference in outcomes in two different techniques of skin closure after stoma reversal&#x0D; Methods: The study was conducted at department of general surgery, Pakistan Institute of Medical Sciences, Islamabad, over a period of six months. Seventy-one patients who underwent ileostomy reversal surgery in an elective setting were assigned two groups randomly: 34 in Group A and 37 in Group B. The group A patients underwent purse string closure for stoma site skin wound, whereas patients in group B underwent conventional linear closure. Time taken for surgery was noted and the patients were followed over one month period for development of any surgical site infection or dog-ear deformity.&#x0D; Results: The incidence of surgical site infection was 8.8% in the purse string closure group compared to 43.2 % in the linear closure group. Seven patients in group B developed dog ear deformities, whereas no such case was noted in Group A.&#x0D; Conclusions: Purse string closure is an effective and applicable technique for the closure of skin wounds after stoma reversal surgery. It is comparatively better in terms of prevention of surgical site infection as well as dog ear deformity in the closure of skin wounds after ileostomy reversal.

COMPARISON OF OUTCOME (IN TERMS OF RECURRENCE) OF INCISION &amp; DRAINAGE VERSUS ASPIRATION OF BREAST ABSCESS

Breast abscesses can lead to significant morbidity and have a negative impact on quality of life. This study aimed to compare recurrence rates after incision and drainage versus aspiration techniques in managing breast abscesses. Objective: To compare the outcome of incision and drainage versus aspiration techniques in managing breast abscesses, specifically recurrence rates. Methods: This study employed a Randomized Controlled Trial design and was conducted at the Department of General Surgery, Nishtar Hospital, Multan, over a period of six months from July 1, 2019, to January 1, 2020. A total of 60 patients meeting the inclusion criteria were randomized into two groups: Group A underwent needle aspiration, while Group B underwent incision and drainage. Both groups received a 10-day course of tab. Ciprofloxacin 500mg BD and tab danzen DS BD. The researcher performed all the procedures. Patients were followed for two weeks, and recurrence of the abscess was recorded as either "yes" or "no". Results: The study included 60 patients with a mean age of 25.58 ± 3.64 years. Of these, 35 (58.3%) were from rural areas and 25 (41.7%) from urban areas. Seventeen (28.3%) patients were unmarried, and 43 (71.7%) were married. The mean body mass index was 25.12 ± 1.97 kg/m2, with obesity present in 7 (11.7%) patients. Thirty-five (58.3%) patients were lactating, with a mean abscess duration of 3.25 ± 0.57 months. The mean abscess size was 1.20 ± 0.18 centimeters, with 55 (91.7%) abscesses ≤ 2 centimeters in size. Diabetes was not present in any patients. Recurrence occurred in 15 (25.0%) patients, with a recurrence rate of 13.3% in Group A and 36.7% in Group B (p = 0.072). Conclusion: The recurrence of breast abscesses was lower in the aspiration group compared to the incision and drainage group. These findings support the use of needle aspiration techniques for the management of breast abscesses. Surgeons treating such patients should consider employing aspiration techniques to achieve better outcomes, thereby reducing the burden of related morbidities and mortalities.

Bogdan N. Kotiv — surgeon, professor, general of medicine (on the 60th anniversary of his birth)

March 14, 2024, marked the 60th anniversary of Bogdan N. Kotiv, the Deputy Head of the Military Medical Academy named after S.M. Kirov for clinical work, abnormal chief surgeon of the Academy, Honorary Doctor of the Russian Federation, Doctor of Medical Sciences, Professor, and Major General of the Medical Service. After graduating from the academy, B.N. Kotiv served in the Transcaucasian Military District as a leading surgeon in a separate medical battalion. In 1988, a young military surgeon participated in the provision of assistance to victims of the earthquake in the city of Spitak (Armenia) and received the first experience in providing medical care in military field conditions. In 1990, B.N. Kotiv entered the adjunct school at the Department of General Surgery, and in 1993, he successfully defended his dissertations for the degree of candidate of medical sciences. In 1998, the dissertation for the Doctor of Medical Sciences degree was brilliantly defended. In 2006, Bogdan N. Kotiv headed the Department of Hospital Surgery. When it was going through difficult times, a reorganization of the educational process occurred. Bogdan N. carefully preserved the traditions of teaching thoracic surgery and actively introduced the experience of modern complex surgical interventions into the educational process, including on the abdominal organs. The surgical school of the Department of Hospital Surgery rapidly took a leading position. In 2013, B.N. Kotiv was appointed the Deputy Head of the Academy for Academic and Scientific Work. Since 2021, Bogdan N. Kotiv has been the Deputy Head of the Academy for Clinical Work. He controlled and coordinated the clinical base of the academy, organized interactions with military hospitals throughout the country, and often went on business trips. At the beginning of a special military operation, a colossal responsibility fell on his shoulders. There was a need to quickly solve the permanently emerging problems of organizing the provision of medical care to the wounded in the conditions of the Academy clinics. With his direct participation, the clinical base was redesigned, its bed capacity was expanded, and new technologies for providing specialized medical care to the wounded, sick, and injured were introduced. For several generations of surgeons, Bogdan N. has been a wise mentor and role model. Under the leadership of Bogdan N. Kotiv, the range of scientific research conducted at the academy has significantly expanded. The fundamental directions of medicine for the study of the molecular and cellular foundations of combat lesions and cellular and tissue engineering technologies have received new development, and multidisciplinary scientific research is being conducted regarding the regenerative abilities of the liver.

Inguinal Hernia Repair Using the External Oblique Muscle Fascia: Desarda Technique

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: An inguinal hernia is a protrusion of abdominal cavity contents or pre-peritoneal fat through a hernial defect in the inguinal region. Desarda&amp;apos;s technique is an aponeuroplasty, based on closure of the posterior wall of the inguinal canal by a flap of the external oblique fascia. This technique has the advantage over prosthetic cures in that it is a tension-free cure and does not require an implant. The aim of this study is to demonstrate the feasibility of curing inguinal hernias using the Desarda technique, and to evaluate the initial results in our practice. &amp;lt;i&amp;gt;Material And Method&amp;lt;/i&amp;gt;: This is a prospective study over a 2-year period (January 2017 - December 2018), covering 100 cases of uncomplicated inguinal hernia cure in 98 patients operated on by aponeurotic plasty (Desarda technique), in the general surgery department of Ignace DEEN Hospital. Selection criteria were: informed consent, age over 15 years, uncomplicated primary inguinal hernias, normal prostate ultrasound and PSA results for adult males over 50 years of age. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The study included 100 cases of uncomplicated inguinal hernia repair in 94 patients operated on by aponeurotic plasty (Desarda technique). The patients were 88 men (94%) and 6 women (6%), with a mean age of 44.7 years and extremes of 19 and 78 years. The majority of patients (37 or 39.36%) were blue-collar workers. The hernia was unilateral in 88 patients and bilateral in 6. One woman had a bilateral hernia. The hernia was located only on the right in 72 cases and only on the left in 20. According to the Nyhus classification, type IIIb 45% was the most frequent. The patients were operated on under spinal anesthesia in 68 cases. On the first postoperative day, nine patients (9.57%) were assessed as having moderate pain. Beyond the third month, pain assessment revealed five cases of chronic pain. Surgical site infection was the most frequent complication. With an average follow-up of 17 months, no cases of recurrence were noted.

Role of Case-Based Discussion as Workplace-Based Assessment Tool in Urology and General Surgery

OBJECTIVES To determine the effectiveness of case-based discussion in terms of medical record-keeping, clinical reasoning, clinical judgment, and self-reflection in the management of patients. METHODOLOGY A multidisciplinary descriptive study was conducted in the Department of Urology Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar, and Department of General Surgery, Hayatabad Medical Complex Peshawar, Pakistan, from January to December 2023. A total number of 20 postgraduate residents, ten from Urology and General Surgery, participated in the study with equal male and female participants. Case-based discussion (CBD) assessments focused on medical record-keeping, clinical Decision-making, clinical judgment, management, follow-up, and reflective writing. The data was collected on structured proforma and was analyzed on SPSS-25. RESULTSThe total number of study participants was 20, and 410 Case-Based Discussion sessions were conducted. This constitutes an average of 4.8 assessments per week. Most encounters were related to medical clinical decisions and management. The case-based discussion showed significant improvement on the Likert scale of the supervisor’s rating, which extended over four quarters on all major parameters of formative assessment (p 0.001). The multimodal regression test showed significant enhancement in learning parameters on case-based discussions. R2=0.172 F ration=25.141 n=410 (p=0.001). There was no significant difference in the gender of residents as well as training specialty of residents of urology and general surgery (p &gt;0.05). CONCLUSION A case-based discussion is an effective tool for formative assessment of Urology and General Surgery postgraduate residents.

Study of incidence of occult pneumomediastinum due to blunt chest trauma

Background: Pneumomediastinum refers to the presence of extraluminal gas within the mediastinum. If signs of pneumomediastinum are not present on chest X-ray and it is detected on contrast-enhanced computed tomography (CECT) thorax then it is known as occult pneumomediastinum. There is a dearth of literature regarding occult pneumomediastinum in patients with blunt chest trauma. Aims and Objectives: This study was done to see the incidence as well as outcome of occult pneumomediastinum in patients of blunt chest trauma. Materials and Methods: A prospective study was done in the department of general surgery at a tertiary care institute in which a total of 32 patients with blunt chest trauma were taken. The patients with occult pneumomediastinum were identified using CECT and appropriate management was done in all patients. Correlation of occult pneumomediastinum with subcutaneous emphysema, rib fracture, jugular venous pressure (JVP), pleural effusion, and outcome was seen. Results: It was evident from this study that 18.8% of patients of with chest trauma had occult pneumomediastinum. Incidence of blunt chest trauma is most common in the age group of 31–60 years as this age group is more vulnerable to roadside accidents and other accidents. There is a strong correlation between the presence of central subcutaneous emphysema, raised JVP, and worse outcomes with occult pneumomediastinum (P&lt;0.05). Conclusion: This study showed a high incidence of occult pneumomediastinum in patients with chest trauma which is ultimately associated with high mortality. Hence, we should keep high index of suspicion regarding the presence of occult pneumomediastinum so that timely management of these patients can be done to prevent morbidity and mortality.

Wide-Awake Surgery and Coronavirus Disease 2019: A Rural Experience

Surgeons across all subspecialties had to adapt to the COVID-19 pandemic to triage patients and steward hospital resources. Hand surgeons found themselves in a unique position to move some hospital-based procedures to a clinic-based setting, which has now impacted their post-pandemic practices. Performing procedures in the clinic using the wide-awake local anesthesia no tourniquet technique is interestingly similar to minor-surgeries traditionally carried out in a general surgery clinic. By abstracting institutional case volumes from orthopedic, hand, and general surgery departments from 2019 to 2022, we identified trends that further support the potential for clinic-based procedures in hand surgery. This communication provides a foundation to compare cost and surgical indications for wide-awake local anesthesia across surgical disciplines.

Evaluation of outcome of systemic tranexamic acid injection in drain output in ventral hernia repair

The primary objective of the study was to determine the mean drain output after systemic tranexamic acid injection in patients undergoing ventral wall hernia repair. This was a descriptive cross-sectional study conducted in the Department of General Surgery, Hamdard University Hospital Karachi, Pakistan for a period of six months from Oct 2020 to April 2021. The patients undergoing ventral hernia repair were included. Injection tranexamic acid 1gm intravenous twice a day for 1st post-operative day and then capsule Tranexamic acid 500mg per oral three times a day for two consecutive days was given and drain output was measured for 3 days. A total of 63 patients with ventral hernia were included, mean age of patients was 41.476 (±SD= 8.693). There were 41 male patients (65.1%) and 22(34.9%) females. The mean drain output on first day, second and third day was 115.047+14.678 ml/day, 91.919+9.947 ml/day, 66.914+7.070 ml/day and 273.254+29.165 ml/day respectively. The results showed overall reduction in postoperative drain output after oral and intravenous tranexamic acid for 72 hours. However further large scale randomized controlled trials are recommended for confirmation of these findings.