Department Of General Surgery Research Articles

Retrospective Study for Evaluation of TIRAD Scoring System Irrespective of FNAC in Decision Making Outcomes in Thyroidectomy

Abstract Background Thyroid nodules present a common clinical problem. Palpable nodules are present in about 5% of the population, and are noted incidentally on ultrasound in up to 70% of people, with increased prevalence in older patients. The incidence of thyroid nodules has increased due to exposure to medical radiation, iodine intake, obesity, insulin resistance, genetics and inorganic phosphates. With a 300% increase in the annual thyroid cancer rate. Aim of the Work The aim of this study is to evaluate the value of Ultrasound and TIRAD scoring system for decision making outcomes in thyroidectomy done for thyroid nodules. Patients and Methods This Retrospective cohort study was conducted at (General surgery department), Ain Shams University Hospitals and Ain shams University specialized Hospitals and was conducted over a period of six months starting from date of approval of the protocol. Results In our study, Conventional sonography has 66.66% sensitivity and 92.5% specificity as it suspected malignancy (positive suspecting findings) in 14 patients; eight of them were proved to be malignant and six of them were benign by histopathology accounting for low positive predictive value (57.14%) and it suspected benignity (negative suspecting findings) in 78 patients; 74 of them were perfectly correlated with the histopathology accounting for high negative predictive value (94.87%). In our study, the rate of detecting patients with thyroid cancer (sensitivity) was calculated as 80%, the rate of distinguishing healthy individuals (specificity) was 88.88%, the Positive Predictive Value (PPV) was 57.14% and the negative predictive value (NPV) was 96% for FNAC. In our study, the sensitivity and the specificity of FNAC in detecting cancer was near to the literature but the (PPV) was lower than the literature and was non diagnostic in fourty patients (40%), we think that this discrepancy depends on many factors including radiology, pathology, and the materials used in FNAC method, and patients with multiple nodules. Conclusion Neck US and FNAC have proven low sensitivity in differentiating malignant from benign thyroid nodules

1021 Accuracy of Clinical Coding in General Surgery and Its Financial Impact

Abstract Aim To analyse the clinical coding performed at a tertiary centre after patient discharge and compare it with the clinical summary to identify any inconsistency and its financial implications. Method Fifty patient episodes were selected randomly between June 2023 and August 2023 under the general surgery department. Clinical notes, discharge summaries and existing clinical codes were scrutinized by liaison with the clinical coding department. Financial losses were noted, and the summary was later presented at the local clinical governance meeting. Results A total of £38,760 was lost in 50 patients. Loss incurred was primarily due to incomplete information in the discharge summary, related to the patient’s comorbidities, incomplete diagnosis, and procedure/investigations. These results were discussed in a clinical governance meeting and a poster was made to disseminate the conclusion and improve the quality of the discharge summary. Conclusions A total of £38,760 of funding was lost due to discrepancies in the clinical coding. An intervention in the form of a poster and teaching session was conducted for junior doctors and a repeat cycle is planned in the due course of time to improve the quality and minimise the loss of funding.

278 Outpatient "Did Not Attend" Episodes: A Cohort Study Investigating Influencing Factors

Abstract Aim Outpatient "Did Not Attend" (DNA) episodes represent a significant financial burden to healthcare systems, with an estimated cost of £1 billion for the NHS. Understanding factors that contribute to DNA episodes is crucial for optimizing healthcare resource utilization. We examined a cohort of outpatient clinics within the general surgery department at South Tees Hospitals NHS Foundation Trust to identify factors associated with DNA episodes. Method A prospectively collected database of all outpatient clinics was interrogated from 01/01/2021, to 31/03/2023. Information on patient age, gender, appointment type (new vs. follow-up, face-to-face vs. remote), index of multiple deprivation (IMD) decile, and driving distance was recorded for each clinic attendance. Results Of 19,769 clinic appointments, 1,509 (8%) resulted in DNAs. Disproportionate number of patients with DNAs resided in the lowest IMD decile (19%), compared to other deciles (range: 6.4%-10%). Driving distance did not differ between attended (median: 16 km, IQR: 6-30 km) and DNA groups (median: 15 km, IQR: 5-30 km). DNA rates did not vary between remote (8%) and face-to-face (7%) clinics. Multivariable binary logistic regression found older age, IMD, and hospital site as predictors of outpatient DNA. Individuals who were younger and from the lowest IMD decile were more likely to DNA. Conclusions Outpatient DNA is multifactorial. Travel distance/duration and remote consultations did not influence attendance in our cohort. Working-age patients and those residing in lower IMD deciles were more likely to DNA. Solely relying on remote consultations may not be sufficient to effectively address DNA episodes.

Diagnostic Accuracy of Ultrasound in Evaluation of Obstructive Jaundice with MRCP as a Gold Standard

Abstract Background MRCP has high sensitivity for CBD stones, strictures and malignancies in cases of obstructive jaundice especially cases with suspicion (clinical/CBD-IHBR dilatation on USG). As MRCP has more diagnostic accuracy compared to ultrasound in detecting the cause of obstruction in cases of obstructive jaundice, USG may be considered as an initial screening test and MRCP for definitive treatment planning. The limitation of the study is the small sample size. Objective To evaluate cross sectional retrospective study was done From June 2021 to June 2022 on 31 patients (17 females and 14 males) presenting with obstructive jaundice were referred from Internal Medicine, General Surgery and Clinical Oncology Department to Diagnostic Radiology Department in Ain Shams University hospitals, MRCP were done for all the patients and then Abdominal US examination were performed and then comparison between US & MRCP result were done. Results The US has sensitivity of 100.0%, specificity of 100.0% and accuracy of 100.0 % in detection of level of obstruction and also has sensitivity of 71.0% and accuracy of 71.0% in detecting cause of obstruction taking MRCP as a gold standard. Conclusion MRCP is an excellent tool for detecting the cause of obstructive jaundice, Use of MRCP could therefore spare the patients from invasive preoperative endoscopic procedures and it can also most likely reduce overall surgical costs. We propose MRCP as the method of choice for the diagnostic imaging of obstructive jaundice.

The Role of CT in Differentiating the Non Pediatric Renal and Adrenal Region Fatty Masses

Abstract Background CT is indicated in many abdominal conditions because of its excellent morphological resolution and its ability to image many different structures, such as abdominal viscera, pelvic organs, lungs and bones, with a single examination. Aim of the Work The aim of this study is to highlight the accuracy of multi-detector computed tomography scan in diagnosing the different fatty lesions of the renal and adrenal regions by comparing the CT study of the benign lesions with their follow up CT scan and comparing the CT study of the malignant cases with their histo-pathological results. Patients and Methods The study was conducted on 34 patients most of them had unrelated complaints(incidental findings) and were referred to Radiology department, Theodor Bilharz Research Institute. Their age ranged from 20 years to 81 years old (mean age 56.35 years±13.61). Most of the patients were males 21cases while female were 13 cases. The patients were referred from oncology, general surgery, and urology departments of Theodor Bilharz Research Institute hospital as well as the outpatient clinics to perform MDCT in the period from September 2021 to June 2022. Results MDCT examinations were done for 34 patients and concluded that MDCT should be used in the first place in the course of diagnostic procedures of patients with renal and adrenal region fatty lesions and this was justified by an overall diagnostic accuracy of 100% for benign lesions and 82% for malignant lesions, where MDCT could correctly diagnose (33/34) cases and only 1 case was misdiagnosed, confirming the ability of MDCT to show up the accurate diagnosis, the exact location, extent of tumor, along with involvement of adjacent organs and vessels. Conclusion It also has a high accuracy in differentiation of malignant from benign lesions and detection of lymph node involvement & metastasis. There by improving the prognosis.

Management of Common Bile Duct Stones: Evaluation of the Effect of Size of Stones as the Determinant for the Procedure for Treatment in Era of Laparoscopic and Endoscopic Surgery

Abstract Background Common bile duct stones (CBDS) are estimated to be present in 10–20% of individuals with symptomatic gallstones. A variety of imaging modalities can be employed to identify the condition while management of confirmed cases of CBDS may involve endoscopic retrograde cholangiopancreatography (ERCP), surgery and radiological methods of stone extraction. Clinicians are therefore confronted with a number of potentially valid options to treat individuals with suspected CBDS. Objective To determine if ERCP sphincterotomy and extraction is effective in management of CBDS ranging from 10 to 20 mm or if surgical intervention is preferred in a sample of patients with common bile duct stones. Patients and Methods In this study, the data of (30) patients with CBDS who presented for the first time to the department of General surgery at Ain Shams University hospitals, Cairo, Egypt. Were collected during the period of August 2021 to February 2022. Results In the current study, all patients received proper pre-operative assessment and were operated on using same endoscope set and by experienced operators. Also, all patients were observed for post ERCP complications. The current study found that ERCP stone extraction in stones ranging from 10-20 mm success rate shows no significant difference in comparison with results that were published in different recent researches studying ERCP success rate in different stone sizes. Conclusion The current study found that success rate of ERCP in CBD stones extraction in stones ranging from 10-20 mm in size is similar to success rate in stone extraction compared to other studies not specifying stone size range. Also, complication rate was comparable to other recent published studies’ complication rate.

645 Time to Cholecystectomy for Gallstone Pancreatitis

Abstract Aim AUGIS 2016 guidelines state that patients with mild gallstone pancreatitis should undergo a cholecystectomy within the same admission or if discharged within two weeks of presentation. This reduces readmission and leads to shorter hospital stays. In 2020, compliance at Poole hospital was 57%. This audit aimed to identity current compliance and opportunities for improvement. Method Retrospective study of patients admitted at Poole Hospital from 01/12/22 to 31/05/23. This was followed by presentation of findings and discussion at staff meeting and staff education and re-audited from 10/07/23 to 10/11/23. Results 29 patients with gallstone pancreatitis were admitted during the initial study period. 22 fit for surgery, 2 patients passed away and 5 were unfit for surgery. 9 had cholecystectomy within 2 weeks giving a guideline compliance of 41%. Median hospital stay overall was three days. Median wait time to cholecystectomy was 5.5 days. Three patients who did not have a cholecystectomy within 2 weeks were later readmitted with pancreatitis. Five patients had previously been admitted with gallstone related diseases. The main barrier to compliance identified was a lack of regular theatre slots for cholecystectomy leading to regular cancellation on CEPOD. The later re-audit showed a compliance of 32%. Conclusions Compliance with AUGIS guidelines has fallen since 2020. Unfortunately, staff education and presentation of findings failed to improve compliance and a high rate of readmission wastes resources. To improve, service configuration is needed with dedicated theatre slots, this should be considered for the planned Poole and Bournemouth general surgery department mergers.

Assessment of Wide Local Excision in Patients with Multifocal Breast Cancer using Wire Clip Bracketing

Abstract Background Breast-conserving surgery, also known as BCS, is both oncologically and surgically safe and has a long term survival rate in comparison to modified radical mastectomy. BCS can be performed with a simple wide excision or with variant levels of oncoplastic surgical techniques. There are many factors that can affect aesthetic outcomes, these factors are either both patient-related or surgeon-related, however the volume of breast tissue that needs to be excised is the most important factor. Aim To assess the feasibility and the safety of wide local excision in patient that have multifocal breast cancer using wire clip bracketing. Patients and Methods The Population was female patients with multifocal breast cancer at Breast unit general surgery department, Ain shams university. Results The mean size of tumors were 2.2 ± 1.1 mm according to mastographic characteristics, There were 55.0% with Non-palpable masses, 45.0 % with Palpable. 40% Positive LNs, we had 100% free resection margins with least resection margin being 0.8 cm as we confirmed all margins intraoperative with frozen section, 13 patients (65%) got excellent degree of satisfaction with the post-operative cosmetic outcome of our surgical procedure, 4 patients (20%) got good degree and 3 patient (15%) got fair degree of satisfaction. Conclusion Wide local Excision using the wire bracketing technique leads to more optimal resection volumes for multifocal breast cancer without compromising margin status with good aesthetic outcomes.

Assessing morinidazole for surgical site infection in class III wounds prevention: a multi-centre, randomized, single-blind, parallel-controlled study

Surgical site infections are significant postoperative risks, antibiotic prophylaxis is crucial due to the presence of anaerobic bacteria. This study investigated the efficacy and safety of a novel nitroimidazole, morinidazole, in SSI reduction in class Ⅲ wounds, as there is currently a lack of evidence in the existing literature. A multicenter randomized clinical trial was conducted from December 2020 to October 2022 in the general surgery departments of 12 tertiary hospitals in China. 459 patients in two treatment groups using morinidazole plus ceftriaxone or ceftriaxone alone. Efficacy and safety were evaluated including SSI incidence, adverse events, and compliance. Statistical analysis employed SAS 9.4 software. Data analysis was performed from February to May 2023. A total of 440 participants (median [IQR] age, 63.0 [54.0, 70.0] years; 282 males [64.09%]; 437 patients were of Han race [99.32%]) were randomized. The experimental group exhibited a significantly lower SSI rate compared with the control group (31 [14.49%] vs 52 [23.01%]; risk difference, 1.76%, 95%CI, 1.08% to 2.88%; P=0.0224). The superficial incisional site infections revealed a marked reduction in the experimental group (12 [5.61%] vs 31 [13.37%]; risk difference,2.68%; 95%CI,1.34%to5.36%; P=0.0042). Non-surgical site infections, severe postoperative complications, and total adverse events showed no statistically significant differences between the groups (P>0.05). The significant decrease in SSI rates and superficial incisional infections demonstrates morinidazole as a valuable prophylactic antibiotic. Our findings provided valuable insights for clinical practice, where this new-generation nitroimidazole can play a crucial role in SSI prevention.

Initial Experience of Robot-Assisted Surgeries.

To present initial experience with the first 100 cases of robotic-assisted surgery by the Department of General Surgery. Descriptive study. Place and Duration of the Study: Department of Surgery, National Hospital and Medical Centre, Lahore, Pakistan, from May 2022 to August 2023. Demographic and postoperative details of the first 100 patients to undergo robotic-assisted surgery by the Department of General Surgery were reviewed. Prospective data were collected from the hospital information database as well as the CMR database. The data collected in the hospital database included the patients' age, diagnoses, genders, complications during hospital stay as well as 90-day readmission, morbidity, and mortality. Data collected by CMR via Versius robotic surgery console or internal databases included operative minutes using the console. The average age of patients undergoing robotic surgery was 44.26 ± 14.08 years. Cholecystectomy (78%) was the most commonly performed robotic-assisted procedure. Only one patient had blood loss of more than 100ml. There was no postoperative complication, readmission or mortality during the study period. With proper patient selection, robotic-assisted surgery is safe and feasible even in low-middle-income countries (LMICs). Robotic-assisted surgery, Pakistan, Initial experience, Outcomes, Versius.

Immediate Latissimus Dorsi Flap Reconstruction: Assessing Aesthetic Outcomes Following Mastectomy in Breast Cancer Patients.

Breast Cancer has now become the leading cause of cancer-related deaths among women. In a traditional radical mastectomy, there can be complications that may affect the physiological characteristics of the breast and subsequently cause profound psychological stress to the patients. Hence, latissimus dorsi (LD) flap reconstruction provides an aesthetic approach in patients undergoing mastectomy. The goal is to maximize the flap's soft tissue coverage while minimizing the magnitude of donor site defect and complication. A prospective observational study was conducted in the Department of General Surgery, Safdarjung Hospital, New Delhi, India, where 30 breast cancer patients were enrolled and had undergone mastectomy with immediate LD flap reconstruction. Cosmetic assessments using BREAST-Q questionnaires were conducted postoperatively at various intervals starting from postoperative day one, week two, and week six. The subjective evaluation was done by the patient, while a blinded nurse and surgeon did the objective assessment. The majority (n=23, 76.7%) were aged 31-50 years. Initial postoperative BREAST-Q scores declined but significantly improved by week six, attributed to gradual wound healing over time, resulting in improved breast shape and contour. The objective scoring done by the blinded surgeon and nurse improved at six weeks compared to two weeks postoperatively. Almost similar outcomes were observed between preoperative and six-week postoperative scores with a significant overall p-value of <0.001. No significant statistical differences were noted between blinded surgeons and nurses for objective scoring. The rising trend of breast cancer in younger demographics emphasizes the importance of balancing cosmetic satisfaction with oncological outcomes. Immediate LD flap breast reconstruction provides a reliable means for soft tissue coverage with acceptable perioperative morbidities for patients undergoing mastectomy. Complication rates were acceptable, with donor site seroma, surgical site infection (SSI), and shoulder weakness among them. They could be prevented or treated (prolonged drain in situ, quilting sutures, and seroma aspiration) or resolved with time (SSI and shoulder function).

Analysis of risk factors associated with postoperative pancreatic fistula after robotic-assisted distal pancreatectomy

Objective: To investigate pertinent risk factors for postoperative pancreatic fistula(POPF) after robotic-assisted distal pancreatectomy(RDP). Methods: This is a retrospective cohort study. Clinical data of 1 211 patients who underwent various methods of distal pancreatectomy at the Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between January 2021 and December 2023 were retrospectively collected. Among the 1 211 patients,440 cases were in the robot-assisted group(173 males and 267 females),with an age(M(IQR)) of 55(29)years;720 cases were in the open surgery group (390 males and 330 females),with an age of 64(15)years;and 51 cases were in the laparoscopic group(17 males and 34 females),with an age of 56(25)years. These 440 patients who underwent RDP were divided into two cohorts based on the presence of clinically relevant pancreatic fistulas(grades B and C). Univariate and multivariate analysis were performed on 27 factors related to POPF. Univariate analysis methods included independent sample t-test,Mann-Whitney U test,and χ2 test,while multivariate analysis utilized binary logistic regression. Results: After stratification by pathological type,there was no significant difference in the incidence of pancreatic fistula between the robot-assisted group and the open surgery group(benign tumor:χ2=1.200,P=0.952;malignant tumor:χ2=0.391,P=0.532). The surgical duration of the RDP group (Z1=15.113,P1<0.01; Z2=4.232, P2<0.01) was significantly shorter than that of the open surgery and laparoscopic groups,so as the intraoperative blood loss (Z1=12.530,P1<0.01;Z2=2.550,P2=0.032). Postoperative hospital stay in the RDP group was significantly shorter than that in the open surgery group (Z1=10.947, P1<0.01), but not different from that in the laparoscopic group (P2>0.05). All 440 patients underwent successful surgery,of which there was only 1 case who underwent a conversion to open surgery. A total of 104 patients(23.6%) developed clinically relevant pancreatic fistulas,and no perioperative mortality was observed. Univariate analysis revealed that 6 factors were associated with POPF after RDP: gender(χ2=12.048,P=0.001),history of smoking (χ2=6.327,P=0.012),history of alcohol consumption (χ2=17.597,P<0.01),manual pancreas division (χ2=9.839,P=0.002),early elevation of amylase in drainage fluid (Z=5.187,P<0.01),and delayed gastric emptying (χ2=4.485,P=0.034). No statistically significant association with POPF was found for the remaining factors(all P>0.05).The cut-off value for the early amylase level in the drainage fluid was determined to be 7 719.5 IU/ml,with an area under curve of 0.676 determined by receiver operating characteristic curve analysis. Binary logistic regression analysis identified a history of alcohol consumption(P=0.002,95%CI: 0.112 to 0.623), manual pancreas division(P=0.001,95%CI:1.446 to 4.082),early amylase level of drainage fluid ≥7 719.5 IU/ml(P<0.01,95%CI:0.151 to 0.438),and delayed gastric emptying (P=0.020, 95%CI: 1.131 to 4.233) as independent risk factors for POPF of RDP. Conclusion: Patients with pancreatic body and tail tumors who receive RDP therapy are at increased risk of developing a pancreatic fistula if they have a history of alcohol consumption,manual pancreas division,early elevation of amylase in drainage fluid to ≥7 719.5 IU/ml, or delayed gastric emptying.

Role of Postoperative Intact Parathyroid Hormone Levels in Predicting Hypocalcaemia after Thyroidectomy.

To determine the sensitivity and specificity of intact parathyroid hormone (iPTH) levels in predicting hypocalcaemia after thyroidectomy. A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa International Hospital and Shifa Foundation, Islamabad, from May 2021 to 2022. The sample size was calculated to be 205 with consecutive non-probability sampling. Serum iPTH levels and serum calcium levels were measured postoperatively at 6 hours and 24 hours and recorded in a proforma for analysis. After collection, the data were entered and analysed using SPSS version 24.0. Among 205 patients, 157 (76.6%) were females and 48 (23.4%) were males. At 6 hours postoperatively, 121 (59%) patients had normal iPTH levels and 123 (60%) patients had normal serum calcium levels (p = 0.15). At 24-hour, 130 (63.4%) patients had normal iPTH levels and 92 (44.9%) patients had normal serum calcium levels (p = 0.001). Overall, 8 (3.9%) patients developed symptomatic hypocalcaemia (p = <0.001). The sensitivity and specificity of iPTH levels at ≤15 pg/ml were 100% and 70%, respectively, but at 24 pg/ml cut-off level, the specificity increased to 90% with sensitivity of 100%. Low serum iPTH levels at 6 hours after surgery can predict hypocalcaemia in patients undergoing thyroidectomy, even if serum calcium levels appear normal at that time. Parathyroid hormone, Serum calcium, Hypocalcaemia, Total thyroidectomy, Calcium homeostasis.

The Outcome of the Laparoscopic Hysterectomy in Al-Yarmouk Teaching Hospital in 2022–2023

Abstract Background: Hysterectomy is a common gynecological procedure used for various benign conditions like abnormal uterine bleeding, uterine prolapse, and fibroids. Different surgical methods, including vaginal, abdominal, laparoscopic, and robotic-assisted approaches, offer unique advantages and disadvantages. Total laparoscopic hysterectomy (TLH), introduced in 1989, offers benefits like smaller incisions, less blood loss, reduced pain, shorter hospital stays, and faster recovery. Objectives: The objective of this study was to evaluate patient outcomes, complications, and satisfaction with laparoscopic hysterectomy surgery. Patients and Methods: This cross-sectional study was conducted in Al-Yarmouk Teaching Hospital in Baghdad, General Surgery Department, from August 2022 to August 2023. Twenty-five patients who underwent laparoscopic hysterectomy for benign conditions were included. Patients were carefully assessed, ruling out malignancies through extensive clinical and radiological examinations, ultimately qualifying for the procedure. Data on patients’ demographics, comorbidities, previous surgical history, uterine size, indication for hysterectomy, type of procedures performed, and postoperative complications were gathered and subjected to analysis. The follow-up duration extended over 3 months, with assessments done on the 3rd day, 10th day, 1st month, and 3rd month postsurgery. Results: The mean age was 51.52 ± 9.47 years. Dysfunctional uterine bleeding was the most common indication (44%), followed by postmenopausal bleeding (32%). Most patients underwent TLH with bilateral salpingo-oophorectomy (BSO) (68%), and the mean operative time was 110 min. Complications were observed in 10 (40%) cases, with common issues being blood transfusion, port-site infection, and bladder injury. Hospitalization lasted 2 days, and postoperative pain reduced gradually over time. Patients who underwent concomitant BSO had significantly higher complications than those with isolated TLH. Postoperative pain levels were comparable between the two groups. Conclusion: Laparoscopic hysterectomy is an effective option for treating benign gynecological conditions, offering benefits like improved postoperative pain control and shorter hospital stays. However, the potential for complications, particularly in cases involving additional procedures, is to be considered.

824 Assessing the Quality of Surgical Operation Notes in the General Surgery Department at a District General Hospital (QI Project)

824 Assessing the Quality of Surgical Operation Notes in the General Surgery Department at a District General Hospital (QI Project)

The potential of indocyanine green fluorescence detection in surgical cut margin of breast conserving surgery.

Fluorescence-guided surgery (FGS) is a cutting-edge technology that uses near-infrared (NIR) fluorescence imaging to guide surgeons in surgery. Indocyanine green (ICG) is a fluorescent dye, which can be used for in vivo imaging of tumor cells. We aimed to explore the use of ICG fluorescence-guided technology as a rapid intraoperative margin assessment method for breast cancer surgery. In addition, we also compared the dose selection of ICG. This was a non-randomized prospective cohort study. Data were collected between August 2021 and October 2022 in the Division of Breast Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University. Upon specimen removal, tumor margins were immediately analyzed by ICG fluorescence detection and then sent to the pathology department for intraoperative frozen section analysis and subsequent routine pathological examination. Abnormal margin rates were calculated and compared using intraoperative frozen section analysis and under the guidance of ICG fluorescence. The study included 69 cases of breast cancer patients who underwent tumor resection assisted by ICG fluorescence-guided technology, including 18 patients with a 0.5 mg/kg dose and 51 patients with a 1.0 mg/kg dose. According to the study findings, the ICG test achieved a sensitivity of 81.82% and a specificity of 75.82%. At a dose of 0.5 mg/kg, the sensitivity was 66.67% whereas the specificity was 93.33%. At the dose of 1 mg/kg, the sensitivity was 87.5%, and the specificity was 74.42%. Similarly, for intraoperative frozen section analysis, the sensitivity was 81.82%, but the specificity was enhanced to 94.83%. Positive surgical cut margin was not identified in 2/69 by ICG fluorescence and frozen section analysis respectively. The sensitivity of ICG fluorescence detection is comparable to that of frozen section analysis, but the specificity is poor. The sensitivity increased and the specificity decreased at 1 mg/kg compared to the 0.5 mg/kg dose. ICG fluorescence can be used as a supplementary tool for frozen section analysis. These findings support further development and clinical performance assessment of ICG fluorescence.

Hydrocele among Patients undergoing Surgery in the Department of Surgery in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Hydrocele, an accumulation of serous fluid within the remnant of the processus vaginalis, is a common cause of painless scrotal enlargement. While prevalent, few studies have been conducted to assess the extent and risk factors of hydrocele in Nepal. This study aimed to assess the prevalence and associated factors of hydrocele among patients undergoing the surgery department at a tertiary care center in Nepal. This descriptive cross-sectional study was conducted at a tertiary care center. Data were retrospectively collected from medical records over one year (2021 July to 2022 June), including all patients undergoing surgery in the general surgery department. Ethical Approval was received from the Institutional Review Committee of the same institute (Reference number: 820/2080/81) Cases of hydrocele surgery were identified, and relevant data were extracted using a structured proforma. Descriptive analyses were performed using Microsoft Excel 2016. Out of 1812 surgeries, 95 (9.72%) were hydrocele surgeries. Of these, 94 (98.95%) were non-communicating hydroceles, 79 (83.16%) were unilateral, and 90 (94.74%) showed positive transillumination tests. The mean age of patients was 50.84 ± 17.02 years, with the highest number of cases in the 46-55 age group (20%). Postoperative complications occurred in 19 (20%) patients, with seroma and surgical site infection being the most common (31.58% each). Hydrocele surgeries comprised a significant portion (5.24%) of surgical cases at the tertiary care center, with the majority being non-communicating and unilateral types.

Postoperative complications and hernia recurrence after the use of various ventral hernia repair techniques

Prosthetic hernioplasty (HP) for ventral hernias (VH) has a complication rate of up to 27% and a hernia recurrence rate up of to 37%, depending on the chosen technique. The use of laparoscopic HP techniques allows for a shorter hospital stay and a lower risk of wound infection. There is a wide range of data on the superiority of laparoscopy over the open technique in terms of recurrence rates and various types of complications. The results of comparing HP with and without suturing of the hernia defect are controversial. Objective — to study the structure and incidence of postoperative complications, as well as the frequency of hernia recurrences after the use of open and laparoscopic HP for VH. Materials and methods. A multicenter prospective study, which included 482 patients diagnosed with VH, was conducted at the clinical base of the Department of General Surgery No. 2 at Bogomolets National Medical University. A total of 279 (57.9%) patients had primary VH, while 203 (42.1%) had incisional VH. The patients were divided into two groups, comparable in terms of age, sex, and hernia size distribution. Group 1 included 250 (51.9%) patients who underwent open HP with suturing of the hernia defect: subgroup 1a — open sublay (n=243; 50.4%), and subgroup 1b — open intraperitoneal onlay mesh technique (IPOM) (n=7; 1.5%). Group 2 included 232 (48.1%) patients who underwent laparoscopic HP using the IPOM technique: subgroup 2a — IPOM without suturing of the aponeurosis defect (n=81; 16.8%), subgroup 2b — IPOM with suturing of the aponeurosis defect (n=108; 22.4%), and subgroup 2c — IPOM+ with open aponeurosis defect suturing (n=43; 8.9%). Follow‑up evaluations were carried out at intervals of 2 weeks, 1 month, 6 months, and 1 year to assess the presence of complications, recurrence, and satisfaction with the cosmetic effect of the operation. Results. The overall frequency of complications after HP was 15.6%, while after open sublay it was 21.2%, and after laparoscopic IPOM it was 9.9%. All cases of complications belonged to Grades I—IIIb according to the Clavien‑Dindo classification. In both groups, there were no fatalities. In group 1, the frequency of seroma was 11.6% and hematoma was 5.6%, and in group 2, it was 7.3% and 0.9%, respectively. A statistically significant increase in the frequency of hematoma development was observed after open HP techniques compared to laparoscopic ones (p=0.004), while the frequency of seroma detection was comparable (p=0.148). Non‑suturing of the aponeurosis defect after laparoscopic IPOM in patients with VH did not result in an increase in the total number of complications or the percentage of recurrence (p &gt;0.05). Laparoscopic IPOM with hernia suturing demonstrated significantly higher patient satisfaction with the appearance of the anterior abdominal wall compared to other HP techniques (р &lt;0.05). Conclusions. The open sublay and laparoscopic IPOM HP procedures have a comparable recurrence rate of VH (p &gt;0.05). The incidence of infectious complications and hematomas is significantly higher after open operations compared to laparoscopic ones (p=0.041 and p=0.004, respectively).

Evaluation of General Surgery Physicians' Approaches to Surgical Antimicrobial Prophylaxis by Questionnaire Method

Introduction: Surgical site infections (SSIs) are infections of the incision site, organ or cavity that occur after surgery, causing a significant burden in terms of morbidity, mortality and healthcare costs. SSIs are the most common healthcare-associated infections in low- and middle-income countries and may affect one-third of surgical patients. This study aimed to conduct a face-to-face survey to evaluate general surgeons' approaches and knowledge levels before and after the training seminar on the use of surgical antimicrobial prophylaxis (SAP). Material and Method: An information-oriented questionnaire consisting of 10 questions was administered to a total of 18 surgeons working a General Surgery Department before and after the education meeting to evaluate their knowledge and attitudes towards the use of SAP. Data were presented as number, percentage, mean (standard deviation) and Fisher exact test was used to compare categorical data. Results: All participants answered the question regarding the time of prophylactic antibiotic administration correctly in both surveys. According to the current American Society of Health-System Pharmacists (ASHP) guideline for cefazolin, 42.2% of the patients had the correct time of antibiotic administration. The proportion of patients whose cefazolin selection, dose and time of administration were appropriate was 14.6%. The number of physicians who thought that postoperative antibiotic prophylaxis was not significantly increased from 16 (88.8%) before the meeting to 18 (100%) after the meeting (p&gt;0.05). In our study, the number of patients who continued to be given antibiotics unnecessarily postoperatively was 66 (16.4%). Conclusion: In order to increase the rate of optimal application of the theoretical knowledge to patients in practice, it is important to organize routine trainings based on current literature and service data for surgeons with a high workload and to follow the reflection of these trainings to the clinic in order to improve SAP compliance rates.

Postoperative Outcomes And Surgical Complications In Typhoid Ileal Perforation

Surgical repair for typhoid ileal perforation is essential to prevent peritonitis and sepsis. Postoperative outcomes, which include survival rates and recovery times, underscore the importance of comprehending surgical complications to refine treatment strategies and enhance patient survival. Objective: To determine postoperative outcomes and surgical complications in typhoid ileal perforation. Methods: The prospective cohort was conducted at General Surgery Department of Liaquat University Hospital in Hyderabad &amp; Jamshoro. 228 Patients of age 18 years or more and of any gender, who were operated for having single typhoid ileal perforation, were included in the study. While patients with multiple perforations, TB peritonitis or having traumatic perforations, were excluded from the study. Results: The most common age group was found to be 18-30 years (40.4%), followed by 31-40 years (28.1%), 41-50 years (19.3%), 51-60 years (7.9%), and &gt;60 years (4.4%). Males comprised 57.9% of the population, while females made up 42.1%. The mean length of hospitalization was found to be 14 ± 5 days. The majority of patients experienced good outcomes, accounting for 158 individuals (69.3%), while 70 patients (30.7%) had adverse outcomes. Among the adverse outcomes, there was a mortality rate of 7.2% (16 patients) and 54 patients (23.7%) experienced complications, some experienced more than one complication. Conclusions: The study concluded that though the majority of patients recover well, a significant proportion (7.2%) still faced adverse postoperative outcomes in terms of mortality. 54 patients (23.7%) experienced complications, some experienced more than one complication.