The repair of an inguinal hernia is one of the most common surgical procedures performed worldwide. Both Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) laparoscopic techniques have emerged as competitive alternatives to open mesh repair. This study evaluated the outcomes of open inguinal hernia repair vs laparoscopic procedures. Materials and Procedures: One hundred patients with inguinal hernias were included in this prospective comparative analysis. They were split equally into groups for laparoscopic (n = 50) and open repair (n = 50). Assessments were made of surgical time, postoperative discomfort, complications, hospital stay, recurrence, recuperation, and patient satisfaction. Statistical analysis has been carried out using SPSS program; p<0.05 was considered significant. Results and Observations: Compared to the open group (45.6±10.7 min; p=0.002), the laparoscopic group's mean operating time was significantly greater (60.2±15.4 min). However, postoperative discomfort was much reduced with laparoscopic repair. The laparoscopic group returned to regular activities faster (7.5±2.1 days vs. 14.2±3.7 days; p=0.002) and had a shorter mean hospital stay (1.2±0.5 days vs. 2.8±0.9 days; p=0.001). The group that underwent laparoscopy had fewer wound infections and ongoing pain. After a year, the laparoscopic group had a recurrence rate of 2%, whereas the open group had a rate of 6%. Following laparoscopic repair, patient satisfaction and quality-of-life ratings increased. Conclusion: Laparoscopic inguinal hernia repair offers improved postoperative recovery, less discomfort, less hospitalizations, fewer problems, and higher patient satisfaction, making it a safe and effective alternative to open surgery despite a longer operating time.
Background: Congenital pouch colon (CPC) is an unusual congenital abnormality in which a pouch-like dilatation of a shortened colon is associated with an anorectal malformation (ARM), predominantly reported from the Indian subcontinent. Certain rare variants may closely mimic Hirschsprung’s disease (HD) as they are not associated with an ARM and present later in life. The radiological findings too favour HD. This results in diagnostic confusion.Case Report: A 3-year-old boy presented with long-standing constipation and intermittent abdominal distension. Radiological evaluation suggested HD. Exploratory laparotomy revealed a Type II CPC with a proximal colonic pouch and a distal shortened segment of normal-calibre colon terminating in anal stenosis. A diverting ileostomy was performed, with a plan for staged definitive reconstruction.Conclusion: Rare variants of CPC should be considered in the differential diagnosis of children presenting withconstipation and imaging suggestive of HD, as the surgical management and prognosis differ significantly and this is the main teaching from this case.
Background: The clinical signs of peritonitis in patients with strangulated inguinal hernia, causing perforated small intestine diverticulosis, are often difficult to be recognized. The clinical signs of diverticulosis can be similar or even misdiagnosed with abdominal wall hernia because the pathology of both diseases has some similarities in their mechanisms. Multiple studies indicate that connective tissue disorders might significantly contribute to the development of diverticulosis and hernias in the abdominal wall. Case Report: A 64-year-old male presented with sudden-onset abdominal pain lasting six hours. He also reported a palpable, non-reducible mass noted in the left inguinal region, accompanied by nausea and vomiting. On physical examination, there was tenderness, rebound tenderness, and defans muscular tense in the entire abdominal region, and a non-reducible mass was palpable in the left inguinal region. Five mililiter of brown gastric fluid was obtained from the NGT tube. The results of a plain abdominal X-ray were dilatation of the small intestine and large bowel; no step ladder image, no free air was seen, and the psoas line was not visible. The diagnosis of small intestine diverticulosis with perforation was concluded during exploratory laparotomy based on indications of peritonitis. Conclusion: The clinical signs of diverticulosis can resemble an inguinal hernia, so surgeons need to be aware of this occurrence to select the treatment and avoid post-operative worsening.
Vaginal intraepithelial neoplasia (VaIN) and primary vaginal malignancies represent a rare subset of lower genital tract neoplasms, accounting for approximately 1% of all gynecological cancers. VaIN, a precursor lesion with substantial oncogenic potential, remains a diagnostic and therapeutic challenge. Its incidence is increasing due to heightened awareness, expanded cytologic and HPV screening, and routine colposcopic evaluation. Risk factors include prior cervical intraepithelial neoplasia, hysterectomy for CIN, immunosuppression, prior pelvic irradiation, persistent high-risk HPV infection, smoking, HIV, and diethylstilbestrol (DES) exposure. The vaginal microbiome's composition is increasingly recognized as a determinant of host susceptibility to HPV and neoplastic transformation. The Lower Anogenital Squamous Terminology (LAST) classifies VaIN into low-grade (VaIN 1) and high-grade squamous intraepithelial lesions (VaIN 2 and 3), with the latter harboring a significant risk of progression to invasive disease. High-grade VaIN necessitates definitive treatment, whereas low-grade lesions may be monitored. Therapeutic modalities include wide local excision, laser ablation, LEEP, and in select cases, upper vaginectomy. Non-excisional therapies such as CO₂ laser vaporization, photodynamic therapy, and plasma energy ablation are feasible in the absence of invasion. The choice of treatment should be individualized based on lesion extent, visualization, and prior therapies. Recurrence is not uncommon, warranting vigilant long-term surveillance. Primary vaginal carcinomas, chiefly squamous cell in origin, are staged clinically using FIGO and TNM classifications. Definitive management involves external beam radiotherapy (EBRT) with concurrent chemotherapy, followed by image-guided adaptive brachytherapy. Prognosis is primarily stage-dependent. Uncommon histologic subtypes such as vaginal melanoma and sarcomas pose unique diagnostic and therapeutic considerations due to their aggressive nature and rarity. This review consolidates the evolving landscape of VaIN and vaginal cancer, emphasizing diagnostic standardization, risk stratification, and a tailored multimodal treatment paradigm aligned with contemporary oncologic principles.
Struma ovarii (SO) is a rare ovarian tumor, constituting 1% of all ovarian tumors and 3% of ovarian teratomas, predominantly composed of thyroid tissue. While typically benign, SO can undergo malignant transformation. We report a case of a 41-year-old woman with a six-month history of abdominal distention. Imaging revealed a solid cystic mass in the right adnexa with ascites and elevated CA125 levels. The surgical intervention included a hysterectomy and bilateral salpingo-oophorectomy, with pathology confirming struma ovarii with follicular thyroid carcinoma. Postoperative recovery was uneventful, and all follow-up tests were normal. This case underscores the diagnostic challenge posed by SO due to its resemblance to ovarian cancer and highlights the importance of thorough exploration, pathological examination, and long-term follow-up. Serum thyroglobulin levels can be an effective marker for monitoring tumor recurrence. Our findings contribute to the understanding and management of SO with malignant transformation.
Collision tumors, the coexistence of two distinct neoplasms in the same tissue without histological admixture, are rare, particularly in the ovary. This report documents an unusual case of a 50-year-old postmenopausal woman who presented with a 4-month history of lower abdominal pain and distention. Imaging and surgical findings revealed a large right ovarian mass, which histopathology identified as a mucinous cystadenoma coexisting with a benign cystic teratoma. This rare combination underscores the importance of considering collision tumors in differential diagnoses of ovarian masses. Molecular studies suggest a potential clonal relationship, with shared genetic changes supporting a teratomatous origin for mucinous tumors. This case contributes to the limited literature on ovarian collision tumors, emphasizing the need for awareness and accurate diagnosis of these rare entities to guide appropriate treatment strategies.
COVID-19 exhibits wide spectrum of clinical manifestations, from mild symptoms to severe thrombotic events-death. Vascular coagulopathy plays critical role in severe complications. Patients with pre-existing peripheral vascular disease (PVD) are at heightened risk due to endothelial dysfunction, inflammation, and prothrombotic state. Present study aimed to evaluate vascular complications associated with COVID-19 & assess role of antithrombotic agents & corticosteroids during early (golden) stage of infection. Methods: This observational study was conducted in Department of General Surgery at D.Y. Patil School of Medicine, Nerul, Navi Mumbai, from Jan 2021–Dec 2022. 20 patients with confirmed COVID-19 & vascular ischemia involving abdomen and/or limbs were enrolled based on RT-PCR results, CT Severity Scores (CT-SS >5), CORADS >5, antibody positivity, and/or previous history of PVD. Detailed clinical assessment, laboratory investigations, imaging (Doppler studies, CECT, CT angiography), operative procedures, postoperative outcomes recorded. Patients followed for 1month post-discharge. Statistical analysis performed using SPSS v21, with Chi-square tests applied for categorical variables (p<0.05 considered significant). Mean age was 55.1 ± 11.9 years, with 75% males. Comorbidities included hypertension (25%), diabetes (10%), diabetes with hypertension (15%), other combinations including hypothyroidism, tuberculosis, and IHD (5% each). Laboratory abnormalities included elevated CRP, D-dimer, PT, leukocytosis (5% each). Imaging revealed SMA thrombosis as most frequent thrombus site (25%), followed by femoral artery involvement (15%). Surgical interventions included exploratory laparotomy with resection/anastomosis (15%), laparotomy with ileostomy (15%), right below-knee amputation (15%), femoropopliteal grafting (5%), and thromboembolectomy (5%), while 20% were managed conservatively. 17 patients (85%) were fully vaccinated, yet thrombotic events were still observed. Statistically significant association was found between thrombus location & surgical procedure performed (p=0.031). No significant association was observed between prior use of antiplatelet agents and diagnosis (p=0.154). Conclusion: COVID-19 associated with significant vascular complications, particularly SMA thrombosis and femoropopliteal involvement, even in fully vaccinated patients. Early imaging, prompt diagnosis, and timely surgical intervention are crucial to prevent limb loss and improve survival. While antiplatelet use did not significantly impact thrombus occurrence, further multicentric studies with larger sample sizes are needed to clarify preventive role of antithrombotic therapy and vaccination in mitigating vascular complications.
Blood transfusion is a vital medical procedure used to restore lost blood and improve oxygen supply in patients.It plays a life-saving role in surgeries, trauma cases, and conditions like anemia and cancer. While transfusions can be highly beneficial, they are not without risks. Complications such as allergic reactions, infections, and iron overload may occur. Fortunately, with careful practices and growing alternatives like autologous donation and artificial blood, the safety of transfusion is steadily improving. This article provides an easy-to-understand but in-depth look at the uses, risks, preventive strategies, and substitutes for blood transfusion, based on the latest research and expert guidelines.
Objective: To find out better hemodynamic stability in patients with intrathecal 0.75% hyperbaric bupivacaine alone and with pethidine.Study Design: Quasi experimentalPlace and Duration: This study was conducted in department of Anesthesiology. Combined Military Hospital Multan from 2-3-23 to 2-12-23 total duration of the study was 6 months.Methodology: Pregnant women numbering 80 with gravidity 2 undergoing elective lower segment cesarean section surgery meeting the inclusion criteria were selected. They were divided in two equal groups A and B, n-40 each. Group A received 10mg of 0.75% bupivacaine whereas group B were injected with 7.5mg of 0.75% bupivacaine plus 25mg of pethidine. Comparative decrease in blood pressure in terms of ‘mean arterial pressure’, incidence of hypotension, bradycardia, nausea and post spinal shivering were noted.Results: Mean Arterial Pressure (MAP) decreased in both groups at 2.5-minute post intrathecal injection but this decline was more prominent in group A 70±2 versus 80±3 for group B respectively (p 0.001). At I0 minute the decline in MAP was lesser but the difference between the two groups remained significant statistically. Similarly, frequency of bradycardia and post-op shivering remained on the lower side in group B. The major difference was seen in the frequency of hypotension in both the groups.Conclusion: Addition of pethidine to bupivacaine for intrathecal use keeps the hemodynamic profile of the patients relatively more stable and thus avoids the feto-maternal adverse events.
Tissue regeneration and wound healing represent critical areas in medical science, with significant advance-ments in recent years. These fields involve restoring damaged tissues and promoting recovery, which are essential for improv-ing patient outcomes and quality of life. Innovations such as biomaterials, stem cell therapy, advanced wound dressings, and regenerative medicine have significantly impacted these areas. This study provides a comparative analysis of innovations in tissue regeneration and wound healing in Nigeria and South Africa. The focus includes technological advancements, research contributions, and statistical data to highlight progress and challenges in both countries. Data from various healthcare institu-tions, research publications, and government reports form the basis of this analysis.Additionally, surgical innovations that minimize wound occurrence and improve wound healing, such as mini-mally invasive surgery, negative pressure wound therapy (NPWT), and the use of advanced suture materials, are transforming clinical outcomes in both Nigeria and South Africa. Minimally invasive techniques reduce tissue damage, leading to smaller wounds and faster recovery. NPWT has proven effective in managing chronic wounds and reducing infection rates, while an-timicrobial and absorbable sutures have lowered complications related to wound closure. Cold plasma therapy and stem cell applications are also emerging as promising approaches for chronic wound care and tissue regeneration. These innovations, coupled with the efforts in regenerative medicine and biomaterials, are providing both nations with effective tools to manage wound healing more efficiently. This comparative study aims to shed light on the current state of tissue regeneration and wound healing in these nations, offering insights into the advancements made, the effectiveness of various approaches, and the potential future devel-opments in this vital medical field.
Skin metastasis from squamous cell carcinoma of the uterine cervix is a rare occurrence with reported incidences ranging from 0.1% to 2%. This often indicates advanced-stage disease and poor prognosis. We present the case of a 50-year-old multiparous woman diagnosed with cervical squamous cell carcinoma FIGO stage 2A1 following a six-month history of abnormal uterine bleeding. Despite initial treatment with radical hysterectomy, the patient was noncompliant with postoperative radiotherapy and experienced disease recurrence manifesting as vaginal and cutaneous lesions. Subsequent chemotherapy failed to halt disease progression, leading to palliative care. The timing of skin metastasis onset following primary treatment is a crucial prognostic factor, with earlier appearances indicating poorer outcomes. Skin metastases are often preterminal, necessitating palliative care.
Gliomatosis peritonei (GP) is a rare condition characterized by benign glial implants in the peritoneum, omentum, and lymph nodes, typically associated with immature ovarian teratomas and less frequently with mature teratomas. We present a case of a 21-year-old woman with severe abdominal pain and a large abdominal mass. Imaging revealed a large multilocular cystic mass suggestive of a dermoid cyst with torsion. During exploratory laparotomy, a large cystic mass with hair, teeth, and sebaceous material was found in the left ovary, alongside multiple nodules in the omentum. A left salpingo-oophorectomy, omentectomy, and peritoneal biopsies were performed. Histopathology confirmed a mature teratoma with GP. The patient's postoperative period was uneventful, and no adjuvant therapy was required. This case underscores the importance of recognizing GP in patients with ovarian teratomas, highlighting the typically benign nature and favorable prognosis of GP with proper surgical management.
Background: The lack of ideal materials and the high incidence of complications make tracheal defect reconstruction challenging. The use of aponeurosis as a surgical patch and flap in reconstruction is not uncommon, but no studies had been conducted to analyse its use in tracheal defect reconstruction, though its effectivity in wound healing was significant in reconstruction of other organs. Objective: This study aims to compare collagen density, fibroblast expression, and neovascularization in tracheal defect reconstruction using primary suture and using external oblique muscle aponeurosis patch. Methods: This randomized control trial is a laboratory experimental study using male New Zealand white rabbits. Randomization was carried out with permuted block randomization into a control group (primary suture) and a treatment group (reconstruction with external oblique muscle aponeurosis patch). Mascroscopic and histopathological assessments were carried out 14 days after surgery. Results: We got homogeneous samples in both groups (9 samples each) in terms of age (p = 0.763), weight before procedure (p = 0.347), and weight after procedure (p = 0.536). Macroscopically, no wound dehiscence, pus, or inflammation at the surgical site in either the control or treatment groups. Histopathological analysis showed that there were no differences in collagen density (p = 1.00), fibroblast expression (p = 0.414), and neovascularization (p = 0.558) between the two groups. Conclusion: It can be concluded that there are no differences in collagen density, fibroblast expression, and neovascularization in New Zealand rabbits with tracheal defect using primary suture and using external oblique muscle aponeurosis patch
Colon cancer is most common type of malignancies all over the world. Various risk factors including genetic mutations,old age,family history, smoking, drinking excessively, poor diet and several others are associated with increasing cases of colorectal carcinoma(CRC). Diagonosis is usually made by colonoscopy and and confirmed by tissue biopsy. After diagonosis delay to treatment can worsen the disease progression and long-term outcome.Treatment options for CRC include surgical resection either open or laparoscopic both with their merits and demerits. Laparoscopic resection have been well accepted for treatment and is known to result in less hospitalisation and blood loss while open surgery still has same overall survival rate, morbidity and mortality. Surgical treatment is associated with postoperative complications including port site metastases, surgical site infections (SSIs),Adhesions, intestinal obstruction, venous thromboembolic events, colonic ischemia, these complications can be decreased by preoperative assessment, intraoperative care and postoperative interventions. Controlling nutritional status (COUNT) score is prognostic factor of postoperative complications and mortality of patients with CRC. 5-years survival rate has increased upto 70% due to improved treatment modalities.
Acute appendicitis is a surgical emergency and one of the most common cause if acute abdominal pain. Appendicitis means inflammation of vermiform appendix. Common age group is 10 -20 years. Causes of appendicitis include obstruction of its lumen with fecolith, calculi, infection and lack of dietary fiber. Clinical presentation vary thus called chameleon of surgery .Typical feature include periumblical pain that migrates to right iliac fossa over the next 24 hours accompanied by nausea ,anorexia and vomiting. Typical features were first described by Murphy and are present in 50 percent of the cases.Atypical symptoms include diarrhea,constipation,urinary tract infection. Pregnant women feel pain in the upper abdomen due to displacement of appendix by uterus. It can be classified as un complicated which means inflammation with abscess formation and complicated that means appendix is inflammed along with abcess formation and peri appendiceal phelgmon.Clinical signs include elevated temprature and rebound tenderness. Physical examination includes a postive rovsing sign, obturator sign, obturator sign or psoas sign. Alvardo scoring system is one the few scoring systems used to diagnose a case of suspected appendicitis. Total score is 10.A score of 7-10 indicated surgical intervention. Among the imaging modalities usg abdomen is the first choice but CT abdomen is superior to it because of its increased sensitivity and specificity. Laproscopic appendectomy is most effective surgical intervention. Uncomplicated cases can be treated with piperacillin tazobactam. Complicated cases can be treated with combination antibiotics cephalosporin combined with flouroquinolones or metronidazole.
Spontaneous gastric perforation is a serious, rare and life threatening condition. Perforation of the stomach is a full thickness injury to the wall of the organ. As the peritoneum completely covers the stomach, perforation of the wall creates a communication between the gastric lumen and the peritoneal cavity. Gastric perforation is caused by three different mechanisms. We report a case of gastric perforation in a Preterm, very low birth weight neonate in our NICU and based on the signs of abdominal distension and increased abdominal girth. Abdomen ultrasonography and Contrast dye study was done which showed perforation, following which exploratory laparotomy was performed and surgical repair was carried out. As it has high mortality rate so its prompt recognition and surgical intervention is utmost necessary
Background: Obesity is associated with a higher incidence of several diseases, including diabetes, cardiovascular disease,and cancer. Bariatric surgery, regardless of its type, is the most effective approach for treating morbid obesity. This studyaimed to compare the outcome of SASI bypass with that of RYGB regarding weight loss, improvement in comorbidities,malnutrition, and postoperative complications.Methods: Patients with morbid obesity who underwent RYGB or SASI bypass and were followed for 12 months from May2020 through May 2021 were included in the current prospective study. Weight loss, improvement in comorbidities,complications, and nutritional status were compared between a group of consecutive patients who underwent SASI bypassand a group of patients who underwent RYGB during the same study period.Conclusion:The average percentage of postoperative weight loss was not significantly different between the two groups.There were no significant differences in the remission of comorbidities between the two groups. Few postoperativecomplications were reported in both groups. The outcome of SASI bypass and Roux en Yregarding weight loss andimproving of comorbidities were satisfactory
Introduction: A T-Skin stapler is a type of skin staple commonly used in the closure of surgical wounds on skinslices. Quick and accurate treatment of patients is required. However, there is still limited research comparingthe handling speed of the tool with other skin staples.Method: We used a T-Skin stapler that is built of sterile grade 317 L medical metal with code SS1 and thesurgical thread type T-Silk no. 330 with code S21. We created numerous portions in goat experimental animalsthat were aged over 2-3 years and weighed more than 20.5-26 kg after randomly inflicting gout on animals withsurgical incision wounds (10 cm).Result: The T-Skin stapler and surgical threads had comparable results with respect to wound closure, but the TSkinstapler was faster in all steps observed. A comparison of the speed of surgical wounds with a stapler wasfound to be 6.3 times faster than using sutures with surgical threads. The time used to remove the staples was anaverage of 92.4 seconds, while the time taken for thread removal was 110.6 seconds.Conclusion: The T-Skin stapler and surgical threads had comparable results with respect to wound closure;however, the T-Skin stapler was faster in all steps observed.
Aim: This work aimed to compare Piezosurgery stapedotomy with the conventional approach in the managementof otosclerosis in terms of intraoperative time, postoperative complications, and air-bone gap improvement.Methods: This randomized controlled clinical trial was conducted in Beni-Suef University hospital from August2021 to June 2022 according to the ethical considerations of the local institutional review board. It included 40patients suffering from hearing loss due to otosclerosis, diagnosed based on clinical features, audiometry andimpedancemetry. Patients were randomly divided into two groups: group P underwent stapedotomy by thePiezosurgery medical device, and group C underwent stapedotomy by the conventional method.Results: Both groups were matched regarding their baseline characteristics. The air bone gap (ABG) postoperativelyreached a mean of 7.7±6.7 dB (median=6) in group P and 7.6±6.8 (median=7) dB in group C, with no significantdifference. The percentage of reduction of A-B gap was 76.21%±17.6% in group P (Piezosurgery), while group C(conventional) was 75.8% ±18.7%, with no significant difference. The operative time in group P was (35.5± 4.5)minutes vs (29.7 ±3.2) minutes in group C, with a significant difference. Regarding the complication, there was nosignificant difference between Piezosurgery and conventional surgery regarding intraoperative and postoperativecomplications (P-value > 0.05).Conclusion: This work concluded no difference between conventional techniques and Piezosurgery in (ABG)reduction postoperatively, intraoperative, and postoperative complications, only surgical time was longer inPiezosurgery group and was statistically significant.
Torsion of undescended testis within inguinal canal is a rare surgical emergency. The delay in detection as wellas treatment may result in poor salvage of affected testes. There are limited number of such cases are reported inmedical literature. Clinical examination and early surgical intervention remain the main stay of management. Wepresent a case of a14-year-oldmale child presented to surgical OPD with abdominal pain, vomiting and rightgroin swelling. He was diagnosed as the torsion of cryptorchid testis in right inguinal canal. Emergencyexploration done through the inguinal approach and orchidopexy was carried out on the right side.
