Introduction: The principle of modern open hernia surgery is tension-free mesh repair. The choice of mesh component varies from surgeon to surgeon and depends on patient factors. This study was aimed at identifying the benefit of lightweight polypropylene meshes for open inguinal hernia surgery over the heavyweight ones. Methods: A one-year prospective observational study from 1st January 2022 to 31st December 2022 was conducted to identify the effects of both lightweight and heavyweight meshes. The patients were interviewed on follow-ups up to one year after surgery and different aspects of health related to this surgery were assessed single-blindly. Results: Higher score in the HRQoL (Health Related Quality of Life) in the light-weight mesh group suggest that lightweight mesh provides better overall satisfaction with the patient’s experience, improved post-operative recovery and well-being. Alternatively heavyweight mesh cohort rarely achieved full satisfaction during one-year follow-up in the physical and mental health domains. Conclusion: HWM had a distinctive advantage over LWM with regard to recurrence. The two types of prosthetic meshes had equivalent outcomes for postoperative pain, seroma, foreign body sensation, infection, and numbness. Studies focused on defect sizes and fixation methods are warranted for further stratification. Journal of Surgical Sciences 2024;28(2): 69-76
Introduction: In surgical practice, surgical site infections (SSIs) continue to be a significant issue. The SSI rate following general abdominal surgery is still more than 15% despite preventive measures including antibiotic prophylaxis and anti-septic skin preparation. Following an open choledocholithotomy, this complication is also frequent. There is little information about the benefits of wound drainage in open choledocholithotomy, despite numerous trials demonstrating its effectiveness in lowering infection. The purpose of this study was to evaluate the efficacy of subcutaneous drain placement in reducing superficial SSI following open choledocholithotomy. Methods: 44 patients who underwent open choledocholithotomy between January 2022 and December 2022 were included in the study after convenience sampling. Two groups of patients were created. Twenty-two patients (group I) had a subcutaneous drain, while 22 patients (group II) had no subcutaneous closed suction drain. All patients were diagnosed clinically and by doing imaging followed by open procedure of conventional choledocholithotomy. In the cohort with subcutaneous drain, daily subcutaneous drain collection was documented. Following surgery, each patient was assessed for the presence of wound dehiscence, superficial SSIs, and wound seromas and compared. The statistical program SPSS 22 Windows version 10 was applied for data analysis and presentation. Results: Most of the patients were female 27 (61.36%). Among them 17(38.64%) cases were present in the 41-50 years of age group. Commonest risk factors were diabetes 7(31.82%), CKD 4(18.18%) and hypoalbuminemia 8(36.36%) in case groups. Surgical site infection (SSI) took place in 4(18.18%) patients among the group with subcutaneous drain and 13(59.09%) among the control cohort. Available organisms were Staphylococcus Aureus 8(36.36%) and Escherichia Coli 6(13.64%) in both groups, isolated from both bile culture and wound swab culture. Conclusion: The prevention of superficial surgical site infection was positively impacted by the installation of a drain in the wound following an open choledocholithotomy by lowering the rate of SSIs and hospital stays. Journal of Surgical Sciences 2024;28(2): 49-54
Introduction: Acetabular fractures, which frequently result in hip dislocation, are complicated intraarticular injuries caused by high-energy trauma. Many patients get post-traumatic osteoarthritis and femoral head avascular necrosis despite surgery. Total hip replacement (THR) is necessary due to the discomfort, limping, decreased mobility, and functional impairment caused by these disorders. There is yet little information on THR results in these situations. In patients with osteoarthritis and/or avascular necrosis following surgical repair of acetabular fracture dislocation, this study assessed the functional result and complications of THR. Methods: This quasi-experimental study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, from March 2022 to September 2024. A total of 30 patients were included and followed for a minimum of 24 weeks. Functional outcome was assessed using the Harris Hip Score (HHS), along with evaluation of pain, limping and postoperative complications. Results: The mean age of participants was 46.9 ± 11.442 years, with male predominance (80%). The mean HHS improved significantly from 25.8 ± 6.386 preoperatively to 91.9 ± 2.998 at 24 weeks (p < 0.001). Excellent outcomes were observed in 83.3% of patients and good outcomes in 16.7%. The surgery successfully eliminated the marked preoperative pain reported by 90.0% of patients, resulting in 80.0% experiencing only mild pain and 20.0% achieving complete pain relief postoperatively. Limping improved significantly, with 66.7% achieving normal gait. Complications were minimal (6.7%), including superficial surgical site infection and heterotrophic calcification and no major complications were observed. Conclusion: Total hip replacement provides excellent short-term functional outcomes, significant pain relief and low complication rates in patients with post-traumatic hip complications following acetabular fractures. Journal of Surgical Sciences 2024;28(2): 62-68
Introduction: Breast cancer is the most common malignancy among women worldwide and represents an increasing oncological burden in Bangladesh. Delayed presentation, limited screening facilities, and heterogeneity in tumor biology continue to influence treatment outcomes in low- and middle-income countries. This study aimed to evaluate the clinicopathological profile, molecular subtypes, treatment patterns, and short-term outcomes of breast cancer patients treated at a tertiary care teaching hospital in Bangladesh. Methodology: This retrospective observational study was conducted in the Department of Surgery, Anwar Khan Modern Medical College Hospital, Dhaka, Bangladesh. Histopathological confirmed breast cancer patients treated between January 2022 and June 2023 were included in the analysis. Results: A total of 43 patients were analyzed. The median tumor size was 3.0 cm (IQR: 2.0–4.0 cm), and the median symptom duration was 4.0 months (IQR: 2.0–6.0 months). ER/PR-positive, HER2- negative tumors constituted the most common molecular subtype. Tumor size greater than 2 cm was significantly associated with nodal positivity (OR 9.14, 95% CI 1.53–54.54; p=0.020). Tumor size demonstrated a significant positive correlation with the number of involved lymph nodes (rho=0.62, p<0.001). Symptom duration was also positively correlated with tumor size (rho=0.60, p<0.001). Conclusion: Breast cancer patients in Bangladesh continue to present with relatively advanced disease. Longer symptom duration was associated with larger tumor size, and larger tumor size was significantly associated with nodal positivity, highlighting the importance of early diagnosis, timely referral, and breast cancer awareness programs to improve clinical outcomes. Journal of Surgical Sciences 2024;28(2): 77-84
Introduction: Presentation of gastro-intestinal emergencies, especially in young children, varies widely, which renders recognition of the underlying disorder and treatment challenging. Critically targeted imaging techniques are becoming increasingly important in obtaining the correct diagnosis without unnecessary delay. Minimally invasive techniques have become the method of choice for the diagnosis and treatment of many abdominal emergencies in children. Methods: This prospective study was conducted in department of surgery at Anwer Khan Modern Medical College Hospital, Dhaka from January 2020 to August 2022. All the pediatric patients irrespective of sex with diagnosis of gastro-intestinal emergencies undergoing surgical intervention were included in the study. All clinical and operative findings were recorded and in the post-operative period patients were followed up of their progress and treatment outcome. Results: A total of 40 cases of gastro-intestinal emergencies were managed by surgical intervention during the study tenure. This study includes 7 cases of intestinal obstruction (5 for intussusception and 2 for worm bolus), 3 cases of infantile hypertrophic pyloric stenosis (IHPS) and 30 cases of acute appendicitis or their complications. Abdominal pain, distension and vomiting were the prominent symptoms of presentation. Wound infection was the commonest postoperative complication. Conclusion: Acute abdominal complaints in children are common presentations in the emergency department. As in our country, many medical college hospitals do not have the individual pediatric surgery department, but we have to manage pediatric surgical emergencies as routine surgical emergencies in adult cases. So, they are often differing from those in adults and need to manage properly from the very beginning. This study was conducted to determine the etiology, presentation, diagnosis and outcome of surgical management for pediatric gastro-intestinal emergencies. Journal of Surgical Sciences 2024;28(2): 55-61
Introduction: Colorectal cancer (CRC) is a common malignancy with significant genetic heterogeneity. Mutations in proto-oncogenes such as Kirsten rat sarcoma viral oncogene homologue (KRAS), Neuroblastoma RAS viral oncogene homolog (NRAS), and B-Raf proto-oncogene, serine/threonine kinase (BRAF) play a pivotal role in CRC development impacting prognosis and treatment. This study aims to correlate mutations in these genes with tumor localization in both primary and metastatic Colorectal Carcinoma (CRC). Methods: This prospective cross-sectional study was conducted between July 2023 and June 2024 at BSMMU. A total of 30 CRC patients, confirmed via histopathology, were included. Purposive sampling was used to select patients. Tumor tissue samples were collected and analyzed for KRAS, NRAS, and BRAF mutations using DNA isolation, Polymerase Chain Reaction (PCR) amplification, and sequencing techniques. Results: Among the 30 patients, the majority were male (66.7%) with a mean age of 50.4 years. KRAS mutations were found in 5 patients (16.7%), while no mutations in NRAS or BRAF were detected. Rectal cancer was the most frequent tumor location (36.7%), followed by hepatic and splenic flexure (16.7% each). No significant correlation was observed between KRAS mutations and tumor localization. Conclusions: There was no statistically significant correlation between KRAS, NRAS, and BRAF mutations and tumor localization in the BSMMU CRC patient cohort. The study highlights the need for larger sample sizes to better understand the genetic landscape of CRC in Bangladesh. Small sample size may limit the ability to detect significant associations. Further large-scale studies could offer more conclusive insights. Journal of Surgical Sciences 2024;28(1): 42-46
Introduction: Gallbladder cancer typically remains silent until an advanced and often noncurative stage with the shortest median survival after diagnosis. This study was conducted to find out the factors responsible for diagnosis of carcinoma gallbladder at advanced stage. Materials and Methods: This observational study was conducted in the Bangabandhu Sheikh Mujib Medical University from July 2022- June 2023 on 110 patients of carcinoma gallbladder. The patients were grouped into early (stage I, II) and advanced stage (stage III, IV) on the basis of imaging or histopathology report. All the variables related to diagnosis of carcinoma gallbladder were evaluated and factors related to delayed diagnosis were worked out. Results: 28 (25.5%) patients of this study group were incidental, 16 (14.5%) were early and 66 (60%) were advanced gallbladder carcinoma. Rural residence, low educational level and poor economic status of our people, lack of specific symptom at early stage of the disease, lack of sensitivity of most commonly performed imaging (USG) and absence of sensitive tumour marker at early stage were responsible for delayed diagnosis of the disease. Conclusion: Clinicians should be very suspicious to diagnose gallbladder carcinoma at early stage. Patients presenting with symptoms of benign biliary disease should be investigated properly, when there is suspicious gallbladder wall thickness, CA 19-9 and CECT or MRI should be warranted. Journal of Surgical Sciences 2024;28(1): 9-14
Introduction: The role of laparoscopic appendectomy in complicated appendicitis remains controversial because of concerns regarding operative difficulty and postoperative infectious complications. This study evaluated and compared the outcomes of laparoscopic and open appendectomy in patients with complicated appendicitis. Methods: A prospective observational comparative study was conducted over two years in a tertiary care hospital in Dhaka, Bangladesh. Adult patients diagnosed with acute appendicitis were prepared for laparoscopic appendectomy. During laparoscopy, those found to have complicated appendicitis were enrolled in the laparoscopic appendectomy (LA) group. Patients with uncomplicated acute appendicitis underwent conventional laparoscopic appendectomy and were not included in the study. Pre-operatively diagnosed complicated appendicitis patients were enrolled in the open appendectomy (OA) group. The primary outcome measure was postoperative intra-abdominal abscess (IAA) formation. Secondary outcomes included operative duration, postoperative hospital stay, wound infection, conversion rate, morbidity, readmission, and procedural cost. Results: A total of 48 patients were enrolled, 34 patients in the laparoscopic group and 14 in the open surgery group. IAA occurred in 6.7% of LA vs 10% of OA (p=0.34). Operative time was longer in LA (75±20 vs 60±18 min; p<0.01). The LA group had shorter hospital stay (3.2±1.1 vs 4.8±1.5 days; p<0.001). Wound infection was lower in LA (4% vs 12.5%; p=0.03). Conversion to open was necessary in five patients (14.7%) of LA. Although the laparoscopic approach involved slightly higher procedural costs and required prolonged operation time, it demonstrated superior postoperative recovery and shorter hospital stay. Conclusion: Laparoscopic appendectomy for complicated appendicitis is a safe and effective surgical option associated with lower wound infection rates, shorter hospitalization, and acceptable postoperative complication rates. In experienced hands, laparoscopic surgery should be considered a preferred approach in selected patients with complicated appendicitis. Journal of Surgical Sciences 2024;28(1): 28-35
Introduction: Healthcare-associated mycobacterial infection is an uncommon but important complication of minimally invasive surgery. Delayed port-site infection after laparoscopy may be misclassified as persistent bacterial surgical-site infection, especially in settings where mycobacterial culture and molecular testing are not routinely available. This study reanalyzes a multicenter Bangladeshi cohort of delayed non-healing port-site lesions using a more conservative epidemiological framework of probable healthcare-associated mycobacterial infection. Methods: This retrospective multicenter observational cohort study reviewed 483 laparoscopic procedures performed by six experienced laparoscopic surgeons in five hospitals in Narayanganj, Bangladesh, from September 2020 to January 2021. Patients with delayed non-healing port-site ulcers, abscesses, or discharging sinuses who underwent histopathological evaluation and improved after anti-tubercular therapy were included. Categorical variables were analyzed using the Pearson chi-square test and Cramer’s V. Results: Among 483 laparoscopic procedures, 87 patients developed port-site infection and 66 fulfilled the inclusion criteria. Female patients accounted for 64 cases (96.97%). Laparoscopic cholecystectomy was the most common associated procedure (54/66, 81.82%), followed by laparoscopic appendectomy (9/66, 13.64%). Abscess was the commonest presentation (41/66, 62.12%), followed by discharging sinus (25/66, 37.88%). Histopathology showed granulomatous inflammation in 56 patients (84.85%) and non-specific inflammation in 10 patients (15.15%). The highest number of cases occurred after operations performed in October 2020 (45/66), and the interval from surgery to presentation ranged from 28 to 65 days. The month of operation was significantly associated with port-site involvement (Pearson chi-square = 33.82, p = 0.0133). Perioperative antibiotic regimen was also associated with the type of subsequent intervention (Pearson chi-square = 23.68, p = 0.0006), although this association was considered non-causal and confounded by operative indication and clinical severity. All patients improved after anti-tubercular therapy. Conclusion: The delayed onset, temporal clustering, granulomatous histopathology, and response to anti-mycobacterial therapy strongly suggest a probable healthcare-associated mycobacterial outbreak after laparoscopic surgery. In the absence of microbiological confirmation, the broader term “probable mycobacterial port-site infection” is more scientifically defensible than “confirmed port-site tuberculosis”. Strengthening instrument reprocessing, outbreak surveillance, and mycobacterial diagnostic capacity is essential for patient safety in high-burden, resource-limited settings. Journal of Surgical Sciences 2024;28(1): 20-27
Epidermoid inclusion cysts of the perineal region are a very rare entity, which require careful diagnosis by appropriate imaging and according management. We are here to describe an unusual case of a huge perineal epidermoid inclusion cyst extending upwards into pelvic cavity, which was removed successfully by meticulous dissection in abdominoperineal approach. Essential investigations to ensure accurate diagnosis in addition to surgical techniques followed to ensure complete removal & to prevent recurrence are described in this case report. Journal of Surgical Sciences (2021) Vol. 25 (1) : 53-57
Background: The variability of prognosis within a clinical & pathological stage of gastric cancer, underscores the need for specific biological markers to identify subgroups of patients for intensive treatment. The purpose of this study was to evaluate the correlation between HER2overexpression with different stages of carcinoma stomach. To our knowledge, this is the first study from Bangladeshi population reporting on the relationship of HER-2 expression with different stages of carcinoma stomach. Methods: This cross-sectional study included 53 patients with gastric cancer who underwent surgery at different Hospital in Dhaka city between November 2016 and October 2017. All the patients were clinically staged before surgery & tumor samples were examined for HER2 expression by immunohistochemistry (IHC). The results correlated with clinicopathological features & stages of carcinoma stomach. Percentage expression for positivity of HER2 was estimated along with 95% confidence interval. The differences in the positivity rate between different sex, stages and grades were tested through ‘Chi’ square test of significance and a value of p <0.05 was consider to be statistically significant. Results: The mean age was 51.74±12.02 years, more than half (52.8%) patients were male. Almost two third (66.0%) patients had tumor location in antrum and more than three fourth (79.2%) patients had intestinal type carcinoma. Regarding the Staging it was observed that 21(39.6%) patients had T =staging 4b, 33(62.3%) N=staging 1 and 16(30.2%) M=staging 1. Nearly two third (66.0%) patients had grading 2. More than three fourth (75.5%) patients had HER2 scoring 0/1+ Negative, followed by 10(18.8%) had 3+ positive and 3(5.7%) had 2+ equivocal. Statistically no significant association (p>0.05) were found betweenHER-2 positive group with age, gender and tumor location. More than three fourth (80.0%) patients had intestinal type and 2(20.0%)had diffuse type histological pattern in HER2 positive group, which was statistically significant (p<0.05). More than three fourth (80.0%) patients had T =staging 4b in positive group and 13(30.2%) in negative group. More than two third (70.0%) had N=staging 1 in positive group and 26(60.4%) in negative group. More than three fourth (80.0%) M=staging 1 in positive group and 8(18.6%) in negative group. The difference of T =staging and M=staging was statistically significant (p<0.05) between two groups. Though there was no significant association with tumor grading. Conclusion: The patients of gastric cancer with HER2 overexpression constitute a distinct subgroup. In this study HER2 overexpression was significantly associated with Intestinal type, T & M staging but not with N staging. Thus it evident that HER2 status is associated with advanced stages of gastric carcinoma. Journal of Surgical Sciences (2021) Vol. 25 (1) : 42-46
Background: Complex fistula-in-ano is a therapeutic challenge for both the surgeon and the patient. Surgery is associated with significant morbidity despite of recent advances in treatment modalities. The aim of this study was to evaluate the outcome of elastic seton for the management of complex anal fistula. Methods: This prospective randomized controlled trial was done in clinically diagnosed patients of complex anal fistula who underwent operation by cutting seton placement in the colorectal surgery unit, department of surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from May, 2015 to April, 2016. Total 36(50%) patients treated by application of elastic seton (Experimental group) were included in group I and 36 (50%) patients treated by non-elastic seton (control group) were included in group II after randomization by lottery. Post-operative outcome variables within 6 months follow up after surgery were evaluated. Results: In this study, majority of the patients were found in between 30 to 50 years of age and in the both groups, number of male were higher. Mean healing time was 42.91±13.71 days in elastic seton group and 77.36±17.29 days in non-elastic seton group. Staged fistulotomy was required in 35(97.2%) cases of group-II whereas no cases of Group-I required staged fistulotomy. Mean duration of seton in place was 17.02±7.07 days in Group-I and 52.38±7.28 days in group-II. No significant difference of post-operative pain, incontinence and recurrence in both groups. Conclusion: This study showed that the elastic cutting seton may be a valid alternative for the treatment of complex anal fistula, eliminating the need for postoperative adjustment or staged procedure. Journal of Surgical Sciences (2021) Vol. 25 (1) : 36-41
Background: Pancreatic leakage is a major cause of postoperative mortality and morbidity after pancreaticoduodenectomy (PD). A recent study introduced Blumgart anastomosis (BA), which minimizes severe complications after PD. This study compares BA with conventional anastomosis (CA) for pancreaticojejunostomy (PJ) after PD in the Department of Surgical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital. Methods: This retrospective observational study includes 20 patients who underwent PD between November 2020 to November 2021. The patients were divided into two groups according to the anastomosis type. Of them, 10 patients underwent anastomosis using CA (group A, conventional anastomosis including Dunking and Duct to mucosa) and 10 underwent anastomosis using BA (group B, Blumgart anastomosis). The methods were compared in context of postoperative pancreatic fistula (POPF), post pancreatectomy hemorrhage (PPH), and delayed gastric emptying (DGE) to see the overall outcome of two techniques. Results: Mean duration of operation time was significantly shorter in group B (373.1±102.0 versus 256.4±58.5 min, p<.05), and the number of intraoperative transfusion units (mean) was less in group B (2.5±1.4 versus 1.7±1.5 unit). Statistically significant difference was also observed between groups A and B in the incidence of postoperative pancreatic fistula (POPF) (30.0% versus 10.0%, p=034.) and PPH (50% versus 30%, P=0.0643), DGE (30% versus 40%, p=0.124) was not statistically significant. The length of postoperative hospital stay (mean) was not statistically different between groups A and B (12.0±6.3 versus 10±7.2 days, p=0.08). There was one mortality which was observed in Group-A. Conclusions: BA after PD was associated with a decreased risk POPF, DGE and PPH. Therefore, the results of this study suggest that BA-type PJ is superior to CA-type PJ in terms of postoperative complications. Journal of Surgical Sciences (2021) Vol. 25 (1) : 47-52
Background: Gastric cancer is the fifth most common cause of cancer-related death in Bangladesh. Curative resection remains the main modality of its successful treatment but the rate of postoperative complications is still high. Besides surgical factors, patient’s clinicopathological characteristics influence complications. This study was aimed to find out the association of the patients’ haemoglobin and serum albumin levels with short-term surgical complications in operable gastric cancer. Methodology: Following convenience sampling, 32 patients of operable gastric cancer who underwent gastrectomy in the Department of General Surgery, Bangabandhu Sheikh Mujib Medical University, from July 2019 to June 2020 were observed for their clinicopathological characteristics and postoperative complications. Data were analyzed with SPSS version 23 and Chi-square (÷2) test was done to find out the association of complications with the patients’ haemoglobin and serum albumin levels. Result: Out of the 32 patients 12 (37.50%) patients developed complications. Thirty days mortality was 6.30%. Preoperative low Hb level (Male < 13 gm/dl & female < 11.50 gm/dl), low albumin level (< 3.50 gm/dl)) and postoperative lowest Hb level (< 9 gm/dl) were significantly associated with complications (p-value 0.018, 0.003 and <0.001 respectively). In univariate regression analysis of different patient factors for developing complications BMI (><18.50 kg/m2), Preoperative Hb level (Male ><13 and female ><11.50), Postoperative lowest Hb level (><09 gm/dl), and preoperative serum albumin (><3.50gm/dl) had significant (p><0.05) association with complications but in multivariate regression analysis Postoperative lowest Hb level (><09 gm/dl) and S. Albumin level (><03.50 gm/dl) were found to be independently associated with complications (p><0.05). ><0.001 respectively). In univariate regression analysis of different patient factors for developing complications BMI (<18.50 kg/m2), Preoperative Hb level (Male <13 and female <11.50), Postoperative lowest Hb level (<09 gm/dl), and preoperative serum albumin (<3.50gm/dl) had significant (p<0.05) association with complications but in multivariate regression analysis Postoperative lowest Hb level (<09 gm/dl) and S. Albumin level (<03.50 gm/dl) were found to be independently associated with complications (p<0.05). Conclusion: Our patients are generally malnourished having low BMI along with low haemoglobin and serum albumin levels. As these factors lead to increased complications in gastrointestinal surgery, perioperative correction of low haemoglobin and serum albumin levels should be done adequately to reduce postoperative complications in patients with operable gastric cancer. Journal of Surgical Sciences (2020) Vol. 24 (2) : 23-29
Background: Anal stenosis is a rare but disabling condition characterized by an abnormal narrowing of anal canal to a varying extent due to stricture of skin, anal musculature or mucosa that has been replaced by fibrous connective tissue. The condition usually develops as a consequence of several anorectal procedures but commonly after haemorrhoidectomy, performed over zealously without adequate technical knowledge. In rare circumstances, anal stenosis may occur without previous anorectal surgery. Application of corrosive chemical substances by the quack for treating anorectal conditions is an alarming cause giving rise to anal stenosis. Objectives: To evaluate the causes of anal stenosis and results of treatment by Dimond Flap Anoplasty. Methods: This prospective study was performed in Dhaka Medical College Hospital and in a private hospital in Gazipur, Bangladesh between periods from January 2014 to December 2016. Nine patients of anal stenosis were included in this study. Data collection sheets regarding demographic data, cause of the event, and outcome of surgery were then analyzed. Results: Total 09 patients were included in this study, among them 04 patients were female and 05 males with lowest age of 32 to the highest age of 65 years. 04 patients (45%) were due to application of corrosive agent by quack, 02 patients (22.22%) due to RTA having extensive perineal injury, 03 patients (33%) due to postoperative causes. Following anoplasty, no patient had flap necrosis, and 02 patients (22.22%) developed postoperative wound infection. One patient had some form of incontinence, specially if loose stools. Conclusion: Anal stenosis develops most commonly after anorectal operations. We found maltreatment in the form application of corrosive agent by quacks for the treatment of anorectal diseases, specially in females, is common cause of anal stenosis in our study. The results of diamond flap anoplasty is highly effective in the treatment of anal stenosis irrespective of aetiology. Journal of Surgical Sciences (2021) Vol. 25 (1) : 5-9
Background: Palate repair surgeries are being performed in Bangladesh as well as in whole world by different techniques. The study was done to compare early complications of Von Langenbeck and Bardach Palatoplasty techniques. Methods and materials: This prospective observational study was conducted with the Patients admitted with cleft palate with or without cleft lip into Department of Plastic Surgery, DMCH. A total of 60 patients were selected according to inclusion and exclusion criteria. Thirty patients were included in Group I who were underwent Von Langenbeck palatoplasty. Another Thirty patients were included in Group II and they underwent Bardach palatoplasty. P value was significant at <0.05. Results: Majority of respondents belonged to age group 7-12 months and 13-18 months. The mean age was 13.1±4.51 (SD) in Group I and 12.6±4.58 (SD) Group II with female dominance. No statistical significance was noted in age, sex, and other demographic features between two groups. Postoperative hemorrhage (16.7% vs 20%), wound infection (16.7% vs 10%) and wound dehiscence (10% vs 6.7%) was statistically insignificant between two groups (p>0.05). Only 10% in Group I and 6.7% in Group II experienced post-operative fistula formation without statistical significance (p>0.05). No statistical significance was noted between two Groups according to age range. Conclusion: This study found no difference between Von Langenbeck and Bardach technique of palatoplasty in relation to early complication. However further long follow up study is recommended to validate these findings. Journal of Surgical Sciences (2021) Vol. 25 (1) : 30-35
Background: The common abdominal hernias include paraumbilical, umbilical, incisional and epigastric hernia. All varieties of ventral hernias are characterized by a defect in anterior abdominal wall. Incisional hernia is defined as a defect occurring through the operative scar. It is the only hernia considered to be truly iatrogenic. It occurs due to failure of the lines of closure of abdominal wall following laparotomy. Conventionally these hernias are treated by suture repair which has led to a substantial rate of recurrence whereby increasing demand for a better technique of repair. The introduction of mesh repair of these hernias has shown encouraging results over the past few years and many studies have shown a substantial decrease in the rate of recurrence with this technique. Objectives: To assess the early post-operative complications (within 30 days) following Intra peritoneal onlay mesh repair in Dhaka Medical Collage & Hospital, Dhaka, Bangladesh. Methods: This Observational study conducted in department of Surgery, DMCH, Dhaka in study period from June 2016 to May 2017. A total of 30 patients were purposively selected from department of Surgery in DMCH who underwent laparoscopic Intra peritoneal onlay mesh repair for ventral hernia. Patients with ventral hernia in department of Surgery, DMCH, Dhaka in study period. Data analysis was done by SPSS for windows version 21. The 30 days post-operative outcome was analyzed. Postoperatively, patients were observed for Post-operative pain, seroma, post-operative ileus, post- operative cellulitis, wound infection, mesh infection, mesh migration, early mesh failure. Patients were followed up on 7th, 15th and 30th post-operative day. Results: With the objectives to determine the early post-operative complications (within 30 days) following Intra peritoneal onlay mesh repair in department of surgery in DMCH, a total of 30 patients were purposively selected. It was found that more than half of the patients (55.3%) were 31-45 years age group. Only 13.8 % from younger age group (15-30 years). Rest of them are older (>46 years) group. Among the respondents most of the patients were female (65.1%). It was found that 36.66 % patient were with incisional hernia (81.6%) followed by para umbilical hernia (11.2%), only 2.6% were umbilical hernia. It also showed that all hernia cases were common after 30 years except umbilical hernia. Most of the cases in this study, hernia lesions were between 5-7 cm in size (73.7%). 13.8% were hernia with size of defect 8 cm and 12.5 % were hernia defect less than 5 cm. Most of the incisional and Para-umbilical lesions were between 5-7 cm sizes whereas epigastric hernia lesions were less than 5 cm size. Among all post-operative complications, seroma formation was highest in this study. In incisional hernia repair 23.38% patients develop seroma after operation, when post- operative seroma formation compared with different type of hernia repair, it found statistically significant in this study. 16% patients with incisional hernia had developed post-operative wound infection. Conclusion: Among the ventral abdominal hernia incisional and the para umbilical hernia constitute the most. In the repair of these hernias through laparoscopic intraperitoneal onlay mesh repair the most common early post-operative complications were seroma formation and wound infection in the form of superficial surgical site infection. Larger hernia required longer operative duration and associated with more post-operative complication. Journal of Surgical Sciences (2021) Vol. 25 (1) : 10-22
Background:The emergence of endoultrasound (EUS) has shown this modality to be an excellent method of detecting and staging lesions in the pancreas with a low rate of complications. Controversy has arisen about whether the approach with the conventional image (CT/US) guided FNA or endoultrasound (EUS) guided FNA is the preferred method to obtain cells from suspicious mass. Objectives:To assess the diagnostic efficacy of endoultrasound guided fine needle aspiration (EUS FNA) versus conventional imageguided fine needle aspiration (CT/US FNA) in pancreatic malignancy. Methodology:Twentyeight cases of clinically suspected patients of pancreatic malignancy were included in the study. Each enrolled patient underwent to either a conventional image guided fine needle aspiration or endoultrasound guided fine needle aspiration of the pancreatic mass for diagnosis of pancreatic malignancy. Data were analyzed with the help of SPSS version 23. Statistical analysis was done by student t-test and Chi square (÷2) test. Statistical significance was set at p<0.05. Result: Diagnostic accuracy in terms of distinguishing the cytopathology was 57.1% in conventional image(CT/US) guided FNA group and 85.7% in EUS guided FNA group. These values were numerically convincing for preferring EUS guided FNA method but was statistically insignificant. Again, if we consider the diagnosis of malignancy alone the values were 35.7% and 64.3% for CT/US guided FNA and EUS guided FNA respectively. This was also not significant statistically. Conclusion:Numerically EUS guided FNA showed better precision in detecting pancreatic malignancy and thereby its accuracy in yielding adequate tissue sample for cytological evaluation and inference. Journal of Surgical Sciences (2020) Vol. 24 (2) : 57-60
