Search

Background: To evaluate 490 consecutive children who underwent hernia repair over a 3-year period. Technical details and clinical results are reported. Methods: Retrospective study of open and laparoscopic inguinal hernia repair performed in dept. of pediatric surgery, NSCB Medical College, Jabalpur, M.P. during July 2009 to July 2012 was done. The variables evaluated were age, sex, type of inguinal hernia, presence of an associated hydrocele, side of hernia, incarceration, obstruction, strangulation, occurrence of opposite-side hernia, recurrence, and other associated complications and conditions. Correlation between radiology and intraopearative findings was done. A total of 540 open internal rings were closed surgically in 490 children (boys and girls, aged 02 days to 14 years, mean 32 months). 400 cases underwent open repair by standard technique and 90 cases underwent laparoscopic surgery. In laparoscopic technique one 5-mm and two 3-mm instruments were used to access the peritoneal cavity. The internal inguinal ring was closed with a non-absorbable suture or tacker as described in paper. Results: There were no significant intraoperative complications. Length of procedure ranged between 20 and 50 minutes with a mean of 35 minutes in laparoscopy and 20 min in open surgery. Postoperative hospital stay ranged from 1 to 3 days. Five children who presented with a right-sided hernia and three with a left hernia (total of 8) were found to have a patent contralateral internal ring on laparoscopy. Mean follow-up was 20 months. There were 2 hernia recurrences (0.4%) 1 in open and 1 in laparoscopic group. Conclusions: Ultrasonography of inguinal region is good adjuvant for diagnosis in doubtful cases. Majority of hernia cases were operated by standard open surgical technique. Laparoscopic hernia repair in children is a safe and feasible technique. There is clear visualization of structures and vas remains untouched and opposite patent ring is seen which can be managed in same setting. As per our experience the recurrence rate is comparable to that of the traditional open approach with a superior cosmetic result.

Background: Haemorrhoids is a common disease affecting humans. Surgical treatment of haemorrhoids includes by using stapler and conventional or open method. Both the methods have its own advantages and disadvantages. This study is done to evaluate the efficacy of both the procedures in our settings. Objective of the study was to study the efficacy of two surgical methods of treatment of hemorrhoids, in terms of (1) operation time; (2) post-operative pain; (3) hospital stay; (4) return to normal activity and return to work; (5) complications; (6) recurrence; (7) patient satisfaction. Methods: A comparative study was done between open and stapling methods for the treatment of symptomatic hemorrhoids in CMCH, Bhopal, India over a period from November 2011 to December 2014. Results: There was major statistically significant difference was seen among different parameters between these two procedures of haemorrhoidectomy, open versus stapler procedure for prolapsing hemorrhoids (PPH). Conclusions: In present study there is definite difference noted between two surgical methods as evident from table 1- 10 as evident from p-value. As far as satisfaction of patient is considered in both the groups satisfaction is similar except for the cost of device which added for the most cause of dissatisfaction.

Background: Patient satisfaction is one objective of care, and along with recovery from illness or amelioration of presenting problem, it is therefore an outcome of care too. The objective of the study was to evaluate the satisfaction level among surgical patients before and after counselling and to studies the relationship of literacy and acceptance for surgery. Methods: Patients coming to surgical OPD, having definite surgical problem and who needs surgical intervention are taken into consideration.108 patients were selected on pilot basis. Depending on the common complaints by patient regarding doctor patient relationship and satisfaction of patient after consultation at our institute, a five point questionnaire was prepared with an option to answer as satisfied, partially satisfied and not satisfied with reasons. Results: In our study total 108 patients coming to surgical OPD were taken. Out of which 66 (61.11 %) were males and 42 (38.88%) were females. All of them are above 18 years of age group. The youngest was 18 years and oldest was 66 years of age. Females were found to be more satisfied after patient empowerment and counselling as compared to males. Older patients were found to be more satisfied than younger ones which are comparable with the international studies. In our study, females took much time for empowerment, understanding and counselling but found to be more firm on the decision once taken by them. In our study, overall satisfaction level of patients has increased after counselling and patient empowerment (from 37% - 63%). Conclusions: Making of a successful surgeon requires apart from extensive knowledge of his subject, he should be able to know the psyche of patients , hearing them and giving them sufficient time will solve most of problems for flourishing his practice, becoming a good ,sensible and famous surgeon and will help to avoid so many unnecessary medico-legal litigations against innocent surgeons.

Background: The lifetime prevalence of kidney stone disease is estimated at 1-15%. The various treatment options available for urinary calculus disease are open surgery, ureterorenoscopy, percutaneous nephron-lithotomy retrograde intra-renal surgery & extracorporeal shock wave lithotripsy. The aim of the study was to study whether performing extracorporeal shockwave lithotripsy (ESWL) under intravenous anesthesia can reduce no. of sessions by increasing intensity of shockwaves and its comparison with ESWL under local anesthesia and also to study the safety of higher intensity shock waves. Methods: The nucleus of this prospective study done between March 2011 to February 2015 was 60 patients with renal or upper ureteric solitary calculus less than or equal to 2 cm in size, in which ESWL is elected as the treatment. These were randomized into one of the two groups with 30 patients in each - Group I: in which patients underwent ESWL under IV anesthesia & group II: in which patients underwent ESWL under local anesthesia. Results: For age group, P value of age difference of the two groups was 0.6 and not significant. During the study it was found that there was statistically significant reduction in number of sessions required for complete stone clearance in Group I. In group I the average number of shock waves used was 3800, whereas in group II it was 5967. The P value of difference between the means was extremely significant (P =0.003). Time taken for clearance of stone in group I was 1 month in 22 patients and 3 months in 8 patients with the average being 1.53. In group II time taken for clearance was 1 month in 9 patients and 3 months in 21 patients and the mean was 2.4. Conclusions: The use of total intravenous anesthesia (TIVA) for ESWL reduces the number of sessions significantly by allowing higher intensity and number of shock waves & improved fragmentation due to regular and controlled respiratory excursions, and immobility of the patient, leading to significantly less wastage of shockwaves when compared to ESWL without TIVA.

Background: Hydrocoele fluid closely surrounds testes and by virtue of this, it is liable to cause some change in the external environment of testes. This can be in the form of increased pressure, increased temperature. This can ultimately result in the morphological alteration of testes, which in turn can affect spermatogenesis and steroid genesis. Methods: It was a cross-sectional study conducted in the department of surgery, Peoples college of Medical Sciences and hospital, Bhopal. A total of 92 cases of unilateral scrotal hydrocoele were studied. Bilateral cases were excluded from the study. Results: In our study, we found the association between the duration of hydrocoele with histopathological changes and impaired spermatogenesis is highly significant and also the association between size of hydrocoele with histopathological changes and impaired spermatogenesis is significant. Conclusions: There are few variables which did not show significant association with impaired spermatogenesis in presence of hydrocoele were pain, fever, family history of hydrocoele, cord thickening, amber colour of fluid and lymphadenopathy. To sum up it would seem that big hydrocoele of long duration impair spermatogenesis and may lead to sub-fertility or infertility.

Background: The aim of the present study was to evaluate the indications, complications and outcome of colostomy in newborn patients.Methods: This is a descriptive, retrospective study carried out in the Department of Pediatric surgery, Gandhi Medical College Bhopal to evaluate acceptance and outcome of colostomy in newborn over a one year period from March 2018 to March 2019. All newborn with diagnosis of anorectal malformation, Hirshsprungs disease and other emergency conditions underwent transverse loop colostomy by expert and trained pediatric surgeon.Results: Out of 40 patients operated complications of colostomy was seen in 18 (45%) patients. Most common complication was skin excoriation in 08 patients (20%), bleeding from stoma site in 02 (05%) cases. Stoma prolapse occurred in 02 (05%) patients. Wound infection, dehiscence, stomal stenosis and parastomal hernia was seen in one patient each 2 (2.5%). 2 (0.5%) patient died due to multiple congenital anomalies.Conclusions: Colostomy in children is associated with significant morbidity in developing country. To minimize these problems, the pediatric surgeon should focus on the management and early closure of a colostomy.