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Background: Surgical site infections (SSIs) are infections of the tissues, organs, or spaces exposed by surgeons while performing an invasive procedure. SSI is one of the most common healthcare-associated infections, but its importance as a health-care priority is not fully understood, and limited work has been published defining the role of surgeons in SSIs. Aims and Objectives: In the present study, we assess the burden of SSI after gastrointestinal (GI) surgery in a tertiary care hospital in the Central India. Materials and Methods: The present study was conducted on patients admitted to Gandhi Medical College-affiliated Hamidia Hospital, Bhopal, in the General Surgery Department. The study included 207 patients who underwent emergency/routine GI surgeries between September 2020 and April 2022. Patient characteristics and laboratory data were recorded on a pre-designed form, and all patients were evaluated postoperatively for soakage along with culture and antibiotic testing. Results: The overall incidence of SSI was 42.51% and its distributions between emergency and routine surgeries were 22.7% and 19.8%, respectively. SSI was predominant in male patients. White blood cell level was significantly associated between emergency and routine surgeries, while Hb level, serum protein level, and the time required for surgery were insignificant. SSI under contaminated dirty wounds was prevalent in both emergency and routine surgeries. Klebsiella was the most commonly isolated organism, followed by Escherichia coli. The commonly susceptible antibiotics have been found to be meropenem, pipzo, amikacin, and imipenem. Commonly resistant antibiotics were amoxiclav, ceftriaxone, linezolid, and doxycycline. Conclusion: This paper presents the incidence of SSI in the hospital setting of Central India and the factors that may contribute to the high incidence of SSI. Further research needs to be done to better understand how specific risk factors are responsible for post-operative wound infections in open GI surgery. [ABSTRACT FROM AUTHOR]

Background: Fluid therapy is the most challenging and debatable aspect of perioperative care. Choice of administrating intravenous fluid perioperative period varies considerably among anesthesiologist. Aims and Objectives: The aims of this study were to compare the effects of intraoperative administration of balanced crystalloid solution (Plasma-Lyte A®) and 0.9% sodium chloride (NaCl) on acid-base balance in the post-operative period on patients undergoing gastro intestinal surgery at a tertiary care hospital. Materials and Methods: A prospective, randomized, comparative, and observational study was conducted on 80 patients of either sex aged 18-60 years with ASA-l and ASA-II who underwent gastrointestinal surgery which was at first randomly allocated to two equal groups of 40 each. Group 1 received Plasma-Lyte A® as the sole crystalloid and Group 2 received 0.9% NaCl. Intraoperative crystalloid infusion volumes, urinary output, blood loss, and blood transfusion volumes were recorded on hourly basis. Electrolytes (Na+, K+) and arterial blood gases were measured after induction of anesthesia and then every hour in the intraoperative period and at the 1st, 6th, and 12th hour of post-operative period. Results: The demographic data with respect to age, sex, and type of surgery were comparable among the two groups with no significant difference (P>0.05). Intraoperative and post-operative fluid transfusion and blood transfusion were also comparable with no significant difference. On intergroup comparison, serum Na+ conc. of both the groups was comparable and no difference shown at the time of induction, but after 12 hours following operation, there was a significant increase in Group 2 (P<0.05). There was no significant difference in serum K+ concentration in both the groups except at 6-hour postoperatively, there was an increase in K+ concentration in Group 1 (P<0.05). Serum Cl- concentration at post-operative 1st, 6th, and 12th hour interval very significantly increased in Group 2 (P<0.001). A significant decrease in pH (P<0.05) observed in 0.9% NaCl group in comparison to Plasma-Lyte® group when the duration of surgery increased to more than 120 minutes. Conclusion: Plasma-Lyte A® and 0.9% NaCl can be used safely during gastrointestinal surgery as the sole crystalloid. However, chance of developing hyperchloremic metabolic acidosis is more with 0.9% NaCl than Plasma-Lyte A® in prolonged surgery exceeding 2 hours. [ABSTRACT FROM AUTHOR]

Despite surgical and anesthetic advances, many studies show complications after major gastrointestinal surgery in a subset of patients. Studies have also shown that the main focus must be developing new therapies for postoperative benefit. Studies have shown interest in the FTS pathway but need to be more precise. Our literature review shows that very little FTS pathway data is available from India. Thus, we investigated FTS use in our study. We performed 70 elective abdominal surgical procedures. Comorbidities and other variables that may affect surgery were assessed for patients. Each individual learned about FTS and its benefits. After counseling, written informed consent was obtained. Each individual received an appropriate workout program and behavior change strategy. We found that FTS reduced postoperative ileus and NG tube usage. Hence, FTS is superior to traditional surgery when utilized appropriately during surgery. [ABSTRACT FROM AUTHOR]

Purpose: To understand the actual impact of the Covid-19 pandemic and frame the future strategies, we conducted a pan India survey to study the impact on the surgical management of gastrointestinal cancers. Methods: A national multicentre survey in the form of a questionnaire from 16 tertiary care gastrointestinal oncology centres across India was conducted from January 2019 to June 2021 that was divided into a 15-month pre-Covid era and a similar period of active Covid pandemic era. Results: There was significant disruption of services; 13 (81%) centres worked as dedicated Covid care centres and 43% reported suspension of essential care for more than 6 months. In active Covid phase, there was a 14.5% decrease in registrations and proportion of decrease was highest in the centres from South zone (22%). There was decrease in resections across all organ systems; maximum reduction was noted in hepatic resections (33%) followed by oesophageal and gastric resections (31 and 25% respectively). There was minimal decrease in colorectal resections (5%). A total of 584 (7.1%) patients had either active Covid-19 infection or developed infection in the post-operative period or had recovered from Covid-19 infection. Only 3 (18%) centres reported higher morbidity, while the rest of the centres reported similar or lower morbidity rates when compared to pre-Covid phase; however, 6 (37%) centres reported slightly higher mortality in the active Covid phase. Conclusion: Covid-19 pandemic resulted in significant reduction in new cancer registrations and elective gastrointestinal cancer surgeries. Perioperative morbidity remained similar despite 7.1% perioperative Covid 19 exposure. [ABSTRACT FROM AUTHOR]

The aim was to do a retrospective analysis and audit of our 90-day and in-hospital mortalities after gastrointestinal and hepatopancreatic biliary surgeries performed in our department and analyze factors predicting them. All patients who underwent gastrointestinal and hepatopancreatic biliary surgery in our department in the last 3 years were evaluated for 90-day postoperative and in-hospital mortalities and various factors affecting them. Categorical values were analyzed using the chi-square test or Fisher's exact test wherever appropriate. Continuous variables were analyzed using the Student t-test for parametric data and Mann–Whitney U test for nonparametric data after skewness and kurtosis analysis. Multivariate analysis was done using logistic regression analysis. A p-value less than 0.05 was considered statistically significant. Statistical analysis was done using SPSS version 23(IBM). Four hundred and twelve patients underwent gastrointestinal and hepatobiliary surgery in the last 3 years at our institute. Two hundred and twenty-two patients underwent major gastrointestinal and hepatobiliary surgeries in the last 3 years at our institute. Ninety-day all-cause mortality after major surgery was 10.8%, all-cause in-hospital mortality was around 8.5% in major surgery. Ninety-day mortality in elective and emergency surgeries was 6.7% and 22.4%, respectively. In-hospital mortality in elective and emergency surgeries was 4.8% and 18.9%, respectively. There was no 90-day mortality after nonmajor surgery. On multivariate analysis, nontechnical complications and emergency surgery independently predicted 90-day mortality. On multivariate analysis, acute kidney injury, nontechnical complications, and emergency surgeries independently predicted in-hospital mortalities. Nontechnical complications and emergency surgeries are independently associated with 90-day mortality, and acute kidney injury, nontechnical complications, and emergency surgery independently predict in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal (GI) malformations have varied short-term and long-term outcomes reported across various neonatal units in India. Methods: This descriptive study was done to study the clinical profile, outcomes and predictors of mortality in neonates operated for congenital GI malformations in a tertiary neonatal care unit in South India between years 2011 and 2020. Details were collected by retrospective review of the case sheets. Results: Total of 68 neonates were included with esophageal atresia (EA) in 10, infantile hypertrophic pyloric stenosis (IHPS) in 9, duodenal atresia (DA) in 10, ileal atresia in 8, jejunal atresia in 5, anorectal malformations (ARM) in 11, meconium ileus/peritonitis in 9, malrotation in 2, and Hirschsprung's disease (HD) in 4. Antenatal diagnosis was highest in DA (80%). Associated anomalies were maximum in EA (50%), the most common being vertebral, anal atresia, cardiac defects, tracheoesophageal fistula, renal and radial abnormalities, and limb abnormalities association (VACTERL). Overall mortality was 15%. IHPS, DA, Malrotation, HD and ARM had 100 % survival while ileal atresia had the least survival (38%). Gestational age <32 weeks (odds ratio [OR] 12.77 [1.96, 82.89]) and outborn babies (OR 5.55 [1.01, 30.33]) were significant predictors of mortality in babies operated for small intestinal anomalies. None of the surviving infants were moderately or severely underweight at follow-up. Conclusion: Overall survival of surgically correctable GI anomalies is good. Among the predictors for mortality, modifiable factors such as in-utero referral of antenatally diagnosed congenital anomalies need attention. One-fifth had associated anomalies highlighting the need to actively look for the same. Although these neonates are vulnerable for growth failure, they had optimal growth on follow-up possibly due to standardized total parenteral nutritional policy during neonatal intensive care unit stay. [ABSTRACT FROM AUTHOR]

Not so long ago after the stuttering and rather uncertain beginnings of the subspecialty of surgical gastroenterology in this country, we, one a recent and the other a less recent entrant into the field, thought it might be an opportune time to examine how and why it has become so popular among young surgeons and where it is now. In this article we will trace its history, i.e. why and how it was started, describe its consolidation, discuss the present situation and its problems and try and suggest what should be done in the future. [ABSTRACT FROM AUTHOR]

Introduction: A significant proportion of patients undergoing major gastrointestinal operations suffer from malnutrition. Although the benefit of postoperative nutritional support is well established, the effects of energy intake during pre-operative period is less reported. The present study was designed to test the effect of structured pre-operative nutritional therapy on the postoperative recovery of patients undergoing major gastrointestinal operations. Methods: A randomized clinical trial was conducted among 80 patients of the surgical gastroenterology department of a tertiary care center in south India. A simple random sampling method was used. The nutritional status of all participants was assessed by subjective global assessment (SGA). While control group received standard energy intake nutrition, the experimental group received calculated nutrition with an extra 50 g of soy protein for seven days pre operatively. Data were analysed using SPSS version 20. Results: The median day of removal of abdominal drainage tube was 3 (0-5) compared to 5 (2.5-7.5) in the control group. In the intervention group, the median time for the appearance of bowel sounds and starting of enteral feeding was 1.1 (0.5) days and 2 (1-2) days, while in the control group, it was 1.6 (0.9) days, 3 (1-4) days, respectively which was significant at P < 0.05. Similarly, the mean (SD) postoperative serum albumin on third day was 3.6 (0.4) g/dL vs 3.4 (0.4) g/dL experimental and in the control group. Conclusion: Preoperative nutrition protocol improved the patients' clinical outcomes in terms of post-operative serum albumin, the timing of bowel sounds, and early initiation of enteral feeds. [ABSTRACT FROM AUTHOR]

The purpose of this prospectively collected database is to evaluate the safety of placement of a feeding jejunostomy (FJ) in patients undergoing upper gastrointestinal surgery and evaluating the gastrointestinal (GI) and mechanical complications. A total of 46 consecutive patients who underwent upper gastrointestinal surgery for various benign and malignant diseases were included. All of these patients underwent Witzel feeding jejunostomy at the time of laparotomy. The patients were followed postoperatively to record the gastrointestinal and/or mechanical complications that occurred during the hospital stay of the patients. Feeding jejunostomy could be performed in 100% of the patients and postoperatively, jejunostomy feeds could be started in 97.8% of the patients. 34.8% of the patients underwent an emergency laparotomy; 81.25% of the patients in the emergency group developed a significant postoperative FJ related complications with significant mechanical complications in the emergency group. GI complications were 82.14%; diarrhea was the most frequently encountered (69.5%). GI complications were more frequent and significant in patients with a low preoperative serum albumin (< 3.5 g/dl). No mortalities were recorded as a direct consequence of a FJ. Jejunostomy feeding is an excellent method of providing enteral nutritional support in patients undergoing major abdominal surgery and in patients with upper aero digestive tract pathologies who cannot be fed by mouth. Tube feeding is associated with complications which are minor and self-limiting or can be managed by simple bedside maneuvers. Feeding jejunostomy should be considered in all patients who may require short- or long-term enteral nutrition. [ABSTRACT FROM AUTHOR]

Background: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckel's diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckel's diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children. Methods: A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir. Results: A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction. Conclusion: Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal. [ABSTRACT FROM AUTHOR]

A 21-year-old female patient presented with vague lower abdominal pain associated with nausea since 2 days. On examination, she was tender in the right iliac fossa. Based on clinical presentation and radiological test finding, she was diagnosed as appendicitis and was subjected for diagnostic laparoscopy and appendectomy. Histopathology proved it to be a tubercular appendix, which is a rarely encountered entity. However, in a country like India, tuberculosis (TB) is highly prevalent; however, TB of appendix is rare and less known., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)