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Congenital Dermoid Fistula of the Anterior Chest Region (CDFACR) is a subcutaneous fistula that ends caudally in the subcutaneous tissue close to the sternoclavicular joint, originating from the skin at the anterior border of the sternocleidomastoid. The fistulous track is lined by keratinised stratified squamous epithelium with hair follicles, sebaceous glands and sweat glands. It presents clinically as a cutaneous pit, sinus, or infected mass. It is rare and can be complicated by recurrent infection and abscess formation. Before surgery, imaging the complete extent of the sinus is essential to prevent recurrence. Authors hereby, report a case of a 20-year-old male presenting with discharge from the anterior chest wall. On radiological and histopathological examination, it was diagnosed as a congenital dermoid fistula. In the present report, authors present a case of CDFACR confirmed through comprehensive evaluation, including sonography, Computed Tomography (CT) sinography, Magnetic Resonance Imaging (MRI) and histopathology. The present case also represents the first documented instance of CDFACR from India, highlighting the importance of multimodal imaging in the diagnosis and management of this rare congenital anomaly. [ABSTRACT FROM AUTHOR]

Background: Perianal fistulas (PF) affect one-third patients with Crohn's disease (CD) with limited therapeutic options. There is dearth of literature on safety and efficacy of bone marrow-derived mesenchymal stromal cells (BMSCs) in this population. Methods: An open-label, phase I/II, single-arm study was conducted involving local administration of human allogeneic bone marrow-derived mesenchymal stromal cells in perianal fistula of patients with Crohn's disease refractory to standard therapies. Clinical severity and biomarkers were assessed at baseline and periodically until week 104 , and MRI at week 24 and 104. Primary and secondary objectives were to assess safety and efficacy respectively. Fistula remission was complete closure of fistula openings with < 2 cm perianal collection on MRI, and fistula response was decrease in drainage by ≥ 50%. Change in perianal disease activity index, quality-of-life and Van Assche index on MRI over time was assessed using mixed-effect linear regression model. Results: Ten patients (male:8, mean age:27.4 ± 12.0years) were recruited. Self-resolving procedure-related adverse events occurred in three patients, with no follow-up adverse events. In intention to treat analysis at week 24, two patients (20%) achieved fistula remission and seven (70%) had fistula response. At week 52, two (20%) patients were in remission and seven (70%) maintained response. At 104 weeks, two (20%) patients maintained response and one (10%) was in remission. Statistically significant decrease in perianal disease activity index (P = 0.008), Van Assche Index (P = 0.008) and improvement in quality-of-life (P = 0.001) were observed over time. Conclusions: Allogeneic BMSCs are safe and effective for the treatment of perianal fistulizing CD with significant improvement in clinical severity and radiological healing. Trial registration: The study was prospectively registered on Clinical trials registry – India (CTRI), CTRI/2020/01/022743 on 14 January 2020, http://ctri.nic.in. [ABSTRACT FROM AUTHOR]

Introduction: Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. Methods: This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. Results: In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. Conclusion: Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Perianal sepsis and anal fistula are troublesome diseases in the field of colorectal surgery due to recurrence and fecal incontinence. Aim: To investigate the role of "one-stage complex anal fistula resection with anal sphincter reconstruction without stool diversion" on fecal incontinence and recurrence. Methodology: This is a prospective cohort study of 350 patients with complex perianal fistulas who underwent fistulectomy and anal sphincter reconstruction (primary suture repair) without stool diversion; Patients were followed up for 1 year after the operation after complete healing of the wound. Suppression of stool and gas was assessed using the Wexner score and fistula recurrence was assessed clinically and radiologically using MRI. Out of 350 patients, only 8 had different degrees of fecal incontinence: 4 had gas incontinence, 4 had soil incontinence, and 16 had relapse after 3 months. 12 people relapsed after 6 to 9 months. Confirmatory MRI was also performed at the end of the follow-up period and two patients had hidden fistula ducts leading to the upper abscess cavity. This resulted in 32 recurrent cases. 10 patients had delayed wound healing. Conclusion:As compared to other treatment methods for complex anal fistulas described in the literature, one-stage surgery (hemorrhoidectomy with primary sphincter repair) has a lower risk of incontinence, a lower recurrence rate, and better anal fistula formation. It gave good results in terms of wound healing. [ABSTRACT FROM AUTHOR]

Background: Congenital anomalies diagnosed on Ultrasound scan, autopsy plays a vital role in confirming the diagnosis and many times gives information regarding additional malformations. Autopsy on dead fetuses/infants helps the parents by giving information regarding the recurrence risk of fetal anomaly. This study confirms the utility of fetal autopsy in identifying the cause of fetal loss which will indicate the need in genetic counseling of the couple. Aim: The study is done to record the incidence of congenital malformations in Fetal Autopsy. Details are collected from the department of Obstetrics and Gynecology. Methodology: A total of 98 fetal autopsies were done in the department of Pathology in a tertiary care teaching hospital, South India from the period of June 2015 to May 2020. Results: In 98 autopsies performed, 90 were fetal deaths and 8 neonatal deaths. Out of 62 autopsies on male fetuses, 22 had congenital malformations and of 36 autopsies on female fetuses, 14 had congenital malformations. Congenital anomalies were commonest in the birth weight group of <1000 gms, accounting for 28 cases. Most of the fetal deaths occurred in mothers with age group of 21-30 accounting to 27 cases out of 72 autopsies. Incidence of congenital anomalies was highe st in primigravida. Congenital malformations were seen in 36 cases which accounted for 36.7% of fetal and early neonatal deaths. Malformations of the central nervous system (33.3%) were the most common. Neural tube defects like anencephaly and spina bifida were seen in 8 cases. The second most common anomalies were encountered in Gastrointestinal system (19.4%), followed by genito-urinary system (13.8%) and cardiovascular system (8.3%). Tracheo esophageal fistula was the only case seen involving the respiratory system. Rare cases like Prune belly syndrome, Jarcho Levin syndrome were observed. Two cases of cystic hygroma and one case of Phocomelia with a history of Thalidomide intake by the mother were seen. Conclusion: Due to financial constraints only karyotyping was performed in the present study. Further studies including molecular biology should be carried out to identify more cases with congenital anomalies so that proper genetic counseling can be given to the parents to avoid subsequent anomalous births. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary infections are the most common infectious cause of disability and mortality in Chronic Kidney Disease (CKD) stage V patients on haemodialysis after cardiovascular disease. The incidence of pathogenic invasion of the lungs causing pneumonia is markedly higher in CKD stage V patients undergoing haemodialysis as compared to the general population. The risk is due to various factors including immune dysfunction, prolonged hospital stays leading to contact exposure, and hospital-acquired infections. The other important factors are anaemia, uremic toxins promoting pulmonary oedema, age, and vascular access through the arteriovenous fistula and internal jugular vein leading to catheter-induced respiratory infections. Aim: To study the common pathogens involved in causing lung infection in CKD stage V patients on maintenance haemodialysis. Materials and Methods: This cross-sectional study was conducted in the Department of Medicine/Nephrology at Andhra Medical College and King George Hospital, Visakhapatnam, Andhra Pradesh, India. The duration of the study was two months, from June 2019 to July 2019. A total of 50 patients were included in the study with CKD stage V on haemodialysis. The samples were between ages 18 to 75 years with respiratory symptoms and signs including fever, productive cough, and shortness of breath being the major complaints. These patients were subjected to certain investigations to isolate the organism. The parameters assessed were blood culture and sputum culture, haemoglobin, and chest X-ray. Sputum examination for Acid-fast Bacilli (AFB) was done to rule out tuberculosis. Statistical Package for Social Sciences (SPSS) version 17.0 was used for statistical analysis and measurement, data were expressed as the Mean±Standard Deviation (SD). Results: The majority of the subjects were in the mean age group of 49 years and males were predominantly affected. The commonly isolated organism was Gram-negative bacilli-Pseudomonas, with access common through arteriovenous fistula as compared to Escherichia coli (E.coli), which was common in patients with access through Internal Jugular Vein (IJV). Conclusion: The respiratory infection, that posed the burden in the present study was pneumonia. The common organism isolated was gram-negative bacteria being pseudomonas. The respiratory infections identified, were more through Arteriovenous Fistula (AVF) access and common in patients with moderate to severe anaemia. [ABSTRACT FROM AUTHOR]

Background: Fistula in ano is always a troublesome condition for the clinician and the patients owing to its complexity, recurrences, and high morbidity since ancient times. There is no gold standard treatment modality to date documented in the literature for complex fistula in ano. Material and methods: We enrolled 60 consecutive adult patients attending the surgical outpatient department of a tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 20 each in the Ligation of intersphincteric fistula tract (LIFT), Fistulectomy andKsharsutra(Special medicated seton) group were respectively recruited randomly. A prospective observational study was conducted. The primary outcomes were postoperative recurrence and morbidity. Post-operative morbidity is measured in terms of postoperative pain, postoperative bleeding, pus discharge and post-operative incontinence. The result of the study were analysed after 6 months of follow-up by clinical examination at outpatient department and at 18 months follow up done telephonically. Results: At 6 months of follow-up, 2 patients (10%) had a recurrence in the Ligation of intersphincteric fistula tract procedure group, 3 patients (15%) in the fistulectomy group and 6 patients (30%) in Ksharsutra group, however 3(15%), 4(20%) and 9(45%) patients developed recurrence in Ligation of Intersphincteric fistula tract, Fistulectomy and Ksharsutra group respectively at 18 month of follow-up. The differences in the recurrence were not statistically significant.The mean Visual analogue score for postoperative pain after 24 h as well as after 48 h were statistically significant in Ligation of intersphincteric fistula tract versus Ksharsutra group (p < 0.05). The Visual analogue score for post–operative pain was also significant in the Ligation of the intersphincteric fistula tract versus the Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation of intersphincteric fistula tract procedure. Postoperative morbidity was statistically significant between the Ligation of intersphincteric fistula tract versus the Ksharsutra and the Ligation of intersphincteric fistula tract versus Fistulectomy. Conclusion: Ligation of intersphincteric fistula tract had less postoperative morbidity compared to Fistulectomy and Ksharsutra procedure; although recurrence was less compared to other methods it was statistically not significant. [ABSTRACT FROM AUTHOR]

Introduction: Haemodialysis (HD) is the most important treatment approach in patients with Chronic Kidney Disease (CKD), awaiting kidney transplantation, demanding the longterm need for dialysis access. Aim: To study the profile of Arteriovenous Fistula (AVF) surgery in patients undergoing haemodialysis in the Karnataka region, India. Materials and Methods: This prospective, interventional singlecentre study was conducted at the Institute of Nephrology and Urology, KR Hospital Campus, Mysuru, India, from April 2018 to April 2021. All the patients undergoing haemodialysis with AVF aged between 11-90 years were included. Demographic details (age, sex, co-morbidities) and fistula-related complications associated with surgery were examined in the immediate, late, and delayed postoperative period. Categorical variables were presented as numbers and percentages whereas, continuous variables were expressed as mean {Standard Deviation (SD)}. The data was collected in Excel Sheet and the statistical analysis was performed using Statistical Package for Social Sciences (SPSS), version 20.0. Results: In total, 200 patients with a mean (SD) age of 48.8 (13.0) years underwent AVF formation and the majority were below <60 years of age (n=154, 77.0%). The incidence of fistula surgery and patency rates was higher in men (n=140, 70.0%). Most patients had left non dominant arm (n=187, 93.5%) and remaining right non dominant arm (n=13, 6.5%). The most common site of AVF was left brachial cephalic (n=135, 67.5%). The most common cause of CKD was diabetes mellitus (n=90, 45.0%). The most common immediately observed complications were bleeding (n=13, 6.5%), pain (n=12, 6.0%) and oedematous limb (n=5, 5.0%). Stitch abscess was the most common late complication observed in 14 patients (7%). Rupture of the aneurysm and AVF failure were delayed complications observed in eight (1.5%) and 17 (8.5%) patients, respectively. Conclusion: In this study, bleeding, stitch abscess and AVF failure were found to be the most common immediate, late, and delayed postoperative complications, respectively. However, more studies are required to understand the outcome of AVF in Chronic Renal Failure (CRF) patients from India. [ABSTRACT FROM AUTHOR]

We presented a case report of a 1-day-old female child admitted to the neonatal intensive care unit (NICU) with abdominal distension. Prenatal ultrasonography in the second trimester had revealed a large abdominal cyst. On examination, a common cloaca was noted along with a distended abdomen. Radiographic imaging confirmed the presence of collapsed small bowel pushed to the right, while a single large bowel filled most of the abdominal cavity. Further investigations, including ultrasound, indicated a 5.2 cm distended large bowel containing fecal material but no free fluid. The patient underwent exploratory laparotomy, during which an end ileostomy was performed following closure of the fistula with the urogenital tract. The postoperative period was uneventful, and the patient was discharged on postoperative day 5 with regular follow-up scheduled. Type I congenital pouch colon associated with common cloaca is an extremely rare condition involving complex malformations of the gastrointestinal and urogenital systems. This case report describes the clinical presentation, management, and outcomes of a 1-day-old female child with Type I congenital pouch colon and associated common cloaca. [ABSTRACT FROM AUTHOR]

Background: Breast abscess continues to be a major cause of morbidity in developing countries. The treatment of breast abscess continues to be a challenge. In era of technical advances management of breast abscess has shifted to minimally invasive and painless techniques which are more patient friendly. Aims: to compare outcomes in management of breast abscess by incision and drainage versus ultrasound guided needle aspiration. Methods: The present study was carried out in the department of surgery in a tertiary care hospital central India. A total of 100 female patients with acute lactational breast abscess between 18 and 45 years of age were enrolled in our study. The patients were randomized into group A (incision and surgical drainage) and group B (ultrasound-guided needle aspiration). Results: In our study total 100 patients were analysed, majority of the cases (53% in group A & 54% in group B) belong to 21-25 years age group. Post operative pain, high recurrence rate, fistula formation, cessation of breast feeding, ugly scar formation and longer duration of hospital stay were observed in incision & drainage procedure as compared to USG aspiration. Conclusions: USG guided aspiration is the safest, painless, day care and widely accepted procedure for treatment of breast abscess as compared to the incision and drainage, it reduced the post-procedure hospital stay and minimum scar formation. [ABSTRACT FROM AUTHOR]

Introduction: Vesicovaginal Fistula (VVF) is the most common acquired fistula of the urinary tract in women. Robotic surgery is recently introduced for VVF repair and has benefits over conventional methods. Aim: To describe experience with robot-assisted laparoscopic repair of VVF in patients. Materials and Methods: This was a retrospective observational study conducted from February 2014 to February 2018, at Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India. The study included 24 patients who underwent robot-assisted laparoscopic VVF repair. After cystoscopy ureteric catheter was passed through the fistula and retrieved through vagina. Bilateral ureteric catheters were placed simultaneously with vaginal packing. Da Vinci Si robot was docked with patient in trendelenburg position. After trocar placement transperitoneally the fistula was approached. Through vertical or transverse cystotomy, fistula was identified. With the circumferential incision around the fistula, both the bladder and vagina was separated and the fistulous tract was excised. Bladder was closed vertically and vaginal opening was closed transversely interposing the Omentum. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 40.33 years. Elective hysterectomy done for benign conditions (91.67%) was the major cause of VVF in patients followed by emergency hysterectomy (8.33%). All of the patients underwent adhesiolysis while two patients performed right ureteric re-implantation additionally. The median operative time was 127.50 minutes. The median duration of drain and hospital stay was three days each. Urethral Foley's catheter removal done at 2-3 weeks based on operating surgeon's preference and the mean duration of follow-up was 26 months. Conclusion: Robot-assisted laparoscopic VVF repair is convenient and an effective approach in the successful management of VVF in complex fistulas and recurrent cases. [ABSTRACT FROM AUTHOR]

Child Sexual Assault (CSA) is not an uncommon but an under-reported crime. Along with social and psychological critical issues, there are multiple challenges faced by the surgical team for the treatment of complex perineal injuries associated with CSA. This study was conducted to find clinical presentation and management of CSA along with its problems and challenges encountered by the pediatric surgical team. This was a retrospective study from 2010 to 2019, conducted in the department of pediatric surgery at a tertiary referral center. All-female patients with a definitive history of sexual assault were included in the study. Seven patients fulfilled the inclusion criteria and the mean age was 5.3 years. After a primary survey, all patients were taken up for examination under anesthesia (EUA). Three patients were managed by the primary repair of the wound and did well during follow-up. Four patients had grade 4 perineal injury and required stage reconstruction. As a first stage, repair of rectal tear, vaginal tear, and the perineal body reconstruction was done along with diversion colostomy. One patient required redo repair of the perineal body and one had developed a rectovaginal fistula. Three patients completed all stages and they are fully continent. The spectrum of injuries varies widely in CSA and more chances of high-grade perineal injuries in children due to distinctive local anatomy. EUA is crucial to assess the extent of the injury and to decide the course of management. Meticulous anatomical repair and diversion stoma is the key for successful complex repair and excellent long-term outcomes in terms of continence for the severe grade of perineal injuries. [ABSTRACT FROM AUTHOR]

Context: Since the gap between two atretic segments of oesophagus is a critical determinant of prognosis for oesophageal atresia/tracheoesophageal fistula (EA/TEF), the search for a surrogate non-invasive pre-operative marker of long gap atresia continues.Aims: The purpose of the study was to compare the presence of normal and supernumerary ribs with length of EA and survival rates.Settings and Design: A prospective observational study was conducted at a tertiary care referral neonatal intensive care unit in North Karnataka, India, from January 2016 to June 2019.Subjects and Methods: Amongst babies with EA/TEF, pre-operative radiograph helped determine the number of ribs, and babies were divided into two groups; Group I: babies with 12 ribs and Group II: babies with supernumerary ribs.Statistical Analysis Used: Nominal variables were expressed as percentage and continuous variables as mean standard deviation. MedCalc software was used to compare proportions and means. A P < 0.05 was considered statistically significant.Results: Of the 61 cases, 51 were operated. Long gap EA was predominantly seen amongst babies in Group II (40% in Group II vs. 27% in Group I, P= 0.424). Survival rates by percentage were lower in babies in Group II (60% in Group II vs. 80% in Group I, P= 0.188). Both the above findings were proven statistically insignificant. The overall survival rate amongst the study population was 78.4% (39/51).Conclusions: Supernumerary ribs were associated with a higher occurrence of long gap EA and lower survival rates, though statistically insignificant. Multicentre collaboration may provide significant input for strengthening or refuting the above hypothesis. [ABSTRACT FROM AUTHOR]

Aim: We had done this study for TEF with Anorectal malformation and TEF with no Anorectal malformation in terms of age, sex, surgical outcomes and mortality.Materials and Methods: This was a retrospective review of cases with clinical data (from April 2012 to April 2017). The participants of this study were 236 patients who had been diagnosed and managed for ARM. Among these patients, 25 patients associated with EA were selected as the subject patient group.Results: The incidence of tracheoesophageal fistula with ARM was 11.1%. The study has more male preponderance. All cases are of Type c except two cases of Type a. According to the classifications of ARMs, there were two cases with rectourethral fistula and eight cases with rectoperineal fistula and covered anus in the males. In females, there was a varied distribution of seven cases. There was one case (4%) presenting as a part of the Vertebral anorectal malformation cardiac tracheoesophageal renal and limb anomalies (VACTERL) association, which is the representative example of a complex anomaly. Most of the cases died due to cardiac problem and pneumonitis (due to delayed presentation).Conclusion: The study concludes the experience of EA (±fistulae) with ARM, their distribution, incidence and outcome of the tertiary care centre. [ABSTRACT FROM AUTHOR]

General dentists should be aware that extraoral dental cutaneous lesions can be confused with dermatologic lesions. We report two cases of cutaneous lesions of dental origin that were initially misdiagnosed as being dermatologic in origin. Multiple treatments were performed, including plastic surgery, but the lesions did not resolve. Then, the lesions' dental etiology was identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. A dental etiology, as part of a differential diagnosis, should be kept in mind with orofacial skin lesions. (Quintessence Int 2011;42:455-458) [ABSTRACT FROM AUTHOR]

To present a rare case of a midline congenital upper lip sinus and its management. Background: A lip sinus is a rare condition, where a failure of the complete union during early stages of development leads to its formation. The prevalence of lower lip sinus is estimated to be about 0.00001% of the white population and that of upper lip sinus is even rarer. A congenital lip sinus maybe associated with syndromes such as; Von der Woude syndrome, or maybe present in isolation. A 25-year-old male presented to our clinic with intermittent swelling in the upper lip region. Clinical examination revealed a congenital midline lip sinus in the upper lip region, which had no intra-oral communication, and was managed by surgical excision. Till date, there has been a hand full of case reports of upper lip sinuses and fistulae, out of which only few are reported in India. We herein report a case of congenital upper lip sinus presenting as an intermittent swelling of the upper lip with its successful surgical management. [ABSTRACT FROM AUTHOR]

Abstract Study objectives To review the key parameters related to the proposed modified pediatric tracheostomy technique with to determine the efficacy, safety and outcomes in a tertiary hospital in south India. Patients and Methods A retrospective chart review of all children aged below 16 years who underwent tracheostomy at a tertiary hospital in south India during the period of August 2014 to August 2016. Data on age, gender, indication for tracheostomy, primary disease condition, duration of intubation, complications and decannulation rate were recorded. Results Fifty children aged below 16 years underwent tracheostomy between August 2014 and August 2016. The average of the children was 5.35 years. (Range14 days to 14 years). The male female ratio was 1.6:1. In our study prolonged intubation was the most common indication (62%). None of the children had early post-operative complications such as bleeding, pneumothorax, surgical emphysema or accidental decannulation. Peristomal granulations (24%) was the most common complication although none was severe to warrant operative intervention. One child had a lifethreatening tube block requiring cardiopulmonary resuscitation. None of the children had accidental decannulation during the period of the study. Tracheocutaneous fistula was seen in 2 children (4%) and was the only long-term complication. These children required surgical decannulation. There was no clinical evidence of tracheal stenosis or tracheomalacia in any child. Conclusion Pediatric tracheostomy is challenging for both the surgeon and the care-giver specially in the early post-operative period. Our proposed modified technique addresses these concerns and without any significant complications. [ABSTRACT FROM AUTHOR]

Introduction:  Esophageal atresia with or without tracheoesophageal fistula (EA with or without TEF) is one of the neonatal surgical emergencies requiring surgical intervention in the early neonatal period, influencing the developmental outcome in the operated children. This study was aimed to assess the developmental status of children operated for EA with or without TEF along with maternal stress, their quality of life (QOL), and coping abilities.Materials and Methods:  A descriptive cross-sectional survey was conducted on 51 children aged up to 5 years after EA with or without TEF repair and their mothers' in a tertiary care facility. The tools used were, namely, demographic datasheet of child and mother, anthropometry assessment, Developmental Assessment Scale for Indian Infants, and modified Vineland Social Maturity Scale for the developmental evaluation, Child Behavior Checklist (1.5-5 years) caregiver report form, Parental Stress Scale, WHOQOL BREF, and Coping Strategies Checklist.Results:  The majority of children had low weight (47.1%) and height (31.4%), for reference age. The overall and social developmental delay was observed in 40.7 and 37.5% of children, respectively, and few children (7.4%) had behavioral problems in the borderline range. Among the mothers, 47% had moderate stress and relatively poor QOL in environmental (60.1 ± 18.9) and psychological (60.8 ± 18.8) domains. The most commonly used coping strategy by the mothers was an emotional outlet (29.4%).Conclusion:  Developmental delay was present in children operated for EA with or without TEF caused significant stress among mothers, affecting their QOL for which the emotional outlet was the most commonly used coping strategy. [ABSTRACT FROM AUTHOR]

Tracheocutaneous fistulas present secondary to homicide, suicide, and accidents. Most of the times, they can be repaired primarily, with secondary reconstruction required in complex cases. Such reconstructions can be performed using pedicled flaps without much difficulty. Any surgeon, without the need of microsurgical expertise or special instrumentation, can perform such reconstruction. Three patients presented to the department following homicidal cutthroat injuries, with trachea-cutaneous fistula. Two patients were managed with pectoralis major musculocutaneous flaps and one was managed with sternocleidomastoid flap. All patients attained good wound healing and fistula closure. The two skin paddles provided lining and cover, and the intervening muscle provided an additional waterproofing. These flaps are a reliable method of reconstructing such defects. [ABSTRACT FROM AUTHOR]

Spontaneous enterocutaneous fistula due to strangulated inguinal Richter's hernia is a rare presentation and occurs mostly either due to ignorance of the patients or delay in seeking timely medical intervention. It is seen mostly in patients from developing countries like India, Nigeria, etc., Reported here is the case of a 50-year-old female patient who presented with left sided fecal fistula which on investigation was found to be due to incarcerated inguinal Richter's hernia. The patient refused for any surgical intervention and hence was managed successfully and conservatively. No similar case reports have been found in the literature thus highlighting its significance. [ABSTRACT FROM AUTHOR]

Objective:Tuberculosis is a global health problem that is especially prevalent in developing countries such as India. Recently, atypical presentation has become more common and a high index of suspicion is essential. This study analysed the various presenting symptoms and signs of tuberculous otitis media and the role of diagnostic tests, with the aim of formulating criteria for the diagnosis.Methods:A total of 502 patients underwent tympanomastoidectomy over a two-year period. Microbiological and histopathological examinations and polymerase chain reaction analysis of tissue taken during tympanomastoidectomy were performed.Results:A total of 25 patients (5 per cent) were diagnosed with tuberculous otitis media. Severe mixed hearing loss, facial palsy, labyrinthine fistula, post-aural fistula, perichondritis and extradural abscess were noted.Conclusion:There seems to be a resurgence in tuberculous otitis media in India. Microbiological, histopathological and polymerase chain reaction tests for tuberculosis are helpful for its diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To analyze surgical complications after primary cleft palate repair in a setting with limited resources. Patients and Design: A total of 1608 consecutive cleft palate repairs with 1408 follow-ups, operated upon between 2011 and 2013, were reviewed retrospectively through medical records. Patients were 10 months to 50 years old at the time of surgery, with a median age of 9 years. Setting: Guwahati Comprehensive Cleft Care Center, Guwahati, India. Intervention: Primary cleft palate repair. Main Outcome Measures: Postoperative complications in terms of necrosis, dehiscence, fistula, infection, and "hanging palate" were assessed, as was perioperative bleeding. Logistic regression was used with complication (yes/no) as the binary dependent variable and with age, cleft type, and surgeon (visiting/long-term) as covariates. Results: The overall incidence of postoperative complications was 16.9% with a fistula rate of 13.6%. The incidence of perioperative bleeding was 1.8%. Logistic regression analysis identified cleft severity (P ≤ .001) and visiting surgeon (P ≤ .01) as factors related to the incidence of postoperative complications. Age at surgery was related to both the incidence of postoperative complications (P ≤ .001) and perioperative bleeding (P < .05). Conclusion: Due to increased risks of surgical complications, older patients with complete clefts should only be operated upon after careful consideration. In addition, these patients should be assigned to surgeons experienced with this cleft type. [ABSTRACT FROM AUTHOR]

Although tuberculosis is a rather common disease in the Indian subcontinent, tracheobronchial involvement in tuberculosis is still rare. Fistula formation between bronchi is very rare considering that only four cases have been published in the English literature. We present a case of multislice computed tomography (CT) and virtual bronchoscopy diagnosis of interbronchial fistula in a patient with tuberculosis along with a review of literature of the same. This happens to be the smallest of the interbronchial fistula identified on imaging so far and the first case from the Indian subcontinent. This is also the first instance where the diagnosis appears to have been made using only multislice CT generated virtual bronchoscopy without the aid of fiber optic bronchoscopy. [ABSTRACT FROM AUTHOR]

Background: Thyroglossal duct remnants are more common in paediatric population. Complete excision of the tract is necessary to prevent recurrence. Sistrunk's surgery is done for thyroglossal duct remnants. This surgery has considerable failure rate. Aims and Objectives: This study was done to present our clinical experience regarding the successful management of thyroglossal cyst and fistula to know the role of imaging in prevention of recurrence after Sisktrunk's surgery. Material and Methods: This is an observational study of 15 cases of thyroglossal cyst and fistula. The data was collected retrospectively from the medical records of SDM College of Medical Sciences and Hospital. Results: No recurrence was seen in this series with a follow up period of 1 year. Conclusion: CT fistulography for thyroglossal fistula and USG neck for thyroglossal cyst is the imaging modality of choice. Nevertheless, it is pivotal to excise a wider core of tissue in revision cases to ensure complete cure to prevent possible recurrence. [ABSTRACT FROM AUTHOR]

Objective: Palatal fistulas are not uncommon after palatoplasty. Although there are currently many techniques that can be used to close large palatal fistulae, most of these procedures are usually cumbersome and mostly unreliable with high recurrence rates. The facial artery musculomucosal (FAMM) flap was described to circumvent these problems. The purpose of this study was to review our experience with the FAMM flap to reconstruct palatal fistulas, most of them being recurrent. Materials and Methods: A retrospective analysis was done of 11 FAMM flaps performed between January 2007 and March 2012. Results: There were no major complications. Venous congestion was seen in two cases. Two flaps developed terminal marginal necrosis. One patient had suture line dehiscence. There were no recurrences of the fistula after repair. All patients had a satisfactory closure of the fistula. Conclusion: FAMM flap is a reliable and versatile flap that provides like with the like tissue and is a good option for closure of recurrent wide palatal fistulae. [ABSTRACT FROM AUTHOR]

Spontaneous enterobiliary fistulae are a complication of biliary disease or a disease of adjacent structures. Cholecystocolic fistulae are rare in relation to gallbladder carcinoma (GBC). Previous reports have presented images showing subtle findings suggestive of cholecystocolic fistula. We report the unusual spread and rare images of a case of cholecystocolicfistula,to highlight the aggressive nature of GBC and findings of gross transmural invasion of the colonic wall. The images acquired in all three planes define the anatomical and pathological extent conclusively. There are a higher number of GBC cases across the geographic belt of North India compared to the West. In this case, the patient's pathology was extensive and unresectable, and therefore palliative and supportive care was advised. [ABSTRACT FROM AUTHOR]

Aim: To evaluate our results of definitive repair of anorectal malformations in patients with delayed presentation, during and beyond adolescence. Material and Methods: It is a retrospective analysis of all adolescent patients presenting for the first time for definitive repairs and innate patients--colostomy performed during the neonatal period, but who had lost to follow-up. It includes 15 patients (2 male and 13 female) aged from 13 to 32 years. Three well-decompressed female patients were managed by primary anterior sagittal anorectoplasty (ASARP). Twelve patients underwent staged procedures. Five patients (two male and three female) underwent posterior sagittal anorectoplasty (PSARP). The oldest male patient underwent abdominal-PSARP. Results: All of them attained socially acceptable fecal continence at follow-up of 1-4½ years. They are satisfied with the functional and cosmetic outcome of repair of their anomalies. Conclusions: Prospects of fecal continence are good when definitive repair of anorectal malformations is done by an expert, even in the adolescent age group and beyond. [ABSTRACT FROM AUTHOR]

Objective:Abnormalities of the third branchial arch are less common than those of the second arch and usually present with left thyroid lobe inflammation. This paper describes 15 cases of pyriform sinus fistulae of third branchial arch origin usually presenting as recurrent thyroid abscess on the left side.Method:A retrospective review of 15 cases of third arch fistulae managed 2000 and 2008, diagnosed based on histopathology and radiological evidence of a fistulous tract, and treated with fistulectomy with left hemithyroidectomy.Results:All patients (six boys and nine girls, aged three to 15 years) presented with recurrent low neck inflammation. Pre-operative ultrasound, computed tomography fistulography and barium swallow demonstrated a third arch fistulous tract, left-sided in all cases. The fistula was detected intra-operatively and pathologically in all cases. Surgery (successful in all cases) emphasised complete recurrent laryngeal nerve and ipsilateral pyriform sinus exposure, to facilitate tract excision, with left hemithyroidectomy. There was no recurrence over three to five years' follow up.Conclusion:Paediatric recurrent low neck inflammatory episodes, due to thyroidal abscess, especially left-sided, should raise suspicion of pyriform sinus fistulae. [ABSTRACT FROM PUBLISHER]

Background/Aim: Enterocutaneous fistula (ECF) is a difficult condition managed in the surgical wards and is associated with significant morbidity and mortality. Sepsis, malnutrition, and electrolyte abnormality is the classical triad of complications of ECF. Sepsis with malnutrition is the leading cause of death in cases of ECF. Although it is a common condition, no recent report in literature on the profile of patients with ECF has been documented from the southern part of India. Materials and Methods: All consecutive patients who developed or presented with ECF during the study period were included in the study. The etiology, anatomic distribution, fistula output, clinical course, complications, predictive factors for spontaneous closure, and outcomes for patients with ECF were studied. Results: A total of 41 patients were included in this prospective observational study, of which 34 were males and 7 were females. About 95% of ECF were postoperative. Ileum was found to be the most common site of ECF. Also, 49% of fistulas were high output and 51% were low output. Serum albumin levels correlated significantly with fistula healing and mortality. Surgical intervention was required in 41% of patients. Conclusion: Most of the ECF are encountered in the postoperative period. Serum albumin levels can predict fistula healing and mortality. Conservative management should be the first line of treatment. Mortality in patients with ECF continues to be significant and is commonly related to malnutrition and sepsis. [ABSTRACT FROM AUTHOR]

Background: Although mortality of Whipple's pancreaticoduodenectomy (WPD) is reduced to <5%, morbidity still remains between 30 and 50%. Pancreaticojejunal anastomosis remains the main cause of morbidity. Blumgart anastomosis using transpancreatic U sutures has been proposed to decrease the leak rate and its associated morbidity. We analyzed the results of Blumgart anastomosis applied in consecutive cases of WPD. Methods: Of 189 patients with periampullary or pancreatic cancer admitted, 100 patients underwent WPD. Except for 2 patients (no duct identified preoperatively), all patients underwent pancreaticojejunostomy by the Blumgart anastomotic technique. The records of 98 patients were analyzed for pancreatic leak and its related complications using the definitions given by the International Study Group for Pancreatic Surgery. Results: Of 98 patients, 63 were men. The mean operative time was 390 min (270-690 min) and blood loss was 275 ml (100-1,000 ml). Overall mortality was 3.06%. The clinically significant pancreatic anastomotic failure leak was seen in only 7 (7.14%) cases (grade B, n = 4; grade C, n = 3) with one patient requiring relaparotomy due to leak. Only one patient died due to a leak-related complication. Conclusion: Blumgart pancreaticojejunal anastomosis can be routinely used for reconstruction in WPD. It is a technically simple procedure and is associated with low rates of fistula and its related complications. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: A significant number of esophageal atresia and tracheoesophageal fistula patients have long gaps and a high propensity to leak. Anastomotic leak in esophageal atresia is associated with a significant morbidity and mortality. Aim: In a prospective randomized trial, we analyzed the risk factors leading to anastomotic dehiscence and studied the effect of pleural wrap as an additional vascular cover around the esophageal anastomosis. Materials and Methods: Forty patients were divided into two groups A and B randomly. In 20 patients of group A, pleural wrap was utilized for covering the anastomosis and in 20 patients of group B, no such wrap was utilized. Results: Both the groups were comparable regarding age, sex, weight, gap length, tension at anastomosis and the hospital stay. The overall leak rate was 25% (10/40) in both the groups. The leak rate was not significantly different in two groups whenever a gap length was less than 2 cm or more than 3 cm. However, for a gap length of 2-3 cm, the leak rate in group A was 18% (2/11) and in group B was 50% (4/8) (P = 0.05). Thirty percent (3/10) of patients, whose anastomosis was under tension, leaked in group A as compared to 75% (6/8) in group B patients (P = 0.001). Conclusions: Use of pleural wrap was associated with less anastomotic dehiscence in patients with moderate gap esophageal atresia (2-3 cm) especially when the anastomosis was under tension. [ABSTRACT FROM AUTHOR]

Of the approximately 80,000 new cases of all cancers detected every year in India, 10-15% are gynecological malignancies. As per population-based registries under the National Cancer Registry Program, the leading sites of cancer among women are the cervix uteri, breast, and oral cavity. About 50-60% of all cancers among women in India are mainly of the following four organs: cervix uteri, breast, corpus uteri, and ovaries. Over 70% of these women report for diagnostic and treatment services at an advanced stage of disease, resulting in poor survival and high mortality rates. Among all gynecological cancers, ovarian cancer is the deadliest one and, in 2/3rd of the cases, is detected in an advanced stage. But, in India and in other developing countries, due to inadequate screening facilities for the preventable cancer cervix, this kills more women than any other cancer in females. Gynecology Oncologist as a sub-specialist has an immensely important role in curtailing the menace of gynecological malignancies by providing comprehensive preventive, curative, palliative and follow-up services, with the aim of assuring a good quality of life to women as a cornerstone of cancer management. [ABSTRACT FROM AUTHOR]

The value of standard Pancreaticoduodenectomy for Periampullary carcinomas has long been a matter of debate. Though the mortality has dramatically reduced in high volume centers with dedicated hepatobiliary surgery units, the rate is still high in peripheral institutes. In this study our aim was to access the overall post operative outcome associated with pancreaticoduodenectomy performed in a government medical college. A total of 44 patients who underwent pancreaticoduodenectomy for operable periampullary cancers were evaluated. The overall morbidity rate was 31.1%. A total of 13 (29.5%) died following the operation and of its complications though the rate has reduced drastically to 14.2% in2008. The average length of hospital stay was 22 days. The mean survival was 15 months. Pancreaticoduodenectomy can safely be performed in government medical colleges with good results. In view of the majority of the patients in rural and suburban communities, not all patients need referral to higher centers. [ABSTRACT FROM AUTHOR]

Introduction: Our objective was to analyze the incidence, etiopathology, diagnosis and therapeutic aspects of the genitourinary fistula in an Indian population. Methods: This is a retrospective analysis of the genitourinary fistulae repaired at the Department of Urology, Institute of Medical Sciences, Banaras Hindu University, between January 1990 and December 2006. The surgical approach varied in each patient. Interposition grafts or flaps were used as and when required. The main outcomes analyzed were the incidence, etiology, surgical approaches, accessory procedure required, need for tissue interposition, cure rate per repair and overall success rate. Results: Out of 558 cases, 403 were vesicovaginal, 84 ureterovaginal, 43 urethrovaginal and 28 vesicouterine fistulae. The most common etiology was obstructed labor (72.2%), followed by hysterectomy. The transvaginal route was preferred for repair wherever possible. The transabdominal route was adopted for the repair of supratrigonal vesicovaginal, ureterovaginal and vesicouterine fistulae and if bladder augmentation was required. Conservative management was successful in 1.9% of the vesicovaginal fistulae and in 8 cases of ureterovaginal fistula. The remaining cases were managed surgically with excellent results. Conclusion: Genitourinary fistulae are not life-threatening but are socially debilitating. Surgical repair provides the definitive cure, but expectant treatment can be tried in selective patients. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Most cholecystocutaneous fistulas are postoperative complications of liver and biliary tract surgery or trauma. External biliary fistulas rarely occur spontaneously as a result of intrahepatic abscess (pyogenic or parasitic), necrosis or perforation of the gallbladder, or other inflammatory process involving the biliary tree. A cholecystocutaneous fistula as a presentation of an underlying cancer arising from the gall bladder is an extremely uncommon finding. Over the past 50 years fewer than 20 cases of spontaneous cholecystocutaneous fistulas have been described in the medical literature but so far there has been no published report of a cholecystocutaneous fistula arising from adenocarcinoma of gall bladder. We here report a case of a patient presenting with spontaneous cholecystocutaneous fistula from cancer of gall bladder. [ABSTRACT FROM AUTHOR]

We describe an 8-year-old male who presented with persistent lung abscess. The boy was subsequently found to be having congenital broncho-esophageal fistula. This condition has been reported rarely worldwide in children. It is probably the first case of congenital broncho-esophageal fistula presenting as persistent lung abscess from India. [ABSTRACT FROM AUTHOR]

The anomalies of branchial cleft and thyroglossal tract accounts for the majority of fistulas in head neck region. A simultaneous presentation of both type of fistula in a same patient is very rare with no such cases reported in Indian literature till date. Here we present a case of simultaneous complete branchial and thyroglossal fistula in a 13-year-old girl with radiologically demonstrable internal opening on fistulogram managed surgically. [ABSTRACT FROM AUTHOR]

The article discusses a study that was conducted to analyze the impact of nonclosure of rectourethral (RU) fistula and to do a analysis by comparison of the complications with and without nonclosure of RU fistula at the time of posterior sagittal anorectoplasty (PSARP) in anorectal malformation cases (ARM). It also highlights the risks and complications involved in it. It concludes that RU fistula closure is not necessary during PSARP and nonclosure avoids urological complications.

In this article the author discusses the surgical repair of hypospadias in India. The author states it must consider the distinction between functionally necessary and practicable operative procedures, establish therapeutic objectives and the rate of the formation of fistula. The author also mentions that its main hindrance is the limitation that has been imposed by the width of the urethral plate.

Arteriovenous shunts in the forearm of 30 patients with end-stage renal disease were converted to arteriovenous fistulae using the same, previously cannulated blood vessels. The shunts were done because these patients needed immediate dialysis. After 2-4 weeks when the cephalic veins had dilated sufficiently shunts were converted to fistulae. In 28 patients fistulae were usable within 24-48 hours without interruption of the dialysis schedule and without loss of access site. In one patient the use was delayed for 20 days while a local skin infection was treated. In another patient the fistulae did not function.