Search

Introduction: Age adjusted Charlson comorbidity index (a-CCI) is an established scoring system to predict long-term mortality. However, its role in predicting 30-day post-operative outcome in general surgery patients is not well elucidated. Methods: This was a prospective observational study. Consecutive patients operated under general anaesthesia between January 2019 and December 2020 were enrolled. Their a-CCI was calculated and stratified as Grade 0 comorbidities (a-CCI score = 0), Grade A comorbidities (a-CCI score = 1 and 2) and Grade B comorbidities (a-CCI score ≥ 3). Postoperative complications were graded according to Clavien Dindo (CD) grading system and classified as minor complications (CD Grades I and II), major complications (CD Grades III–IV) and mortality (CD Grade V). Binary logistic regression and multi-nominal logistic regression analysis were done and relative risk ratios were calculated. Result: A total of 925 patients were enrolled. The mean age was 42.75 (14–85 ± 10) years. 31% of our patients had complications within 30 days of surgery which included mortality in 2.7%. Compared with patients with Grade 0 comorbidities, the odds of getting complications is 1.2 times more in patients with Grade A comorbidities and 1.84 times more in patients with Grade B comorbidities (P = 0.205, 0.001 respectively). In comparison to patients with Grade 0 co-morbidities, risk of mortality is 3 and 17.86 times more in patients with Grade A and Grade B comorbidities (P = 0.121 and < 0.001 respectively). Conclusion: a-CCI has clinical relevance in general surgical patients and can predict early post-operative outcome. It should be a part of our armamentarium for pre-operative assessment of surgical patients. [ABSTRACT FROM AUTHOR]

Background. The Covid-19 pandemic severely affected surgical training as the number of surgeries being done was reduced to a bare minimum. Teaching and training of clinical skills on a simulator are desirable as they may have an even larger role during the Covid-19 pandemic. Commercially available simulators with optimum fidelity are costly and may be difficult to sustain because of their recurring cost. The development of low-cost simulators with optimum fidelity is the need of the hour. Methods. We developed animal tissue-based simulators for imparting skills training to surgical residents on some basic and advanced general surgical procedures. Porcine tissue and locally available materials were used to prepare these models. The models were pilot-tested. Standard operating procedures were developed for each skill that was shared with the participants well before the 'hands-on' exercise. An online pre-test was conducted. The training was then imparted on these models under faculty guidance adhering to Covid-19- appropriate behaviour. This was followed by a post-test and participant feedback. The entire exercise was paperless. Results. Sixty residents were trained in 10 sessions. Most of the participants were men (44; 73%). The mean pre-test and post-test scores were 40.92 (standard deviation [SD] 6.27) and 42.67, respectively (SD 4.06). Paired sample t- test suggested a significant improvement in the post-test score (p<0.001). The activity and the models were well appreciated by the residents. Conclusion. The animal tissue-based indigenous models are easy to prepare, cost-effective and provide optimum fidelity for skill training of surgical residents. In addition to skill acquisition, training on such modules may alleviate the stress and anxiety of the residents associated with the loss of surgical training during a time-bound residency period. [ABSTRACT FROM AUTHOR]

Complete removal of all the contents of a hernial sac is crucial in laparoscopic inguinal hernia repair. We report a case who underwent transabdominal preperitoneal repair for a complete, irreducible inguinal hernia. He had persistent scrotal swelling and new onset scrotal pain post‐surgery. Ultrasonography of the scrotum revealed a well‐defined hypoechoic scrotal lesion. A magnetic resonance imaging revealed a fat‐containing mass lesion, hypointense on T2 fat‐saturated image. He underwent exploration of the scrotum and a well‐encapsulated mass was excised. The histopathological evaluation revealed a well‐encapsulated structure comprising of lobules of fibroadipose tissue with foci of chronic inflammation and foamy histiocytes likely retained omentum from previous surgery. His scrotal pain disappeared post‐excision. A missed retained omentum in the hernial sac causes considerable anxiety to patients and diagnostic and therapeutic dilemmas for the treating surgeon. We coined the term "omentaloma of the scrotum" for such a lesion. [ABSTRACT FROM AUTHOR]

Background: Laparo-endoscopic hernia surgery is recommended by various international bodies. However, its uptake by general surgeon is low. We aim to assess the impact of Three Dimensional (3D) endovision system in learning laparoscopic transabdominal preperitoneal (TAPP) repair of groin hernia and transferability of skills acquired from 3D to the Two Dimensional (2D) environment. Methodology: Senior resident doctor with no previous experience in laparoscopic hernia surgery did 20 consecutive cases of TAPP repair using 3D endovision system followed by another five cases of TAPP repair using 2D endovision system. Total operating time, operating time during different phases of hernia surgery, faculty take over time, path length of needle holder, and scissors were recorded. Cumulative sum (CUSUM) and split group analysis were done to assess the learning process. Trainee's operating time was compared with that of experts' from previously published study of the same group. Data were compared between last block of five cases done using 3D system and cases done using 2D system for skill transferability. Results: CUSUM method provided inflection points of total operating time, hernia dissection and mesh placement at 9th case, and peritoneal suturing at 11th case in learning TAPP hernia. After 10th case, trainee's operating time was within the middle 50 percentage of experts operating time. Total operating time in last block of cases done under 3D vision and that of 2D endovision comparable, although peritoneal closure was significantly longer in 2D vision ( P = .074, .2, .145, .001). Conclusion: Reduction on operating time appears after ninth case of TAPP hernia repair using the 3D endovision system. The skills acquired under 3D endovision system are transferable to perform the procedure under 2D endovision system, albeit incompletely. Use of 3D technology may facilitate adaptation of TAPP hernia repair by young surgeons.