Laparoscopic Transabdominal Preperitoneal Mesh Hernioplasty: A Medical College Experience

Objectives: To determine the feasibility and patient’s outcome of laparoscopic transabdominal preperitoneal mesh hernioplasty for inguinal hernias. Patients and Methods: This study was carried out from March 2011 to April 2014. A total of 130 patients underwent laparoscopic transabdominal preperitoneal mesh hernioplasty (TAPP) for uncomplicated inguinal hernia. Of this, 10 patients presenting with bilateral inguinal hernias were operated in the single sitting. A 15 cm × 12 cm polypropylene mesh was used in all cases. Operative morbidity, postoperative pain, seroma formation, evidence of superficial infection, chronic groin pain and hernia recurrence were noted. The majority of the patients were discharged within 24 hours and follow-up was done at 1 week, 1 month, and 6 months. Results: 130 patients presenting with uncomplicated inguinal hernias were operated over a period of three years in the department of surgery, Govt. Medical College Srinagar. The mean age of the patients was 39.18 years (range: 18 - 70 years). The median duration of operation was 48.5 minutes (range: 18 - 120 minutes). None of the procedure was converted to open inguinal hernia repair. Postoperative pain was observed in 9.23% of the cases and was easily controlled by oral analgesics. Six patients (4.62%) developed seroma, out of which one required aspiration while others settled conservatively. Two patients (1.54%) developed wound infection and one patient (0.77%) had recurrence. None of the patients developed scrotal hematoma or neuralgia. Return to normal activity after TAPP repair was found to be after a median of 16.1 days. Conclusion: Transabdominal preperitoneal repair for inguinal hernia using proline mesh may be a safe and effective procedure with low morbidity, early return to normal activity and with a very low recurrence after six months follow-up.

Laparoscopic Surgery for Meckel’s Diverticulum Presenting as Small Bowel Obstruction: A Case Report

Meckel’s diverticulum is not commonly encountered surgical entity and presents unique challenges for a pediatric surgeon, as it is prone to varied complications. A 14-year-old boy was admitted with us with a 48-hour history of lower abdominal pain and multiple episodes of vomiting. Radiological imaging studies revealed a high-grade partial small bowel obstruction. A fleeting conservative management was tried. The diagnostic laparoscopy revealed a small bowel obstruction secondary to a Meckel’s diverticulum. The diverticulum was resected using an endovascular GIA stapler. The patient was discharged on postoperative day four, tolerating a regular diet. Laparoscopy is a useful diagnostic and therapeutic means for a patient with a small bowel obstruction due to an uncertain etiology.

An Analysis of War Weaponry Trauma Victims from a Medical College Setting in Kashmir Valley

Background: Kashmir valley, being a known conflict zone keeps on receiving war victims due to scuffles between civilians and the government forces. Such upsurges have been noted in the recent past in 2008 and 2010;however, a new face of upheaval took place in the month of July 2016. Herein, we present an analysis of 500 abdominal trauma victims reported to our department at Government Medical College Srinagar, Kashmir, India. Methods: Government Medical College Srinagar Kashmir is a tertiary care teaching hospital situated in the heart of Kashmir valley. Being one of the referral hospitals, for trauma, we received a total figure of 6149 trauma victims out of which 500 were purely of abdominal in nature managed by the department of surgery. The study conducted was a short analysis of these abdominal trauma patients that reported from 8th July to 8th November 2016. Results: The result of analysis of 500 abdominal trauma patients is reported herein. The male female ratio of patients was 19.8:1 (male = 95.2%, female = 4.8%). The age range was from 5 years to 65 years with majority reported in the age range of 15 - 30 years. The number of bullet injuries was =85 and the pellet injuries were =349. The commonest organs involved were small intestines, spleen, large bowel and liver in descending order. Penetrating injuries were seen in =60.4%, non-penetrating were seen in =39.6%. The patients were grouped into conservative, non operative and operative group. The commonest morbidity observed was wound sepsis and a total mortality reached to a figure of 2%. Conclusion: This short study of analysis of trauma victims has explored the newer horizons of trauma management and we believe and conclude that specialized trauma hospitals with skilled manpower and modern gadgets of handling trauma is need of an hour especially in developing countries like ours.

A Point-Specific Site for Placement of Epigastric Port in Iaparoscopic Management of Gallbladder Disease: An Observational Study

Backgound: Laparoscopic cholecystectomy has revolutionized the world in the surgical management of benign gallbladder disease. However, for any procedure to learn properly, anatomy becomes a major concern. Aims and Objectives: We present a point, a convenient site, speedily accessible by our maneuver of placing epigastric port on the patient. Materials and Methods: This is an outcome of an observation with the prospective study of 100 patients irrespective of age, sex, body habitus and severity of gallstone disease. Our point for epigastric port satisfies all the criteria for an ideal port. Results: Our general observation with majority of patients with this point specific epigastric port placement was that it is easy to locate, needs less thrust on trocar for creation, stays on the linea alba, is easily maneuverable facilitates safe, easy and speedy dissection, causes less portal bleeds and is easy to angulate towards the right of falciform ligament. Conclusion: The point specific epigastric port conveys many benefits to the operating surgeon in terms of easy location, adds safety and speed to the procedure, causes less portal bleeds, needs less thrust and is easy to angulate to the right of the falciform ligament adding technical ease to the surgeon. It is easy to be learnt, taught and practiced by the young surgeons.

Primary Malignant Peripheral Nerve Sheath Tumor of the Breast—A Case Report

Malignant peripheral nerve sheath tumor is a rare soft tissue sarcoma. Breast is an extremely rare location of this lesion and presentation as a breast lump in the absence of pain or previous benign neural tumor is even rarer. We report such a lesion in a 60 year-old female who presented with hard and painless breast lump for 2 years. Histopathology revealed a malignant spindle cell tumor of low grade potential. It was subsequently confirmed to be malignant peripheral nerve sheath tumor (MPNST) on the basis of immunopositivity for vimentin, neurone specific enolase and S-100.

An Early Experience of Stapled Hemorrhoidectomy in a Medical College Setting

Background: Stapled hemorrhoidectomy, popularly known as Longo technique is in use for the treatment of hemorrhoids since its first description to surgical fraternity in the world congress of endoscopic surgeons in 1998. Objectives: To evaluate the feasibility, patient acceptance, recurrence and results of stapled haemorrhoidectomy in our early experience. Methods: Between Jan 2012 and Dec 2013, 42 patients with symptomatic GRADE III and IV hemorrhoids were operated by stapled hemorrhoidectomy by a single surgeon at our surgery department. The evaluation of this technique was done by assessing the feasibility of the surgery;and recording operative time, postoperative pain, complications, hospital stay, return to work and recurrence. Results: All the procedures were completed successfully. The mean (range) operative time was 30 (20 - 45) min. The blood loss was minimal. Mean (range) length of hospitalization for the entire group was 1 (1 - 3) days. Only 3 patients required more than 1 injection of diclofenac (75 mg) while as rest of the patients were quite happy switching over to oral diclofenac (50 mg) just after a single parenteral dose. All the patients returned to their routine work in less than a week’s time. The mean (range) follow-up was 6 (4 - 12) months. There were no major intraoperative or postoperative complications except for retention of urine in 8 patients. The patients are still on regular follow-up and have not had recurrence as yet. Conclusion: Stapled hemorrhoidectomy technique is a safe alternative to the traditional Milligan-Morgan technique. It can be performed as an office procedure, is well tolerated by patients and is cost effective than conventional surgical therapy.

Multiple Calcifying Epitheliomas of Malherbe’s of Axilla: A Case Report of Rare Variety

Pilomatrixoma, a rare benign tumour of sebaceous gland is commonly known as calcifying epithelioma of Malherbe or Tricholemmal cyst. We came across even the rarest form of this benign tumour of skin. Our case report was interestingly detected at a higher age group, unusual site of the body, multiple in nature following postoperative incision drainage of abscess in left axilla.