Lower Limb Amputations- A Necessary Evil- An Observational Study from a North Indian Tertiary Care Hospital

Limb loss to amputation is a major problem especially in developing countries where majority of the cases are preventable. It is a burden, not just for the patient, but also for their care givers which imposes tremendous financial and psychological burden upon them. The aim was to outline the patterns, indications and complications of lower limb amputations among patients admitted to MMIMSR, Mullana, Ambala, India, which is a tertiary care centre.METHODSThis was a prospective, observational study that was conducted at MMIMSR, Ambala, for a period of 18 months. 50 patients underwent lower limb amputations in our hospital during the study period.RESULTSThe age ranged between 23 to 85 years. Males outnumbered females by a ratio of 4.5:1. Toe disarticulations were the most common. Diabetes mellitus (DM) was the most common cause (62%) followed by Non-DM peripheral vascular disease (PVD) (22%). Two patients expired in the post-operative period. Infection of the stump was the most common local complication in the post-operative period. Hospital stay ranged from 6 days to 40 days.CONCLUSIONSAlthough trauma is still the most common cause of lower limb amputations (LLA) in the developing nations, amputations for complications of diabetes is on the rise and may be the leading aetiology in future. Diabetic gangrene followed by PVD were the common causes of amputation in our settings. The study shows that most of the causes are potentially avoidable. Community health education programmes that are primarily focussing on road safety measures, early presentation to the physician and good diabetic control are pivotal to decrease the incidence of amputations for preventable indications.

Diagnostic Value of Upper Gastrointestinal Endoscopy Prior to Cholecystectomy in a Tertiary Care Institute

Cholelithiasis is one of the most common problems encountered in surgery department. It has always been a challenge to distinguish upper gastrointestinal symptoms due to gall stones from other causes. The persistence of abdominal symptoms even after cholecystectomy is highly discouraging for surgeons.METHODSThis is a prospective study conducted on 50 cases at the Department of Surgery, MMU Hospital, Mullana among ultrasonographically proven gall bladder stones. After history taking and examination, all the patients were subjected to endoscopy 1-2 days prior cholecystectomy, and biopsies were obtained for histopathology if required.RESULTSOut of a total of 50 patients, 44 (88%) were females and 6 (12%) were males with a M:F ratio of 3:22. 28 (56%) presented with typical pain and 22 (44%) presented with atypical pain. All patients were subjected to upper gastrointestinal endoscopy (UGE) and no lesion was found on endoscopy of 28 patients who presented with typical pain while out of 22 patients who presented with atypical pain, 18 (81.8%) had abnormal endoscopic finding and only 4 (18.2%) had normal endoscopy (p<0.001). Gastritis (72.2%) was the most common finding on upper gastrointestinal endoscopy followed by duodenitis (27.8%), oesophagitis (22.2%) and peptic ulcer (11.1%). On follow-up after 1 week of cholecystectomy all the patients except 10 from atypical group had persistence of preoperative symptoms.CONCLUSIONSPresence of atypical pain in patients with gall stones is highly likely to have other coexisting upper gastrointestinal pathologies. Hence, upper gastrointestinal endoscopy prior to elective cholecystectomy in patients with atypical presentation can be clinically helpful.

Correlation of Clinical Findings with Radiological and Intraoperative Findings in Cases of Intestinal Obstruction

Intestinal obstruction accounts for 15% of all patients presenting to emergency department with complaints of acute abdominal pain. Recognising obstruction early, aggressive preoperative treatment, skilled surgical techniques and intensive postoperative management improves outcome. We wanted to correlate the clinical findings with radiological and intra-operative findings in cases of intestinal obstruction.METHODS50 cases of intestinal obstruction chosen by simple random technique, were studied in the department of general surgery at MMIMSR, Mullana, Ambala. Intraoperative findings were compared with x-ray, USG abdomen and CT abdomen findings.RESULTSAdhesions and bands (26%) were found to be the most common cause of intestinal obstruction. Most common finding on plain x-ray abdomen was the presence of dilated gut loops (82%). USG abdomen has limited diagnostic value in cases of intestinal obstruction with most common finding reported in USG abdomen being that of small bowel obstruction (62%). Out of 49 patients who underwent CT scan abdomen and surgery, CT findings matched with intraoperative in 45 patients (91.84%) and the most common finding was adhesions and bands (22.4%).CONCLUSIONSX-ray abdomen and USG abdomen have limitations and are diagnostic only in a handful of cases. CT abdomen provides much more elaborate information and helps the surgeon to understand the pathology. Preoperative CT also helps prevent laparotomies in scenarios where surgeon with preoperative knowledge can opt for laparoscopic approach, thereby reducing postoperative stay in the hospital and complication. So, understanding of the imaging modalities and knowing when to use them and what to look for can save precious time of the patient and also that of the surgeon allowing for early diagnosis and better plan of treatment.

Comparative Study of Conventional Three Ports with Single Port Laparoscopic Inguinal Hernia Repair in a Tertiary Care Hospital

Introduction: Inguinal hernia repair is the most frequentlyperformed surgical procedure worldwide. Advances inlaparoscopic techniques have ushered an opportunity toimprove and improvise many surgical procedures. Singleincision laparoscopic surgery (SILS) was developed withthe aim of reducing the invasiveness of conventionallaparoscopy, and has been successfully performed by manysurgeons. Aim of the study was to asses the safety andfeasibility of single por laparoscopic approach for inguinalhernia repair.Material and methods: This study was conducted on 50patients presenting to Acharya sri chander college of MedicalSciences and Hospital, Sidhra, Jammu ASCOMS over aperiod of one year from November 2011 to October 2012 withuncomplicated inguinal hernia in whom 25 patients underwentsingle port laparoscopic TAPP(SPL-TAPP) hernia repairand 25 underwent conventional three port transabdominalpreperitoneal hernia repair.Results: No significant differences were noted among patientdemographics. The age group ranged from 20-60 years. Themean Age, weight and height in SPL-TAPP were 44.4, 59.46and 157.2 cm respectively. Mean operative time, hospital stayin single port TAPP was significantly lower as compared toconventional surgery. Moreover postoperative complicationswere also lesser in SPL-TAPP with almost no reoccurances.Conclusion: Single port TAPP offers to be safe andefficacious with minimum reoccurances and shorter hospitalstay