ABSTRACT
Background: Laparoscopy involves insufflation of the abdomen by gas so that the endoscope can view the intra-abdominal contents without being in direct contact with the viscera or tissue. Access to the abdomen is the one challenge of laparoscopy that is particular to the insertion of surgical instruments through small incisions. Materials and Methods: The study was a prospective, randomized, double-blind, and comparative study conducted on 100 consenting patients who underwent laparoscopic surgeries at Father Muller Medical College Hospital, for a period of 3 years from December 2014 to 2017 for various conditions needing laparoscopy who fulfilled a pre-determined the inclusion and exclusion criteria. Results: In our study, the least age was 20 years, and maximum age was 61 years. Age ranged from 18 to 65 years with mean age of 40 years. Most cases were males 86%. There was no difference in the two groups in terms of demography and perioperative factors such as type of surgery and body mass index; hence, the data were statistically comparable. The mean time needed to create pneumoperitoneum was 2.31 ± 1 min in Veress needle technique and 3.99 ± 1 in open method (P = 0.000) gas leak was observed in 11 patients in open group whereas no patient had a gas leak in Group B (P = 0.000). Pneumoperitoneum was achieved in all 100 cases. There were 7 cases of abdominal wall hemorrhage 4 acute that was managed laparoscopically by harmonic cauterization. No vascular injury, bowel, omental was noted in both groups. Neither open nor closed needed with conversion to open due to inadequate access into the peritoneal cavity. One closed as access could not be gained was converted to open method. 3 (6%) patients had post-operative hematoma at the umbilical port site in open Group A whereas no one developed this complication in a closed group 9 (9%) patients presented with surgical site infection at the umbilical trocar site and 4 in the closed group
ABSTRACT
Introduction: Abdominal pain remains the foe runner of complaints’ presenting to the general surgeon in the present world. Acute appendicitis is the most common of the acute abdominal conditions presenting which requires immediate surgical intervention. Materials and Methods: The study was a prospective experimental study conducted on 100 cases evaluated and diagnosed as acute appendicitis and was admitted to Father Muller Hospital who underwent laparoscopic appendectomy from the time period September 2014 to August 2016. Results: In present study, the enrolled patients above the age of 16 years, in our study most patients who were treated with laparoscopic appendectomy were in the age group 21–30 years with 39%, females accounted for 51% of the study. In our study, we found that the serum glutamic pyruvic transaminase levels serum glutamic oxaloacetic transaminase levels, unconjugated bilirubin levels increased postoperatively statistically significantly with a P < 0.001 and returned to the baseline levels 7th day postoperatively.
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Background and Objective: Thyroid disorders are implicated in a broad spectrum of reproductive disorders ranging from abnormal sexual development to menstrual irregularities, infertility, and premature menopause. Thyroid disorders are 10 times more common in women than men. Materials and Methods: This study was a cross-sectional study conducted in the Department of Obstetrics and Gynaecology endocrinology and surgery, at Father Muller Medical College Hospital, Mangalore, Karnataka. On 100 women in the age group of 15–45 years attending or admitted in the hospital during the period from September 2016 to August 2015, with suspected thyroid disorders with menstrual disturbances for a period of 18 months. Results and Observations: The most common age group was 35–45 years with 49% of the study population. 42% were unmarried. Most of the patients presented to us <3 months of onset of symptoms 37%, 46% from 3 months to 6 months, and 3% patients had symptoms more than 2 years. In our study, population in menstrual irregularities had 32% subclinical hypothyroid, 48% hypothyroid, 20% hyperthyroid, respectively, there was significant association with thyroid hormone levels with Fisher’s exact test P = 0.020. Conclusion: Menstrual disturbances are one of the most common complaints of women for which biochemical estimation of thyroid hormones should be done subclinical hypothyroidism and hypothyroid cases account for a large treatable percentage of menstrual disturbance
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Background: One of the most common referrals to a radio-diagnostician in their daily practice is an evaluation of right lower abdominal pain by ultrasound. Among the causes of right lower abdominal pain appendicitis is the most common pathology accounting for probably more than 70% of the causes of right lower abdominal pain. Materials and Methods: This is a study of patients operated for acute appendicitis in Surgical Department of Father Muller Medical College Hospital from October 2012 to September 2013. The patients who met the inclusion and exclusion criteria were subjected to a radiological imaging, through anesthetic workup following which appendectomy was done and the excised specimen for histopathological examination. The collected data were analyzed. Results: Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score in this study had a sensitivity of 95.5% and a specificity of 89.7%, the positive predictive value was 95% and the negative predictive value was found to be 89% which was statistically significant (P < 0.001). The modified Alvarado scoring system had sensitivity and specificity of 81.1% and 87.2%, the positive predictive value was 81% and the negative predictive value was 87% for the diagnosis of acute appendicitis, which was statistically significant (P < 0.001). Between the two scores, RIPASA score had a more statistical significance than the modified Alvarado scoring system statistically significant (P < 0.001). Conclusion: Ultrasound plays a key role in diagnosing acute appendicitis and can be corelated well with the histology and both RIPASA score modified Alvarado scoring system are useful tools in evaluating acute appendicitis.
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Background: The occurrence of groin hernias is so common that the overall lifetime risk of developing one is 15% in male and about 5% in female. The most significant advances to impact inguinal hernia repair have been the addition of prosthetic materials to conventional repair and the introduction of laparoscopy to general surgical procedures. Materials and Methods: A total of 100 consecutive consenting cases who presented with a primary diagnosis of uncomplicated inguinal hernia to the Department of General Surgery at Father Muller Medical College Hospital from the period December 2013 to January 2016. Following a detailed history and clinical diagnosis a provisional diagnosis was made and the investigations. The following details regarding the patient were collected age of the patient, symptoms, and their duration, treatment given, complications if any, duration of hospital stay, and duration of return to work. Results: In our study, the mean age was 47.43 years and the most common age group when hernia occurred was 35-54 years with 54% of the cases. 97% were males and 3% females. Swelling was the most common presenting. Most hernias 43% occurred on the right side, followed by 18% on the left and 39% had bilateral involvement. The duration of surgery in the totally extraperitoneal (TEP) group the mean duration was 47.60 min the transabdominal preperitoneal (TAPP) group the mean duration was 48.90 min. The only post-operative complication occurred in our study was urinary retention. Conclusion: There is statistically significant difference between the two groups, namely, TEP and TAPP with respect to the duration of surgery and resuming routine activity postoperatively. The only finding of significance is the post-operative complication was urinary retention; this is not a major one, and this contributed an increase in the post-operative hospital stay being increased in the TEP group than the TAPP group with a two-tailed P = 0.
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Introduction: Gastroesophageal reflux is the backward flow of gastric contents into the esophagus. Gastroesophageal reflux is a normal physiological process that occurs several times a day without symptoms or damage of the esophageal mucosa in most otherwise healthy individuals. Materials and Methods: This study was a cross-sectional prospective observational study, in which the patients are chosen by purposive sampling technique; the first consecutive 350 cases were taken to evaluate the patterns of demographic and lifestyle profile among patients aged between 30 and 60 years of age attending a tertiary care center, South India. This study was focused to evaluate the clinical scenarios of various patients diagnosed with gastroesophageal reflux disease (GERD) based on diagnostic criteria in South Indian population attending Department of General Surgery and Gastroenterology, Father Muller Medical College, Mangalore, from August to July 2016. Results: The mean age was 33.6 ± 10.0 years. Females (62%) were the predominant when compared to males. Heartburn was present in 50%, regurgitation in 40% and the presence of both symptoms was observed in 48.3%. Majority of the study subjects have mild GERD (77%) followed by moderate and severe grades. The body mass index range of ≥30.0 kg/m2 was highest (48%). 58% belong to lower socioeconomic group. The patients who are consuming non-vegetarian diet, smokers, stress, hypertension, and diabetes mellitus have a significant association and more succumbed to the development of GERD (P < 0.05). Conclusion: Socioeconomic factors have a significant impact on the GERD manifestations. A number of studies have been performed to evaluate the influence of socioeconomic status and GERD and concluded that lower socioeconomic status has a significant negative impact on the quality of life and implied to GERD.
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Background: The diabetic foot ulcer is a major complication of diabetes mellitus. (1) It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations. (2) Diabetes mellitus impedes wound healing by prolonging the inflammatory phase. Increased glucose in the tissue precipitates infection. (3) Diabetic microangiopathy which affects microcirculation. Increased glycosylated hemoglobin decreases the oxygen dissociation. Increased glycosylated tissue protein decreases the oxygen utilization. This study is intended to show the efficacy of carboxymethyl cellulose (CMC) dressing for a faster healing of diabetic ulcers when compared with the conventional saline dressing. Materials and Methods: This study was a prospective case–control comparative study conducted at the Department of General Surgery and Gastroenterology, father Muller Medical College, Mangalore, from August to July 2016. 80 consenting patients who met the predefined criteria were taken for the study and divided into two groups, 40 patients each is put in the CMC with silver dressing group and the conventional saline dressing group. Results: There was no statistically significant difference between the two groups in terms of gender, age, glycemic control, and site of ulcer P < 0.001. In our study, we found that there was statistically significant difference in the rate of infection between the two groups. Conclusion: Silver impregnate dressings have a role in the management of diabetic ulcers by reducing the local burden of infection which is an important cause for non-healing ulcer analgesia.