ABSTRACT
Background Enhanced recovery after surgery (ERAS) protocols are nowadays considered the standard of care for various elective surgical procedures. However, its utilization remains low in tier-two and tier-three cities of India, and there exists a significant variation in the practice. In the present study, we have investigated the safety and feasibility of these protocols or pathways in emergency surgery for perforated duodenal ulcer disease. Methods A total of 41 patients with perforated duodenal ulcers were randomly divided into two groups. All the patients across the study were treated surgically with the open Graham patch repair technique. Patients in group A were managed with ERAS protocols, while patients in group B were managed with conventional peri-operative practices. A comparison was established between the two groups in terms of the duration of hospital stay and other postoperative parameters. Results The study was conducted on 41 patients who presented during the study period. Group A patients (n=19) were managed with standard protocols, and group B patients (n=22) were managed with conventional standard protocols. As compared to the standard care group, patients in the ERAS group showed quicker postoperative recovery and lesser complications. The need for nasogastric (NG) tube reinsertion, postoperative pain, postoperative ileus, and surgical site infections (SSI) were all significantly lower in the patients of the ERAS group. A significant reduction in the length of hospital stay (LOHS) was found in the ERAS group when compared to the standard care group (relative risk {RR}=61.2; p=0.000). Conclusions The application of ERAS protocols with certain modifications in the management of perforated duodenal ulcers yields significant outcomes in terms of reduced duration of hospital stay and fewer postoperative complications in a selected subgroup of patients. However, the application of ERAS pathways in an emergency setup needs to be further evaluated to develop standardized protocols for a surgical emergency group of patients.
ABSTRACT
Background Ventral hernias are commonly encountered problems in the field of general surgery. Incisional hernia is a common complication following abdominal surgery that requires reoperation. This study was conducted to understand the incidence of various types of ventral hernia in both sexes and various age groups, predisposing factors, clinical features, and complications. Methods This prospective observational study was conducted in the Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India, on a total of 100 patients diagnosed with anterior abdominal wall hernia between September 2020 to February 2021. Data collection included thorough history taking and clinical examination along with relevant investigations. The data collected was entered in a proforma, tabulated, and analyzed with the IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States). Results Incisional hernia (43%) was the most common of all ventral hernias. Females were much more affected than males. Out of these types studied, epigastric hernia showed more incidence among males. The average age of presentation was 52 years. Obesity was the most common predisposing factor (34%) with female preponderance. Obese patients were also associated with a higher rate of postoperative complications like wound infection and seroma. In the cases of incisional hernia, 32.6% of the patients gave a history of previous surgery complicated by a wound infection. Incisional hernias were more common in lower midline incisions (34.9%) and after gynecological surgery (55.81%) like total abdominal hysterectomy, cesarean section, or tubal ligation. In the majority of the patients (62.8%), the incisional hernia occurred within three years of the previous surgery. Wound infection following ventral hernia repair occurred in 11% of the cases, wound dehiscence in 3%, and seroma in 2 % of the cases. Conclusions The most common ventral hernias in decreasing order of their frequency are incisional hernia, umbilical hernia, para-umbilical hernia, and epigastric hernia. Epigastric and umbilical hernias are more common in males whereas incisional hernia is more common in females. Obesity and constipation were found to be the major predisposing risk factors. Incisional hernia is more common in females after gynecological and obstetrics surgery. The lower midline segment is the most common site for developing an incisional hernia.
ABSTRACT
Introduction A pilonidal sinus (PNS) is a small passageway in the subcutaneous tissue which develops most frequently in the sacrococcygeal area. In terms of postoperative outcomes, the decision on the best surgical treatment for PNS is still a challenge for a surgeon. Prevention of the disease recurrence and improving quality of the life can be considered primary goals of the treatment. The current study intends to compare two commonly practiced surgical treatments for PNSes-Rhomboid excision with Limberg flap repair against wide-open excision with healing by secondary intention. Methods In a prospective randomized study, 50 patients with sacrococcygeal PNS were divided into two groups. Group A was operated by rhomboid excision with Limberg flap reconstruction and Group B was operated by wide-open excision and healing by secondary intention. Data were collected on a specially designed structured proforma and consisted of patient demographics, medical history, presentation, and postoperative complications assessed for a period of 6 months. Comparative outcomes of interest were postoperative pain, postoperative anxiety, duration of wound healing, duration of work loss, presence of wound infection, and recurrence. Results Mean age of 28 years was observed across the study with a male preponderance (76%). The mean visual analog scale (VAS) score for pain was greater in Group A during the early postoperative period, i.e., days 1, 3, and 7. However, patients in Group B reported a mean VAS score of 3 ± 0 and 1 ± 0 at one month and 2 months, respectively indicating a longer duration of postoperative pain overall. Patients in Group B also reported a significantly higher VAS for anxiety (VAS-A) score for postoperative anxiety/stress in all the follow-up visits. The mean healing time was 20 ± 2 days in Group A and 57 ± 11 days in Group B showing a significant difference. Duration of work loss was also significantly higher in Group B (31 days). Five patients in Group B developed wound infections. No recurrence was observed across both the groups in this study. Conclusion According to the findings of this study, the Limberg flap method outperforms the wide-open excision approach in terms of healing duration, work loss days, postoperative pain, anxiety, and wound infection. Both the techniques, however, are comparable in terms of recurrence.
ABSTRACT
Pilomatrixoma is a benign adnexal skin tumor involving the hair follicle matrix. It is found in children, predominantly involving the face. We report here an interesting and rare case of a 52-year-old male presenting with a large, firm, and painless mass over the scrotum considered to be a sebaceous cyst. The mass was completely excised and a biopsy report revealed it to be a pilomatrixoma of the scrotum. The patient recovered well postoperatively with no recurrence over two years.
