Treatment of Keloids with Surgery and Immediate Postoperative Radiotherapy: Knowledge Gained Over 17 Years.

Background The treatment of keloidal scars with radiotherapy has been practiced for more than a century. Radiotherapy post-surgery has been deemed necessary and effective in preventing recurrence but still, no clear guidelines exist as to the best modality of radiotherapy, the ideal dose, and the time it should be given for keloidal scars. The purpose of this study is to confirm the effectiveness of this treatment and address these issues. Methods Since 2004, 120 patients presenting with keloidal scars were seen by the author. Out of them, 50 were managed with surgery followed by HDR brachytherapy/electron beam radiotherapy delivering 2000 rads to the scar within 24 hours of surgery. Patients were followed up for at least 18 months to assess the scar status and the recurrence of keloids. Recurrence was defined as the appearance of a nodule or an obvious return of the keloid within 1 year of treatment. Results Three patients developed a nodule in the scar, which was deemed a recurrence, making an incidence of 6%. There was no major problem after immediate postoperative radiotherapy. Five patients had delayed healing at 2 weeks and a hypertrophic scar was noted in five patients at 4 weeks that settled with conservative measures. Conclusion Treating the vexing problem of keloids with surgery and immediate postoperative radiotherapy is safe and effective. We recommend that this be adopted as the standard treatment in keloid management.

Professor Leslie H. Blumgart-Pioneering Hepatopancreaticobiliary Surgeon: a Tribute.

Leslie Harold Blumgart was the surgeon behind making Hepatopancreaticobiliary surgery a speciality and his recent demise will always leave a void in that field. He was the person who classified anatomical variations in the biliary tract and devised a special anastomotic technique to decrease the rate of postoperative pancreatic duct fistula after Whipple's pancreaticoduodenectomy. His contribution in managing hepatobiliary oncology cases with chemotherapy and radiotherapy was also significant. No wonder, he was designated as the "living legend" by the International Hepatopancreaticobiliary Association.

Surgeon's guilt after postoperative complication.

Surgery is an art, surgical dilemmas are not mathematical problems with rigid, straight cut solutions and the human mind/body is not a perfect science. In such a scenario, unexpected, sudden complications can happen during surgery. While better diagnostic and advanced techniques in surgery, have minimised surgical errors to a great extent, with the risk of post-operative death being as low as 3.6% now, still when complications due occur, the surgeon faces a huge backlash not only from the patient relatives, but from his peers, the hospital management, the social and print media. The surgeon also fears violent retribution, not just consumer issues but a threat of arrest and legal battles. All these make a surgeon the "second victim" in the event of a post-operative complication, leading to changes in practice behaviour, emotional turmoil and even serious mental issues like depression and suicide. In this era of instant judgement by a largely unregulated social media, it is urgently required to address this issue and provide appropriate strength/support to the surgical fraternity.

Pandemic profiteering during the second wave of Covid-19.

The first wave of the Covid pandemic saw us facing acute shortages of masks, personal protective equipment, and sanitisers, with even toilet paper disappearing from store shelves. But the Indian small manufacturers seized the opportunity and by the end of last year, we had enough PPE and masks to even export the surplus to other countries. Though we rationed even the lowly surgical masks, people did not hoard or black market any of these. But it gave people the knowledge of what would be required and would be in short supply if the second wave struck. And so started the pandemic profiteering business.

Informed Consent for Surgery During COVID-19.

Informed consent has become a challenging issue when surgery at the time of novel corona virus disease 2019 (COVID-19) is to be performed, in view of increased risk of the need of intensive care unit (ICU) in the post-operative period and the associated high mortality if a patient exhibits COVID-19 symptoms in the post-operative period. We have devised a new informed consent format for all patients undergoing surgery incorporating a few points specific for the disease.

John Benjamin Murphy - Pioneer of gastrointestinal anastomosis.

Surgery as a speciality has reached an advanced refinement today both in terms of teaching and technique. With knowledge gained from years of research, teaching is now evidence-based. With the illuminating, pioneering work of a few great former surgeons, the technique of even complex surgical procedures has been well elucidated now. John Benjamin Murphy is one such surgeon to whom the speciality of surgery would remain perpetually indebted. His landmark achievements not only in gastroenterology but also in urology, orthopaedics, oncoplastic and vascular surgery would leave even a hard-core critic marvelling at his genius. Above all, Murphy was a dedicated teacher who spent 4 days a week demonstrating procedures and lecturing interested surgeons. Herein lies the greatness of the man and a tribute highlighting his achievements are in order.