Impact of COVID-19 on General Surgical Practice in India.

The coronavirus disease 2019 (COVID-19) pandemic is a global health crisis, and surgeons are at increased occupational risk of contracting COVID-19. The impact of the disease on prevalent general surgical practice is uncertain and continues to evolve. The study aimed to study the impact of COVID-19 on general surgical practice in India and the future implications of the pandemic. A survey questionnaire was designed and electronically circulated 1 month after India entered a national lockdown during COVID-19 pandemic, amongst members of Indian Association of Gastro-intestinal Endo-surgeons (IAGES), a surgical association with nearly eight thousand members from across the country. Survey questions pertaining to pre-COVID era surgical practices, impact on current practice, and financial implications were asked. Responses were collected and statistically analyzed. One hundred fifty-three surgeons completed the survey, of which only 9.2% were women. Majority (41%) were into practice for more than 20 years; 36.6% were into private practice at multiple hospitals (free-lancers). Amongst the respondents, 41.8% had mainly laparoscopic practice with mean outpatient consultation of 26 patients/day and elective surgeries of 43 cases/month prior to lockdown. Post-lockdown, daily outpatient consults reduced to 4 patients per day, and 77% had not performed a single elective procedure. Hydroxychloroquine (HCQ) chemoprophylaxis was reported by 52% surgeons. Personal protective equipment (PPE) was used by 52% for all cases, while 71.5% stated there are insufficient guidelines for future surgical practice in terms of safety. A drop of more than 75% of their monthly income was experienced by 52% surgeons, while 22% faced 50-75% reduction. One third (33%) of respondents own a hospital and are expecting a monthly financial liability of 2.25 million rupees (nearly 30,000 US dollars). COVID-19 has led to a drastic reduction in outpatient and elective surgical practices. There is a definite need for guidelines regarding safety for future surgical practices and solutions to overcome the financial liabilities in the near future.

Gastrocoele: a complication of combined oesophageal and antral corrosive strictures.

Corrosive strictures of the gastrointestinal tract are a surgical challenge. We describe a previously undescribed condition called gastrocoele, a rare condition caused by combined oesophageal and antral strictures and review our results. We present our experience with nine cases of gastrocoele due to combined corrosive strictures of oesophagus and antrum between 1993 and 2005. The age group was 21-65 years with female preponderant (66%) sex distribution. The presentation was at a median of 110 days (range 45-400 days) following the corrosive ingestion. The standard investigations included barium swallow, endoscopy, jejunostomy tubogram and barium enema. The surgical procedures performed were antrectomy and coloplasty in six (one staged), antrectomy and oesophageal dilatation in two and gastrojejunostomy and coloplasty in one. There was no major morbidity or mortality with a median follow-up of 3 years. Gastrocoele is a rare entity where good results can be achieved with surgery, however, prevention of corrosive injuries by public education is the best cure!

Dysphagia due to tuberculosis.

OBJECTIVE: Dysphagia due to tuberculosis is rare in both the developing countries with high prevalence rates and the western population following the recent upsurge linked to the AIDS and immigration. AIM: To study tuberculosis as an aetiological factor in the causation of dysphagia and to evaluate the outcome of anti-tubercular treatment and surgical results in these patients. METHODS: Retrospective review of experience with 14 cases of dysphagia due to tuberculosis encountered between 1996 and 2003. RESULTS: The duration of symptoms ranged between 3 and 18 months. All of them underwent oesophagogastroscopy, barium swallow, fiberoptic bronchoscopy and CT scan of the chest. The aetiology was subcarinal node enlargement in seven, tracheo-oesophageal fistula in four, oesophageal ulcer in two and cervical node suppuration in one. Tuberculous involvement was confirmed by pathological examination in all patients. All of them received anti-tuberculous therapy. Seven patients required surgery, transthoracic repair of tracheo-oesophageal fistula in four patients, one patient required subcarinal node excision and two needed abscess drainage. There were no mortalities and there was complete relief of dysphagia in all of them. CONCLUSIONS: Tuberculosis as a causative factor for dysphagia should be considered in regions with high incidences of tuberculosis and in immunocompromised patients. Treatment with anti-tuberculous therapy is effective. Surgery is required only for complications of tuberculosis.