Laparoscopic Retrograde Nephrectomy as a Troubleshooting Technique to Prevent Open Conversion: The Technique Description With a Review of 40 Cases.

Introduction Laparoscopic nephrectomies are safe, with low complication rates in skilled hands. However, traditional approaches may be unsuitable for conditions such as post-renal abscesses, long-standing urinomas, non-functioning kidneys post-pyeloplasty, pyelolithotomies, post-partial nephrectomy recurrences, tuberculous kidneys, pyelonephritis, and redo-renal surgeries. This study describes a modified retrograde nephrectomy technique and its outcomes in 40 cases. Methods We reviewed 40 cases where the retrograde nephrectomy technique was used. Surgeons opted for this method based on intraoperative findings and initial difficulties in accessing the lower pole area. Results Traditional dissection was challenging due to adhesions in the lower pole. The retrograde technique, starting from the renal hilum, allowed early ligation of renal arteries and veins, reducing bleeding risks and facilitating safer caudal dissection. Conclusions The retrograde nephrectomy technique offers a safer and more efficient alternative for complex nephrectomies. Early vascular control minimizes hemorrhage risk, making it a valuable method in challenging renal surgeries.

Sacral Agenesis: Late Presentation and the Psychological Impact of Delayed Diagnosis.

Sacral agenesis (SA) is a rare condition characterized by the absence of one or more lower sacral vertebral bodies. In India, children with this condition often present late with symptoms primarily related to urinary and bowel dysfunction. Maternal diabetes is the only confirmed risk factor, significantly elevating the incidence rate. We discuss a case of a nine-year-old female who presented to the pediatric outpatient department (OPD) with chronic constipation and urinary retention, having experienced symptoms since infancy. Initial investigations at peripheral hospitals had yielded no clear diagnosis, leading to undue psychological distress to the child and family. The child had been born to a mother with diabetes mellitus during pregnancy. Physical examination revealed mild dehydration, anemia, and sacral dimpling. Further evaluation showed renal injury and SA confirmed by MRI, along with other associated findings. This case report highlights the importance of early diagnosis and intervention in pediatric SA, especially given the risk of renal disease progression. The treatment in this case included clean intermittent self-catheterization (CIC), dietary management, and counseling on renal health. Crucially, uncovering the root cause provided immense psychological relief to the child and her family. Pediatric SA remains a diagnostic challenge, often leading to psychological distress in affected individuals who present late. Early recognition and comprehensive management are crucial, especially in cases associated with maternal diabetes, to mitigate the risk of renal complications and improve the overall quality of life for affected children.

The Management of Postoperative Atrial Fibrillation (POAF): A Systematic Review.

Postoperative atrial fibrillation (POAF) refers to new-onset atrial fibrillation (AF) that develops after surgery and is associated with an increased risk of mortality and thromboembolic events. The optimal management and treatment methods for POAF complications are not yet fully established. This systematic review aimed to evaluate the various treatment and management approaches currently available in terms of their suitability, efficacy, and side effects in handling POAF incidence post-surgery. Google Scholar and PubMed electronic databases were searched extensively for relevant articles examining the various management techniques currently used to manage POAF and published between 2018 and 2023. Data were collected on the type of surgery the patients underwent, POAF definition period, intervention, and outcome of interest. Following a systematic assessment guided by the inclusion criteria, 10 of the 579 studies retrieved were included in this study, and 293,417 POAF cases were recorded. Three of these studies used different rhythm control and rate control treatments to manage POAF cases, while seven studies used various anticoagulation therapies to manage POAF incidence. For asymptomatic patients within one to three days of surgery, rate control is sufficient to manage POAF, and routine rhythm control is not needed; rhythm control should be reserved for patients who develop complications such as hemodynamic instability. Anticoagulation was performed in patients whose POAF exceeded four days after surgery. Anticoagulation was associated with an increased risk of mortality, stroke, thromboembolic events, and major bleeding in patients who underwent coronary artery bypass graft (CABG) surgery. In contrast, in a few other studies, anticoagulation treatment led to improved outcomes in patients who developed POAF. A wide range of management methods are available for POAF after different types of surgery. However, there is only limited evidence to guide the clinical practice. The data available are mainly retrospective and insufficient to accurately evaluate the efficacy of the various management methods available for POAF. Future research should make efforts to standardize the treatment for this condition.

Comparison of Efficacy and Safety Between Roux-en-Y Gastric Bypass (RYGB) vs One Anastomosis Gastric Bypass (OAGB) vs Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Systematic Review of Bariatric and Metabolic Surgery.

In recent years, combined restrictive and hypo-absorptive procedures have gained widespread acceptance. The rationale of this systematic review is to compare the safety and efficacy between Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Eighteen eligible studies were finalized for this review. Weight loss outcomes were greater with SADI-S (5 years) and OAGB (10 years). SADI-S offered better resolution of diabetes whereas hypertension and dyslipidaemia resolution were better with OAGB. Although early complications and mortality were higher with SADI-S, late complications were more frequent with RYGB. Both SADI-S and OAGB are as effective as RYGB for weight loss, but OAGB offers lesser complications. However, more data is imperative to determine the next gold standard procedure.

Appendix Playing Hide and Seek: A Variation to Amyand's Hernia.

Amyand's hernia is a rare condition where the appendix becomes trapped in the inguinal hernia sac, leading to severe complications if left untreated. Treatment typically involves surgical repair of the hernia, with the removal of the appendix if necessary. This case report presents a 65-year-old male with compromised cardiac status and a right inguinal hernia, confirmed by ultrasound. The surgery was performed under local anesthesia, and the appendix was normal and reduced back. The patient was discharged on the next day of surgery after an uneventful course in the hospital. There is a difference of opinion regarding the need for an appendectomy in an Amyand's hernia with a normal appendix, with the appendix dancing in and out of the inguinal canal while coughing on the table. The decision to remove or leave a normal appendix in this situation should be based on several factors, including the patient's age, appendix anatomy, and extent of intraoperative inflammation. In conclusion, local anesthesia can be a safe and effective option for patients who are not fit for general or spinal anesthesia. The decision to remove or leave a normal appendix in Amyand's hernia should be based on several factors.

A Systematic Review of Fibonacci Sequence in the Human Abdominal Wall: Facts and Reality.

The Fibonacci sequence is undoubtedly found in nature such as in the spiral of galaxies and flower petals. Fibonacci numbers are a sequence in which each number is the sum of the two preceding ones. The ratio of two consecutive Fibonacci numbers, also called the golden proportion, approximately equals 1.618. We analyzed the existence of Fibonacci numbers and golden ratios in the field of hernia and abdominal wall reconstruction. We found substantial evidence of the use of the golden ratio in siting of the umbilicus. The Fibonacci numbers also showed up frequently in the anatomy of the abdominal wall. However, this was not as appropriate as the other instances in the human body or in nature.