Scientific Program

Day 1

KEYNOTE SPEAKERS
  • New Hope in Brain Glioma Surgery: The Role of Intraoperative Ultrasound. A Review

    ARNAS Ospedale Civico-Di Cristina
    Italy
    Abstract

    Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have become relevant in brain tumor surgery, allowing for a more radical and safer tumor resection. IOUS guidance for brain tumor surgery is accurate in distinguishing tumor from normal parenchyma, and it allows a real-time intraoperative visualization. We aim to evaluate the role of IOUS in gliomas surgery and to outline specific strategies to maximize its efficacy. We performed a literature research through the Pubmed database by selecting each article which was focused on the use of IOUS in brain tumor surgery, and in particular in glioma surgery, published in the last 15 years (from 2003 to 2018). We selected 39 papers concerning the use of IOUS in brain tumor surgery, including gliomas. IOUS exerts a notable attraction due to its low cost, minimal interruption of the operational flow, and lack of radiation exposure. Our literature review shows that increasing the use of ultrasound in brain tumors allows more radical resections, thus giving rise to increases in survival.

  • Outcome of surgeries for non-traumatic hollow viscous perforations

    KNR University of Health Sciences
    India
    Abstract

    Patients with non-traumatic hollow viscous perforations present challenge to the surgeons and outcome depends upon location and surgeon skills. Ileal perforation is common surgical emergency in tropical countries due to high incidence of enteric fever and tuberculosis. Present study was to investigate the outcome of surgeries for non-traumatic hollow viscous perforations. This is a prospective observational study carried out in surgical wards in Mamata General Hospital over a period of 04 years. Evaluation of all the patients fulfilling the inclusion and exclusion criteria with respect to history, physical and investive findings, operative findings and postoperative complications in line with the predetermined objectives was done. Various treatment modalities available and their outcome were also evaluated. Benign causes of gastrointestinal perforation constituted majority of non-traumatic gastrointestinal perforations (99%), whereas only 1% case was due to malignancy. Peptic ulcer perforation (54%) was the major cause of gastrointestinal perforation. Simple closure with omental patch was the operative procedure done for all these cases. Small intestinal perforation was found in 27% cases, which was managed by resection and end to end anastomosis. Appendicectomy was done for appendicular perforation (12%). Colonic perforation was seen in 7% cases, which were managed by resection anastomosis or Hartman’s procedure depending on cases. Most common complication was SSI (34%). 03 cases (2.7%) found to have fungal peritonitis, Mortality was 5.4%% and was due to sepsis and septic shock. Aggressive resuscitation and early meticulous surgery is required to decrease morbidity and mortality in hollow viscous perforation cases.

Young Researchers Forum
Speaker
  • Handmade endoloop knotting technique without knot pusher for appendicular stump closure in laparoscopic appendectomy: a novel technique
    Speaker
    Akhilesh Kumar Yadav
    Shri Shankaracharya Institute of Medical Sciences
    India
    Abstract

    Background: In laparoscopic appendectomy intraabdominal knot tying is of a great concern therefore we undertook this study with the objective to devise a handmade endoloop knotting technique without the use of knot pusher thereby reducing the overall cost of laparoscopic appendectomy. Methods: This prospective study was conducted in MMIMSR Ambala from September 2016 to August 2018. All operations were performed by the same surgical team. Mesoappendix was coagulated with bipolar cautery and cut with scissors. Two or three handmade Meltzer loops were placed on base of appendix and tightened using conventional graspers. Results: 50 patients were included in the study. The time spent for preparing and tying one loop was approximately 20-25 seconds. None of the patients had leakage from the appendicular stump. Only one polyglactin suture was used to make three loops. Knot pusher was not used in any of the patients. Conclusions: Handmade endoloop used in this prospective study for securing appendicular stump using conventional laparoscopic graspers was found to be equally safe and can be easily mastered by any laparoscopic surgeon, which will reduce his dependency upon preformed endoloops making the procedure cost effective.

  • Clinico pathological aspects of solitary thyroid nodule- a hospital based prospective study
    Speaker
    Manoj Prabu
    Saveetha Medical College Hospital
    India
    Abstract

    Background: Nodular goitre is a common endocrine problem in the world today. Solitary thyroid nodule is defined as the presence of a palpable nodule in the otherwise normal thyroid gland. Solitary nodules are one of the most frequent presentations of thyroid disorder. Aim: To study the incidence and other clinical parameters of solitary thyroid nodules and to correlate between clinical diagnosis and histopathological examination of solitary nodule thyroid. Methods: A prospective study was done in patients with solitary thyroid swelling, after taking a detailed history, were examined clinically and confirmed with FNAC and underwent thyroid surgery were included in this study. The histopathological reports were evaluated and correlated with clinical diagnosis by standard statistical methods. Results: Majority of the patients were between 21- 30 years of age. Female: male ratio was about 11.5:1. Swelling in front of the neck was the most common presentation. Most common solitary thyroid swelling was the colloid goitre. Commonest surgery performed was hemithyroidectomy. Conclusion: The majority of the solitary nodule of the thyroid was found to be benign, and this illustrates that hemithyroidectomy is the preferred surgery unless malignancy is suspected by fine needle aspiration cytology.

General Surgery
Speaker
  • Study of associationship between gall stone composition and bacteriological spectrum in chronic calculus cholecystitis
    Speaker
    Krishna Kant Singh
    King George’s Medical University
    India
    Biography

    Dr. Krishna Kant Singh completed his MBBS and MS (Surgery) from the prestigious King George’s Medical University, Lucknow, Worked as Senior Resident and CMO Surgery at KGMU, Then Joined as Lecturer KGMU, and is serving as a Senior Faculty of Department of Surgery General

    Abstract

    Biliary Calculus disease is the commonest morbidity effecting Gasterointestinal tract, in the last century gallstoes disease has shown marked elevation with significant demographic variation in the prevalence rates which varies from 15-25% The Pathogenesis of gallstones is multi-factorial also depends on the type of gallstones, in different studies there is a high variation in the incidence of type of gallstones ranging from Cholestrol, 6% to 65%, Pigment- 3% to 77%, and Mixed 17% to 56% In some studies in 50% cases Bile & Center of Gallstones tested positive and the isolates were- Ecoli, Klebsiella, Citrobacter, Enterococcus, Pseudomonas, these studies included both acute and chronic cholecystitis, In other studies show that Bile positivity is more in acute cholecystitis We could not find credible Literature on the associationship between type of gallstones and the microbiological spectrum in Bile, one such study was done in Tamilnadu but the sample size was only 50, moreover no such study could be found for Northern India This motivated us to undertake this study in North India and study the deviations in incidences of predisposing factors and of type of gallstones, incidence of bile positivity and associationship between type of stone and the microbiologial spectrum for only in chronic calculus cholecystitis

  • A proper application of chemotherapeutic agent at the site of anal fissure: a major concern in healing anal fissure
    Speaker
    Ambreen Mannan
    Isra University Hospital
    Pakistan
    Biography

    Assistant Professor

    Abstract

    Background: To show the efficacy of chemotherapeutic agent by special emphasis on its proper application at the site of anal fissure. Methods: All patients were seen in outpatient department and were initially started with 0.2% Glyceryl trinitrate ointment along with sitz bath and psyllium fiber as a primary treatment while 2% diltiazem cream reserved for refractory cases. The follow up visits were made weekly for perianal pain relief and ulcer healing rate. Results: Results in terms of healing of anal fissure and perianal pain relief in 2 or 4 weeks duration were recorded in SPSS version 17. 0.2% GTN ointment showed 75% results in 2 weeks. While complete response was achieved in 95% cases in 4weeks. 2% diltiazem responded in 98% cases in 2 weeks. Non-compliant (2%) abandoned the medical treatment early in the course and proceeded for surgery where 99.99% results were seen in 2weeks only. Conclusions: Conservative treatment is the gold standard for managing anal fissure. Effective counseling of proper application of ointment at the site of anal fissure is emphasized, which is usually failed by the patient due to intense, excruciating peri anal pain and spasmodic sphincter contraction which led them to proceed to surgery.

Endocrine Surgery
Speaker
  • Thyroid autotransplantation following total thyroidectomy in benign thyroid disorders: a new technique to avoid postoperative hypothyroidism
    Speaker
    Ahmed Mohamed Gamal
    Assiut University
    Egypt
    Abstract

    Background: Although Total thyroidectomy has become the operation of choice in treatment of BMNG, it leads to permanent hypothyroidism which lead the patient to take a lifelong exogenous hormone replacement therapy, which involves daily administration of levothyroxine at a dose that must be in close follow-up in terms of thyroid hormone levels. In addition , reaching euthyroid status using hormone replacement therapy can be affected in presence of other medical problems that interfere with absorption of the drug as mal-absorption syndrome. When all these are considered, there is a necessity of a novel method to avoid the occurrence of postoperative hypothyroidism. Methods: A case series prospective study carried out over 30 patients with benign thyroid disorders for whom total thyroidectomy is indicated to evaluate the capacity of auto-implanted thyroid tissue in achieving an euthyroid state without any need for life long hormone replacement therapy. postoperative Assessment consists of repeated thyroid function tests and thyroid scan with complementary SPECT/CT. Results: significant gradual increase in serum levels of T3 and T4 with corresponding decrease in TSH levels returning to normal levels 6-9 months postoperatively. Thyroid scan with complementary SPECT/CT was done for 15 patients to evaluate the functional capacity of the thyroid implant. Among the 15 patients, 13 patients have functioning thyroid implant (success percent:86.6%). whereas 2 patients show non functioning thyroid implant (failure percent: 13.3%). Conclusion: Thyroid Auto-transplantation following total thyroidectomy in benign thyroid disorders is an effective method to prevent postoperative hypothyroidism.

Surgical oncology
Speaker
  • Acute traumatic brain injury induced endotheliopathy and its impact on clinical outcome
    Speaker
    Dr. S. Arulselvi
    All India Institute of medical sciences (AIIMS)
    India
    Biography

    Arulselvi has done her degree in MBBS from Thanjavur Medical college, Tamil nadu, India and MD (Pathology) in Kasturba Medical College, Manipal, Karnataka. India. She is currently working as Professor in dept of Lab Medicine, JPNA Trauma centre of All India Institute of medical sciences (AIIMS), New Delhi, India. She joined this institute since 2005. She have 95 publications in various international and national indexed journals. She has completed and is currently holding various projects funded by ICMR, DST, DBT, DHR and AIIMS institute. She has been awarded the “Indo US academician and Best researcher award” in 2012. She has won 12 awards from various papers and posters in various conferences. She has also been a reviewer to various journals and Associate editor for Journal of Laboratory Physcicians.

    Abstract

    Background: Injury & hypoperfusion induced stimulation of the neurohumoral system leads to endothelial cell activation, glycocalyx degradation, upregulation of procoagulant/ profibrinolytic factors causing acute coagulopathy. TBI associated coagulopathy(TBI-AC) is linked with progression of haemorrhagic lesions, with an overall prevalence of 32.7% and correlates with high risks of mortality. Objective:We designed a prospective study to assess difference in markers of endotheliopathy [glycocalyx shedding (Syndecan-1) and endothelial disruption (Thrombomodulin)] among severe isolated TBI patients with/without early coagulopathy, and determine its effect on 48hr and 30 day mortality. Materials/methods: We screened for and recruited iSTBI patients (GCS ?8) at emergency department. Sampling was done, ?12 hrs. of injury after informed consent, prior to transfusion. Patients with H/O anticoagulants, liver disease, hypotension, extracranial injuries were excluded.TBI coagulopathy was defined based on conventional coagulation tests as INR?1.27 &/or PT ? 16.7sec &/or aPTT ? 28.8 sec. 20 healthy controls were included.Plasma levels of Syd-1 & TM were estimated by ELISA. 48hr &30day mortality were defined outcomes. Results: 120 cases met the inclusion criteria, aged 35.7±12.12 years, 96% males. TBI-AC was had an incident of 41.6%(50). TBI-AC occurred independently of age, gender, GCS. Compared to control, TBI patients had elevated glycocalyx shedding and no evidence of endothelial damage. Although thrombomodulin levels slightly declined, syndecan levels significantly elevated in coagulopathic compared to non-coagulopathic TBI patients [33.7(21.6-109.5) vs. 29.9(19.2-39.5); p0.03]. ROC curve revealed ?30.50 ng/mL as a cut-off for syndecan-1 to identify TBI-AC.TBI-AC was an independent predictor of mortality (61.1%; OR = 4.73; 95% CI 1.68 to 13.3).Glycocalyx shedding was elevated in non-survivors compared to survivors, regardless of TBI-AC [coagulopathic (79.5(30.5-160.5) vs. 22.1(19.9-66.7); p0.0007); non-coagulopathic (36.3(30.3-48.7 vs. 25.3(18.3-36.1); p0.03)], whereas endothelial damage was significantly elevated in non-survivors compared to survivors of only TBI-AC group and not in patients without TBI-AC [15.3(8.5-87.2) vs. 6.4(2.2-13.4). Patients stratified as endotheliopathy (syd?30.50) had high frequency of 48 hr [20.4% vs. 6.6%] and 30 day [44.1% vs. 16.4%] mortality compared to no endotheliopathy. Conclusion:TBI associated coagulopathy was prevalent in 41.6% (50), and was an independent predictor of mortality (OR = 4.73; 95% CI 1.68 to 13.3). Significant elevations in plasma syndecan associated with TBI-AC, whilst thrombomodulin levels did not vary significantly. “High” syndecan-1 levels (?30.50 ng/mL) were significantly associated with elevated risk of early mortality. We recommend clinically, timed interventions aimed at protecting and repairing the endothelium, to attenuate traumatic endotheliopathy and potentially improve outcomes in isolated TBI patients.

  • Effect of early endothelial cell damage markers on surgical and conservative treatment outcome for isolated severe traumatic brain injury patient management
    Speaker
    Dr. Venencia Albert
    All India Institute of medical sciences (AIIMS)
    India
    Biography

    Venencia Albert recently completed her PhD in Laboratory Medicine from All India Institute of Medical Sciences, India. Her doctoral work was based on the interactions between the coagulation system, vascular endothelium, inflammation in severe brain injury cases. Later she moved to study platelet activation and dysfunction with neurocognitive decline and impaired recovery in mild brain injury patients. She is currently working in scientific publishing in the Indian Journal of Medical Journal run by Indian Council of Medical Research. She intends to continue working in novel surrogate blood biomarkers to help reduce costs of diagnosis in TBI cases and elevate standard of care.

    Abstract

    Our aim was to compare the effect of glycocalyx and endothelial injury and coagulation status between isolated sTBI patients undergoing surgical and conservative treatment and its association with mortality. The study was performed on 120 isolated sTBI patients. Syndecan-1, thrombomodulin, TFPI, thrombin activity [thrombin-antithrombin complexes (TAT) and soluble fibrin monomer (sFM)] and degree of plasmin generation [tissue type plasminogen activator (tPA) and Plasminogen activator inhibitor (PAI-1)] was estimated in samples taken in the emergency department prior to any intervention (<12 hours of injury). The mean age of the patients was 35.4±12.6 years (18-65), 88.3% of the patients were male and 80% were aged <50 years. Computed tomography revealed SDH in 45% and SAH in 35.0% patients. 40%(48) patients underwent surgery with mean operation time of 3.3 hours. GCS score was significantly higher in patients undergoing surgery compared to conservative treatment [7(6-8] vs. 5(4-6); p 0.03]. Markedly elevated Syndecan [36.3(26.4-70.5); p 0.001], tPA [133.5(30.2-414.7) vs 87.6(29.1-261.6); p 0.04] and PAI-1 [100.4(62.0-112.8) vs. 78.9 (57.3-1.2.4); p 0.25] levels were observed in patients undergoing surgery compared to conservative treatment. TM, TFPI, TAT and sFM levels were comparable. Mortality rate of patients undergoing conservative treatment was[26.4%(19)] and for surgically treated was [35.4%(17)] (p 0.29). Endothelial damage was comparable between non-survivors and survivors of surgically treated patients (76.4% vs 64.5%; p 0.3), but was higher in non-survivors (68.4% vs 24.5%; p 0.01) than survivors of conservative treatment with OR of 6.6 (95% CI 2.1-21.0) and hazard ratio [HR] of 4.9 (95 % CI 1.7-13.8). Although our results indicate significant degree of endothelial dysfunction and hypercoagulation in isolated sTBI patients undergoing surgery relative to conservative treatment, mortality rate observed between the two groups was statistically comparable. Endothelial damage was an independent predictor and presents a five times higher risk of mortality in conservatively treated patients. Adjunct to clinical indications, syndecan-1 may be useful in informing clinicians at an early stage about which patients will benefit from surgery or intervention.

  • Breast cancer in North-Central Nigeria: Challenges to good management outcome
    Speaker
    Ifeanyi Charles Umoke
    University of Abuja Teaching Hospital
    Nigeria
    Biography

    Dr. Umoke Ifeanyi is a consultant general surgeon at Kubwa general hospital in Abuja Nigeria. He is a fellow of the West African College of Surgeons, FWACS. His residency training was in University of Abuja Teaching hospital, UATH, Gwagwalada Abuja Nigeria. He was a three-time president of the association of resident doctors of Nigeria UATH and Ebonyi State University Teaching Hospital, EBSUTH, Abakaliki, Nigeria chapters. He is a member of the American Society of Clinical Oncology, ASCO, and lead investigator in UATH of the Globalsurg3 collaborative study on the quality and outcome of surgeries for breast, gastric and colon cancers. His research interest is breast cancer especially mechanisms for metastasis.

    Abstract

    Background Breast cancer is a major health burden globally. Now ranked the number one cancer in females, and the leading cause of cancer deaths in females in our environment, outcome indices have remained poor in developing countries. Aim The aim of this study was to ascertain the major challenges to good management outcome of breast cancer patients in our centre. Patients and methods The case notes of all histologically confirmed cases of breast cancer presenting to our centre from January 2016 to December 2017 were reviewed. Information on the variables of interest were extracted using a proforma. Results Fifty-five (55) patients’ case notes were reviewed. All were females. 30.9% of the patients had early disease vs 67.3% with advanced disease. 76.4% had invasive ductal carcinoma. More lesions occurred on the left and the upper outer quadrants.46% of the 37 patients with advanced disease who required chemotherapy completed the prescribed six courses. None of the patients who required radiotherapy received it. Only 1.8% of those who required hormonal therapy were still taking them at two years follow-up. 3.6%, 11%, and 0% used alcohol, oral contraceptives and tobacco respectively. 81.8% had been lost to follow-up at two years while 14.5% had died while on admission. Conclusion This study identified late presentation with advanced disease; poor compliance and adherence to treatment strategies, and poor access to adjuvant therapy as the major challenges to good outcome for this disease.

Surgical Pathology
Urology Surgery
Speaker
  • Ectopic lumbar kidney: A rare presentation
    Speaker
    Ela Haider Rizvi
    People’s College of Medical Sciences and Research Centre
    India
    Biography

    Surgeon

    Abstract

    Ectopic kidney is a rare developmental anomaly. Such kidneys may be asymptomatic or present with vague symptoms or remain unknown during the lifetime. Early detection and recognition of an ectopic kidney can prevent long-term complications. We report a 70-year-old lady with ectopic right kidney who presented with intermittent episodes of lower abdominal pain since one month 1 month. On clinical evaluation a tender lump was palpable in the right lower quadrant of the abdomen. Sonography revealed empty right renal fossa with normally present left kidney. A mass was detected in the right lower abdomen, with probability of ectopic kidney. Further, Multislice computed tomography with 3-D reconstruction demonstrated ectopic right kidney at the level of L4 to L5 lumbar vertebrae. Urine examination revealed pyuria. The patient was managed on empirical antibiotics for UTI with supportive and symptomatic therapy. On the next day, clinically the lump regressed significantly (Dietl's crises) in size, and the tenderness also reduced. The urine culture report grew Escherichia coli. Patients presenting with lower abdominal pain, and a palpable lump in the lower abdomen, one must include ectopic kidney in the differential diagnosis.

Day 2

KEYNOTE SPEAKERS
  • Inguinal Hernia Repair; Tension Free Mesh Repair, A New Technique

    Cairo University
    Egypt
    Abstract

    Abdominal wall hernias represent a common issue in general surgical practice. The definitive treatment of all hernias, regardless of their origin or type, is surgical repair. There is an ongoing debate about whether to repair primary, unilateral inguinal hernias by the laparoscopic or the open method. Many agree that laparoscopic repair is better for bilateral or recurrent hernias, but its use for primary, unilateral hernias is controversial. So, still the open method has the upper hand in unilateral inguinal hernia repair. There are different methods for repair, nowadays; the most popular method is the mesh repair. In this study, we worked on 200 cases of inguinal hernias, through the period of January 2013, to January 2016. Age groups ranging from 29 – 60 years old, all are males, with mean follow up 1.5 years. The aim of this work is to represents the best method for inguinal hernia repair with the least complications especially recurrence and neuralgia. We modified the technique of tension free mesh repair, and we found that by this method we had no recurrence in all cases ( recurrence rate 0 %), we had only 4 cases of post-operative superficial wound infection (2 %) & 2 cases mesh infection (1%) and 6 cases (3%) neuralgia. In conclusion, this method for unilateral inguinal hernia repair can be utilized for almost all adult inguinal hernias with highly effective repair.

  • Robotic-assisted laparoscopic partial nephrectomy (RAPN): A single centre Indian experience

    Muljibhai Patel Urological Hospital
    India
    Abstract

    BACKGROUND: We summarise our experience with RPN emphasising on learning curve, techniques and outcomes. PATIENTS AND METHODS: A retrospective chart review of 241 patients was done. The parameters analyzed were demographics, tumor characteristics, operative details, postoperative outcome and follow-up. RESULTS: 243 renal units in 241 patients (64 males and 177 females) underwent RAPN. The mean age was 51.48 (18-83) years. The mean tumor size was 5.92 (1.3-11.5) cm. operative time was 176.97 (70-350) min.; mean warm ischemia time was 22.62min (0-47). 8 renal units in 7 patients were operated with the zero ischemia There was 1 recurrence. The average nephrometry score was 6.77. The complications were Clavien grade 1 (n=5, Fever), Clavien grade 3 (n=5, 2-need for exploration & 3 need for post-operative intervention for urine leak), Clavien grade 5 (n=1, immediate post-operative myocardial infarction).6 patients developed chronic kidney disease over a period of 10 years. eGFR trend was preoperative 101.25(17.9-182.4), 1 month 88.30(0.69-177.4), 1 years 99.71(11.3-167). CONCLUSION: Our results suggest that RAPN is safe. RAPN offers excellent oncologic control and disease free status in long-term follow up. Nephrometry score is a good tool to predict the challenges anticipated during surgery. RAPN helps in preserving the renal function in long term.

  • Evaluation of different methods of laparoscopic treatment of common bile duct stones

    Tanta University Hospitals
    Egypt
    Biography

    Assistant Lecturer of Gastrointestinal and Laparoscopic Surgery

    Abstract

    Background: Common bile duct (CBD) stones are the second most common complication of gall bladder stones. The best management of patients with CBD stones remains controversial. The aim of this study was to evaluate the methods of laparoscopic CBD exploration (LCBDE). Methods: This prospective study was conducted on 30 patients with CBD stones through 2 years. CBD stricture was excluded. Authors used transcystic and transcholedochotomy approaches for LCBDE either with or without choledoschope. Primary repair of the choledochotomy incision was done. Results: The mean age was 48.90±11.84 years. Biliary colic was the presentation in 63.3% of patients. The transcystic approach for CBD exploration was used in 16 cases without conversion, 11 cases were completed without choledochoscope, while 5 cases with choledochoscopic guided extraction. Choledochotomy approach had been used in 13 cases, 6 cases were completed with choledochoscope and 7 cases without it, two cases of them failed. One case failed from the beginning and was converted to open exploration. 5 ERCP previously inserted stents were removed. The mean operative time was 162.33±74.67 min. Bile leakage occurred in 2 cases following the choledochotomy approach. The mean hospital stay was 3.37?1.38 days. Conclusion: LCBDE is a feasible, effective and safe approach to bile duct stones. Depending on proper training and gaining experience.

Young Researchers Forum
Speaker
  • Jejunal perforation secondary to trichobezoar (Rapunzel syndrome): A rare presentation
    Speaker
    Jitendra Kumar Saroj
    King George’s Medical University
    India
    Biography

    Gen & Laparoscopic Surgeon

    Abstract

    Trichobezoar is a rare disorder. It usually occurs in young and adolescent females associated with some psychiatric illness. Trichobezoar usually accumulate in the GI tract and most commonly in stomach but it can migrate through the pylorus into the jejunum, ileum and colon. Once the bezoar extends from the stomach into the jejunum or further on, it is referred to as “Rapunzel syndrome”. Though initially asymptomatic but over a period of time it may cause gastric mucosal erosion, ulceration, and perforation of the stomach or the small intestine. If unrecognized, tichobezoar may present with intussusceptions, obstructive jaundice, protein-losing enteropathy, pancreatitis and even death. Small trichobezoar may be extracted by endoscopic fragmentation but bezoars like Rapunzel Syndrome, on the other hand, need open surgical removal. Counseling by a psychiatrist is an important part of management to prevent recurrence.

  • Role of magnetic resonance cholangiopancreatography in diagnosing pancreatobiliary pathologies- a prospective study
    Speaker
    Kulkarni Gaurav Chintaman
    Saveetha University
    India
    Biography

    Dr. Gaurav Kulkarni completed his MBBS from Maharashtra University of Medical Sciences, India. He completed his MS General Surgery from Dr.D.Y.Patil University, India and he is currently doing MCh Urology from Saveetha University, India. He has done one poster presentation and one paper presentation in Indian National Conferences. He has one original research article in an Indian National Medical Journal and one original research article in International surgery Journal. He is also one of the co-authors in two original research articles in an international journal of surgery.

    Abstract

    Background: Non-invasive techniques such as ultrasound and CT scan (abdomen and pelvis) are widely used in investigations of pancreaticobiliary disease, though easily available and cheap, have limitations in term of sensitivity. Invasive procedures like ERCP, though considered gold standard for diagnosis of pancreaticobiliary disease, requires highly skilled team of supporting doctors. MR Cholangio Pancreatography (MRCP) is evolving as an effective non-invasive imaging technique for examining patients with pancreatic or biliary diseases. The purpose is to illustrate the findings of MRCP in various abnormalities affecting the pancreaticobiliary diseases. Objective was to study the role of MRCP as non-invasive imaging modality for diagnosis of pancreatobiliary diseases, in diagnosing lower biliary tract pathologies, pancreatic duct pathologies, determining treatment modality in pancreatobiliary diseases, surgical or endoscopic. Methods: This is a prospective study conducted in Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune for a period of two years from July 2015 to September 2017. 60 patients were enrolled in the study, their MRCP was performed following ultrasonography. Results: The MRCP diagnosed the following pathologies- cholelithiasis, choledocholithiasis, CBD stricture, chronic pancreatitis, choledochal cyst, cholangiocarcinoma, pseudocyst of pancreas, sclerosing cholangitis and GB perforation. Out of 60, 32 underwent surgical procedure and 20 underwent endoscopic procedure and 8 were treated medically. Conclusions: MRCP is very accurate in diagnosing CBD and pancreatic duct pathologies. Its helps in deciding the treatment modality for the same. It decides whether the patient requires ERCP and thus cuts down the rate of ‘negative’ ERCP. Keywords: ERCP, MRCP, Pancreatobiliary

General Surgery
Speaker
  • A comparative study of open (Milligan-Morgan) versus closed (Ferguson) haemorrhoidectomy with and without internal sphincterotomy
    Speaker
    Rita Singh
    MNR Medical College and Hospital
    India
    Biography

    Dr. Rita Singh has done her MBBS and MS General Surgery from GSVM Kanpur, UP, INDIA. She has worked in ESI hospital Kanpur, INDIA as a Surgeon and Joined BHEL General Hospital in Hyderabad, INDIA as a Surgeon in 1992 up to 2014 and then joined MNR Medical College, Hyderabad, INDIA as Assistant Professor since Jan 2015. She is currently working at MNR Medical College as an Assistant Professor.

    Abstract

    Background: Normal anal canal contain cushion of submucosa with vascular tissues. When cushions become abnormal , cause symptoms. This clinical condition is known as Haemorrhoids. Haemorrhoidectomy is surgery for Haemorrhoids, which can be performed by Milligan-Morgan (open technique) or Ferguson (close technique)methods. This study is conducted to compare different surgical modalities of treatment for Haemorrhoids. Method: In total 232 patients suffering from Haemorrhoids with or without fissures were included in the study . Patients were categorised in two groups. Patients undergoing open technique were designated as open group, similarly patients undergoing close technique were designated as close group. In both groups for few patients internal sphincterotomy (I.S.) was performed. Post operative pain was assessed by visual analogue scale in all groups, per operative haemorrhage was assessed by number of swabs used during surgery and VAS estimation, operating time and postoperative hospital stay were recorded. Result : 136 patients were suffering from Haemorrhoids with fissures. Of these 84 patients were operated by open technique and 52 patients by close technique. In all 136 patients , internal sphincterotomy was performed . Remaining 96 patients were suffering from only haemorrhoids. Of these 30 patients were treated by open technique with I.S. , 30 patients were treated by close technique only.25 patients were treated by close technique with I.S. and 10 patients were treated by close technique with out I.S. Close group and open group with I.S. experienced less pain compared to without I.S. in both groups. Per operative haemorrhage and hospital stay in close group was less . Operative time in open group was less compared to close group. Conclusion : Ferguson procedure is found to cause less post operative discomfort. Addition of Internal Sphincterotomy is having a positive effect in reducing post operative time.

  • Postoperative complications after total thyroidectomy for benign thyroid diseases
    Speaker
    Mohammed Nazeeh Shaker Nassar
    Menoufia University Hospitals
    Egypt
    Biography

    Nassar MNS has completed his PhD at the age of 34 years from Menoufia University, Egypt. He is lecturer of general surgery Menoufia University, Egypt. He has over 10 publications.

    Abstract

    This is a prospective study on 207 patients with thyroid disorders who were treated with total thyroidectomy in general surgery department, Menoufia university hospital between October 2015 and December 2018. Patients were divided into two groups based on postoperative histopathological findings group (A) included 73 patients with autoimmune thyroid disease while group (B) included 134 patients with non-autoimmune thyroid disease. All patients were followed up for 6 months postoperatively to evaluate vocal cord palsy and hypoparathyroidism. Results: in our study, the rate of temporary and permanent vocal cord palsies were 4.1% and 1.4% in ATD group respectively while in non-ATD group were 1.5% and 0.7% respectively with no statistically significant difference between both groups, whereas the rate of temporary and permanent hypoparathyroidism were 9.5% and 4.1% in ATD group respectively while in nonATD group were 2.9% and 0.7% respectively with significantly higher rate in ATD group. Conclusion: Surgery for ATD is a challenging procedure but safe with a low incidence of general complications and vocal cord palsy when compared with surgery for non-ATD. However, postoperative hypoparathyroidism is significantly higher due to dense adhesions which obscure the surgical field so a special attention should be paid to the parathyroid glands during total thyroidectomy.

  • Correlations between Parathyroid Hormone Level, Adenoma Size, and Serum Calcium Level among Primary Hyperparathyroidism Patients
    Speaker
    Jubran Al Faifi
    Imam Muhammad Ibn Saud Islamic University
    Saudi Arabia
    Biography

    Assistant Professor

    Abstract

    Aim: The main goal of this study is to determine the association of preoperative parathyroid hormone (PTH) levels with parathyroid gland adenoma sizes and serum calcium levels in patients with primary hyperparathyroidism caused by single?gland adenoma. Methods: We included all patients with single parathyroid gland adenoma who were admitted to and underwent parathyroidectomy at Security Forces Hospital in Riyadh during a period of 10 years from January 1, 2000 to October 30, 2011. PTH level and serum corrected calcium were recorded 1 day before surgery. Adenoma size was recorded from pathology reports for all patients. Results: In 35 cases of parathyroid adenoma including 12 males(34.3%) and 23 females(65.7%) with an average age of 48.94 years (±13.52), the average PTH level 1 day preoperatively was 769.94 pg/mL (±793.27), the average largest dimension (LD) of parathyroid adenoma was 2.18 cm (±1.38), and the average calcium level 1 day preoperatively was 2.71 mmol/L (±0.3). The mean PTH level in males was 1098.5 pg/mL compared to 598.5 pg/mL in females (P = 0.068), mean LD of parathyroid adenoma in males was 2.34 cm versus 2.09 cm in females (P = 0.72), and mean calcium level in males was 2.70 mmol/L compared to 2.72 mmol/L in females(P = 0.46). A positive correlation was found between PTH level and adenoma size, with a correlation coefficient of 0.29 (P = 0.095). The correlation between PTH level and calcium level was negative, with a correlation coefficient of ?0.033 (P = 0.85). Negative correlation was also found between adenoma size and calcium level, with a correlation coefficient of ?0.033 (P = 0.85). Conclusion: Based on the findings of this study, preoperative PTH level or serum calcium level cannot be used to predict adenoma size. Further prospective studies with larger sample sizes are recommended.

  • Comparison of differential function of both kidneys in a healthy renal donor
    Speaker
    Bharat Khadav
    Mahatma Gandhi Medical College and Hospital
    India
    Biography

    Surgeon

    Abstract

    Aims and Objectives To ascertain the better functioning kidney in healthy renal donors Materials and Methods It was a prospective comparative observational study where data from the 398 patients who underwent donor nephrectomy at our institute from January 2014 to December 2017. It was an observational study in which Living Kidney Donors were evaluated for their Renal function with help of DTPA scan. The results were analyzed and statistical significance for our results calculated. Results On statistical evaluation of the data the following results were deduced. Out of the 398 patients 298 were female and 100 were male donors. The age ranged from 18 to 68 years with maximum number of donors being in the age group of 41-50years. In both, men and women, the differential function steadily decreased with progress in age and was found to be statistically significant in both right and left kidneys. Discussion The kidneys filter blood, remove waste products, make hormones, and produce urine. The 2 kidneys drain via the ureters into the bladder where the urine is stored. In persons with end-stage renal disease, renal dialysis or kidney transplantation are the treatment options. The glomerular filtration rate (GFR) is considered to be the most important assessment of kidney function. Donor nephrectomy is unique among major surgical procedures, because it exposes an otherwise healthy patient to the risks of major surgery entirely for the benefit of another person. The fractional renal uptake of intravenously administered Tc-99m DTPA, within 2 to 3 minutes following radiotracer arrival in the kidneys, is proportional to the glomerular filtration rate (GFR). Conclusion The main aim of our study was to find out the better functioning kidney amongst the two. And with the help of statistical analysis we were able to adjudge the right kidney a better functioning one. But due to lack of similar studies our results couldn’t be compared with others.

  • Incidence of Thyroid diseases in a tertiary Hospital : A Retrospective Study
    Speaker
    Shengulwar Sayanna Sayanna
    Mallareddy Medical College for Women
    India
    Biography

    Prof. S.Shengulwar graduated( MBBS ) in the year 1978 & Masters degree(M.S.)general surgery in 1983. Both the degrees completed from Marathwada University, Maharashtra state(INDIA). He has a total teaching experience of nine years. He has published four papers sofar. Presently he is working as a professor in the general surgery department of Mallareddy Medical college for women, Hyderabad for the last one year. He has attended many national and international conferences &CMES. He is a member of the local and national level surgeons associations. His research interests are wide-ranging including the latest topics. His special interest is in Breast & Thyroid surgery.

    Abstract

    Background: Thyroid gland diseases are common in India, particularly hilly and tribal areas. The incidence of thyroid conditions, exact figure is not available but about 5 lakh cases come for Medical Treatment all over India. To study the prevalence of common thyroid diseases in the Sangareddy district area, which is near Hyderabad, particularly age & sex specific incidence. Methods: This is a retrospective study conducted at the Maheshwara Medical College and Hospital, Chitkul, Sangareddy district of Telangana State. The data was collected from the registers of General Surgery outpatient department, operation theatre, medical record section and cytology, histopathology registers of pathology department. A total number of 64 patients were included in this study who was admitted at this hospital during the period of 2 years, from January 2017 to December 2018. The data was analysed by proper statistical methods. Results: The study had shown that most common conditions in this area are benign diseases. The age group ranges 21-30 years, female are most vulnerable (37.51%). The pathological benign condition most common is nodular goiter 48.43%. Conclusions: The observations in this study made may be useful in future to diagnose the cases and advice regarding prevention of the disease.

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This cancellation policy was last updated on November 10, 2019

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