To Study the Biochemical Markers for the Prediction of Fistula Formation after Pancreatic Resection Surgery in the Post Operative Period

Background: To study and assess the potential laboratory biomarkers for foreseeing postoperative pancreatic fistula (POPF) after pancreatic resection medical procedures. Subjects and Methods: 64 patients were studied from Jan 2008 to Dec 2018. All patients undergoing Pancreatic resection surgeries like Pancreaticoduodenectomy (PD), distal Pancreatectomy (DP) for tumors of the periampullary region, Pancreatic body or chronic pancreatitis Clinical data of the patients, surgical approach, pancreatic parenchymal tissue consistency, histopathology of the specimen, white blood cell count and blood amylase levels tube Drain fluid amylase were recorded and analyzed. Correlations between these parameters and postoperative pancreatic fistula (POPF) were assessed. Results : 22 out of the 64 (34.37%) patients developed POPF. The fistula was graded according to the ISPG classification. It was Grade An of every 10 (45.45%) patients, grade B in 8 (36.36%), and grade C in 4 (18.18%),.On univariate and multivariate strategic relapse investigations, higher amylase levels in the stomach waste liquid on a postoperative day (POD)1 and higher serum amylase levels on POD4 indicated a critical relationship with fistula arrangement in the post-operation period (POPF) (P < 0.05). On ROC (recipient working trademark bend) examination, amylase cut-off degree of 2270.67 U/L in the stomach waste liquid was related with a 76.6% affectability and 82% particularity [area under the bend (AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 53.2 U/L was related with a 74.6% affectability and 72.9% explicitness (AUC: 0.784; P = 0.05). Conclusion: Post-operative channel liquid amylase levels on day 1 and serum amylase level on day 4 speak to interesting biomarkers related to POPF improvement after the pancreatic medical procedure.

Comparative Study of Role of Laparoscopic Vs Conventional Management in Peritonitis

Background : A very commonly encountered case in the field of general surgery is peritonitis. In our study, we analyse 100 cases of acute peritonitis due to various causes, being managed conventionally and laparoscopicaly. Subjects and Methods: The observational, continuous, prospective, single centre study was carried out at Gujarat Adani Institute of Medical Science at GK General Hospital Bhuj. The study was conducted for a total duration of 27 months from October 2017- December 2019 (Patients were enrolled in the study and followed up till the day of admission to the day of the discharge). Total 100 patients are enrolled in the study but there were no intervention done. We compare the outcomes in terms of postoperative pain, removal of ryles tube, urinary catheter, drains, early ambulation and duration of hospital stay. Results: Maximum patients were diagnosed as having pre pyloric peptic (pyloric with antral perforation) perforation (45%) followed by jejunal perforation (17%). successful laparoscopic surgery without conversion was done in 92%. study total 4 cases of laparoscopic managed group needed to convert in open including 2 duodenal perforation cases, 1 sigmoid colon perforation case and 1 ascending colon perforation. Conclusion: Laparascopic intervention to be better of the two provided availability of skill and setup.

A Rare Case: Gall Stone Induced Acute Pancreatitis with Normal Amylase and Lipase Levels

Acute pancreatitis (AP) is most commonly diagnosed by increased values of serum amylase and lipase. Acute pancreatitis where value of serum amylase and lipase is normal is very rare. This is a case of gall stone induced AP where levels of serum amylase and lipase are normal but the clinical suspicion and imaging are strongly confirming pancreatitis.

Assessment of the Role of Laparoscopic Management in Patients with Complicated Appendicitis

Background: Present research aimed to evaluate the wellbeing and the effectiveness of laparoscopy for managing complicated appendicitis. Subjects and Methods: Present descriptive research was carry out on 50 patients at tertiary care institution of Gujarat for the period of 1 year. This study is including patients of complicated appendicitis undergoing laparoscopic management. Parameters studied included Age, Gender, WBC count, wound infection and hospital stay. Results: There was increase of total leucocytic count (leukocytosis) in most of the patients; Mean WBCs was 12.71 5.37. 33 patients had pus free IPF collection and perforated appendicitis (PA), 11 patients had turbid free IPF collection with AA (highly inflamed appendix), 2 case was mucocele of the appendix, 2 cases of appendicular abscess (3.3%) and 2 cases of gangrenous appendix. Conclusion: management of complicated appendicitis laparoscopically is practicable, secure and can present a small occurrence of infectious impediments, fewer post-operative pain, fast revival and improved cosmesis on the cost of extended operating time than OA.

Efficacy of Single Dose versus Multiple Dose of Pre-Operative Antibiotic: Teaching Hospital Based Study

Background: The major crisis in any type of surgery is understood to be Surgical Site Infection (SSI). Although laparoscopic cholecystectomy is a nominally invasive procedure, there is a dominant prevalence of SSI in patients. It is also believed that prophylactic antibiotic has major impact in reducing SSI. Subjects & Methods: Seventy cases were enrolled in this study with knowledgeable consent. The study was carried out over a time period of ten months. The subjects acknowledge for elective laparoscopic cholecystectomy were incorporated in our study. Results: Out of the 70 randomized patients, 35 were allotted in single dose (SD group) while 35 patients were allotted in multiple doses (MD group), who got planned treatments and were then investigated. Of the 70 patients, female patients were 58(82.9%) and males were 12(17.1%). Total 43.62 12.18 years was the mean age of patients having symptomatic cholelithiasis, with 18 years as minimum and 77 years as maximum age. The peak of disease was documented in the age group of 30 to 39 years (28.6%). Conclusion: Utility of single antibiotic dose before anesthesia induction in laparoscopic cholecystectomy was likewise efficient as the use of multiple antibiotics doses in surgical site infection of postoperative periods.

Prevalence of Peptic Ulcer Disease among the Patients with Abdominal Pain at Tertiary Care Institute of Gujarat

Background: To establish the occurrence of peptic ulcer disease amid the Subjects with abdominal pain at tertiary care institute of Gujarat. Subjects and Methods: present research was performed at the Department of Surgery, tertiary care institute of Gujarat, for the period of one year in 200 patients with abdominal pain and diagnosed with peptic ulcer disease. Information was composed utilizing pre-designed questionnaire. Results:The majorities of participants was females, most were aged between 18 to 25 years. Around 97% had pain in the epigastric region. Gastric ulcers preponderate for 65% patients in current research, except refused during the later existence of the epoch, as the occurrence of duodenal ulcers stayed stable, however amplified rather the later phase. Conclusion: An extensive diversity of subjects with abdominal pain was documented amid the subjects. On the other hand, the socio-economic situation and educational levels of the Subjects with the illness were below par.

Effect of CO2 Pneumoperitoneum on Liver Function Following Laparoscopic Cholecystectomy

Background: Laparoscopic provides access to abdominal cavity for both diagnostic and therapeutic surgical interventions which were previously only possible through laparotomy. Recent studies have shown marked rise in serum liver enzymes after laparoscopic surgeries which is considered to be related to the impaired liver and splanchnic perfusion. The present study has been carried out with the aim to comprehend changes in liver enzymes after laparoscopic vs conventional cholecystectomy and the effects of these on outcomes of surgery. Subjects and Methods: Between January 2018 and June 2019, 100 patients with symptomatic gall stones which were eligible for cholecystectomy were enrolled in this prospective clinical observational trial. Randomisation to laparoscopic or open cholecystectomy was performed by using a sealed envelope technique just before surgery. All cases were operated by the same consultant surgeon with a standard anaesthetic protocol. Liver function tests were performed before surgery, at 24 hours and day seven postoperatively. Results: In the laparoscopic group, a statistically significant rise in liver enzymes both aspartate aminotransferase and alanine aminotransferase was observed after 24 hrs of surgery as compared to preoperative values (p<.001) and then again touching normal serum level on 7th day postoperatively. Whereas in open cholecystectomy patients, only a slight variation in the liver enzymes was observed, which was not significant compared to preoperative level (p>.05). No statistically significant changes in serum level of GGT, ALP and bilirubin was seen in either group. No mortality or bile duct injury was observed in this study. Conclusion: Transient elevation in level of liver enzymes occurs after cholecystectomy in both open and laparoscopy group but more in laparoscopic arm attributed to CO2 pneumoperitoneum with possibly some other factors contributing to this. These changes return to normal in a week time after the procedure, and no major complication is generally seen in these patients with normal preoperative liver function, but these temporary derangements at times may be of concern to surgeons for its implication to the integrity of biliary tract.

Assessment of Usefulness of CRP, PMN Elastase, PCT and Il- 6 as Prognostic Factors in Patients with Acute Pancreatitis

Background: Acute pancreatitis is an inflammatory disease of the exocrine pancreas with rapid onset. The present study was conducted to assess the usefulness of CRP, PMN elastase, PCT and IL- 6 as prognostic factors in patients with acute pancreatitis. Subjects and Methods: The present study comprised 53 patients who presented with a diagnosis of Acute Pancreatitis. CRP was estimated by turbidimetric immunoassay using CRP/U2A-000 kit. PMN-Elastase was estimated by solid-phase enzyme immunoassay. Procalcitonin was estimated by the immuno- chromatographic test. IL-6 was estimated by Immuno-enzymatic assay. Results: There were 47 males and 6 females in the present study. The mean SD CRP in patients with mild pancreatitis was 44.35 53.04 and in severe pancreatitis was 174.80 14.55, PCT was seen in 4 in mild pancreatitis patients and 12 in severe pancreatitis patients, PMN- elastase level was 3.89 1087 in mild pancreatitis and 3.99 2.75 inn severe pancreatitis patients, IL-6 level was 129.63 319.08 in mild pancreatitis and 1166.76 818.06 in severe pancreatitis patients. The difference was significant (P< 0.05). CRP had higher (100) specificity as compared to PCT (81), PMN- E (10) and IL- 6 (90), Specificity found to be 88, 81, 97 and 94 respectively, PPV was 84, 74, 67 and 90 respectively, NPV was 100, 87, 62 and 94 respectively, accuracy was 92, 81, 62 and 92 respectively, AUC was 0.97, 0.81, 0.43 and 0.95 respectively. Conclusion: Authors found that CRP is the single best predictor of the severity of acute pancreatitis. IL-6 and PCT also are reliable predictors. PMN-Elastase needs to be assessed in patients with acute pancreatitis presenting early in the course of the illness.

Direct Vision Internal Urethrotomy (DVIU) and Regular Clean Self Intermittent Catheterization (CSIC) For Short Bulbar Urethral Strictures: A Durable Solution

Background: To evaluate durability of DVIU results and recurrence of stricture if the CSIC was done regularly up to one year and weekly thereafter. Subjects and Methods: This retrospective study was conducted in the Department of Urology at tertiary care teaching hospital of Rajasthan, India. Files of all patients operated between January 2015 and July 2018 for single bulbar urethral strictures of less than 1-1.5cm size in length, iatrogenic, idiopathic, traumatic or inflammatory origins were evaluated. Patient with multiple or complicated strictures of post urethroplasty, post hypospadias repair, previous radiation or multiple DVIU were excluded from the study. Data of all patients who were on CSIC following direct vision internal urethrotomy were evaluated at 3, 6, 12 and 24 months. Results: Mean age of patients was 41.13 years with range in between 26-74 years. Most common cause of urethral strictures were idiopathic 66 (58.92%) followed by iatrogenic 27 (24.11%) causes. After 24 months of follow up 95 (84.82%) patients maintained urethral caliber up to 16 Fr. Failure or recurrence was found in 17 (15.18%) patients who required intervention. Conclusion: Direct vision internal urethrotomy (DVIU) with regular clean intermittent self-catheterization (CSIC) was found good success rate in bulbar urethral strictures upto 1 cm in selected patients.

A Prospective Study of Clinical Factors (BMI, DM) Influencing Healing of Abdominal Incisions Correlated with Tissue Expression of MMP2, MMP9 and TIMP

Background: There is a dynamic and reciprocal interaction among ECM and involving cells, cytokines, growth factors and proteases (MMP/TIMP). The controlled degradation of ECM by extracellular proteases particularly MMP/TIMP and serene proteases forms the basis of wound healing. To study clinical factors (BMI, DM) influencing healing of acute abdominal surgical wounds as graded by tissue expression of MMP 2, MMP 9 and TIMP. Subjects and Methods: The present study was conducted in 46 patients in the Department of General Surgery, Kamineni Hospitals, L.B. Nagar, Hyderabad. Results: Type II DM was found in 63 % of patients and found to be having significantly affecting wound healing (p = 0.0017). Wound healing was delayed in uncontrolled DM. Diabetics with healed wound had increased expression of MMP-2 and decreased expression of MMP-9 while Diabetics with non-healed had strong expression of MMP-9 and TIMP as compared to MMP-2. Obesity was seen in 47.82 % of patients and significantly affected wound healing (p = 0.0022). Obese patients with healed wounds had increased expression of MMP-2 and MMP – 9 with decreased TIMP levels. Conclusion: The present study strongly supported tissue expression of MMP-2, MMP-9 and TIMP 2 balance between 7-14 days as a good predictor of wound healing in abdominal laprotomy wounds.