Retrospective histopathologic findings of routine cholecystectomy specimens in a teaching hospital in North East India.

Background: Cholecystectomy is one of the most common general surgical operations performed worldwide. Limited data is available about the histopathological diagnoses of various gallbladder diseases in North Eastern part of India even though a higher incidence of gallbladder cancer has been reported from this part of the Country. Hence, a retrospective review of the histopathological findings of routine cholecystectomy specimens was done to assess the incidence of gallbladder cancer and other gallbladder pathologies. Aims and Objective: To study the incidence of gallbladder cancer and other pathologic findings in routine cholecystectomy specimens. Methodology: A retrospective study of the histopathological findings of cholecystectomy specimens with presumed benign gallbladder diseases who had undergone cholecystectomy from June 2013 till October 2021. Results: A total of 1683 patients had undergone cholecystectomy during the study period. In total, 1354 patients underwent laparoscopic cholecystectomy and 339 patients underwent open cholecystectomy. Gallstones were present in 1631 patients. Chronic cholecystitis and cholesterosis were the most common histopathologic findings, followed by pyloric metaplasia. Unsuspected gallbladder cancer was detected in eight patients (0.48%). Conclusion: Chronic cholecystitis was the most common histopathologic finding followed by pyloric metaplasia. Gallstones were found in most patients. Incidental gallbladder cancer was detected in 0.48% of patients.

A case control study of needlescopic herniotomy versus open herniotomy in children.

Introduction: Since the inception of laparoscopy, it has been explored in many fields of surgery, like in the abdomen, hernia, thorax, etc., Laparoscopic hernioplasty in adults is being practiced by many surgeons nowadays. However, the role of laparoscopic inguinal hernia repair in pediatric patients is not well-established, even though it is being explored as an alternative to open herniotomy procedure. In the present study, laparoscopic needlescopic hernia repair was compared with the conventional open herniotomy procedure. Material and Methods: The study was a case-control study conducted in a tertiary care hospital in northeast India during 2018-2021. A total of 25 patients underwent needlescopic hernia repair, the outcome of which was compared by collecting data of 25 more patients who earlier underwent open herniotomy repairs. Results: The laparoscopic needlescopic repair took a longer operative time as compared to the open technique with a smaller-sized incision. Conclusion: Laparoscopic needlescopic hernia repair is a safe and feasible procedure with a similar outcome to open herniotomy but with a smaller scar.

Role of aluminium paint on the management of peristomal skin excoriation . A case.control study.

Introduction: Peristomal skin excoriation is the most common complication of any stoma, especially of ileostomy and entero-cutaneous fistula. Effluent is erosive to skin and at times leads to excoriation of skin and pain or discomfort to the patient. Many strategies or local medications are being used to treat excoriated skin and give comfort to the patient. Aluminium paint is a cheap and effective means of managing skin excoriation. Materials and Methods: This case-control study was conducted in NEIGRIHMS from January 2015 to October 2020 on the role of aluminium paint for the management of skin excoriations due to stoma and fistula. A total of 19 patients were managed with aluminium paint and compared with the data of 19 other patients who were managed by conventional dressings as controls. Results: Aluminium paint helped in the earlier healing of skin excoriations and give comfort to the patients as compared to normal dressings. Conclusion: Aluminium paint is safe and cost-effective skin barrier to prevent and to manage skin excoriations.

A clinical study on surgical causes of Hematuria.

INTRODUCTION: Hematuria is a clinical sign and symptom that every individual would have a worst nightmare and invokes a physician to carefully evaluate possible causes of hematuria. It may be medical or surgical causes. A thorough examination is required to exact the primary pathology. As such, a study on hematuria in North east India is not sufficiently researched or published. MATERIAL & METHODS: Here we present an observational study in our institution on that very topic. A study was done purely on surgical causes of hematuria on symptomatic patients. It was done on the inpatient and outpatient basis in Assam Medical College, Dibrugarh during the period of 2016-2019. Total 43 patients were evaluated, who came with symptomatic hematuria. RESULTS: Out of 43 cases of symptomatic hematuria, 34 were male and 9 were females patients. Carcinoma urinary bladder was the commonest cause of hematuria, followed by BPH, urolithiasis, carcinoma prostrate, carcinoma upper urinary tract, etc. CONCLUSION: Benign prostatic hyperplasia was found to be the most common benign cause and carcinoma bladder was the commonest malignant cause of hematuria.

A cross sectional study of risk factors for surgical site infections after laparoscopic and open cholecystectomy in a tertiary care hospital in North East India.

BACKGROUND: Surgical site infection (SSI) after cholecystectomy unduly delays patients' early return to normal activities and also leaves behind relatively disfigured cosmetic scars at the port sites. This prospective study was undertaken to assess the various risk factors leading to SSI in patients undergoing cholecystectomy, both by laparoscopic and open techniques in this part of India for which no data is available at present. MATERIAL AND METHODS: A total of 1507 cholecystectomies (1184 by laparoscopy and 323 by open technique) during a 6 year period. The various risk factors studied were gender, age, BMI, DM, chronic anaemia, COPD, timing of surgery (elective or emergent), influence of surgeon (operated by resident surgeon or faculty), intraoperative bile spillage, etc., Odd's ratio was calculated to see the influence of the factors on SSI and statistical significance was tested by Chi-square test. RESULTS: The overall rate of infection was 3.12% (1.94% in laparoscopy and 7.43% in the open technique). Intraoperative bile spillage, increasing age, increased duration of surgery, laparoscopic cholecystectomy done by resident surgeons, increased intraoperative blood loss, emergent operations done for acute cholecystitis, etc., were associated with higher rates of SSI. CONCLUSION: Meticulous operative techniques avoiding bile spillage and blood loss during cholecystectomy may reduce the chances of developing SSI.

Role of serum C-reactive protein and interleukin-6 as a predictor of intra-abdominal and surgical site infections after elective abdominal surgery.

INTRODUCTION: Infections after surgeries considerably increase patients' hospital stay, thereby prolonging patients' early return to productive life. At the same time, the cost of hospitalization also increases. Therefore, if objective tests can predict infections before it actually happens, then more preventive measures in the form of upgrading antibiotics can be taken which might prevent patients from developing serious infections and thereby reduce morbidity and mortality of surgery. MATERIAL AND METHODS: It was a prospective cross sectional study to assess the efficacy of acute phase reactants C-reactive protein (CRP) and interleukin 6 (IL 6) in predicting infections in patients undergoing routine general surgical operations. A total of 74 patients were included in the study. Laparoscopic surgical procedures were not included in the study to maintain uniformity in the procedures. Data so collected were analyzed by using SPSS version 22. RESULTS: A total of 27 patients developed wound infections postoperatively. The mean rise in the levels of CRP and IL 6 was higher in those patients who developed postoperative wound infections. The positive predictive value and negative predictive value was found to be better with IL 6 than with CRP. CONCLUSION: It may be concluded that a serial estimation of CRP and IL 6 postoperatively can predict infections and may be utilized routinely in general surgical practice.

Primary inflammatory myofibroblastic tumor of stomach-report of a very rare case.

Primary inflammatory myofibroblastic tumor (IMT) is a very rare tumor arising from stomach and it closely mimics gastric GIST. It usually affects the lung and found in children and young patients. The diagnosis of gastric IMT is usually done post-operatively by immunohistochemistry examination where it is seen that IMT is positive to SMA and vimentin. Complete surgical excision is the treatment of choice and local recurrence is usually seen in incompletely resected cases.

Incidence of nonalcoholic fatty liver disease in patients undergoing laparoscopic cholecystectomy.

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) includes a host of disease spectrum ranging from simple steatosis to steatohepatitis, cirrhosis liver, and even hepatocellular carcinoma. NAFLD can occur at all ages, and the highest prevalence is found in the age group of 35-55 years. NAFLD is becoming the commonest cause leading to hepatic cirrhosis, but there is no prescribed therapy for this common condition. Reduction in body weight may reverse the condition. AIM: To find the prevalence of NAFLD in a cohort of patients undergoing laparoscopic cholecystectomy in this part of the country and also to evaluate the usefulness of routine liver biopsy for the diagnosis of NAFLD. MATERIALS AND METHODS: Interventional type of cross-sectional study. In all, 200 consecutive patients underwent a liver biopsy at the end of a standard laparoscopic cholecystectomy, and detailed histopathological examination was done. Clinical, biochemical, demographic, and anthropometric variables were obtained prospectively. NAFLD Activity Score (NAS) was obtained for each patient. Statistical analysis was done using SPSS version 22. RESULTS: A total of 200 patients (140 females and 60 males) were included in the study. In all, 138 patients were categorized as non-nonalcoholic steatohepatitis (NASH), 39 patients as borderline/suspicious NASH, and 23 patients had definitive NASH. A higher body mass index, weight, total cholesterol, low-density lipoprotein, alkaline phosphatise, and weight circumference were found in patients with NASH. CONCLUSION: The high prevalence of NAFLD in patients with gallstone disease may justify routine liver biopsy during cholecystectomy to establish the diagnosis, stage, and possibly direct therapy.

A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy.

INTRODUCTION: Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. AIM: To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). MATERIALS AND METHODS: This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. RESULTS: The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=<0.05). Furthermore, the patients of the SILC group had less post-operative pain, with lesser analgesic requirements (p=<0.05), shorter hospital stay and earlier return to normal activity. CONCLUSION: SILC is feasible and safe in trained hands. It did not compromise the procedural safety, or lead to any complication. The operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.

Schwannoma of Upper Lip: Report of a Rare Case in a Rare Age Group.

Schwannoma is a benign, encapsulated perineural tumour originating from the schwann cells of the neural sheath of peripheral motor and sensory nerves. It may develop at any age but is extremely rare in paediatric age group. The tumour is frequently located on the head and neck region, the tongue being the most common site followed by the palate, floor of mouth, buccal mucosa, lips and jaws. Schwannomas rarely occur in the lip area and it is exceedingly rare in the upper lip. The lesion is usually solitary but can be multiple when associated with neurofibromatosis. The diagnosis is usually confirmed after biopsy and anti-S100 protein immuno-histochemical staining is usually used to identify the tumour. In the present study the patient was a 14-year-old young girl with the schwannoma on the upper lip which is probably the third such case in a paediatric age group being reported and was excised without any recurrence at 2 year after excision.

A comparative study of two-port versus three-port laparoscopic cholecystectomy.

BACKGROUND: Conventionally, laparoscopic cholecystectomy (LC) is performed by using three or four ports of various sizes. As cosmesis is an important aspect of LC, the trend is now towards use of fewer ports, thereby resulting in better cosmesis for patients. The aim of this study was to compare three-port against two-port LC techniques and to see whether there is any advantage in using one technique over the other. SETTINGS AND DESIGN: The study was conducted in the Department of General Surgery of North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) hospital in Northeast India. A prospective comparative type of study was designed. An odd number of patients were operated on by using the three-port technique (Group A), whereas an even number of patients were operated on by the two-port technique (Group B). MATERIALS AND METHODS: Sixty patients with symptomatic gallstone disease were included in the study after obtaining informed consent from each of the patients. All patients were operated on under general anaesthesia. STATISTICAL ANALYSIS USED: Statistical analysis was done using SPSS software version 22. RESULTS: There were 51 female patients and 9 male patients. The mean patient age was 38.67 years. There was less operative time in group A but less postoperative pain in group B. Cosmetic appearance and patient satisfaction for the scar were better in group B. CONCLUSIONS: The two-port method appeared to have better acceptability among patients due to lower pain score and better cosmesis.

Dexmedetomidine in Attenuation of Haemodynamic Response and Dose Sparing Effect on Opioid and Anaesthetic Agents in Patients undergoing Laparoscopic Cholecystectomy- A Randomized Study.

INTRODUCTION: Perioperative procedures are stressful and lead to haemodynamic instability with potentially devastating consequences. Dexmedetomidine is found to have many of the desired characteristics that are required in perioperative period. AIM: To evaluate the ability of pre and intraoperative dexmedetomidine to attenuate stress induced haemodynamic responses, quantifying the anaesthetic agents sparing as well as its cost-effectiveness in patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS: The present single blind randomized study was conducted with 120 ASA I and II consented patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into 2 groups (i.e., group D and group N). Prior to induction, group D received 1 µg/kg of Dexmedetomidine and group N received Normal saline infusion over 20 minutes. Group D also received maintenance Dexmedetomidine intraoperatively. Bispectral index and minimum alveolar concentration monitoring was done in both the groups. Haemodynamic parameters were noted till 100 minutes post laryngoscopy. Opioid and anaesthetic agent consumptions were also noted and cost analysis was done. Medcalc-Version 12.5.0.0 software was used for statistics and p <0.05 was considered significant. RESULTS: Dexmedetomidine attenuated the stress induced haemodynamics responses and produced stable, relatively non fluctuating haemodynamics throughout. The Minimum Alveolar Concentration (MAC) requirement and the consumptions of Fentanyl and Isoflurane were significantly less in the Dexmedetomidine group (p<0.0001). However, despite anaesthetic dose sparing effect the anaesthetic technique was not cost-effective. CONCLUSION: Dexmedetomidine is effective in attenuating haemodynamic responses in laparoscopic surgery and having dose sparing effect on Fentanyl, Propofol and Isoflurane. However, overall this technique is not cost-effective.

Study of Aortic Valve Sclerosis as A Marker of Atherosclerosis in Acute Coronary Syndromes.

INTRODUCTION: Aortic valve sclerosis has been shown to be associated with increased incidence, chances of developing myocardial infarction and even death. The epidemiological risk factors causing calcification of aortic valves have also been found to cause atherosclerosis. AIM: To analyse the epidemiological risk factors causing aortic valve sclerosis which have been studied in details and analysed to see whether they cause any significant increase in the incidence of cardiovascular events. MATERIALS AND METHODS: This prospective case-control study was conducted between 1st Jan 2015 to 31st Dec 2015 in NEIGRIHMS hospital and data for age, gender, socioeconomic status, hypertension, diabetes, tobacco use, Body Mass Iindex (BMI), cholesterol levels, Electrocardiography (ECG) changes and Ejection Fraction (EF) were collected and analysed by using SPSS software version 22. RESULTS: Hypertension, diabetes, weight, BMI, hyperglycaemia and hyperlipidemia were not found to be significantly associated with aortic valve sclerosis in patients presenting with acute coronary syndromes. The presence of aortic valve sclerosis was also not associated with increased risk of cardiovascular mortality and morbidity. CONCLUSION: The risk factors for atherosclerosis were found to be associated with the presence of aortic valve sclerosis more in the control group and hence finding of a sclerosed aortic valve in the apparent normal population might identify those persons at increased risk of developing coronary artery disease and appropriate preventive measures should be taken before the disease sets in.

Tubercular esophagocutaneous fistula.

Tubercular esophagocutaneous fistula is a rare entity with only about four cases reported so far. We report here a case in a young female who has a very long tract but responded well to antitubercular treatment.

Colonoscopic retrieval of migrated copper-T.

Intrauterine contraceptive devices have been in use for a long time as family planning measures, one of its complications of perforating the uterus and migrating into the peritoneal cavity is also well known. Retrieval in such cases depends on the location of the migrated intrauterine devices and involves laparotomy or laparoscopy. We present here such a case that migrated partially into the lumen of the rectosigmoid and was successfully removed using a colonoscope.