Outcome of modified fleur-de-lis latissimus dorsi myocutaneous flap for breast reconstruction.

BACKGROUND: Reconstruction of breast following mastectomy is important in terms of rehabilitating patients of breast cancer. Numerous approaches have been used in the reconstruction process. A procedure that has gained interest of the patients is reconstruction of breast using the autologous form. Main objective of this study is to determine the outcomes of modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction. METHODOLOGY: This is a retrospective case series which was conducted at the Department of Plastic Surgery, SIMS/Services Hospital, Lahore, from January 2020 till December 2022. 184 patients age 25-60 years and Females with a history of mastectomy, who had to undergo creation of breast shape using a tissue flap from another part of the body at the site of breast following mastectomy were included. All patients were subjected to standard procedure of breast reconstruction with latissimus dorsi flap using modified fleur-de-lis technique and postoperatively weekly assessment in the first month and then monthly until 3 months was carried out and outcome of the study was analysed. RESULTS: The mean age and VAS score of the patients was 49.7 ± 9.17 and 6 ± 2.21, respectively. 57.1 % patients have DCIS, benign in 38 % patients and other tumours were present in 4.9 % patients. Immediate versus delayed reconstruction was done in 63.6 % versus 36.4 % patients respectively. Good aesthetic outcome was achieved in 80.3 % patients CONCLUSION: Modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction yielded a good aesthetic outcome in the majority of the patients.

Evaluating the Safety and Quality of Diagnostic Colonoscopies Performed by General Surgeons: A Retrospective Study.

Introduction Colonoscopy, which is a challenging procedure and requires adequate time to master the skill, is the procedure of choice to visualize colonic mucosa to rule out many colonic pathologies. There is a dearth of published information from real clinical experiences regarding successful procedures and limitations. The end point of colonoscopy is the visualization of the cecal pole by intubating the cecum. Many Europeans and English health organizations recommend that the procedure should have a completion rate of around or above 90%. Gut preparation is an important determinant for a successful procedure and obviates the need for further invasive and/or expensive procedures such as imaging. The majority of colonoscopies are being performed by gastroenterologists (GI) throughout the world, and the role of a surgeon as an endoscopist is in debate. Before this study, neither a retrospective nor a prospective evaluation of the general surgeon's (GS) endoscopy's quality and safety had been evaluated in our institution. Material and method This retrospective observational study was carried out from 1 January 2022 to 31 August 2022 in the Department of Surgery at Mayo Hospital, Lahore, to evaluate colonoscopy completion rates, reason for failure, and complications in terms of bleeding and perforation. All patients undergoing lower gastrointestinal endoscopy (LGiE), both elective and emergency, were included. Patients under 15 years of age and patients known to be hepatitis B-positive or hepatitis C-positive were excluded from the study. All relevant data were entered into a data sheet. Qualitative variables such as gender, cecal intubation, adjusted cecal intubation, gut preparation, reasons for failed colonoscopy, analgesia use, and complications (bleeding and perforation) were calculated as frequency and percentage. Quantitative data such as age and pain score were reported as mean and standard deviation (SD). Details obtained were tabulated and analyzed via the Statistical Package for Social Sciences (SPSS) version 29.0 (IBM SPSS Statistics, Armonk, NY). Results A total of 57 patient data were collected; 35.1% (n=20) were female, and 64.9% (n=37) were males. The cecal intubation rate (CIR) was 49.1% (n=28), and the adjusted rate was 71.9%, excluding incompleteness due to mass obstructing lumen, 8.8% (n=5); planned left colonoscopy, 7% (n=4); sigmoidoscopy, 3.5% (n=2); distal stoma scope, 1.8% (n=1); and colonic stricture, 1.8% (n=1). The prevalent reason for failed colonoscopy was inadequate gut preparation (15.8% {n=9}). Other reasons include patient discomfort, 3.5% (n=2); looping of scope, 7% (n=4); and acute colonic angulation, 1.8% (n=1). No complications were recorded. Conclusion This study shows that colonoscopy can be done by general surgeons safely and effectively with adequate training. High rates of cecal intubation emerge during colonoscopies performed under deep sedation and by skilled colonoscopists. Adequate bowel preparatory regimen is compulsory for quality procedure.

Gastric Staple Line Reinforcement With Ligation Clips for Hemostasis in Laparoscopic Sleeve Gastrectomy.

INTRODUCTION: In Pakistan and worldwide, there is a lack of literature on the role of ligation clips in controlling hemostasis in laparoscopic sleeve gastrectomy. ligation clips are being used to secure hemostasis and act as staple line reinforcement to prevent intra-operative and postoperative bleeding. Data can be utilized to reflect the role of staple line reinforcement with ligation clips so as to guide surgeons about its safety and efficacy. METHODOLOGY: This retrospective observational study was conducted at the Shalamar Hospital, Lahore, Pakistan, and included 120 patients. The patients' demographic parameters, BMI, intra-operative and postoperative bleeding in terms of hematemesis, melena, and fall in hemoglobin (Hb) postoperatively were compared to preoperative Hb and recorded. RESULT: One hundred and twenty cases of laparoscopic sleeve gastrectomy (LSG) were included with a mean age of 44.77±12.05 years. The mean BMI was 52.06±13.85 preoperatively. The mean drop in hemoglobin was 0.04±0.26 with a p-value of 0.07, which is statistically insignificant. Among 120 cases, two (1.7%) patients reported episodes of melena, and four (3.3%) patients reported hematemesis. Postoperative hypotension was recorded in six (5%) patients and eight (6.7%) patients had postoperative tachycardia. CONCLUSION: This study shows ligation clip application along the staple line is an effective means of hemostasis similar to suture application.

Accuracy of RIPASA and Lintula Scores in Diagnosing Acute Appendicitis Using Surgical Findings as the Gold Standard.

BACKGROUND: Appendicitis is an inflammation of the vermiform appendix's inner lining that spreads to its other sections. Appendectomy is still the standard way to cure appendicitis. The diagnosis of acute appendicitis is still clinical and supported by a raised neutrophilic count and imaging studies; moreover, scoring systems, such as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Lintula scores, help the clinicians in the diagnosis. The main objective of this study was to establish the diagnostic accuracy of RIPASA and Lintula scores for acute appendicitis using surgical findings as the gold standard, in an Asian population. METHODS: This was a retrospective cohort study conducted at the Department of Surgery, Mayo Hospital, Lahore, and Department of Surgery, Services Hospital, Lahore. This study was conducted from January 2020 to January 2022, for the duration of two years. A total of 120 patients were enrolled after meeting the inclusion criteria, and demographic data were obtained. Lintula and RIPASA scores were recorded, and patients were classified as positive or negative based on histopathological findings. IBM SPSS Statistics, version 26 (IBM Corp., Armonk, NY) was used to evaluate all of the gathered data. RESULTS: The average age of the patients in this study was 37.39±14.36 years, with a male-to-female ratio of 1.14:1. Taking surgical finding as the gold standard, RIPASA scoring had a diagnosis accuracy of 91.67% while the Lintula score had a diagnostic accuracy of 79.17%. CONCLUSION: While both the RIPASA and the Lintula scoring systems were accurate, the RIPASA scoring system outperformed the Lintula scoring system when surgical findings were used as the gold standard.

Hereditary angio-oedema as a rare cause of small-bowel obstruction.

A 52-year-old man with known hereditary angio-oedema (HAE) presented with a 2-day history of progressive severe abdominal pain, distension, nausea, vomiting and constipation. CT of his abdomen and pelvis showed small-bowel obstruction and ascites. HAE is a rare autosomal dominant disorder caused by a C1 esterase deficiency and involves episodic oedema of subcutaneous and mucosal tissues. It commonly affects the face and limbs, causing deformity; the respiratory tract, causing life-threatening laryngeal swelling; and the gastrointestinal tract, causing small-bowel obstruction. An infusion of a C1 esterase inhibitor was given to the patient. His symptoms resolved within 6 hours, and a repeat CT showed complete resolution 24 hours later. Small-bowel obstruction in HAE is often misdiagnosed, leading to ineffective treatment and unnecessary surgery. Therefore, this should be suspected in patients with HAE presenting with an acute abdomen, and clinicians should understand the unique treatment required.