Outcome assessment of biliary stricture repair following cholecystectomy in a tertiary care centre.

PURPOSE: Bile duct injuries (BDIs) are the potential grievous complications of cholecystectomy that result in substantial morbidity and mortality. Outcomes of BDI management depend on multiple factors such as the type and extent of injury, timing of repair, and surgical expertise. The present retrospective study was conducted to analyse the risk factors associated with the BDI repair outcomes. METHODS: The data of patients having primary or recurrent bile duct stricture following BDI from 1985 to 2018 were retrospectively evaluated. RESULTS: A total of 268 patients underwent hepaticojejunostomy (HJ). Of the total, 218 patients had primary bile duct stricture, and 50 patients had HJ stricture. The most commonly performed procedure for primary BDI was Roux-en-Y HJ (RYHJ), followed by right hepatectomy, right posterior sectionectomy, and left hepatectomy. All patients with strictured HJ underwent RYHJ, except one who underwent a right hepatectomy. Outcome assessment using the McDonald grading system showed that 62%, 27%, 5%, and 6% of patients with primary bile duct stricture had grade A, grade B, grade C, and grade D complications, respectively, with a mortality rate of 3.21%, whereas 46%, 34%, and 18% patients with strictured HJ had grade A, grade B, and grade C complications, respectively, with a mortality rate of 2%. High-up biliary strictures, early repair, and blood loss > 350 mL are the surrogate markers for failure of repair. CONCLUSION: Management of BDI needs a multidisciplinary approach. The outcomes of both primary biliary stricture and strictured HJ can be improved with management of patients in a tertiary care centre. However, attempts to repair within 2 weeks of injury, Strasberg E4 and E5, and blood loss of > 350 mL may have an adverse effect on the outcome of HJ.

Outcomes of the management of corrosive injuries of the upper digestive tract in a tertiary care center.

Esophageal stricture is the most common delayed sequelae of aerodigestive tract corrosive injuries. Early endoscopic dilatation is an integral part of corrosive injury management. Self-dilatation of the esophagus is effective in preventing stricture recurrence. In this prospective study, we included patients with corrosive aerodigestive tract injury from January 2009 to December 2020. We analyzed the outcome of the endoscopic dilatation and self-dilatation treatments administered to patients with a corrosive esophageal stricture. Among 295 patients, 164 had an esophageal injury, 73 had esophago-gastric injury, 55 had a gastric injury, and 3 had the pharyngeal injury. Of the 295 patients, 194 (81.85%) underwent dilatation, and 13 patients with diffuse esophageal injury underwent upfront surgery. Successful dilatation was performed in 169 (87.11%) patients. Of the 68 patients undergoing self-dilatation, 63 patients achieved nutritional autonomy by 28 days. Early endoscopic dilatation effectively prevents surgery, and self-dilatation appears promising to prevent recurrent esophageal stricture.

Prevalence of carcinoma stomach in a tertiary referral centre in Eastern India and its correlation with endoscopic findings.

Carcinoma stomach still remains a major killer cancer all over the world. Delay in early diagnosis or lack of awareness, infrastructure etc. is the major factor for late presentation in developing countries. This work was carried out to study the prevalence of carcinoma stomach in a tertiary referral centre in Eastern India and its corroboration with endoscopic findings. The aim is to create an awareness regarding early diagnosis of this monstrous killer. The study was conducted on 8706 symptomatic patients attending for upper GI endoscopy, of which 165 patients were found to have adenocarcinoma of stomach and 8 patients with other stomach neoplasms. The age, sex, religious status and economic background were analysed. The endoscopic findings, histological nature and grading, site of the lesions vis-à-vis clinical signs and symptoms were analysed and statistically reviewed. Of the total 165 cases of carcinoma stomach, highest number of cases (24.8%) were among 40-49 years of age, followed by 50-59 years (23.7%). The male sex (67.6%) and patients with low socio-economic background (75.7%) were the worst sufferer. On gross microscopic findings of endoscopy, ulcero-proliferative lesions were highest (80.8%) and antrum was the commonest (46.8%) site of neoplastic lesions. Histologically, adenocarcinoma (95.4%) was commonest. The significant symptoms of presentation were pain abdomen (84%), weight loss (89%), anorexia (86%), gastric outlet obstruction (40%) while signs were anaemia (100%), epigastric tenderness (60%), lump abdomen and gastric outlet obstruction (40%). We found a large number of neoplastic lesions in endoscopy series with the highest number in males at forty. This implies a gross economic fall out on the family. The interesting finding of antral growth differs from western series. Liberal use and availability of endoscopy may help in detecting the lesions early with better outcome.

A rare case of persistent muellerian duct syndrome presenting as inguinal hernia.

Irreducible inguinal hernia is a very common emergency surgical problem. In most of the cases the content is either bowel or omentum. Testis, as a content of hernial sac is also found in undescended testis presenting as obstructed or irreducible congenital inguinal hernia. Here a case is reported of a phenotypically normal looking male presenting with irreducible left sided inguinal hernia which on exploration revealed uterus, fallopian tubes and testis. The case is presented because of its rarity of presentation.

Emergency management of sigmoid volvulus--institutional experience over four years.

Sigmoid volvulus is a serious surgical emergency and a common cause of large bowel obstruction in India. Patients present with abdominal pain, distension and obstipation and abdominal skiagram usually reveals the characteristic omega sign. Non-operative detorsion with early elective sigmoidectomy is the procedure of choice where gut viability is not in doubt and features of peritonitis are absent. The objective of this study was to demonstrate the most suitable procedure for management of patients with sigmoid volvulus needing emergency surgery. Results revealed a high incidence of burst abdomen and anastomotic leak as well as a high mortality rate in patients undergoing resection with primary anastomosis without proximal colostomy. Mortality was least with Hartmann's procedure although there was a higher incidence of wound infection. Thus, in the hospital setting, we consider Hartmann's procedure to be the best emergency surgical procedure for sigmoid volvulus as it limits mortality to the least.