Percutaneous Catheter Drainage in Acute Infected Necrotizing Pancreatitis: A Real-World Experience at a Tertiary Care Hospital in North India.

Introduction Open necrosectomy in acute infected necrotizing pancreatitis is associated with very high mortality and morbidity. Moreover, if it is performed before four weeks, the benefits are limited. In this study, we evaluated the safety and efficacy of percutaneous catheter drainage (PCD) in patients with acute infected necrotizing pancreatitis. Methods It was a single-center, observational study, where all consecutive patients with proven or probable infected acute necrotizing pancreatitis in whom PCD was performed were studied. The patients who failed to respond to PCD underwent open necrosectomy. Baseline characteristics and the outcome of all included patients, including complications of PCD, were studied. Results A total of 46 patients (males=36, females=10) underwent PCD over a period of 18 months. Fifteen (32.60%) patients succumbed to their illness. PCD benefitted a total of 31 (67.39%) patients; in 17 (36.95%) patients, it worked as a standalone therapy, while in 14 (30.43%) patients, additional surgery was required where it helped to delay the surgery. Median days at which PCD and surgery were performed were 17.5 days (range: 2-28 days) and 33 days (range: 7-70 days), respectively. Lower mean arterial pressure at presentation, presence of multiorgan failure, more than 50% necrosis, higher baseline creatinine and bilirubin levels, and an early surgery were markers of increased mortality. Three (6.5%) patients had PCD-related complications, out of which only one required active intervention. Conclusion PCD in infected acute pancreatic necrosis is safe and effective. In one-third of the patients, it worked as standalone therapy, and in the rest it delayed the surgery beyond four weeks, thereby preventing the complications associated with early aggressive debridement.

Feasibility of robotic radical hysterectomy (RRH) with a new robotic system. Experience at Galaxy Care Laparoscopy Institute.

The main objective of this study was to assess in a series of 30 patients, the feasibility, oncological safety and efficacy of radical hysterectomy by a new robotic system. Prospective study design. Galaxy Care Laparoscopy Institute and Multispeciality Hospital. We performed Robotic Radical Hysterectomy in patients from August 2019 through February 2020. All the surgeries were performed by a single surgeon (Puntambekar S). Since August 2019, 30 patients with early cervical cancer/endometrial cancer were selected for radical hysterectomy. All patients were in good general condition with controlled medical comorbidities. The mean operative time was 104 min, with mean total lymph node yield of 24.7. The average blood loss was 60 ml and the hospital stay was 2.1 days, and majority of the patients were catheter free by 1 week. Two patients developed uretero-vaginal fistula on the 8th day of surgery. One was managed with Double J stenting and in the other we did laparoscopic ureteroneocystostomy. Our study has demonstrated the feasibility, safety and efficacy of RRH by the Versius robotic systems.

Role of Perioperative Surgical Safety Checklist in Reducing Morbidity and Mortality among Patients: An Observational Study.

BACKGROUND: Safe Surgery Saves Lives. Patient safety is a fundamental of good quality health care, and complications due to the health-care system are well-documented and constitute an important public health problem. Implementation of the checklist in medicine and surgery can help to decrease the risk of adverse events thus can improve patient safety. MATERIALS AND METHODS: After the Institutional Ethical Committee clearance, a total of 500 patients were enrolled and divided into two equal groups. In Group 1 (n = 250), patients underwent surgery before regular implementation of the World Health Organization (WHO) surgical safety checklist (SSC), whereas in Group 2 (n = 250), patients underwent surgery after the WHO SSC was regularly implemented. All the patients were followed up after the surgery, and patients were looked for and compared for the postoperative complications. RESULTS: We found that 27 patients (10.8%) in Group 1 and 13 patients (5.2%) in Group 2 developed major wound disruption (P < 0.05). There were 73 patients (29.2%) in Group 1 and 34 patients (13.6%) in the Group 2 who developed an infection of the surgical site (P < 0.05). There were five patients (2%) in Group 1 while none of the patients in Group 2 developed sepsis during the study (P < 0.05). CONCLUSIONS: We found that implementation of the WHO SSC significantly reduces surgical site infections, major disruptions of the wound, and sepsis.

Management and Outcome of Patients with Pancreatic Trauma.

INTRODUCTION: Pancreatic trauma is a rare entity occurring in 0.2% of patients with blunt trauma abdomen. Once the diagnosis is made, the management of patients is dependent on multiple variables. Conservative management, suture repair, drainage, and resection have been utilized with varying degree of success. This study is aimed to evaluate the management of patients with pancreatic trauma. MATERIALS AND METHODS: This was a prospective study done in the Department of Surgery in Dayanand Medical College and Hospital where forty hemodynamically stable patients diagnosed to have pancreatic trauma on contrast-enhanced computed tomography abdomen were included in the study. RESULTS: Out of forty patients taken in this study, 38 were male and two were female with age ranging from 3 to 50 years. Road traffic accident was the most common cause of pancreatic injury. Pancreatic injuries were graded according to the American Association for Surgery in Trauma scale. Twelve patients had Grade I and II injuries. Grade III was the most common injury occurring in 14 patients. Twenty-four patients underwent surgical management. Mortality rate was 45% and it was in direct correlation with the severity of injury. CONCLUSION: Grade I and II pancreatic injury can be managed conservatively depending upon the hemodynamic status of the patient. Grade III and IV injuries have a better prognosis if managed surgically.

Study Of Clinical Outcomes In Patients With Severe Hepatic Injury: Experience At A Tertiary Care Centre.

Background: Management of liver trauma earlier used to be primarily surgical. With advancement in diagnostic modalities it has gradually shifted to non operative management. Methods: The present study was conducted on 40 patients with severe hepatic injuries (grade 3 onwards). All the patients were compared in terms of various methods adopted for their management and their clinical outcomes Results: Out of a total of 40 patients, maximum numbers of patients were in age group 18-24 years. 82.50 % patients had grade IV and rest had Grade V. 12 patients presented with shock on admission. Failure of NOM (non operative management) was seen in 25% of cases . The average requirement of blood transfusion in our study was 2.157 1.74 units. Average hospital stay in successful NOM cases was lower than in failed NOM. A total of 6 patients had to be operated upon in our study. Active bleed was seen on laparotomy in four patients with no evidence of any injury causing peritonitis. Conclusion: The success rates of non-operative management were significantly higher than the failures rates of non-operative management, without any significant incidence of complications and delayed laparotomies. Grade of liver injury or the amount of hemoperitoneum as detected on CT scan did not influence the outcome of non-operative management. Non-operative management is thus the gold standard in hemo-dynamically stable patients.