Indian Journal of Surgery

Recent randomized trials indicate that oblique subcostal transversus abdominis plane block provides effective analgesia in upper abdominal surgery. Addition of dexamethasone to local anesthetic agent increases its analgesic efficacy. In this randomized, double-blind trial, sixty patients undergoing open cholecystectomy were allocated to two groups. After induction of anesthesia, group R received oblique subcostal transversus abdominis plane block with 18 ml of 0.75% of ropivacaine and 2 ml of normal saline, while 18 ml of 0.75% ropivacaine with 2 ml of dexamethasone was administered in group RD. The primary outcome assessed was total tramadol consumption postoperatively. Secondary outcomes included time to first request for tramadol, sedation score, nausea score, requirement of rescue antiemetics, any side effects, and quality of healing. The total amount of tramadol consumption was significantly lower in group RD as compared to group R (p = 0.009). The time to first request for tramadol was also significantly increased in group RD as compared to group R (p < 0.001). Amount of antiemetics required in group R was more than group RD, and the difference in the requirement was statistically significant (p = 0.017). Oblique subcostal transversus abdominis plane block is effective in providing postoperative pain relief following open cholecystectomy. Addition of dexamethasone to ropivacaine prolongs analgesic efficacy of ropivacaine.

Surgical procedures that involve working in small anatomical spaces can be successfully performed using robot-assisted surgery. We did a retrospective study of the results of 86 robot-assisted pancreatic operations performed in the Abdominal Department No.1 of the A.V. Vishnevsky Institute of Surgery, Moscow. Seventy (81.4%) patients were female, and 16 (18.6%) were male; the average age was 49 (37; 59). The following robot-assisted surgeries were performed: 17 pancreaticoduodenectomies, 45 distal pancreatectomies, 16 tumor enucleations, 6 median resections, and 2 total duodenopancreatectomies. The duration of robot-assisted surgical operations varied depending on the extent of the surgery: for a pancreaticoduodenectomy (PD), it was 400 (360–550) min; for a distal pancreatectomy, it was 210 (180–250) min. Estimated blood loss in a PD was 200 (150–500) ml; in a distal pancreatectomy, it was 100 (50–300) ml. Conversions happened in 6 cases: 2 of them in PD and 4 in distal pancreatectomies. The postoperative length of stay was 15 ± 9 days and depended on the extent of the surgery. The maximum length (16 days) was after robot-assisted pancreaticoduodenectomies (14–25), the minimum (12 days) after organ-preservation surgery (8; 15). Pancreatic fistula А and В occurred in 35 (40.7%) patients and hemorrhages in 6 (7.0%) cases; there were 2 cases of 30-day mortality (2.3%). Robotic assistance can be successfully used in pancreatic surgery. Robot-assisted procedures ensure the precision of lymphadenectomy and anastomoses formation, and the postoperative lengths of stay are more comfortable for patients due to minimal tissue injury. The use of the robot-assisted approach in pancreatic surgery does not guarantee that specific postoperative complications will not occur.

Phẫu thuật đã trở thành một phần không thể thiếu trong chăm sóc sức khỏe toàn cầu, với ước tính có 234 triệu ca phẫu thuật được thực hiện hàng năm. Ngân hàng Thế giới vào năm 2002 đã báo cáo rằng ước tính có 164 triệu năm sống điều chỉnh khuyết tật, chiếm 11% tổng gánh nặng bệnh tật, là do các tình trạng có thể điều trị bằng phẫu thuật. Mục tiêu của nghiên cứu này là khảo sát sự phổ biến của các loại phẫu thuật khác nhau mà các cá nhân đã trải qua trong suốt cuộc đời của họ tại một cộng đồng đô thị ở Delhi. Nghiên cứu cắt ngang được tiến hành từ tháng 10 năm 2008 đến tháng 4 năm 2009 tại Vivek Vihar - một khu dân cư thịnh vượng ở Delhi. Tổng cộng có 3.043 cá nhân cư trú trong 622 hộ gia đình đã được phỏng vấn trong khuôn khổ nghiên cứu. Số hộ gia đình có ít nhất một thành viên từng trải qua phẫu thuật là 306 (49,2%). 12,3% dân số nghiên cứu (375 trong số 3.043) đã trải qua một hoặc nhiều hình thức phẫu thuật chính trong cuộc đời của họ. Phẫu thuật lấy thai (mổ đẻ) được tìm thấy là thủ tục phẫu thuật phổ biến nhất. 61,7% ca phẫu thuật mang tính chất chủ động và 81,9% được thực hiện tại bệnh viện tư nhân. Tỉ lệ mắc các thủ tục phẫu thuật trong suốt cuộc đời là 1,77% ở trẻ em, 12,6% ở nam giới trưởng thành và 15,8% ở phụ nữ trưởng thành (p < 0,001). Được ghi nhận rằng chi phí phẫu thuật tại các bệnh viện tư nhân cao hơn so với bệnh viện công. Các phát hiện của chúng tôi cho thấy rằng phẫu thuật xảy ra với tỷ lệ đáng kể, ít nhất là trong số người dân đô thị thịnh vượng, với phần lớn bệnh nhân lựa chọn giới thiệu đến bệnh viện tư nhân cho ca phẫu thuật của họ.

Renal cell carcinoma (RCC) may metastasize to almost any organ, but metastasis to the small bowel is very rare. Factors responsible for a resistant behavior of small bowel wall are still not clear. Small bowel metastasis from RCC may cause obstruction, bleeding, and perforation. RCC metastasis to the small bowel presenting as intussusception is extremely rare. Only 20 cases of small bowel intussusceptions caused by metastatic RCC have been reported worldwide. Here, we are reporting this rare case of RCC with simultaneous solitary metastasis in jejunum which presented as intussusceptions and which was treated with simultaneous radical nephrectomy, jejunal resection, and anastomosis.

Conventional abdominoplasty in anchor (with “en bloc” resection of the vertical and horizontal skin components) for patients after massive weight loss is related to some disadvantages. This study aimed to evaluate the outcomes of patients undergoing abdominoplasty in anchor with staged skin resection. This was a retrospective case series based on clinical evaluation of patients undergoing abdominoplasty in anchor with the technique of staged skin resection (first the vertical skin component followed by the horizontal component). We evaluated patient data, postoperative complications, patient satisfaction, and esthetic analysis of the postoperative outcomes using photographs at 12 months after surgery (performed by three independent plastic surgeons through a scale from 0 to 10, in which scores were assigned to the visual parameters). The 24 patients included in this study had a mean age of 42.58 years and a pre-abdominoplasty body mass index of 26.94 kg/m2. The overall mean of complications was 45.8%; the most common postoperative complication was seroma (n = 6), followed by infection (n = 3), dehiscence (n = 2), hematoma (n = 2), hypertrophic scar (n = 2), unaesthetic scar (n = 1), and retraction of the umbilicus (n = 1). Postoperative esthetic evaluation provided an average score of 5.61 for these patients. Compared with the literature about the conventional technique of en bloc resection, abdominoplasty in anchor with staged skin resection showed a similar rate of postoperative complications, and the esthetic evaluation of postoperative outcomes was considered satisfactory.