Indian Journal of Surgery

Post cholecystectomy syndrome (PCS) is a term used for the persistence of antecedent symptoms following cholecystectomy. The etiology is mainly non-biliary but remnant gallbladder or cystic duct stump calculi may be the cause in some patients. Ultrasonography is the initial imaging modality but MRCP provides a more accurate diagnosis and serves as a roadmap during surgery. Such patients need a completion cholecystectomy for relieving their symptoms. The study included 41 patients who underwent laparoscopic completion cholecystectomy (LCC) at two health institutions of our state by the same team of operating surgeons over a period of 7 years from January 2013 to December 2019. All the patients included had previously undergone open cholecystectomy at different health centers and reported to us with PCS. The data regarding presentation, imaging, intraoperative findings, complications, and follow-up after LCC were noted and analyzed. Laparoscopic completion cholecystectomy was successfully done in 38 patients (92.6%) and 3 (7.3%) cases had to be converted to open procedure. No major bile duct injury was encountered in any case and there were no mortalities. The majority of the patients (36 patients 87.8%) had complete resolution of symptoms after completion cholecystectomy. Laparoscopic completion cholecystectomy in the hands of an expert laparoscopic surgeon is a safe alternative with good outcomes and acceptable complication rates.

To compare the healing of chronic wounds with honey dressing vs. Povidone iodine dressing in adult subjects with chronic wounds of ≥6 weeks of duration, attending wound care clinic in Surgical Out Patient Department of All India Institute of Medical Sciences, Surgical Out Patient Department of Jai Prakash Narayan Apex Trauma center, New Delhi. Forty five subjects were randomized into two groups i.e., Honey & Povidone iodine dressing group. Dressing was done on alternate day basis for 6 weeks of followup period. Main outcome measure was complete healing at 6 weeks. Wound healing status was assessed at 2 weekly intervals till 6 weeks. Seven out of 22 subjects in honey treated group achieved complete healing as compared to none out of 20 subjects in Povidone iodine treated group. There was a significant decrease in the wound surface area, pain score & increase in comfort score in Honey dressing group in comparison to the Povidone Iodine group at 0.05 level of significance. Honey dressing is highly effective in achieving healing in chronic wounds as compared to Povidone iodine dressing.

Colorectal cancer (CRC) leads to metastatic disease in approximately 30% of patients. In patients with newly diagnosed CRC with both liver and lung metastases, curative resection is rarely possible. The aim of this study is to evaluate the overall (OS) and relapse-free survival (RFS) rates of these patients after resection with curative intent. This study is a retrospective analysis of colorectal cancer patients (n=8, median age 54.3 years) with simultaneous liver and lung metastasis undergoing resection with curative intent between May 1st, 2002, to December 31st, 2016, at our institution. Colon was the primary tumour site in 2 patients and rectum in 6 patients. The median number of liver and lung metastases was 3 and 2, respectively. Patients received various treatment sequences individualized on tumour disease burden. R0 resection was achieved after all but one procedure. Two severe Clavien-Dindo grade IIIb complications were present. Median hospital stay was 9 (3–24) days per procedure. Tumour relapse was observed in all patients with median RFS of 9 (3–28) months and median OS of 40 (17–52) months. In 4 cases, where repeated resection of recurrent metastases (3 liver and 1 lung) was possible, the median OS was 43 months. Our data suggests that patients seem to benefit from resection with curative intent, with tendency to prolonged OS and with acceptable complication rate. Tumour recurrence occurred in all patients. Repeated resection was beneficial and led to further prolonged OS.

Claudins are an important members of tight junction proteins. While studies about the Claudin expression in epithelial tumors are common, studies concerning Claudin expression in malignant melanoma are rare. Investigating the expression of Claudins 1, 4, 7 in malignant melanoma, and if there is an expression, investigating its relation with unfavorable prognostic parameters such as lymphovascular invasion, ulceration, absence of lymphocytic response and presence of satellite nodules. Claudins 1, 4 and 7 were stained immunohistochemically in biopsy samples of 24 cutaneous malignant melanoma and 16 malignant melanoma metastatic to lymph node. There was no significant difference in Claudin 1, 4 and 7 expression between cutaneous and lymph node metastatic malignant melanoma. Claudin 1 expression was determined in all patients. In cutaneous malignant melanoma, no correlation was found between Claudin 1 and unfavorable prognostic parameters. There was a significant correlation between lymphovascular invasion and Claudin 4 positivity. The correlation of the presence of ulceration and satellite nodules with Claudin 7 positivity were significant. Investigations for Claudin expression in malignant melanoma is very rare in the literature and mostly about Claudin 1. The significant correlation between lymphovascular invasion and Claudin 4, and also the presence of ulceration and satellite nodules with Claudin 7 suggests that the role of abnormal expressed tight junction proteins are important and it presents as one of the involved mechanisms and indicator of aggressive behavior for malignant melanoma.

Rectus sheath hematoma is a clinical entity characterized by the presence of blood within rectus abdominis muscle sheath. The aim of this study was to analyze clinical characteristics, diagnostic approach, treatment strategy, and outcomes of patients with rectus sheath hematoma. Patients diagnosed and treated for spontaneous rectus sheath hematoma between March 2010 and March 2014 were included in the study. A total of 10 patients were diagnosed as spontaneous rectus sheath hematoma. The mean age was 66.5 ± 16.9 years, and the mean hospital stay was 4.4 ± 1.8 days. There was no mortality. Six patients were using anticoagulant or antiplatelet agents. Eight patients recovered after conservative treatment. Two patients underwent surgery. Spontaneous rectus sheath hematoma is associated with anticoagulant therapy. Cases with abdominal pain and a non-pulsatile abdominal mass particularly in elderly women should be kept in mind. Treatment is mostly based on supportive care to preserve hemodynamic stability.

This study aimed to compare the efficacy of Harmonic Scalpel Haemorrhoidectomy versus Stapled Haemorrhoidopexy in the management of grade 3 and grade 4 haemorrhoids. This comparison factored in post-operative pain, operating time, intra-operative bleeding, post-operative complications, and recurrence rates. The aim was to aid the decision-making process to determine the course of treatment to be offered to patients. Over the course of 18-months, it was a randomised control trial. A total of 42 patients (21 in each arm) were studied to observe the outcomes of procedures in treating grade III / IV haemorrhoids. The only statistically significant difference was in the post-operative pain, as calculated using Visual Analog Scale, with patients undergoing Stapled Haemorrhoidopexy experiencing lesser pain, thus translating to early hospital discharge and return to work. In conclusion, Stapled Haemorrhoidopexy can be regarded as a better modality with reduced post-operative pain as compared to Harmonic Scalpel Haemorrhoidectomy.

Pancreatic acinar cell carcinoma is a rare tumour, accounting for only about 1 % of all pancreatic tumours. The long-term survival for patients with acinar cell carcinoma is significantly better than the long-term survival of patients with pancreatic adenocarcinoma. As no large series of patients with acinar cell carcinomas exist, our understanding of this disease comes mainly from small case series and case reports. Aggressive surgical resection with negative margins is associated with long-term survival in these more favourable pancreatic cancers. There are no clear treatment guidelines for patients in whom complete surgical resection with curative intent is not possible. Acinar cell carcinomas are chemoresponsive to agents that have activity against pancreatic adenocarcinomas and colorectal carcinomas because of the shared genetic alterations between these cancers. The role of neoadjuvant or adjuvant chemoradiotherapy remains unproven. The aim of this article is to present current knowledge on acinar cell carcinoma and comprehensive review of available literature.