Indian Journal of Surgery

Glomus tumor is a benign vascular tumor derived from the modified smooth muscle cells of the glomus body. The single most common site is the subungual region of the finger, but other common sites include the palm, wrist, forearm, and foot. In this article, we present a rare situation of glomus tumor occurring on the back of the chest over the scapular area in an elderly male patient. The tumor cells exhibited positive expression for CD34 and smooth muscle actin. This paper highlights the fact that a glomus tumor is a benign neoplasm that may occur in multiple locations. Therefore, the significance of a histological and immunohistochemical approach for a correct characterization of this lesion is required.

Minimally invasive surgery has taken over the hernia surgeries in popularity in many countries. Laparoscopic totally extra-peritoneal (TEP) hernia with meshplasty is one of the techniques. A lot of new meshes for laparoscopic hernia surgery have been developed over years. Polypropylene mesh that has been traditionally used has been compared head to head with 3D anatomically shaped large pore polypropylene mesh (3D mesh) and is an emerging alternative that needs no or minimal fixation. We performed a randomised controlled trial enrolling 50 patients with inguinal hernia, randomising 25 patients to receive laparoscopic totally extra-peritoneal repair (TEP) of inguinal hernia using 3D mesh (3DM) and 25 patients to receive laparoscopic TEP repair of inguinal hernia using light weight polypropylene mesh (LWPM). The end points of the study were mesh placement time, postoperative pain, seroma formation, hospital stay, chronic groin pain, sensory impairment and recurrence. We followed up the patients for 3 months. We found that 3DM had less mesh fixation time 12.72 min (p = 0.0001) and less postoperative pain which was statistically significant, but postoperative seroma formation, chronic groin pain, duration of hospital stay, and sensory impairment had no significant difference as compared to LWPM. We also found no recurrence rate in both mesh repair techniques at end of 3-month follow-up. The use of 3D mesh for laparoscopic inguinal hernia repair provides advantages in terms of less fixation time and easy manipulation and conformation of the mesh at the hernia site. Trial registry: CTRI/2019/05/019006.

Myasthenia gravis (MG) is an autoimmune disease caused by antibodies directed against different components of the neuromuscular junction (NMJ), and pathogenic mechanism associated thymic pathologies. Microbiota invading thymus is hypothesized to trigger human autoimmune response by providing antigens to produce NMJ antibodies and clinical manifestations of myasthenia gravis. There are many reports of microbial nucleic acid isolation and protein expression and even a few studies of viable microbes isolated from the human thymus. However, high-resolution investigation of microbial infectious agents from the human thymus that may contribute to myasthenia gravis is very limited. To investigate potential microbial infection within human thymus tissue samples, we performed quantitative real-time PCR of the bacterial 16S ribosomal RNA (rRNA) and fungal 18S rRNA gene analysis on (1) a total of 23 abnormal thymus including 13 thymomas and 4 thymus hyperplasias obtained from MG patients and 6 thymoma-nonMG patients who underwent thymectomy. (2) Another 14 normal thymus were selected as control from patients who underwent congenital heart disease surgery. Results show that a wide range of bacteria agents are exhibited in the thymus, rather than fungus. And an intriguing new observation that shows the microbiota displayed differences among MG patients, thymoma-nonMG patients, and normal thymus as judged from the taxonomic profiles in these three groups. Compared with the normal thymus group, the Klebsiella and Escherichia coli show higher abundance in MG patient group. The thymus harbors bacteria agents and Klebsiella and Escherichia coli may be potential pathogens associated with MG. Further investigations are needed to elucidate the possible associations of Klebsiella and E. coli and MG.

Laparoscopic transcystic common bile duct exploration during laparoscopic cholecystectomy is the treatment of choice for patients with coexisting gallbladder and bile duct stones. Failure of this usually indicates laparoscopic choledocotomy, after which most patients are managed with primary duct closure and less frequently with T-tube placement or bilioenteric anastomosis. The objective of this paper is to describe the indications and complications of T-tube placement after laparoscopic choledocotomy in a consecutive series of single-stage management of 554 patients. Case series analysis of a prospectively collected historical database of all patients treated with T-tube drainage at Cosme Argerich Hospital from July 2008 and December 2020. Surgical indications and postoperative management will be discussed. Five hundred fifty-four patients underwent simultaneous scheduled laparoscopic cholecystectomy and common bile duct exploration during the analyzed period. One hundred thirteen (20.39%) required laparoscopic choledochotomy, after which 54 (48%) were treated with T-tube drainage, 23 for suspicion of incomplete bile duct clearance, 16 for impaired papillary drainage, 13 for inappropriate bile duct wall conditions, and 2 for lateral bile duct injuries. No significant morbidity was related to T-tube drainage. In our setting, and following a strict protocol, T-tube drainage after laparoscopic choledochotomy is a valid alternative to primary duct closure in selected patients.

Melanoma is a serious disease with an increasing incidence and mortality of great extent. A case of cutaneous calcaneal melanoma is described with the whole management we followed. After injection of 99 m Tc-nanocoll for sentinel lymph node detection and its localization at the left inguinal region, its excision performed with the help of gamma probe.

Cystic artery pseudoaneurysm complicating acute cholecystitis is a rare condition. It may be asymptomatic and incidentally radiologically discovered or presents as right upper abdominal pain, hemobilia, and digestive hemorrhage. We report a case of an incidental preoperative discovery of a pseudoaneurysm of the cystic artery associated with Chilaiditi’s sign in a 54-year-old man admitted for acute cholecystitis. To the best of our knowledge, this is the first report associating these two rare entities.

This study was done to assess compare usefulness of localization (MIBI and USG) and surgical cure rates in APHPT with SPHT surgical. Multi-centric retrospective study. 57 APHPT and 156 SPHPT patients included. The demographic data &localisation studies between APHPT and SPHPT along with surgical cure rates in patients who had localized disease versus nonlocalized were compared. APHPT prevalence was 26.76%. APHPT affects older patients (p=<0.05). Serum calcium & PTH were higher in SPHPT (p=<0.05). USG & MIBI scans were positive in 88% and 90% in SPHPT. APHPT showed USG and MIBI positivity in 21.05% and 15.7%. Subset of APHPT patients (n=13) who underwent additional imaging showed true positive lesion in 38.5% (n=5). Bilateral neck exploration done in 73.7% of APHPT& 10.9% of SPHPT (p=0.0001). APHPT has smaller adenoma(p<0.05). In non-localized APHPT (n=42) five needed partial thyroidectomy (11.9%) and six partial thymectomy (14.2%). Intra operative success rate was 97.5% in SPHPT and 95.23% in non-localized APHPT (p=0.63). APHPT presents with mild disease and mostly with negative localization. Cure rates after bilateral neck exploration without additional imaging like PETCT/4D CT/MRI was similar to SPHPT