Vipul Yagnik - Academia.edu (original) (raw)

Papers by Vipul Yagnik

Background: Definitive management of acute fistula-abscess (anal fistulas associated with acute a... more Background: Definitive management of acute fistula-abscess (anal fistulas associated with acute abscess) is gaining popularity
against the two-staged approach (early abscess drainage with deferred fistula management). However, locating an internal opening (IO)
in acute fistula-abscess can be difficult. A recent protocol (Garg protocol) has been shown to be effective in managing anal fistulas
with non-locatable IO.
Purpose: To test the efficacy of the Garg protocol in managing acute fistula-abscess with non-locatable IO.
Methods: Patients with acute fistula-abscess operated by a definitive procedure were included. A preoperative MRI was done in all
patients. Patients in whom the IO was non-locatable after clinical, MRI, and intraoperative examination were managed by the threestep Garg protocol. Garg protocol: 1) Reassessment of MRI; 2) In non-horseshoe fistulas, the IO was assumed to be at the point where
the fistula tract reached closest to the sphincter-complex; 3) In horseshoe fistulas, the IO was assumed to be located in the midline
(anterior or posterior as per the horseshoe location). Low fistulas were treated by fistulotomy and high fistulas by a sphincter-sparing
procedure. The long-term healing rate and change in continence (Vaizey scores) were evaluated.
Results: A total of 201 patients with acute fistula-abscess were operated over six years, and 19 were lost to follow-up. A total of 182
patients (154-males) were followed up (median-37 months). The IO was locatable in 133/182 (73.1%) (control group) and was nonlocatable in 49/182 (26.9%) (study group). The study group was managed as per the Garg protocol. The age, sex-ratio, and fistula
parameters were comparable in both groups. The long-term healing rate was 112/133(84.2%) in the IO-locatable group and 43/49
(87.8%) in the IO-non-locatable group (p=0.64, not-significant). The objective continence scores did not change significantly after
surgery in both groups.
Conclusion: Acute fistula-abscess with non-locatable IO can be managed successfully by the Garg protocol without any risk of
incontinence

Background: Meckel Diverticulum [MD), a common congenital anomaly of the gastrointestinal tract, ... more Background: Meckel Diverticulum [MD), a common congenital anomaly of the gastrointestinal tract, poses a dilemma when incidentally encountered during surgery. Despite historical descriptions and known complications of symptomatic MD, the decision to resect an incidental MD (IMD) lacks clear guidelines. This study aims to assess whether resecting IMDs is justified by synthesizing evidence from studies published between 2000 and 2023. Factors influencing this decision, such as demographic risks, surgical advancements and complications, are systematically examined.
Methods and Material: Following the PRISMA 2020 guidelines, this review incorporates 42 eligible studies with data on outcomes of asymptomatic MD management. Studies, both favoring and opposing resection, were analyzed.
Results: Considering complications, malignancy potential, and operative safety, the risk-benefit analysis presents a nuanced picture. Some authors propose conditional resection based on specific criteria, emphasizing patient-specific factors. Of 2934 cases analyzed for short- and long-term complications, the morbidity rate was 5.69%. Of 571 cases where mortality data were available, all 5 fatalities were attributed to the primary disease rather than IMD resection.
Conclusion: The sporadic, unpredictable presentation of IMD and the variability of both the primary disease and the patient make formulation of definitive guidelines challenging. The non-uniformity of complications reporting underscores the need for standardized categorization. While the balance of evidence leans towards resection of IMDs, this study acknowledges the individualized nature of this decision. Increased safety in surgery and anesthesia, along with better understanding and management of complications favor a judicious preference for resection, while taking into account patient characteristics and the primary disease.

Objectives: The World Health Organization (WHO) mentioned Acinetobacter baumannii as a “priority ... more Objectives: The World Health Organization (WHO) mentioned Acinetobacter baumannii as a “priority of concern” in 2017. Acinetobacter baumannii generally infects immunocompromised patients and causes various nosocomial infections in the intensive care unit (ICU) such as bacteremia, meningitis, ventilator-associated pneumonia, other respiratory infections, and surgical site infections. As oxacillinase has weak hydrolysis activity, more work was needed on this class-D beta-lactamase. Hence, the current Systematic review focuses on the A. baumannii’s oxacillinase (Class-D beta-lactamases) enzyme and its variants collected during 2013–2020 in India for complete genome sequencing. Method: This Systematic review has been done according to PRISMA guideline 2020. We have used the Bacterial and Viral Bioinformatic Resource Centre (bv-brc.org) system for comparative genome analysis. The protein Basic Local Alignment Search Tool (BLAST) was used to identify similarities between sequences, in which BLOSUM62 was used as a scoring matrix. Clustal-W was used for multiple sequence alignment. A phylogenetic tree of the blaOXA gene family has been constructed using MEGA version 11. Result: In India during 2013–2020, for genome sequencing of A. baumannii, the highest number of samples was collected from blood (36%), following the ETA (30%). The average G+C % content was 38.95%. Among the 339 A. baumannii isolates, a maximum of 189 (55.75%) strains caused pneumonia, whereas 113 (33.33%) strains were involved in bacteremia. Carbapenems seemed effective, but resistance against them was higher. Among all A. baumannii genomes, bla-OXA-23 had the highest frequency (314; 92.62%), followed by bla-OXA-66 (241; 71.09%) in India. Conclusion: Our findings indicated that a high percentage of A. baumannii strains that produce oxacillinases exist in India, emphasizing the necessity for indigenous molecular surveillance to assist effective management and preventative initiatives. Comparative genomics and next-generation sequencing will offer tremendous potential for tracking and regulating the spread of this dangerous bacterium.

Indian Journal of Surgery, May 28, 2022

Indian Journal of Surgery

Anz Journal of Surgery, May 1, 2022

Objectives:Carcinoma of the breast is the most common cause of cancer death in women worldwide; i... more Objectives:Carcinoma of the breast is the most common cause of cancer death in women worldwide; in Indian women, it is second only to cervical cancer. The aim of this study was to study the etiological and clinicopathological features of patients presenting with a breast lump in the desert city of Jodhpur, India, with special reference to breast cancer.Material and Methods:This was a retrospective study that involved 648 patients over a 5-year period from 2011 to 2015 in Jodhpur city, Rajasthan.Results:The most common type of lump encountered was fibroadenoma (53.6%) followed by malignancy (51.7%). Of breast cancers, 99.1% were in females with a preponderance in premenopausal women (56.1%). The most affected age group was the fifth decade. Only 11.9% of cases presented within 1 month and 3.75% had a history exceeding 4 years. Lump size was more than 15 cm in 3.07% and <1 cm in 2.7%, with most situated in the upper outer quadrant (54.2%). Most of the patients were in tumor-node-metastasis Stage II (45.4%); the reported mortality rate was 4.1% and recurrence rate was 2.97%. Infiltrating duct carcinoma constituted the majority (86.7%) of cases. Modified radical mastectomy was the most performed procedure (37.2%) and the most favored chemotherapy regimen was CMF. Gynecomastia constituted 2.6% of all breast lumps, while tuberculosis made up 0.46%.Conclusion:Our results show that the patterns of breast disease are in keeping with the demography of the region. However, clinical presentation appears to be strongly influenced by sociocultural factors such as ignorance, taboos and parity, as well as rural habitation and access to health care. We emphasize the need for proper documentation, especially a cancer registry.

Anz Journal of Surgery, Apr 1, 2021

Saudi Journal of Gastroenterology, 2010

Journal of Digestive Endoscopy, Oct 1, 2018

Although migration of biliary stents is not uncommon, stent-induced perforation of the intestinal... more Although migration of biliary stents is not uncommon, stent-induced perforation of the intestinal wall is a rare and serious complication. We report a case of duodenal perforation secondary to migrated biliary stent kept for obstructive jaundice for common bile duct stone in a 64-year-old male. Intestinal perforation secondary to migrated stent should be considered in patients reported with abdominal pain and sepsis after an endoscopic retrograde cholangiopancreatography with biliary stent placement.

Anz Journal of Surgery, Jul 1, 2023

Journal of Gastrointestinal Surgery, Jun 16, 2022

Anz Journal of Surgery, Jun 1, 2011

A 62-year-old male patient was admitted to our hospital for sudden acute constrictive thoracic pa... more A 62-year-old male patient was admitted to our hospital for sudden acute constrictive thoracic pain with electrocardiogram showing acute anterior ST elevation myocardial infarction. Physical examination revealed a significant differential blood pressure in both upper arms. A thoracic computed tomography (CT)-scan showed a DeBakey type A aortic dissection, starting from the aortic valve and extending to the aorto-iliac junction encompassing the aortic arch. Essential hypertension was his sole cardiovascular co-morbidity. His carotid arteries were unconcealed in this aortic dissection. He had urgent aortic repair surgery with a 28 mm aortic prosthesis under extracorporeal circulation. Eight days post-operatively, after weaning from sedation, he remained comatose. Electroencephalogram tracing showed bilateral cerebral dysfunction and cerebral CT-scan showed bilateral lacunar lesions with bilateral frontal hypodensities. Doppler ultrasound of the common carotid arteries showed bilateral dissection with the left common carotid artery extending towards the ostium of the internal carotid artery (Fig. 1). Both his vertebral arteries were patent. The clinical course progressed towards brain stem death and the patient died. Extracranial or common bilateral carotid artery dissections are rare with an unknown prevalence, usually attributed to major trauma and nearly all of common carotid dissections are a result of aortic dissection. We report a case of late onset of bilateral carotid dissection in a post-aortic dissection repair setting in a sedated patient. This late onset could be due to a pre-existing undetectable, subclinical dissection present before surgery. The precipitating factor could be due to hypertensive bouts in the post-operative period. In effect, 2 days prior to the cervical ultrasound, the patient presented systolic hypertensive bouts up to 214 mm Hg despite continuous intravenous nicardipine. Our patient did not have any known connective tissue disorders. Extra care should be taken to avoid hypertensive bouts and maintain tight control of blood pressure in sedated patients in the post-operative period in dissecting diseases of the aorta.

Journal of Minimal Access Surgery, 2018

Anz Journal of Surgery, 2019

Archives of International Surgery, 2016

1. Kshirsagar VV, Male PV, Bendre M, Chavan S, Rathod S. Chronic granulomatous mastitis: A therap... more 1. Kshirsagar VV, Male PV, Bendre M, Chavan S, Rathod S. Chronic granulomatous mastitis: A therapeutic dilemma revisited. Arch Int Surg 2016;6:100‐4. 2. Timothy M, Alfonso D. Inflammatory, reactive and infective condition of the breast. In: Shin SJ, editor. Comprehensive guide to core needle biopsies of the breast. Switzerland: Springer; 2016. pp. 135‐60. 3. Sabel MS. Infectious and inflammatory disease of the breast. In: Sabel MS, editor. Essential of breast surgery. Philadelphia: Mosby Elsevier; 2009. pp. 83‐90. 4. Ogura K, Matsumoto T, Aoki Y, Kitabatake T, Fujisawa M, Kojima K. IgG4 related tumor forming mastitis with histological appearance of granulomatous lobular mastitis: Comparison with other form of mastitis. Histopathology 2010;57:39‐45. Sir, I read an article entitled “Chronic granulomatous mastitis: A therapeutic dilemma revisited”[1] with interest. I would like to congratulate the authors for their effort in writing the topic concisely. However, I would like to add few more information regarding this entity, which you may find useful.

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2019

Tropical Doctor, Feb 6, 2023

Polish Journal of Surgery

Aim: Fistulotomy is the commonest procedure performed for low anal fistulas. The incidence of gas... more Aim: Fistulotomy is the commonest procedure performed for low anal fistulas. The incidence of gas and urge incontinence after fistulotomy and whether Kegel exercises (KE) could help recover sphincter function after fistulotomy has not been studied before. Methods: Patients operated with fistulotomy for low fistulas were recommended KE (pelvic contraction exercises) 50 times/ day for one year postoperatively. Incontinence (solid, liquid, gas, and urge) was evaluated objectively (Vaizey’s scores) preoperatively [Pre-op Group], in the immediate postoperative period [Pre-KE Group], and at 6-month follow-up [Post-KE Group]. Incontinence scores in all three groups were compared to evaluate the efficacy of KE. Results: As many as 101 MRI-documented low anal fistula patients were included. There were 79 males (mean age 39.4 12.9 years) and the median follow-up was 12 months (6–18 months). Two patients were lost to follow-up. Fistulas healed in all the patients. Incontinence was present in 5...