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Papers by mahim koshariya

Research paper thumbnail of Spontaneous Fecal Fistula in a Hiv Patient: A Rare Presentation of Inguinal Hernia

International Journal of …, 2012

Congenital inguinal hernia is a common condition encountered in surgical practice. We report a ca... more Congenital inguinal hernia is a common condition encountered in surgical practice. We report a case of scrotal Enterocutaneous fistula, a rare complication of incarcerated hernia in a HIV patient due to late presentation, neglect and lack of proper management. ...

Research paper thumbnail of Overview of Advancement and Management of Gastrointestinal Stromal Tumors

Journal of modern medical oncology, Sep 22, 2022

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of gastrointestinal tr... more Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of gastrointestinal tract with different expressions of CD117 (transmembrane KIT receptor tyrosine kinase) from other related tumors, which provides insights into the disease management of GIST. Tyrosine kinase inhibitors reduce the incidence of tumor recurrence and make the tumor resectable. Despite the malignant potential of GISTs, gastric GIST shows a better prognosis versus GISTs at other locations. Contrast-enhanced computed tomography (CECT) is considered the radiological diagnosis of choice because biopsy increases the risk of bleeding and tumor spreading. In addition to surgical resection which remains the mainstay of GIST treatment, active surveillance is also available for gastric tumor with a size <2cm. Currently, given the clinical consensus of an increased response of the tumor to chemotherapy after resection of the advanced lesion, patients with metastasis are also indicated for cytoreductive surgery. Various minimally invasive techniques including endoscopic (endoscopic band ligation, endoscopic muscularis dissection, endoscopic submucosal dissection, endoscopic submucosal tunnelling, endoscopic fullthickness resection), laparoscopic and combined techniques (laparoscopic endoscopic cooperative surgery, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique) have been developed for surgical resection of tumors. Due to the high recurrence rate even during treatment, patients receive a physical examination and CECT follow-up every 3-5 months for 5 years followed by annual visits.

Research paper thumbnail of A prospective and retrospective study of Stoppa procedure (giant prosthetic reinforcement of visceral sac) for recurrent, complex and bilateral inguinal hernias

International Surgery Journal, Aug 25, 2018

Background: Managing complex inguinal hernia is always a challenge for surgeons. When recurrent o... more Background: Managing complex inguinal hernia is always a challenge for surgeons. When recurrent or complex hernia is present it is mandatory to adopt an alternative and different approach for the repair of inguinal hernia to avoid any further complication and recurrence. Primary aim of this study is to assess the usefulness of Stoppa procedure in current situation for treatment of bilateral, complex and recurrent hernias. Methods: A prospective and retrospective study of Stoppa procedure (giant prosthetic reinforcement of visceral sac [GPRVS]) for recurrent, complex and bilateral inguinal hernias was conducted in Department of General Surgery Hamidia Hospital from January 2016 to October 2017 , 30 patients with 27 bilateral and 3 unilateral hernias making total 57 hernial sites including five recurrent hernias (after Lichtenstein repair) were operated by GPRVS for bilateral, recurrent and complex inguinal hernias, were included in study. Results: Four complications were seen. One patient developed seroma which resolved spontaneously, one patient developed superficial wound infection. One patient developed right testicular pain which was relieved after medication. One patient developed pain in groin and right thigh which was present preoperatively also but increased after surgery and was relieved on medication. Risk for recurrence present in 18 patients. No recurrence was observed. Conclusions: Because of the excellent results, ease of the procedure and low complication rate, GPRVS is an effective and good option for bilateral, complex and recurrent inguinal hernias.

Research paper thumbnail of Water Soluble Contrast Study Predicts the Need for Early Surgery in Adhesive Small Bowel Obstruction

ABSTRACT Water Soluble Contrast Study Predicts the Need for Early Surgery in Adhesive Small Bowel... more ABSTRACT Water Soluble Contrast Study Predicts the Need for Early Surgery in Adhesive Small Bowel Obstruction Dr. Mahim Koshariya1, Dr. Samir Shukla2, Dr. Sudesh Sharda3, Dr. Akhilesh Ratnakar3, Dr. Vishal Rampuria3, Dr. Avinash Pratap Singh4, Dr. Varun Pendro4, Dr. Puspendra Baghel4, Dr. Samit Chaturvedi4, Dr. M.C. Songara5 Associate Professor1, Assistant Professor2, Senior Resident3, Resident4, Professor and Head5 Department of Surgery, Gandhi Medical College &amp; Associated Hamidia Hospital, Bhopal-462012, Madhya Pradesh, India. Vol. 2(2) : pp 51-56 (2013) Abstract: The study was carried out with the aim to investigate whether the water soluble contrast study followed for 24 hours can be a reliable indicator of the need for earlier surgical intervention in adhesive small bowel obstruction or not? To avoid much dreaded complications like bowel strangulation due to delayed surgical intervention, and to determine the management approach for patients in whom avoiding surgery is highly desirable such as those with multiple previous abdominal operations or small bowel obstruction in the early post-operative period. 40 patients admitted in emergency with clinical and radiologic evidence of adhesive small bowel obstruction were included in this study. All patients were treated conservatively for initial 48 hours. The Gastrograffin study was performed in 28 patients after 48 hours as12 patients showed spontaneous relief in symptoms of obstruction within 48 hours and were managed conservatively. 25 cases showed contrast agent beyond Ileocecal junction on plain radiograph in erect posture before 24 hours of ingestion of oral contrast and conservative treatment was continued. The remaining 3 cases had complete obstruction as shown by the contrast study and underwent surgery. The use of water soluble contrast agent Gastrograffin in adhesive small bowel obstruction after failed conservative treatment can be of great help in diagnosis and management of adhesive small bowel obstruction. Keywords: Gastrograffin, Small bowel obstruction, Water soluble contrast study, Adhesive small bowel obstruction, Bowel obstruction, Small bowel.

Research paper thumbnail of Prevalence of pathogens and their antimicrobial susceptibility in catheter associated urinary tract infection

Hospital-acquired urinary tract infection (UTI) is the most Up to 25% of hospitalised patients un... more Hospital-acquired urinary tract infection (UTI) is the most Up to 25% of hospitalised patients undergo urinary catheterisation, a similar proportion of patients cared for in residential homes will have long term indwelling catheters. Although often necessary intervention, indwelling urinary catheters are a leading cause of nosocomial infections and have been associated with both morbidity and mortality. The urinary tract accounts for more than 40% of total number of nosocomial infections. Most nosocomial infections associated follow instrumentations, usually with the catheter. Results of several studies demonstrated that this antibiotic drug prophylaxis has increased the rate of isolation of resistant organisms. To ensure appropriate therapy, current knowledg is mandatory. The aim of present study was to assess the bacterial profile for catheter associated UTI and the antimicrobial sensitive to most commonly used antibiotics, used in the therapeuti prophylactic settings before the results of the urine culture are available. In our study, the incidence of infection in catheterized patients was found to be 27% which was low but comparable to studies done in India and Western studies. E. coli was t infection and highest sensitivity was found to A

Research paper thumbnail of Pancreas-preserving total duodenectomy without pancreato-enteric anastomosis

PubMed, Feb 7, 2008

Background/aims: Pancreas-preserving total duodenectomy is a challenging surgical technique with ... more Background/aims: Pancreas-preserving total duodenectomy is a challenging surgical technique with organ preservation and has limited indications. We assessed the safety, feasibility and short-term functional outcome of PPTD without the need of pancreato-enteric anastomosis in our surgical technique. Methodology: During the two-year period from 2005 to 2007, three patients underwent pancreas-preserving total duodenectomy at our center. Two patients had diffuse adenomatous polyposis; another had previous transduodenal excision for polyp with recurrence. In all three patients pancreas-preserving total duodenectomy was performed without the pancreato-jejunal anastomosis and were analyzed prospectively. The surgical procedure and outcome is described. Results: Out of three patients who underwent pancreas-preserving total duodenectomy, one patient had pancreatitis postoperatively and recovered well with conservative line of management. The other two patients had an uneventful postoperative course. All the patients were closely followed up and were symptom free, in a good condition with good functional status. Conclusions: To the best of our knowledge this is the first series of pancreas-preserving total duodenectomy without pancreato-enteric anastomosis ever reported. Although the indication for pancreas-preserving total duodenectomy is limited, it can be performed safely with good surgical expertise and knowledge of pancreato-duodenal anatomy. It can be beneficial in elderly patients with concomitant heart disease and associated risk factors. Although it is technically demanding requiring high surgical skills, it excludes the need of pancreas resection with maintenance of gastrointestinal function and the procedure can be performed safely and in less time. But the procedure should be contraindicated in the presence of malignancy and the operated patient should be under long-term surveillance.

Research paper thumbnail of Management of rectal cancer: strategies and controversies

PubMed, May 30, 2008

Colorectal cancer is one of the most common cancers in the western world. The goal of this review... more Colorectal cancer is one of the most common cancers in the western world. The goal of this review is to outline some of the important surgical issues surrounding the management of rectal cancer. In patients with early rectal cancer (T1), local excision may be an alternative approach in highly selected patients. For more advanced rectal cancer, radical surgical resection is the treatment of choice. Total mesorectal excision and negative radial margin (>1 mm) decreases the local recurrence rate and improves survival. In appropriate patients, laparoscopic resection allows for improved patient comfort, shorter hospital stays, and earlier returns to preoperative activity level. In patients with locally advanced disease, neoadjuvant chemoradiotherapy followed by radical excision according to the principles of TME has become widely accepted. Surgical resection is the treatment of choice for resectable liver metastasis of colorectal origin. Surgical resection improves disease-free and overall survival rate. For patients with unresectable metastatic disease, multimodality approach may increase the resectability rate and hence survival.

Research paper thumbnail of Laparoscopic microwave ablation of liver tumors: our experience

PubMed, May 30, 2008

Background/aims: Microwave ablation is the most recent development in the field of tumor ablation... more Background/aims: Microwave ablation is the most recent development in the field of tumor ablation and is a well established and safe local ablative method available for liver tumors (both primary and secondary tumors). The technique allows for flexible approaches to treatment, including percutaneous, laparoscopic, and open surgical access. Laparoscopic technique has the advantages of accurate tumor staging, better tolerability and low cost. It can be performed in tumors which are close to the vital organs. The aim of this study was to evaluate the feasibility and safety of laparoscopic microwave ablation of liver tumors. Methodology: During January 2001 to December 2005, 57 patients with liver tumors were treated with laparoscopic microwave ablation in the department of Surgical Oncology. There were 34 male and 23 female patients. Out of 57 patients, 11 patients had hepatocellular carcinoma and 46 patients had secondaries in the liver. The most common source of secondaries was colorectal cancers. Laparoscopic microwave ablation of tumors was performed in these patients. Results: During the study period, 57 patients with no evidence of extrahepatic disease underwent laparoscopic microwave ablation of unresectable hepatic tumors. No major intraoperative complications occurred. Postoperatively all the patients did well. Four patients developed liver abscess at the ablation area. Two patients required percutaneous aspiration of the liver abscess. No other major complications occurred. Follow-up CT scan shows complete necrosis of the tumors. Patients were followed-up at regular intervals. Conclusions: Laparoscopic microwave ablation is a feasible and safe alternative to open microwave ablation of the liver tumors. It carries all the advantage of minimal invasive surgery. In experienced hands, microwave ablation using laparoscopic technique can be done safely and effectively.

Research paper thumbnail of Pancreatic neuroendocrine tumors: our approach

PubMed, May 30, 2008

Background/aims: Pancreatic neuroendocrine tumors constitute a small percentage of pancreatic tum... more Background/aims: Pancreatic neuroendocrine tumors constitute a small percentage of pancreatic tumors. Surgical resection is the best treatment for these types of tumors. Aggressive surgical resection including multivisceral resection provides long-term survival. Even palliative resection of the tumor is justifiable. Here we share our experience with the management of pancreatic neuroendocrine tumors. Methodology: Between January 1993 and April 2007 we operated on 54 patients with pancreatic neuroendocrine tumor. We have analyzed our data retrospectively. Patients were analyzed in terms of demographic characteristics, operative procedure, postoperative outcome and survival. Results: Out of 54 patients, 31 patients had nonfunctional tumor and 23 patients had functional tumors. Neuroendocrine carcinoma was found in 19 patients. Pancreaticoduodenectomy was performed in 21 patients. Simultaneous liver resection was performed in 4 patients and multiorgan resection for locally advanced pancreatic tumor was performed in 3 patients. Conclusions: Surgical resection is the best option for the treatment of pancreatic neuroendocrine tumors. Aggressive resection provides survival benefit and a better quality of life. If the entire gross tumor can be resected, multiorgan resection or simultaneous liver resection is justifiable.

Research paper thumbnail of An update and our experience with metastatic liver disease

PubMed, Dec 1, 2007

Metastatic liver disease remains a challenging and life-threatening clinical situation with an ob... more Metastatic liver disease remains a challenging and life-threatening clinical situation with an obscure and dismal prognosis and outcome. The liver is the most common site of metastatic spread of colorectal cancer and nearly half of the patients with colorectal cancer ultimately develop liver metastasis during the course of their diseases. Death from colorectal cancer is often a result of liver metastases. Over half of these patients die from their metastatic liver diseases. At the time of diagnosis, hepatic metastases are present in 15-25% of patients, and another 25-50% will develop metachronous liver metastases within 3 years following resection of the primary tumor. Over the last decade, there have been tremendous advances in the treatment of metastatic liver disease. Hepatic resection still remains the gold standard for the treatment of metastatic lesions which are amenable to surgery. Unfortunately, up to 40 percent of patients are identified as having additional disease at the time of exploration, and 20 percent are found to be unresectable. Regional therapies such as radiofrequency ablation, microwave ablation and cryotherapy may be offered to patients with isolated unresectable metastases. Other options like hepatic artery chemotherapy and chemoembolization, portal vein embolization and immunotherapy also play a vital role in management of metastatic liver disease when used in combination with other therapies. This article reviews the history of metastatic liver disease, epidemiology, diagnosis and various treatment modalities available for liver metastases along with our experience in management of advance metastatic liver disease.

Research paper thumbnail of Postoperative hemorrhage after major pancreatobiliary surgery: an update

PubMed, Jul 11, 2008

In recent years, mortality associated with pancreaticoduodenectomy has come down to less than 5% ... more In recent years, mortality associated with pancreaticoduodenectomy has come down to less than 5% but morbidity still remains high. Pancreatic fistula is one of the most common complications following pancreaticoduodenectomy. Postpancreatectomy hemorrhage is a rare but disastrous complication and associated with poor outcome. Early bleeding is usually due to some surgical mishap, but the management is simpler. Delayed hemorrhage has more complex pathophysiology and requires a multimodality approach for its management. In this paper, we review the recent articles related to postoperative hemorrhage after major pancreatobiliary surgery. Here we discuss the incidence, cause, investigations and management of early and late postoperative hemorrhage.

Research paper thumbnail of Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study

PubMed, Dec 24, 2008

Background/aims: Anastomotic leakage is a major problem in colorectal surgery particularly in low... more Background/aims: Anastomotic leakage is a major problem in colorectal surgery particularly in low rectal cancer. The defunctioning loop ileostomy was introduced as a technique to create a manageable stoma that would divert the fecal stream from a more distal anastomosis in order to reduce the consequences of any anastomotic leakage. Therefore, the use of a defunctioning stoma has been suggested, but limited data exist to clearly determine the necessity of routine diversion. This study was designed to evaluate early morbidity, mortality and hospital stay in patients undergoing lower rectal cancer surgery concerned with or without loop ileostomy. Methodology: This is a prospective randomized study that was performed between May 2001 and March 2008. There were 256 patients who underwent elective low anterior resection and stapler anastomosis. They were divided into two groups. Group A consisted of 120 patients who underwent straight anastomosis without ileostomy and group B consisted of 136 patients who underwent straight anastomosis with loop ileostomy. Data regarding patient demographics, underlying pathology, anastomotic problems, and ileostomy-related problems were gathered. The patients were all monitored closely after surgery for an anastomotic leak and all stoma-related complications were recorded. Inclusion criteria consisted of biopsy proven adenocarcinoma of the rectum located at < or = 5 cm above the anal verge, age > or = 22 years, and informed consent. Exclusion criteria included age more than 90 years, associated co morbid conditions Stage IV with disease spread to liver and peritoneum. Results: Indications for surgery were lower rectal cancer (n=256). Mean age 55.5 years (range 22-90 years) and a male: female ratio of 1.1:1. All patients were undergoing elective surgery for lower rectal cancer. In our study 12 patients in group A developed anastomotic leak, two of them were re-explored for anastomotic leak and Hartman's colostomy was carried out. There were two deaths in Group A. In group B anastomotic leak was seen in three patients. In all three, anastomotic healing took place at a later period of time on the 18th, 20th, and 25th postoperative day respectively without any additional morbidity and mortality. Ileostomy-related problems were minor and limited to the stoma and complaints requiring stoma nurse evaluation (n=8), dehydration requiring outpatient care (n=3), bleeding at the stoma closure site (n=l). No stoma site hernias have been identified so far. Conclusions: The use of defunctioning loop ileostomy in all patients undergoing lower rectal surgery with stapler anastomosis is beneficial and safe. Defunctioning loop ileostomy use has resulted in no anastomotic leak rate and considerable low morbidity. So according to our study, we strongly recommend defunctioning loop ileostomy as a routine procedure in patients undergoing lower rectal cancer surgery.

Research paper thumbnail of A comparative study between open and laparoscopic repair of inguinal hernia

International Surgery Journal, Aug 28, 2019

Background: Hernias of the abdominal wall constitute an important public health problem. Laparosc... more Background: Hernias of the abdominal wall constitute an important public health problem. Laparoscopic inguinal hernia repair (TEP) is a minimal access surgical procedure as compared to open hernia repair. The objective of the study was to compare open and laparoscopic hernia repair in terms of safety, complications, morbidity, recurrence, post-op pain and hospital stay. Methods: This was a prospective observational comparative study. Total 50 patients were taken in this study; out of them 25 patients subjected to group A (open repair of inguinal hernia) and 25 patients subjected to group B (laparoscopic repair of inguinal hernia). Postoperatively patients were observed for any complications and followed up one year. Results: Present study shows high incidence of inguinal hernia in males. Mean operative time for open hernia repair group was less than laparoscopic hernia repair group. Time to return to normal work, duration of hospital stay and postoperative pain were less in laparoscopic hernia repair group than open hernia repair group. Out of 25 patients in laparoscopic hernia repair (TEP) 1 patient had recurrence but in open hernia repair group there was no recurrence. Conclusions: Laparoscopic hernia repair is quite safe; it has definite advantages in bilateral and recurrent cases, postoperative pain, early return to normal activities, less postoperative hospital stay and better cosmetic results although it has its own disadvantages in terms of recurrence rate, operative time and cost effectiveness.

Research paper thumbnail of Comparative Study of Catheter Drainage versus Needle Aspiration in Management of Liver Abscess

Surgery, Gastroenterology and Oncology, 2019

Background: Liver abscess is a common condition in India and it has the 2 nd highest incidence of... more Background: Liver abscess is a common condition in India and it has the 2 nd highest incidence of liver abscess in the world. Pyogenic abscess accounts for three quarters of hepatic abscess in developed countries while amoebic liver abscess causes two third of liver abscess in developing countries. Amoebiasis is presently the third most common cause of death from parasitic disease. The world health organisation reported that Entamoeba histolytica causes approximately 50 million cases and 1,00,000 deaths annually. Liver abscess continues to be a disease with considerable mortality in India. Liver abscess has an increasing incidence rate in United States and Europe. Modern treatment has shifted towards IV broad spectrum antibiotics and image guided percutaneous needle aspiration or percutaneous catheter drainage and surgical drainage. Treatment of liver abscess has improved significantly with the introduction of ultrasound and computed tomography. Methodology: This was a retrospective observational study conducted in Department of Surgery, GMC Bhopal, from March 2012 to march 2018. 651 patients were included in this study with the diagnosis of liver abscess. Results: Out of 651 patients, 297 ultrasound guided needle aspirations were done and 246 (83%) responded to it; 354 ultrasound guided pigtail catheter placements were done and 334 (94.3%) responded to it. Most common symptoms were pain in abdomen (n=559), fever (n= 558), nausea and vomiting (n = 455) and weight loss (n= 286). Among the successfully treated patients, early alleviation of symptoms, early resolution of abscess cavity, mean hospital stay and average time for clinical improvement were better among catheter drainage group. Conclusion: Majority of patients with un-ruptured liver abscess can be managed without conventional surgical drainage with Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration

Research paper thumbnail of Same Admission Closure of Temporary Bowel Stomas: Feasibility and Outcomes

Journal of Translational Medicine and Research, 2017

Background/Aim: This pilot study was designed to investigate the feasibility to close protective ... more Background/Aim: This pilot study was designed to investigate the feasibility to close protective loop stomas during the same hospital admission based on data on morbidity and mortality, health-related quality of life and healthcare-related costs shortly after the initial operation as well as to find out the causes that delay the closure and to compare the same admission closure with the delayed closure. Methodology: We created a temporary small bowel stoma due to various pathology and these patients were divided into two groups i.e one with early closure group (same admission closure within 2-3 weeks and late closure group more than 12 weeks and the results were compared. Results: In our study early stoma closure was performed in 20 patients, 6 women and 14 men with mean age 35 years at 16.0 ± 2.8 days after first operation, late closure was performed in other 25 patients, 8 women and 17 men with mean age 32 years. The average hospital stay was comparable between the 2 groups 11.62 ± 9.8 days after late closure and 9.5± 5.0 days after early closure. Stoma related complications were reported more in delayed closure group as compared with early closure group. Conclusions: Based on our study and results obtained ,in our opinion in otherwise fit and healthy patients with normal wound healing ,early stoma closure in same admission stay after first operation is better option. Not only does it reduce hospital stay also ensures early return to work.

Research paper thumbnail of Study on Incidence of Helicobacter Pylori in Patients of Gastroduodenal Perforation Admitted in Tertiary Care Center - Hamidia Hospital Bhopal

Journal of Translational Medicine and Research, 2016

Introduction: Acid-reduction surgery has been strongly advocated in past for perforated peptic ul... more Introduction: Acid-reduction surgery has been strongly advocated in past for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Since Most patients with Gastroduodenal perforation are associated with Helicobacter pylori (H. pylori) infection, Simple oversewing procedures either by an open or laparoscopic approach together with H. pylori eradication appear to supersede definitive ulcer surgery. Material and Methods: Total number of 70 patients were included in this prospective study with diagnosis of perforation peritonitis admitted in emergency ward. These patients were operated in emergency by simple closure of perforation with omental patch repair. Peroperative biopsy sample was taken from margin of perforation and sent for staining by H & E and Giemsa staining for H. pylori. After 15 days endoscopic biopsy was taken from gastric antrum for H. pylori staining. Anti H. Pylori Eradication Therapy (Triple therapy-1 PPI + 2 antibiotic) for 14 days was given to the positive cases. These patients were followed for 1 year for recurrence of ulcer. Results: Out of 70 consecutive patients (mean age = 47 years, range 15-75) of perforation H. pylori was seen in 48 patients (68.57%). Total 28 patients (40%) were having h/o use of NSAIDS in recent past. Male to female ratio was about 3:1 and most common age group was 46-55 years. In the H. pylori positive patients, Anti H pylori eradication therapy was given. These all patients are in follow up and are asymptomatic in 3 months. Conclusions: H. pylori is strongly associated with Gastro duodenal perforation, (48/70) 68.57% were positive for H. pylori. Gastric perforation was more common than duodenal perforation and prepyloric region was commonest site. For H. pylori detection, biopsy and staining is a good method. Early Anti H. pylori therapy for patients of Gastro duodenal perforation who were positive for H. pylori, provide an excellent cure after simple closure of perforation.

Research paper thumbnail of Study of Abnormal Anatomical Variations in Extrahepatic Biliary Apparatus and Its Related Vessels in Cadavers

Journal of Translational Medicine and Research, 2016

Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, ... more Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, laparoscopic hepatobiliary surgery and other open procedures such as open cholecystectomy, biliary stricture surgery, are performed regularly throughout the world and extrahepatic biliary tract is one of the most common sites of the surgical procedures. The incidence of biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. Apart from various other causes of biliary injuries aberrant anatomical course of extrahepatic biliary system is a well established fact of iatrogenic ductal injury. Thus, an adequate recognition and awareness of anatomical abnormalities of extra hepatic biliary tree with its vessel, can decrease the morbidity and mortality related to the surgery. Methods: Study was done in Department of Surgery, Gandhi Medical College and Hamidia Hospital Bhopal, India on 100 cases, during period of Aug 2014 to Nov 2015, and dissection was carried out in department of Forensic Medicine and Toxicology after taking permission from ethical committee. Results: In 100 cases of study 72 were male and 28 were female in which 16% male and 10.7% female showed variations in their anatomy. The most common variation which we observed in our study was short cystic duct in 8 cases, and second most common variations was cystic artery origin, from left hepatic artery in 3 cases and from proper hepatic artery in 1 case, other variations were floating gall bladder in 1 case, intrahepatic union of left hepatic duct and right hepatic duct in 3 cases, low insertion of cystic duct in 3 cases, high insertion of cystic duct to common hepatic duct in 1 case,and in one case cystic artery passing anterior to common hepatic duct. Conclusion: There was a significant variations seen in extrahepatic biliary apparatus and its related arterial supply in our study, and these variations observed could definintely be useful to hepatobiliary, laparoscopic surgeons and radiologist. And will further contribute to literature available on variations of extrahepatic biliary system.

Research paper thumbnail of Outcome of the Unidentified/Unaccompanied Patient of Traumatic Brain Injury in Trauma Unit of Gandhi Medical College and Associated Hamidia Hospital Bhopal (India)

International Journal of Medical and Biomedical Studies, Nov 27, 2019

All unidentified / unaccompanied & unknown TBI patients admitted in department of neurosurgery, G... more All unidentified / unaccompanied & unknown TBI patients admitted in department of neurosurgery, Gandhi Medical College Bhopal from June 2016 to May 2019 were enrolled in this study. Management of unidentified and unaccompanied patients is difficult in any health care setup due to challenges in managing their day to day care. Traumatic brain injury is the most common cause of death in trauma patients. We analyzed demography, mode of injury, clinical presentation & condition at admission, treatment given, hospital stay, outcome & factors affecting outcome of the patients. Very few studies in world literature are available on this subgroup of patients. We analyzed data pertaining to 100 consecutive patients at our hospital. Aim and Objectives: The aim and objective of this study is to determine the outcome of traumatic Brain Injury in patients who were admitted in trauma unit/ Neurosurgery unit of Gandhi medical College Bhopal India from June 2016 to May 2019. As unaccompanied / unknown/ unidentified. In this study we collected the data of unknown/ unidentified patients of TBI to analyze the outcome. Material and Methods: It was a prospective study of all unaccompanied/ unknown patients who were admitted in the trauma unit/ Neurosurgery unit of surgery department of Gandhi Medical College & Associated Hamidia Hospital Bhopal India from June 2016 to May 2019 a total number of 100 unidentified /unaccompanied patients were admitted whose data were collected and analyzed Departmental staff, social workers, police and media persons help were take in for relocation of unknown patients to their home or non government organization shelter homes. Results: There were total 100 consecutive patient enrolment in this study, 87% of the patients were male. Most common age group was 40-59 years, 48% patients falls in this age group. Most common cause of trauma was road traffic accident (48%), followed by Cause Unknown (36%). Overall mortality was 39%. Others clinical characteristic and type of lesion in traumatic brain injury of unidentified and unaccompanied patients is given in detail in. Out of 100 patients, 43 (43%) patients were managed conservatively based on CT head findings and neurological status & 57 (57%) were operated. Decompressive Craniectomy was most common operative procedure depending on the clinical & neurological status. Overall complication rate during hospital stay was 26%.

Research paper thumbnail of Life expectancy with glioblastoma at GMC, Bhopal

IP Indian Journal of Neurosciences, Jul 15, 2020

The majority of the patients who were diagnosed with the glioblastoma at GMC, Bhopal. The only ex... more The majority of the patients who were diagnosed with the glioblastoma at GMC, Bhopal. The only exceptions are the patients that have died or were not fit enough for referral. Among these patients, we have searched for those, which were older than 70 years at the time of diagnosis Result: When comparing the groups of the patients younger than 70 with those older, the difference in median survival between groups was statistically significant at p < 0.001. Conclusion: Microsurgery is safe and effective in order to improve or preserve short-term quality of life in glioblastoma patients. Total tumor resection is not associated with a significantly greater risk for neurological deterioration, either in patients with preoperative functional impairment, or in functionally independent patients. For glioblastoma the survival also depends on person's age, type of tumor, and overall health play a role as treatments improve people newly diagnosed with these aggressive brain tumors may have a better outcome. Glioblastoma is linked to age, with better rates for those below 65 years of age, but also to aggressive and complete surgical excision, a good Karnofsky index score before surgery and the application of radiotherapy after surgery Study Design: Observational Study

Research paper thumbnail of Anomalous anatomical variation in extrahepatic biliary tree and pancreas and its related vessels: a cadaveric study

International Surgery Journal, Aug 28, 2019

Background: Congenital anamolies of extrahepatic biliary apparatus and pancreas have long been re... more Background: Congenital anamolies of extrahepatic biliary apparatus and pancreas have long been recognized and are of clinical importance because when present may surprise the surgeon during surgery and lead to iatrogenic injuries. Surgeries on extra-hepatic biliary apparatus and pancreas are regularly performed throughout the world. Thus insight into the normal anatomy and congenital variations will reduce complication and definitely improve outcome. Methods: Study was conducted in department of surgery GMC Bhopal and dissection was carried out in Department of Forensic Medicine on 100 cadavers with approval from ethical committee. Results: In 100 cases 70 were male and 30 female. The most common variation in extra hepatic biliary apparatus was short cystic duct was found in 6% cases then formation of common hepatic duct by union of right hepatic duct and left hepatic duct was intrahepatic in 3% cases. There was low insertion of cystic duct with common hepatic duct in 1% case. Cystic artery originating from left hepatic artery in 1% case, in 1% case cystic artery was anterior to common hepatic duct. In Pancreas anterior arterial arcade was absent in 2% cases and its origin varied in 2% case. Posterior pancreatic arcade absent in 1% cases and variation in origin was present in 1% case. The variation in pancreatic duct course was present in 22% cases. Conclusions: Thus significant variation was seen and it could definitely be helpful to hepatobiliary, laproscopic surgeons, radiologist and will further contribute to literature on variation of extrahepatic biliary apparatus and pancreas and its related vessels.

Research paper thumbnail of Spontaneous Fecal Fistula in a Hiv Patient: A Rare Presentation of Inguinal Hernia

International Journal of …, 2012

Congenital inguinal hernia is a common condition encountered in surgical practice. We report a ca... more Congenital inguinal hernia is a common condition encountered in surgical practice. We report a case of scrotal Enterocutaneous fistula, a rare complication of incarcerated hernia in a HIV patient due to late presentation, neglect and lack of proper management. ...

Research paper thumbnail of Overview of Advancement and Management of Gastrointestinal Stromal Tumors

Journal of modern medical oncology, Sep 22, 2022

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of gastrointestinal tr... more Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of gastrointestinal tract with different expressions of CD117 (transmembrane KIT receptor tyrosine kinase) from other related tumors, which provides insights into the disease management of GIST. Tyrosine kinase inhibitors reduce the incidence of tumor recurrence and make the tumor resectable. Despite the malignant potential of GISTs, gastric GIST shows a better prognosis versus GISTs at other locations. Contrast-enhanced computed tomography (CECT) is considered the radiological diagnosis of choice because biopsy increases the risk of bleeding and tumor spreading. In addition to surgical resection which remains the mainstay of GIST treatment, active surveillance is also available for gastric tumor with a size <2cm. Currently, given the clinical consensus of an increased response of the tumor to chemotherapy after resection of the advanced lesion, patients with metastasis are also indicated for cytoreductive surgery. Various minimally invasive techniques including endoscopic (endoscopic band ligation, endoscopic muscularis dissection, endoscopic submucosal dissection, endoscopic submucosal tunnelling, endoscopic fullthickness resection), laparoscopic and combined techniques (laparoscopic endoscopic cooperative surgery, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique) have been developed for surgical resection of tumors. Due to the high recurrence rate even during treatment, patients receive a physical examination and CECT follow-up every 3-5 months for 5 years followed by annual visits.

Research paper thumbnail of A prospective and retrospective study of Stoppa procedure (giant prosthetic reinforcement of visceral sac) for recurrent, complex and bilateral inguinal hernias

International Surgery Journal, Aug 25, 2018

Background: Managing complex inguinal hernia is always a challenge for surgeons. When recurrent o... more Background: Managing complex inguinal hernia is always a challenge for surgeons. When recurrent or complex hernia is present it is mandatory to adopt an alternative and different approach for the repair of inguinal hernia to avoid any further complication and recurrence. Primary aim of this study is to assess the usefulness of Stoppa procedure in current situation for treatment of bilateral, complex and recurrent hernias. Methods: A prospective and retrospective study of Stoppa procedure (giant prosthetic reinforcement of visceral sac [GPRVS]) for recurrent, complex and bilateral inguinal hernias was conducted in Department of General Surgery Hamidia Hospital from January 2016 to October 2017 , 30 patients with 27 bilateral and 3 unilateral hernias making total 57 hernial sites including five recurrent hernias (after Lichtenstein repair) were operated by GPRVS for bilateral, recurrent and complex inguinal hernias, were included in study. Results: Four complications were seen. One patient developed seroma which resolved spontaneously, one patient developed superficial wound infection. One patient developed right testicular pain which was relieved after medication. One patient developed pain in groin and right thigh which was present preoperatively also but increased after surgery and was relieved on medication. Risk for recurrence present in 18 patients. No recurrence was observed. Conclusions: Because of the excellent results, ease of the procedure and low complication rate, GPRVS is an effective and good option for bilateral, complex and recurrent inguinal hernias.

Research paper thumbnail of Water Soluble Contrast Study Predicts the Need for Early Surgery in Adhesive Small Bowel Obstruction

ABSTRACT Water Soluble Contrast Study Predicts the Need for Early Surgery in Adhesive Small Bowel... more ABSTRACT Water Soluble Contrast Study Predicts the Need for Early Surgery in Adhesive Small Bowel Obstruction Dr. Mahim Koshariya1, Dr. Samir Shukla2, Dr. Sudesh Sharda3, Dr. Akhilesh Ratnakar3, Dr. Vishal Rampuria3, Dr. Avinash Pratap Singh4, Dr. Varun Pendro4, Dr. Puspendra Baghel4, Dr. Samit Chaturvedi4, Dr. M.C. Songara5 Associate Professor1, Assistant Professor2, Senior Resident3, Resident4, Professor and Head5 Department of Surgery, Gandhi Medical College &amp; Associated Hamidia Hospital, Bhopal-462012, Madhya Pradesh, India. Vol. 2(2) : pp 51-56 (2013) Abstract: The study was carried out with the aim to investigate whether the water soluble contrast study followed for 24 hours can be a reliable indicator of the need for earlier surgical intervention in adhesive small bowel obstruction or not? To avoid much dreaded complications like bowel strangulation due to delayed surgical intervention, and to determine the management approach for patients in whom avoiding surgery is highly desirable such as those with multiple previous abdominal operations or small bowel obstruction in the early post-operative period. 40 patients admitted in emergency with clinical and radiologic evidence of adhesive small bowel obstruction were included in this study. All patients were treated conservatively for initial 48 hours. The Gastrograffin study was performed in 28 patients after 48 hours as12 patients showed spontaneous relief in symptoms of obstruction within 48 hours and were managed conservatively. 25 cases showed contrast agent beyond Ileocecal junction on plain radiograph in erect posture before 24 hours of ingestion of oral contrast and conservative treatment was continued. The remaining 3 cases had complete obstruction as shown by the contrast study and underwent surgery. The use of water soluble contrast agent Gastrograffin in adhesive small bowel obstruction after failed conservative treatment can be of great help in diagnosis and management of adhesive small bowel obstruction. Keywords: Gastrograffin, Small bowel obstruction, Water soluble contrast study, Adhesive small bowel obstruction, Bowel obstruction, Small bowel.

Research paper thumbnail of Prevalence of pathogens and their antimicrobial susceptibility in catheter associated urinary tract infection

Hospital-acquired urinary tract infection (UTI) is the most Up to 25% of hospitalised patients un... more Hospital-acquired urinary tract infection (UTI) is the most Up to 25% of hospitalised patients undergo urinary catheterisation, a similar proportion of patients cared for in residential homes will have long term indwelling catheters. Although often necessary intervention, indwelling urinary catheters are a leading cause of nosocomial infections and have been associated with both morbidity and mortality. The urinary tract accounts for more than 40% of total number of nosocomial infections. Most nosocomial infections associated follow instrumentations, usually with the catheter. Results of several studies demonstrated that this antibiotic drug prophylaxis has increased the rate of isolation of resistant organisms. To ensure appropriate therapy, current knowledg is mandatory. The aim of present study was to assess the bacterial profile for catheter associated UTI and the antimicrobial sensitive to most commonly used antibiotics, used in the therapeuti prophylactic settings before the results of the urine culture are available. In our study, the incidence of infection in catheterized patients was found to be 27% which was low but comparable to studies done in India and Western studies. E. coli was t infection and highest sensitivity was found to A

Research paper thumbnail of Pancreas-preserving total duodenectomy without pancreato-enteric anastomosis

PubMed, Feb 7, 2008

Background/aims: Pancreas-preserving total duodenectomy is a challenging surgical technique with ... more Background/aims: Pancreas-preserving total duodenectomy is a challenging surgical technique with organ preservation and has limited indications. We assessed the safety, feasibility and short-term functional outcome of PPTD without the need of pancreato-enteric anastomosis in our surgical technique. Methodology: During the two-year period from 2005 to 2007, three patients underwent pancreas-preserving total duodenectomy at our center. Two patients had diffuse adenomatous polyposis; another had previous transduodenal excision for polyp with recurrence. In all three patients pancreas-preserving total duodenectomy was performed without the pancreato-jejunal anastomosis and were analyzed prospectively. The surgical procedure and outcome is described. Results: Out of three patients who underwent pancreas-preserving total duodenectomy, one patient had pancreatitis postoperatively and recovered well with conservative line of management. The other two patients had an uneventful postoperative course. All the patients were closely followed up and were symptom free, in a good condition with good functional status. Conclusions: To the best of our knowledge this is the first series of pancreas-preserving total duodenectomy without pancreato-enteric anastomosis ever reported. Although the indication for pancreas-preserving total duodenectomy is limited, it can be performed safely with good surgical expertise and knowledge of pancreato-duodenal anatomy. It can be beneficial in elderly patients with concomitant heart disease and associated risk factors. Although it is technically demanding requiring high surgical skills, it excludes the need of pancreas resection with maintenance of gastrointestinal function and the procedure can be performed safely and in less time. But the procedure should be contraindicated in the presence of malignancy and the operated patient should be under long-term surveillance.

Research paper thumbnail of Management of rectal cancer: strategies and controversies

PubMed, May 30, 2008

Colorectal cancer is one of the most common cancers in the western world. The goal of this review... more Colorectal cancer is one of the most common cancers in the western world. The goal of this review is to outline some of the important surgical issues surrounding the management of rectal cancer. In patients with early rectal cancer (T1), local excision may be an alternative approach in highly selected patients. For more advanced rectal cancer, radical surgical resection is the treatment of choice. Total mesorectal excision and negative radial margin (>1 mm) decreases the local recurrence rate and improves survival. In appropriate patients, laparoscopic resection allows for improved patient comfort, shorter hospital stays, and earlier returns to preoperative activity level. In patients with locally advanced disease, neoadjuvant chemoradiotherapy followed by radical excision according to the principles of TME has become widely accepted. Surgical resection is the treatment of choice for resectable liver metastasis of colorectal origin. Surgical resection improves disease-free and overall survival rate. For patients with unresectable metastatic disease, multimodality approach may increase the resectability rate and hence survival.

Research paper thumbnail of Laparoscopic microwave ablation of liver tumors: our experience

PubMed, May 30, 2008

Background/aims: Microwave ablation is the most recent development in the field of tumor ablation... more Background/aims: Microwave ablation is the most recent development in the field of tumor ablation and is a well established and safe local ablative method available for liver tumors (both primary and secondary tumors). The technique allows for flexible approaches to treatment, including percutaneous, laparoscopic, and open surgical access. Laparoscopic technique has the advantages of accurate tumor staging, better tolerability and low cost. It can be performed in tumors which are close to the vital organs. The aim of this study was to evaluate the feasibility and safety of laparoscopic microwave ablation of liver tumors. Methodology: During January 2001 to December 2005, 57 patients with liver tumors were treated with laparoscopic microwave ablation in the department of Surgical Oncology. There were 34 male and 23 female patients. Out of 57 patients, 11 patients had hepatocellular carcinoma and 46 patients had secondaries in the liver. The most common source of secondaries was colorectal cancers. Laparoscopic microwave ablation of tumors was performed in these patients. Results: During the study period, 57 patients with no evidence of extrahepatic disease underwent laparoscopic microwave ablation of unresectable hepatic tumors. No major intraoperative complications occurred. Postoperatively all the patients did well. Four patients developed liver abscess at the ablation area. Two patients required percutaneous aspiration of the liver abscess. No other major complications occurred. Follow-up CT scan shows complete necrosis of the tumors. Patients were followed-up at regular intervals. Conclusions: Laparoscopic microwave ablation is a feasible and safe alternative to open microwave ablation of the liver tumors. It carries all the advantage of minimal invasive surgery. In experienced hands, microwave ablation using laparoscopic technique can be done safely and effectively.

Research paper thumbnail of Pancreatic neuroendocrine tumors: our approach

PubMed, May 30, 2008

Background/aims: Pancreatic neuroendocrine tumors constitute a small percentage of pancreatic tum... more Background/aims: Pancreatic neuroendocrine tumors constitute a small percentage of pancreatic tumors. Surgical resection is the best treatment for these types of tumors. Aggressive surgical resection including multivisceral resection provides long-term survival. Even palliative resection of the tumor is justifiable. Here we share our experience with the management of pancreatic neuroendocrine tumors. Methodology: Between January 1993 and April 2007 we operated on 54 patients with pancreatic neuroendocrine tumor. We have analyzed our data retrospectively. Patients were analyzed in terms of demographic characteristics, operative procedure, postoperative outcome and survival. Results: Out of 54 patients, 31 patients had nonfunctional tumor and 23 patients had functional tumors. Neuroendocrine carcinoma was found in 19 patients. Pancreaticoduodenectomy was performed in 21 patients. Simultaneous liver resection was performed in 4 patients and multiorgan resection for locally advanced pancreatic tumor was performed in 3 patients. Conclusions: Surgical resection is the best option for the treatment of pancreatic neuroendocrine tumors. Aggressive resection provides survival benefit and a better quality of life. If the entire gross tumor can be resected, multiorgan resection or simultaneous liver resection is justifiable.

Research paper thumbnail of An update and our experience with metastatic liver disease

PubMed, Dec 1, 2007

Metastatic liver disease remains a challenging and life-threatening clinical situation with an ob... more Metastatic liver disease remains a challenging and life-threatening clinical situation with an obscure and dismal prognosis and outcome. The liver is the most common site of metastatic spread of colorectal cancer and nearly half of the patients with colorectal cancer ultimately develop liver metastasis during the course of their diseases. Death from colorectal cancer is often a result of liver metastases. Over half of these patients die from their metastatic liver diseases. At the time of diagnosis, hepatic metastases are present in 15-25% of patients, and another 25-50% will develop metachronous liver metastases within 3 years following resection of the primary tumor. Over the last decade, there have been tremendous advances in the treatment of metastatic liver disease. Hepatic resection still remains the gold standard for the treatment of metastatic lesions which are amenable to surgery. Unfortunately, up to 40 percent of patients are identified as having additional disease at the time of exploration, and 20 percent are found to be unresectable. Regional therapies such as radiofrequency ablation, microwave ablation and cryotherapy may be offered to patients with isolated unresectable metastases. Other options like hepatic artery chemotherapy and chemoembolization, portal vein embolization and immunotherapy also play a vital role in management of metastatic liver disease when used in combination with other therapies. This article reviews the history of metastatic liver disease, epidemiology, diagnosis and various treatment modalities available for liver metastases along with our experience in management of advance metastatic liver disease.

Research paper thumbnail of Postoperative hemorrhage after major pancreatobiliary surgery: an update

PubMed, Jul 11, 2008

In recent years, mortality associated with pancreaticoduodenectomy has come down to less than 5% ... more In recent years, mortality associated with pancreaticoduodenectomy has come down to less than 5% but morbidity still remains high. Pancreatic fistula is one of the most common complications following pancreaticoduodenectomy. Postpancreatectomy hemorrhage is a rare but disastrous complication and associated with poor outcome. Early bleeding is usually due to some surgical mishap, but the management is simpler. Delayed hemorrhage has more complex pathophysiology and requires a multimodality approach for its management. In this paper, we review the recent articles related to postoperative hemorrhage after major pancreatobiliary surgery. Here we discuss the incidence, cause, investigations and management of early and late postoperative hemorrhage.

Research paper thumbnail of Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study

PubMed, Dec 24, 2008

Background/aims: Anastomotic leakage is a major problem in colorectal surgery particularly in low... more Background/aims: Anastomotic leakage is a major problem in colorectal surgery particularly in low rectal cancer. The defunctioning loop ileostomy was introduced as a technique to create a manageable stoma that would divert the fecal stream from a more distal anastomosis in order to reduce the consequences of any anastomotic leakage. Therefore, the use of a defunctioning stoma has been suggested, but limited data exist to clearly determine the necessity of routine diversion. This study was designed to evaluate early morbidity, mortality and hospital stay in patients undergoing lower rectal cancer surgery concerned with or without loop ileostomy. Methodology: This is a prospective randomized study that was performed between May 2001 and March 2008. There were 256 patients who underwent elective low anterior resection and stapler anastomosis. They were divided into two groups. Group A consisted of 120 patients who underwent straight anastomosis without ileostomy and group B consisted of 136 patients who underwent straight anastomosis with loop ileostomy. Data regarding patient demographics, underlying pathology, anastomotic problems, and ileostomy-related problems were gathered. The patients were all monitored closely after surgery for an anastomotic leak and all stoma-related complications were recorded. Inclusion criteria consisted of biopsy proven adenocarcinoma of the rectum located at < or = 5 cm above the anal verge, age > or = 22 years, and informed consent. Exclusion criteria included age more than 90 years, associated co morbid conditions Stage IV with disease spread to liver and peritoneum. Results: Indications for surgery were lower rectal cancer (n=256). Mean age 55.5 years (range 22-90 years) and a male: female ratio of 1.1:1. All patients were undergoing elective surgery for lower rectal cancer. In our study 12 patients in group A developed anastomotic leak, two of them were re-explored for anastomotic leak and Hartman's colostomy was carried out. There were two deaths in Group A. In group B anastomotic leak was seen in three patients. In all three, anastomotic healing took place at a later period of time on the 18th, 20th, and 25th postoperative day respectively without any additional morbidity and mortality. Ileostomy-related problems were minor and limited to the stoma and complaints requiring stoma nurse evaluation (n=8), dehydration requiring outpatient care (n=3), bleeding at the stoma closure site (n=l). No stoma site hernias have been identified so far. Conclusions: The use of defunctioning loop ileostomy in all patients undergoing lower rectal surgery with stapler anastomosis is beneficial and safe. Defunctioning loop ileostomy use has resulted in no anastomotic leak rate and considerable low morbidity. So according to our study, we strongly recommend defunctioning loop ileostomy as a routine procedure in patients undergoing lower rectal cancer surgery.

Research paper thumbnail of A comparative study between open and laparoscopic repair of inguinal hernia

International Surgery Journal, Aug 28, 2019

Background: Hernias of the abdominal wall constitute an important public health problem. Laparosc... more Background: Hernias of the abdominal wall constitute an important public health problem. Laparoscopic inguinal hernia repair (TEP) is a minimal access surgical procedure as compared to open hernia repair. The objective of the study was to compare open and laparoscopic hernia repair in terms of safety, complications, morbidity, recurrence, post-op pain and hospital stay. Methods: This was a prospective observational comparative study. Total 50 patients were taken in this study; out of them 25 patients subjected to group A (open repair of inguinal hernia) and 25 patients subjected to group B (laparoscopic repair of inguinal hernia). Postoperatively patients were observed for any complications and followed up one year. Results: Present study shows high incidence of inguinal hernia in males. Mean operative time for open hernia repair group was less than laparoscopic hernia repair group. Time to return to normal work, duration of hospital stay and postoperative pain were less in laparoscopic hernia repair group than open hernia repair group. Out of 25 patients in laparoscopic hernia repair (TEP) 1 patient had recurrence but in open hernia repair group there was no recurrence. Conclusions: Laparoscopic hernia repair is quite safe; it has definite advantages in bilateral and recurrent cases, postoperative pain, early return to normal activities, less postoperative hospital stay and better cosmetic results although it has its own disadvantages in terms of recurrence rate, operative time and cost effectiveness.

Research paper thumbnail of Comparative Study of Catheter Drainage versus Needle Aspiration in Management of Liver Abscess

Surgery, Gastroenterology and Oncology, 2019

Background: Liver abscess is a common condition in India and it has the 2 nd highest incidence of... more Background: Liver abscess is a common condition in India and it has the 2 nd highest incidence of liver abscess in the world. Pyogenic abscess accounts for three quarters of hepatic abscess in developed countries while amoebic liver abscess causes two third of liver abscess in developing countries. Amoebiasis is presently the third most common cause of death from parasitic disease. The world health organisation reported that Entamoeba histolytica causes approximately 50 million cases and 1,00,000 deaths annually. Liver abscess continues to be a disease with considerable mortality in India. Liver abscess has an increasing incidence rate in United States and Europe. Modern treatment has shifted towards IV broad spectrum antibiotics and image guided percutaneous needle aspiration or percutaneous catheter drainage and surgical drainage. Treatment of liver abscess has improved significantly with the introduction of ultrasound and computed tomography. Methodology: This was a retrospective observational study conducted in Department of Surgery, GMC Bhopal, from March 2012 to march 2018. 651 patients were included in this study with the diagnosis of liver abscess. Results: Out of 651 patients, 297 ultrasound guided needle aspirations were done and 246 (83%) responded to it; 354 ultrasound guided pigtail catheter placements were done and 334 (94.3%) responded to it. Most common symptoms were pain in abdomen (n=559), fever (n= 558), nausea and vomiting (n = 455) and weight loss (n= 286). Among the successfully treated patients, early alleviation of symptoms, early resolution of abscess cavity, mean hospital stay and average time for clinical improvement were better among catheter drainage group. Conclusion: Majority of patients with un-ruptured liver abscess can be managed without conventional surgical drainage with Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration

Research paper thumbnail of Same Admission Closure of Temporary Bowel Stomas: Feasibility and Outcomes

Journal of Translational Medicine and Research, 2017

Background/Aim: This pilot study was designed to investigate the feasibility to close protective ... more Background/Aim: This pilot study was designed to investigate the feasibility to close protective loop stomas during the same hospital admission based on data on morbidity and mortality, health-related quality of life and healthcare-related costs shortly after the initial operation as well as to find out the causes that delay the closure and to compare the same admission closure with the delayed closure. Methodology: We created a temporary small bowel stoma due to various pathology and these patients were divided into two groups i.e one with early closure group (same admission closure within 2-3 weeks and late closure group more than 12 weeks and the results were compared. Results: In our study early stoma closure was performed in 20 patients, 6 women and 14 men with mean age 35 years at 16.0 ± 2.8 days after first operation, late closure was performed in other 25 patients, 8 women and 17 men with mean age 32 years. The average hospital stay was comparable between the 2 groups 11.62 ± 9.8 days after late closure and 9.5± 5.0 days after early closure. Stoma related complications were reported more in delayed closure group as compared with early closure group. Conclusions: Based on our study and results obtained ,in our opinion in otherwise fit and healthy patients with normal wound healing ,early stoma closure in same admission stay after first operation is better option. Not only does it reduce hospital stay also ensures early return to work.

Research paper thumbnail of Study on Incidence of Helicobacter Pylori in Patients of Gastroduodenal Perforation Admitted in Tertiary Care Center - Hamidia Hospital Bhopal

Journal of Translational Medicine and Research, 2016

Introduction: Acid-reduction surgery has been strongly advocated in past for perforated peptic ul... more Introduction: Acid-reduction surgery has been strongly advocated in past for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Since Most patients with Gastroduodenal perforation are associated with Helicobacter pylori (H. pylori) infection, Simple oversewing procedures either by an open or laparoscopic approach together with H. pylori eradication appear to supersede definitive ulcer surgery. Material and Methods: Total number of 70 patients were included in this prospective study with diagnosis of perforation peritonitis admitted in emergency ward. These patients were operated in emergency by simple closure of perforation with omental patch repair. Peroperative biopsy sample was taken from margin of perforation and sent for staining by H & E and Giemsa staining for H. pylori. After 15 days endoscopic biopsy was taken from gastric antrum for H. pylori staining. Anti H. Pylori Eradication Therapy (Triple therapy-1 PPI + 2 antibiotic) for 14 days was given to the positive cases. These patients were followed for 1 year for recurrence of ulcer. Results: Out of 70 consecutive patients (mean age = 47 years, range 15-75) of perforation H. pylori was seen in 48 patients (68.57%). Total 28 patients (40%) were having h/o use of NSAIDS in recent past. Male to female ratio was about 3:1 and most common age group was 46-55 years. In the H. pylori positive patients, Anti H pylori eradication therapy was given. These all patients are in follow up and are asymptomatic in 3 months. Conclusions: H. pylori is strongly associated with Gastro duodenal perforation, (48/70) 68.57% were positive for H. pylori. Gastric perforation was more common than duodenal perforation and prepyloric region was commonest site. For H. pylori detection, biopsy and staining is a good method. Early Anti H. pylori therapy for patients of Gastro duodenal perforation who were positive for H. pylori, provide an excellent cure after simple closure of perforation.

Research paper thumbnail of Study of Abnormal Anatomical Variations in Extrahepatic Biliary Apparatus and Its Related Vessels in Cadavers

Journal of Translational Medicine and Research, 2016

Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, ... more Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, laparoscopic hepatobiliary surgery and other open procedures such as open cholecystectomy, biliary stricture surgery, are performed regularly throughout the world and extrahepatic biliary tract is one of the most common sites of the surgical procedures. The incidence of biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. Apart from various other causes of biliary injuries aberrant anatomical course of extrahepatic biliary system is a well established fact of iatrogenic ductal injury. Thus, an adequate recognition and awareness of anatomical abnormalities of extra hepatic biliary tree with its vessel, can decrease the morbidity and mortality related to the surgery. Methods: Study was done in Department of Surgery, Gandhi Medical College and Hamidia Hospital Bhopal, India on 100 cases, during period of Aug 2014 to Nov 2015, and dissection was carried out in department of Forensic Medicine and Toxicology after taking permission from ethical committee. Results: In 100 cases of study 72 were male and 28 were female in which 16% male and 10.7% female showed variations in their anatomy. The most common variation which we observed in our study was short cystic duct in 8 cases, and second most common variations was cystic artery origin, from left hepatic artery in 3 cases and from proper hepatic artery in 1 case, other variations were floating gall bladder in 1 case, intrahepatic union of left hepatic duct and right hepatic duct in 3 cases, low insertion of cystic duct in 3 cases, high insertion of cystic duct to common hepatic duct in 1 case,and in one case cystic artery passing anterior to common hepatic duct. Conclusion: There was a significant variations seen in extrahepatic biliary apparatus and its related arterial supply in our study, and these variations observed could definintely be useful to hepatobiliary, laparoscopic surgeons and radiologist. And will further contribute to literature available on variations of extrahepatic biliary system.

Research paper thumbnail of Outcome of the Unidentified/Unaccompanied Patient of Traumatic Brain Injury in Trauma Unit of Gandhi Medical College and Associated Hamidia Hospital Bhopal (India)

International Journal of Medical and Biomedical Studies, Nov 27, 2019

All unidentified / unaccompanied & unknown TBI patients admitted in department of neurosurgery, G... more All unidentified / unaccompanied & unknown TBI patients admitted in department of neurosurgery, Gandhi Medical College Bhopal from June 2016 to May 2019 were enrolled in this study. Management of unidentified and unaccompanied patients is difficult in any health care setup due to challenges in managing their day to day care. Traumatic brain injury is the most common cause of death in trauma patients. We analyzed demography, mode of injury, clinical presentation & condition at admission, treatment given, hospital stay, outcome & factors affecting outcome of the patients. Very few studies in world literature are available on this subgroup of patients. We analyzed data pertaining to 100 consecutive patients at our hospital. Aim and Objectives: The aim and objective of this study is to determine the outcome of traumatic Brain Injury in patients who were admitted in trauma unit/ Neurosurgery unit of Gandhi medical College Bhopal India from June 2016 to May 2019. As unaccompanied / unknown/ unidentified. In this study we collected the data of unknown/ unidentified patients of TBI to analyze the outcome. Material and Methods: It was a prospective study of all unaccompanied/ unknown patients who were admitted in the trauma unit/ Neurosurgery unit of surgery department of Gandhi Medical College & Associated Hamidia Hospital Bhopal India from June 2016 to May 2019 a total number of 100 unidentified /unaccompanied patients were admitted whose data were collected and analyzed Departmental staff, social workers, police and media persons help were take in for relocation of unknown patients to their home or non government organization shelter homes. Results: There were total 100 consecutive patient enrolment in this study, 87% of the patients were male. Most common age group was 40-59 years, 48% patients falls in this age group. Most common cause of trauma was road traffic accident (48%), followed by Cause Unknown (36%). Overall mortality was 39%. Others clinical characteristic and type of lesion in traumatic brain injury of unidentified and unaccompanied patients is given in detail in. Out of 100 patients, 43 (43%) patients were managed conservatively based on CT head findings and neurological status & 57 (57%) were operated. Decompressive Craniectomy was most common operative procedure depending on the clinical & neurological status. Overall complication rate during hospital stay was 26%.

Research paper thumbnail of Life expectancy with glioblastoma at GMC, Bhopal

IP Indian Journal of Neurosciences, Jul 15, 2020

The majority of the patients who were diagnosed with the glioblastoma at GMC, Bhopal. The only ex... more The majority of the patients who were diagnosed with the glioblastoma at GMC, Bhopal. The only exceptions are the patients that have died or were not fit enough for referral. Among these patients, we have searched for those, which were older than 70 years at the time of diagnosis Result: When comparing the groups of the patients younger than 70 with those older, the difference in median survival between groups was statistically significant at p < 0.001. Conclusion: Microsurgery is safe and effective in order to improve or preserve short-term quality of life in glioblastoma patients. Total tumor resection is not associated with a significantly greater risk for neurological deterioration, either in patients with preoperative functional impairment, or in functionally independent patients. For glioblastoma the survival also depends on person's age, type of tumor, and overall health play a role as treatments improve people newly diagnosed with these aggressive brain tumors may have a better outcome. Glioblastoma is linked to age, with better rates for those below 65 years of age, but also to aggressive and complete surgical excision, a good Karnofsky index score before surgery and the application of radiotherapy after surgery Study Design: Observational Study

Research paper thumbnail of Anomalous anatomical variation in extrahepatic biliary tree and pancreas and its related vessels: a cadaveric study

International Surgery Journal, Aug 28, 2019

Background: Congenital anamolies of extrahepatic biliary apparatus and pancreas have long been re... more Background: Congenital anamolies of extrahepatic biliary apparatus and pancreas have long been recognized and are of clinical importance because when present may surprise the surgeon during surgery and lead to iatrogenic injuries. Surgeries on extra-hepatic biliary apparatus and pancreas are regularly performed throughout the world. Thus insight into the normal anatomy and congenital variations will reduce complication and definitely improve outcome. Methods: Study was conducted in department of surgery GMC Bhopal and dissection was carried out in Department of Forensic Medicine on 100 cadavers with approval from ethical committee. Results: In 100 cases 70 were male and 30 female. The most common variation in extra hepatic biliary apparatus was short cystic duct was found in 6% cases then formation of common hepatic duct by union of right hepatic duct and left hepatic duct was intrahepatic in 3% cases. There was low insertion of cystic duct with common hepatic duct in 1% case. Cystic artery originating from left hepatic artery in 1% case, in 1% case cystic artery was anterior to common hepatic duct. In Pancreas anterior arterial arcade was absent in 2% cases and its origin varied in 2% case. Posterior pancreatic arcade absent in 1% cases and variation in origin was present in 1% case. The variation in pancreatic duct course was present in 22% cases. Conclusions: Thus significant variation was seen and it could definitely be helpful to hepatobiliary, laproscopic surgeons, radiologist and will further contribute to literature on variation of extrahepatic biliary apparatus and pancreas and its related vessels.