Asif Mehraj | Sher-i-Kashmir Institue Of Medical Sciences,soura,srinagar-190011,india (original) (raw)

Papers by Asif Mehraj

Medicine and Pharmacy Reports

Background. Anal fistula is often considered to be a dilemma because of the need to maintain a fi... more Background. Anal fistula is often considered to be a dilemma because of the need to maintain a fine balance between postoperative incontinence and recurrence. We tried to find whether apprehension of causing incontinence should stop us from performing fistulectomy. The aim of this study was to determine whether fistulectomy was associated with increased rate of fecal incontinence and recurrence, compared to other procedures used for the treatment of anal fistula. Methods. It was a prospective, single center, observational study. All patients with anal fistula operated at a tertiary care teaching institute over a period of two years were included in the study. Recurrence rates and fecal incontinence were compared between patients subjected to fistulectomy and other procedures for treatment of fistula in ano. Results. A total of 124 patients with anal fistula were included. 92.8% patients were ≤ 60 years of age with high male preponderance (89.5%). Perineal discharge was the commonest...

Indian Journal of Colo-Rectal Surgery, 2019

SSI is a common complication following colorectal surgeries. We present data on the incidence of ... more SSI is a common complication following colorectal surgeries. We present data on the incidence of the same and the factors attributed for its causation at our centre which is a tertiary care centre and a high volume centre for colorectal surgeries. Of the total 538 patients, 316 (58.7%) were males while 222 (41.3%) were females. Mean age of the patients was 47.36±15.57 years, with a minimum age of 18 years and a maximum of 85 years. Elective procedures contributed for 84.01% (452) while 15.98% (86) cases were performed as emergency procedures. Of the total 538 patients 452 patients were electively operated, of which 67 (14.8%) developed SSIs. In emergency procedures 86 patient were operated, of which 31 (36.0%) developed SSI. In our study, total SSI was observed in 67 cases, of which superficial SSI were 46 (68.65%), and deep SSI cases, were11 (16.4%), and organ space SSI cases were 10 (14.9%).

International journal of scientific research, 2018

BACKGROUND:Colorectal cancer (CRC) is one kind of malignant tumour of the digestive tract which h... more BACKGROUND:Colorectal cancer (CRC) is one kind of malignant tumour of the digestive tract which has high morbidity and mortality all over the world. Kashmir has been reported to have high incidence of gastrointestinal cancers. In Kashmir, CRC represents third most common GIT cancer after esophageal and gastric cancer AIMS: This prospective study was conducted at Sher-i-Kahmir Institute of Medical Sciences in the colorectal division of General and Minimal Invasive Surgery department to see the relationship between various demographic variables and lymph node yield after surgery for mid-lower rectal cancers. METHODOLOGY:The Study is Prospective one.The Inclusion Criteria include, Growth about 4-10 cm from anal verge with HPE documented adenocarcinoma and the Exclusion Criteria include a)Growth beyond 10cms of anal verge.b)Patients subjected to Abdomino-perineal resection & c) Patients with histopathology other than Adenocarcinoma. The detailed history viz-a-viz demography of the patie...

Background: Distal rectal cancers present a challenging task for surgeons in terms of providing a... more Background: Distal rectal cancers present a challenging task for surgeons in terms of providing a Sphincter Saving Procedure (SSP) as compared to Abdomino Perineal Resection (APR) and maintaining oncological safety. Because of better understanding of cancer biology, better surgical techniques, newer neoadjuvant therapies and advent of surgical staplers, SSP’s are more preferred option. Aim: The aim of our study was to determine the various types of surgical treatment options in practice for distal rectal tumours and to compare the trend of APR and SSP at a high volume centre. Secondary outcome was to compare quality of life (QOL) between APR and SSP group. Methods: This was a Retrospective study of 3 years carried out in department of colorectal surgery at SKIMS, Srinagar. Patients with rectal cancer within 10cm from anal verge who underwent APR and other SSP were included. Results: A total of 143 patients were included in the study. Overall, APR was done in 29 (20.28), LAR in 101 (...

Introduction Nipple discharge continues to be a bothersome complaint by the patients. Nipple disc... more Introduction Nipple discharge continues to be a bothersome complaint by the patients. Nipple discharge is associated with non malignant causes as well and needs proper evaluation and treatment. We conducted a study in our departement to analyse the various management options for patients suffering from various types of nipple discharge. Patients and methods: Patients presenting with complaints of nipple discharge, either spontaneous or non spontaneous in the age group of 15-55 years were included in the study. Patients with breast cancer , lump or abscess were excluded. Results A total of 66 patients with mean age of 39 were selected for analysis. Mean age of the patient was 39 years. 32 patients (48.4%) had greenish discharge, 16 (24.4 %) had bloody discharge, 12 (18.2%)had clear discharge and 6 (9.09%) had milky discharge. Cytology and Imaging of the patients were done according to the age of the patient. of discharging fluid was done in all cases which revealed epithelial ce...

Background: Colorectal Cancer (CRC) is a disease with a major worldwide burden in terms of patien... more Background: Colorectal Cancer (CRC) is a disease with a major worldwide burden in terms of patient sufferings and cost of treatment. The age-standardized rates of CRC in India are 4.2 and 3.2/ lac for males and females respectively. Objective: To study the Clinico-pathological profile of colorectal cancer patients in Kashmir. Methods: This 5 year study, conducted in Colorectal Division of Department of General and Minimal Access Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Kashmir, included prospectively all the patients who presented with CRC from August 2014 to June 2016 and retrospectively the data of 3 years of all the patients with CRC was studied. Parameters studied were age, sex, site of lesion, clinical presentations and histology of the lesion. Results: Among 930 patients included in this study, CRC was most common (24.2%) in the age group of 56 to 65 years. About 19.25% of patients were below the age of 35 years. Male to female ratio was 3:2 (p-value 0....

ANZ Journal of Surgery, 2021

The concept of ghost ileostomy (GI) developed in order to combine the advantages of a covering il... more The concept of ghost ileostomy (GI) developed in order to combine the advantages of a covering ileostomy (CI) without entailing its complications in patients subjected to low anterior resection (LAR). GI is just a pre-stage ileostomy that at any time can be externalized. In case of anastomotic leak (AL), the GI is matured to complete the CI in order to divert the faecal stream from the anastomotic leakage site. However, in case of uneventful post-operative course, GI prevents all complications related to defunctioning ileostomy. We also carried out a case–control study in order to evaluate the feasibility of GI and CI in LARs for carcinoma of the rectum. We included 33 patients in the GI group and 29 patients in the CI group. The two groups were statistically comparable with respect to serum albumin levels, colon leakage score and distance of anastomosis from anal verge. We did not find any significant differences in the two groups with respect to start of oral liquids, drain remova...

Annals of Colorectal Research, 2021

The concept of ghost/Khatith ileostomy is a bridge between covering ileostomy and no-ileostomy (‘... more The concept of ghost/Khatith ileostomy is a bridge between covering ileostomy and no-ileostomy (‘Khatith’ meaning ‘hidden’ in Kashmiri language). We performed the pre-stage ghost ileostomy (GI) without parietal wall split. The technique of GI is that after the completion of resection-anastomosis of rectal cancer, a terminal ileal loop at about 20cm from ileocecal junction is identified. Small (10-12F) Ryle’s tube (RT) is passed through a small opening in the mesentery of the identified ileal loop. A small 4-5mm incision is given on abdominal wall at pre-operatively marked proposed stoma site in right iliac fossa region. Haemostatic Kelly’s forceps is introduced through this small incision to get out the two limbs of the RT that has been already looped around the identified ileal loop. These two limbs of the RT are cut short and fixed to each other and to the skin around it with 2-0 silk sutures, taking care to keep the tubing loop loose enough to avoid any tension to the vascular su...

Background: Accurate preoperative evaluation of proven bladder carcinoma is important because the... more Background: Accurate preoperative evaluation of proven bladder carcinoma is important because therapy depends on the clinical stage of the disease. Various imaging modalities have been used for such staging, and as such there is a need to look for the single best modality. Aim and objective: To determine the sensitivity, specificity and overall accuracy of MRI in staging urinary bladder carcinoma, and to evaluate its role in making comparison between superficial vs. invasive tumors and organ confined vs. non organ confined tumors. Material and Methods: This prospective study was undertaken on 25 patients of proven bladder carcinoma who were candidates for radical cystectomy. They were investigated in a sequential manner which included all routine investigations beside transabdominal ultrasonography, cystoscopy and biopsy (TUR / cystoscopic) and magnetic resonance imaging (MRI). Radical cystectomy was performed in all patients. MRI staging was correlated with the pathologic staging. ...

Ulcerative Colitis (UC) is an inflammatory disease resulting from an interaction between genetic ... more Ulcerative Colitis (UC) is an inflammatory disease resulting from an interaction between genetic and environmental factors and observed predominantly in developed countries. However incidence in developing countries is also on the rise, possibly as a result of more westernisation. UC is characterized by mucosal inflammation of the rectum and to a variable extent the colon in a continuous fashion. Patients generally present with manifestations of the disease including abdominal pain, diarrhoea, rectal bleeding, and weight loss in the second or third decade of life. The patient's management is influenced by the extent of inflammation ; with medical management being started as first line of treatment for mild to moderate disease while as surgery is reserved for advanced and complicated disease. The aim of this chapter is to highlight the indications for surgery, principles of surgical decision-making, operative techniques with associated complications and a few special considerations.

Ileocolic surgeries for various indications can be performed using staplers or sutures, and evide... more Ileocolic surgeries for various indications can be performed using staplers or sutures, and evidence based inference shows definite advantages with staplers over suturing in most of the studies. The present retrospective case control randomized study was undertaken to compare hand sewn and stapled techniques of ileocolic surgery in terms of outcome with respect to various variables and indications. Outcome from the study indicate that Anastomosis by stapling devices in ileocolic surgery has definite advantage over hand sewn anastomosis in terms of less operative time, early return of bowel sounds, passage of first flatus, resumption of oral feeding, and easy applicability in fast-track surgeries.

Surgical Site Infection (SSI) is the infection of the skin and subcutaneous tissues, organs or sp... more Surgical Site Infection (SSI) is the infection of the skin and subcutaneous tissues, organs or spaces exposed by surgeons during the performance of an invasive procedure. Appropriate antimicrobial therapy is mandatory not only to improve the prognosis of patients with SSIs but also to minimize the occurrence of antibiotic-resistant organisms. To use antibiotics appropriately, especially before the availability of culture sensitivity reports, information on the prevalent microbial flora isolated from SSIs is of particular value. The purpose of this study was to study the bacteriological spectrum of SSIs in colorectal surgical patients. This 2-year prospective study of 272 patients was conducted in the Department of Colorectal Surgery at a tertiary care hospital in Kashmir. Postoperatively surgical site infected cases were identified using CDC, USA definition for SSI. After discharge from hospital, patients were followed for up to 30 days to check any signs of SSI. If there were no si...

Indian Journal of Surgery, 2021

Worm infestations are still quite common in the whole world and more so prevalent in tropical cou... more Worm infestations are still quite common in the whole world and more so prevalent in tropical countries. Ascariasis is one of the most common form of parasitic infections in humans. It is found in any part of the gastrointestinal tract, including hepatobiliary system as well. It can present as a wide range of clinical spectrum ranging from asymptomatic carriers to anemia, bowel obstruction, cholangitis, and obstructive jaundice besides other manifestations. Various diagnostic modalities are used to establish diagnosis of this condition including clinical examination, ultrasonography, CT scan, and magnetic resonance cholangiopancreatography (MRCP). Most of the times, medical management is sufficient; however, many times due to complications associated with these worms, endoscopic or surgical intervention is required. In this review, we will discuss various clinical features, diagnostic modalities, and treatment options of this disease.

Colorectal surgical procedures involve significant morbidity associated with it. The traditional ... more Colorectal surgical procedures involve significant morbidity associated with it. The traditional perioperative measures involves practices that prolong hospital stay, delays normal physiological milieu, and incurs extra cost on health care system enhanced recovery after surgery (ERAS) protocol is a combination of strategies combined in a structured pathway to decrease the physical insult and aid fast recovery after surgery ERAS comprises of many perioperative (preoperative, intraoperative, and postoperative) measures that are backed by strong scientific evidence to optimize surgical outcomes. ERAS involves multidisciplinary approach for its proper implementation and to achieve appropriate results. In this chapter, we will look into the rationale behind this protocol and describe its various components.

New Treatment Modalities in Rectal Cancer

The management of colorectal cancer is complex and is associated with high morbidity and mortalit... more The management of colorectal cancer is complex and is associated with high morbidity and mortality. However, as compared to the past the morbidity and mortality have decreased significantly. Advancement in technology has played a pivotal role in improving outcomes in such patients. Technological advances in screening methods have made it possible to pick early lesions and thus improve survival rates. Similarly, innovations in diagnostic tools have led to better staging so that better multimodality treatment can be offered to selected patients. Use of newer surgical instrumentations like staplers has increased the sphincter preservation rate so as to give better quality of life to patients. Besides benefits to patients, advances in technology have provided improved working conditions for the surgeons in the form of better electrosurgical devices, high-quality imaging systems and better ergonomics in operating rooms. In this chapter, we discuss some of the technological advances used in rectal cancer surgeries.

New Treatment Modalities in Rectal Cancer

British Journal of Surgery, 2021

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

BJS Open, 2020

Background: During the initial COVID-19 outbreak up to 28.4 million elective operations were canc... more Background: During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. Methods: An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). Results: Based on data f...

Clinical Colorectal Cancer

International Journal of Clinical and Experimental Medicine Research

Introduction: Surgical site infections (SSIs) are the third most common nosocomial infections, ac... more Introduction: Surgical site infections (SSIs) are the third most common nosocomial infections, accounting for 38% of nosocomial infections among surgical patients. SSIs after colorectal surgical procedures are associated with increased morbidity, mortality, hospital stay and cost of treatment. The various risk factors for the development of SSI depend upon the patient characteristics as well as the surgical procedure. Aims and objectives: To study the incidence of SSI and various clinico-surgical factors affecting the occurrence of SSI in patients undergoing colorectal surgery. Material and methods: This 2 year prospective study included total of 350 patients who underwent different types of colorectal surgical procedures depending on the underlying pathology. Parameters studied were age, sex, BMI, nutritional status, smoking history, ASA grade, associated co-morbidities, type of surgical approach (open or laparoscopic) and mean operating time. Postoperatively patients were followed for development of any SSI and data as such collected was subjected to various statistical analysis tests and preoperative risk factors were correlated with postoperative SSI taking into consideration the statistically significant results only where p-value was <0.05. Results: Total of 350 patients were included in this hospital based prospective study from June 2013 to May 2015. The overall incidence of SSI in our study was 17.4%. Rate of SSI in patients with some associated co-morbidity was 21.5% while as it is about 14.1% in the patients without any comorbidity. However we did not find any statistically significant correlation of SSI with smoking status, surgical settings (elective vs emergency) and surgical approach (open vs laparoscopic). SSI rate in patients with BMI>25 was 29.2% while it was 11.3% in patients with BMI<25 (p-value of 0.01). SSI developed in 14.1% patients with ASA grade-I and 21.9% patients with ASA grade-II and none in ASA grade-III. With respect to age group the incidence of SSI in our study was highest in age group 75-95 (66.7%) and lowest in youngest age group 15-35 (10.6%); (p-value of 0.001). Also mean operating time was higher in patients that developed SSI (179.54± 37.21) as compared to those that didn't develop SSI (156.33± 49.58); (p val-ue=0.012). Incidence of SSI in our study was 5.9% in well built patients and 33.3% in under-nourished patients (p-value 0.0001). Conclusion: Overall incidence of SSI in our study (17.4%) is comparable to that reported in literature. The incidence of SSI is significantly higher in patients with higher BMI (obese patients), with higher mean operating time, higher age-group patients and in under-nourished patients.

Medicine and Pharmacy Reports

Background. Anal fistula is often considered to be a dilemma because of the need to maintain a fi... more Background. Anal fistula is often considered to be a dilemma because of the need to maintain a fine balance between postoperative incontinence and recurrence. We tried to find whether apprehension of causing incontinence should stop us from performing fistulectomy. The aim of this study was to determine whether fistulectomy was associated with increased rate of fecal incontinence and recurrence, compared to other procedures used for the treatment of anal fistula. Methods. It was a prospective, single center, observational study. All patients with anal fistula operated at a tertiary care teaching institute over a period of two years were included in the study. Recurrence rates and fecal incontinence were compared between patients subjected to fistulectomy and other procedures for treatment of fistula in ano. Results. A total of 124 patients with anal fistula were included. 92.8% patients were ≤ 60 years of age with high male preponderance (89.5%). Perineal discharge was the commonest...

Indian Journal of Colo-Rectal Surgery, 2019

SSI is a common complication following colorectal surgeries. We present data on the incidence of ... more SSI is a common complication following colorectal surgeries. We present data on the incidence of the same and the factors attributed for its causation at our centre which is a tertiary care centre and a high volume centre for colorectal surgeries. Of the total 538 patients, 316 (58.7%) were males while 222 (41.3%) were females. Mean age of the patients was 47.36±15.57 years, with a minimum age of 18 years and a maximum of 85 years. Elective procedures contributed for 84.01% (452) while 15.98% (86) cases were performed as emergency procedures. Of the total 538 patients 452 patients were electively operated, of which 67 (14.8%) developed SSIs. In emergency procedures 86 patient were operated, of which 31 (36.0%) developed SSI. In our study, total SSI was observed in 67 cases, of which superficial SSI were 46 (68.65%), and deep SSI cases, were11 (16.4%), and organ space SSI cases were 10 (14.9%).

International journal of scientific research, 2018

BACKGROUND:Colorectal cancer (CRC) is one kind of malignant tumour of the digestive tract which h... more BACKGROUND:Colorectal cancer (CRC) is one kind of malignant tumour of the digestive tract which has high morbidity and mortality all over the world. Kashmir has been reported to have high incidence of gastrointestinal cancers. In Kashmir, CRC represents third most common GIT cancer after esophageal and gastric cancer AIMS: This prospective study was conducted at Sher-i-Kahmir Institute of Medical Sciences in the colorectal division of General and Minimal Invasive Surgery department to see the relationship between various demographic variables and lymph node yield after surgery for mid-lower rectal cancers. METHODOLOGY:The Study is Prospective one.The Inclusion Criteria include, Growth about 4-10 cm from anal verge with HPE documented adenocarcinoma and the Exclusion Criteria include a)Growth beyond 10cms of anal verge.b)Patients subjected to Abdomino-perineal resection & c) Patients with histopathology other than Adenocarcinoma. The detailed history viz-a-viz demography of the patie...

Background: Distal rectal cancers present a challenging task for surgeons in terms of providing a... more Background: Distal rectal cancers present a challenging task for surgeons in terms of providing a Sphincter Saving Procedure (SSP) as compared to Abdomino Perineal Resection (APR) and maintaining oncological safety. Because of better understanding of cancer biology, better surgical techniques, newer neoadjuvant therapies and advent of surgical staplers, SSP’s are more preferred option. Aim: The aim of our study was to determine the various types of surgical treatment options in practice for distal rectal tumours and to compare the trend of APR and SSP at a high volume centre. Secondary outcome was to compare quality of life (QOL) between APR and SSP group. Methods: This was a Retrospective study of 3 years carried out in department of colorectal surgery at SKIMS, Srinagar. Patients with rectal cancer within 10cm from anal verge who underwent APR and other SSP were included. Results: A total of 143 patients were included in the study. Overall, APR was done in 29 (20.28), LAR in 101 (...

Introduction Nipple discharge continues to be a bothersome complaint by the patients. Nipple disc... more Introduction Nipple discharge continues to be a bothersome complaint by the patients. Nipple discharge is associated with non malignant causes as well and needs proper evaluation and treatment. We conducted a study in our departement to analyse the various management options for patients suffering from various types of nipple discharge. Patients and methods: Patients presenting with complaints of nipple discharge, either spontaneous or non spontaneous in the age group of 15-55 years were included in the study. Patients with breast cancer , lump or abscess were excluded. Results A total of 66 patients with mean age of 39 were selected for analysis. Mean age of the patient was 39 years. 32 patients (48.4%) had greenish discharge, 16 (24.4 %) had bloody discharge, 12 (18.2%)had clear discharge and 6 (9.09%) had milky discharge. Cytology and Imaging of the patients were done according to the age of the patient. of discharging fluid was done in all cases which revealed epithelial ce...

Background: Colorectal Cancer (CRC) is a disease with a major worldwide burden in terms of patien... more Background: Colorectal Cancer (CRC) is a disease with a major worldwide burden in terms of patient sufferings and cost of treatment. The age-standardized rates of CRC in India are 4.2 and 3.2/ lac for males and females respectively. Objective: To study the Clinico-pathological profile of colorectal cancer patients in Kashmir. Methods: This 5 year study, conducted in Colorectal Division of Department of General and Minimal Access Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Kashmir, included prospectively all the patients who presented with CRC from August 2014 to June 2016 and retrospectively the data of 3 years of all the patients with CRC was studied. Parameters studied were age, sex, site of lesion, clinical presentations and histology of the lesion. Results: Among 930 patients included in this study, CRC was most common (24.2%) in the age group of 56 to 65 years. About 19.25% of patients were below the age of 35 years. Male to female ratio was 3:2 (p-value 0....

ANZ Journal of Surgery, 2021

The concept of ghost ileostomy (GI) developed in order to combine the advantages of a covering il... more The concept of ghost ileostomy (GI) developed in order to combine the advantages of a covering ileostomy (CI) without entailing its complications in patients subjected to low anterior resection (LAR). GI is just a pre-stage ileostomy that at any time can be externalized. In case of anastomotic leak (AL), the GI is matured to complete the CI in order to divert the faecal stream from the anastomotic leakage site. However, in case of uneventful post-operative course, GI prevents all complications related to defunctioning ileostomy. We also carried out a case–control study in order to evaluate the feasibility of GI and CI in LARs for carcinoma of the rectum. We included 33 patients in the GI group and 29 patients in the CI group. The two groups were statistically comparable with respect to serum albumin levels, colon leakage score and distance of anastomosis from anal verge. We did not find any significant differences in the two groups with respect to start of oral liquids, drain remova...

Annals of Colorectal Research, 2021

The concept of ghost/Khatith ileostomy is a bridge between covering ileostomy and no-ileostomy (‘... more The concept of ghost/Khatith ileostomy is a bridge between covering ileostomy and no-ileostomy (‘Khatith’ meaning ‘hidden’ in Kashmiri language). We performed the pre-stage ghost ileostomy (GI) without parietal wall split. The technique of GI is that after the completion of resection-anastomosis of rectal cancer, a terminal ileal loop at about 20cm from ileocecal junction is identified. Small (10-12F) Ryle’s tube (RT) is passed through a small opening in the mesentery of the identified ileal loop. A small 4-5mm incision is given on abdominal wall at pre-operatively marked proposed stoma site in right iliac fossa region. Haemostatic Kelly’s forceps is introduced through this small incision to get out the two limbs of the RT that has been already looped around the identified ileal loop. These two limbs of the RT are cut short and fixed to each other and to the skin around it with 2-0 silk sutures, taking care to keep the tubing loop loose enough to avoid any tension to the vascular su...

Background: Accurate preoperative evaluation of proven bladder carcinoma is important because the... more Background: Accurate preoperative evaluation of proven bladder carcinoma is important because therapy depends on the clinical stage of the disease. Various imaging modalities have been used for such staging, and as such there is a need to look for the single best modality. Aim and objective: To determine the sensitivity, specificity and overall accuracy of MRI in staging urinary bladder carcinoma, and to evaluate its role in making comparison between superficial vs. invasive tumors and organ confined vs. non organ confined tumors. Material and Methods: This prospective study was undertaken on 25 patients of proven bladder carcinoma who were candidates for radical cystectomy. They were investigated in a sequential manner which included all routine investigations beside transabdominal ultrasonography, cystoscopy and biopsy (TUR / cystoscopic) and magnetic resonance imaging (MRI). Radical cystectomy was performed in all patients. MRI staging was correlated with the pathologic staging. ...

Ulcerative Colitis (UC) is an inflammatory disease resulting from an interaction between genetic ... more Ulcerative Colitis (UC) is an inflammatory disease resulting from an interaction between genetic and environmental factors and observed predominantly in developed countries. However incidence in developing countries is also on the rise, possibly as a result of more westernisation. UC is characterized by mucosal inflammation of the rectum and to a variable extent the colon in a continuous fashion. Patients generally present with manifestations of the disease including abdominal pain, diarrhoea, rectal bleeding, and weight loss in the second or third decade of life. The patient's management is influenced by the extent of inflammation ; with medical management being started as first line of treatment for mild to moderate disease while as surgery is reserved for advanced and complicated disease. The aim of this chapter is to highlight the indications for surgery, principles of surgical decision-making, operative techniques with associated complications and a few special considerations.

Ileocolic surgeries for various indications can be performed using staplers or sutures, and evide... more Ileocolic surgeries for various indications can be performed using staplers or sutures, and evidence based inference shows definite advantages with staplers over suturing in most of the studies. The present retrospective case control randomized study was undertaken to compare hand sewn and stapled techniques of ileocolic surgery in terms of outcome with respect to various variables and indications. Outcome from the study indicate that Anastomosis by stapling devices in ileocolic surgery has definite advantage over hand sewn anastomosis in terms of less operative time, early return of bowel sounds, passage of first flatus, resumption of oral feeding, and easy applicability in fast-track surgeries.

Surgical Site Infection (SSI) is the infection of the skin and subcutaneous tissues, organs or sp... more Surgical Site Infection (SSI) is the infection of the skin and subcutaneous tissues, organs or spaces exposed by surgeons during the performance of an invasive procedure. Appropriate antimicrobial therapy is mandatory not only to improve the prognosis of patients with SSIs but also to minimize the occurrence of antibiotic-resistant organisms. To use antibiotics appropriately, especially before the availability of culture sensitivity reports, information on the prevalent microbial flora isolated from SSIs is of particular value. The purpose of this study was to study the bacteriological spectrum of SSIs in colorectal surgical patients. This 2-year prospective study of 272 patients was conducted in the Department of Colorectal Surgery at a tertiary care hospital in Kashmir. Postoperatively surgical site infected cases were identified using CDC, USA definition for SSI. After discharge from hospital, patients were followed for up to 30 days to check any signs of SSI. If there were no si...

Indian Journal of Surgery, 2021

Worm infestations are still quite common in the whole world and more so prevalent in tropical cou... more Worm infestations are still quite common in the whole world and more so prevalent in tropical countries. Ascariasis is one of the most common form of parasitic infections in humans. It is found in any part of the gastrointestinal tract, including hepatobiliary system as well. It can present as a wide range of clinical spectrum ranging from asymptomatic carriers to anemia, bowel obstruction, cholangitis, and obstructive jaundice besides other manifestations. Various diagnostic modalities are used to establish diagnosis of this condition including clinical examination, ultrasonography, CT scan, and magnetic resonance cholangiopancreatography (MRCP). Most of the times, medical management is sufficient; however, many times due to complications associated with these worms, endoscopic or surgical intervention is required. In this review, we will discuss various clinical features, diagnostic modalities, and treatment options of this disease.

Colorectal surgical procedures involve significant morbidity associated with it. The traditional ... more Colorectal surgical procedures involve significant morbidity associated with it. The traditional perioperative measures involves practices that prolong hospital stay, delays normal physiological milieu, and incurs extra cost on health care system enhanced recovery after surgery (ERAS) protocol is a combination of strategies combined in a structured pathway to decrease the physical insult and aid fast recovery after surgery ERAS comprises of many perioperative (preoperative, intraoperative, and postoperative) measures that are backed by strong scientific evidence to optimize surgical outcomes. ERAS involves multidisciplinary approach for its proper implementation and to achieve appropriate results. In this chapter, we will look into the rationale behind this protocol and describe its various components.

New Treatment Modalities in Rectal Cancer

The management of colorectal cancer is complex and is associated with high morbidity and mortalit... more The management of colorectal cancer is complex and is associated with high morbidity and mortality. However, as compared to the past the morbidity and mortality have decreased significantly. Advancement in technology has played a pivotal role in improving outcomes in such patients. Technological advances in screening methods have made it possible to pick early lesions and thus improve survival rates. Similarly, innovations in diagnostic tools have led to better staging so that better multimodality treatment can be offered to selected patients. Use of newer surgical instrumentations like staplers has increased the sphincter preservation rate so as to give better quality of life to patients. Besides benefits to patients, advances in technology have provided improved working conditions for the surgeons in the form of better electrosurgical devices, high-quality imaging systems and better ergonomics in operating rooms. In this chapter, we discuss some of the technological advances used in rectal cancer surgeries.

New Treatment Modalities in Rectal Cancer

British Journal of Surgery, 2021

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

BJS Open, 2020

Background: During the initial COVID-19 outbreak up to 28.4 million elective operations were canc... more Background: During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. Methods: An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). Results: Based on data f...

Clinical Colorectal Cancer

International Journal of Clinical and Experimental Medicine Research

Introduction: Surgical site infections (SSIs) are the third most common nosocomial infections, ac... more Introduction: Surgical site infections (SSIs) are the third most common nosocomial infections, accounting for 38% of nosocomial infections among surgical patients. SSIs after colorectal surgical procedures are associated with increased morbidity, mortality, hospital stay and cost of treatment. The various risk factors for the development of SSI depend upon the patient characteristics as well as the surgical procedure. Aims and objectives: To study the incidence of SSI and various clinico-surgical factors affecting the occurrence of SSI in patients undergoing colorectal surgery. Material and methods: This 2 year prospective study included total of 350 patients who underwent different types of colorectal surgical procedures depending on the underlying pathology. Parameters studied were age, sex, BMI, nutritional status, smoking history, ASA grade, associated co-morbidities, type of surgical approach (open or laparoscopic) and mean operating time. Postoperatively patients were followed for development of any SSI and data as such collected was subjected to various statistical analysis tests and preoperative risk factors were correlated with postoperative SSI taking into consideration the statistically significant results only where p-value was <0.05. Results: Total of 350 patients were included in this hospital based prospective study from June 2013 to May 2015. The overall incidence of SSI in our study was 17.4%. Rate of SSI in patients with some associated co-morbidity was 21.5% while as it is about 14.1% in the patients without any comorbidity. However we did not find any statistically significant correlation of SSI with smoking status, surgical settings (elective vs emergency) and surgical approach (open vs laparoscopic). SSI rate in patients with BMI>25 was 29.2% while it was 11.3% in patients with BMI<25 (p-value of 0.01). SSI developed in 14.1% patients with ASA grade-I and 21.9% patients with ASA grade-II and none in ASA grade-III. With respect to age group the incidence of SSI in our study was highest in age group 75-95 (66.7%) and lowest in youngest age group 15-35 (10.6%); (p-value of 0.001). Also mean operating time was higher in patients that developed SSI (179.54± 37.21) as compared to those that didn't develop SSI (156.33± 49.58); (p val-ue=0.012). Incidence of SSI in our study was 5.9% in well built patients and 33.3% in under-nourished patients (p-value 0.0001). Conclusion: Overall incidence of SSI in our study (17.4%) is comparable to that reported in literature. The incidence of SSI is significantly higher in patients with higher BMI (obese patients), with higher mean operating time, higher age-group patients and in under-nourished patients.