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... A possible reason is that women are susceptible to femoral hernia, which has a high rate of bowel resection of up to 45% [20]. The female-to-male ratio for femoral hernia is about 10:1 [21]. Moreover, femoral hernia was reported to be far less common than inguinal hernia, with a reported incidence of 2-8% of adults and a high bowel resection rate of 45% [20]. ...

Peng Chen
Libin Huang
Wenming Yang
Zongguang Zhou

Background: Early recognition of the risk of bowel resection of patients with incarcerated groin hernia will facilitate the clinical decision making of surgeons and improve the outcomes of patients. This study aimed to quantitatively analyse the risk factors of bowel resection in incarcerated groin hernia patients. Materials and methods: A systematic literature search for studies on risk factors of bowel resection in incarcerated groin hernia patients was performed in the PubMed and Embase databases from inception until July 15, 2019. The Newcastle-Ottawa Scale was used to evaluate the quality of included study. Review Manager version 5.3 was used for data analysis. Results: Seven articles with a total of 762 patients published between 2004 and 2017 were included. The total rate of bowel resection was 21.0% (160/762). Eight factors were significantly related to the risk of bowel resection in the pooled analysis: female sex, age, age (>65 years), femoral hernia, bowel obstruction, duration of incarceration (hours), white blood cell count, and neutrophilic leukocyte count. Patients who underwent bowel resection had a significantly increased hospitalization times and postoperative complications. Conclusion: The 8 risk factors mentioned above are significantly associated with bowel resection in incarcerated groin hernia patients. The results of this meta-analysis provide a strong reference for the decision making of surgeons in the treatment of incarcerated groin hernia, facilitating the timely surgery and improving the outcome of patients.

... Poor prognosis with 2 year mortality rate of 50-60% and 3 year survival rate of less than 30% is evident if the severe symptomatic AS remains untreated [6,7]. Males are affected most frequently [8]. ...

Abstract Frequency of Calcific Aortic Stenosis in Tertiary Care Hospital of Karachi Background: Calcific aortic stenosis (AS) has become one of the most frequent types of Valvular Heart Disease (VHD) among elderly patients. Prevalence of aortic valve disease (AVD) increases with age and the incidence of calcific AS are on the rise as the general age of the population increases. Objectives: This study was conducted to find out the frequency of calcific AS in patients of tertiary care hospital. Methods: The cross sectional study was carried out in National Institute of Cardiovascular Disease (NICVD) during the period of January to December 2012 after institute approval. A total of 50 echocardiographically diagnosed elderly patients of calcific AS were included from OPD and echocardiography department. All patients were evaluated for clinical features, ECG, echocardiographic findings and outcome were noted and analyzed by using software SPSS version 21. Results: In our study we found 62% male and 38% female. The mean age was 67.12 years ± 5.08 with the range of 60 to 85 years. On echocardiography, out of 50 AS selected patients 18% had mild AS, 22% had moderate AS, and 60% had severe AS. One bicuspid aortic valve has been found. Conclusion: In elderly calcific AS constitutes a significant health problem. As the age advances it is an important cause of cardiovascular mortality and morbidity.

Harish Chauhan
Daxesh Patel
Nishan Gaudani

INTRODUCTION: An ideal hernia repair should be tension free, tissue based, with no potential damage to vital structures, no long term pain or complications and no recurrence. Although Lichtenstein's prosthetic repair is simple and safe, but it is also correlated with risk of infections, recurrence, chronic pain, testicular atrophy and infertility, foreign body sensations and chronic groin sepsis. Desarda hernia repair does not require mesh and provide more physiological support. It is simple, easy to learn. AIMS AND OBJECTIVES: a) To compare the operative time, postoperative stay and time required to return normal activity between two groups. b) To compare early complication rate and late complication rate between two groups. MATERIALAND METHODS: This observational study was conducted among patients admitted with the diagnosis of primary inguinal hernia in SMIMER, Surat. The patients were randomly allocated to either Lichtenstein or Desarda method of hernia repair. Operating time, post operative stay and duration of return to normal activity were recorded. Early complications were noted and the patients were followed up to 12 months for late complications (chronic pain, foreign body sensation, and recurrence). RESULTS: The mean operative time and postoperative stay did not show signicant differ for both groups. Patients operated by Desarda technique returned to normal activity signicantly early by 12.2 ± 2.54 days as compared to patients operated by Lichtenstein techniques (14.0 ± 2.76 days, p = 0.01). Most common early complication in both groups was pain (D group; 40.0%, Lgroup: 45.2%) followed by wound infection (D group; 8.0%, Lgroup: 6.5%) and seroma (D group; 0.0%, Lgroup: 3.2%). Occurrence of chronic pain was more in Lgroup (58.1%) as compared to D group (16.0%, p=0.001). None of the patients from D group had foreign body sensation. Foreign body sensation was observed only in ve patients of Lgroup (16.1%). Recurrence rate during one year in Lgroup (6.5%) was higher than D group (4.0%). CONCLUSION: Early return to work was potential benet of Desarda repair. Early complications were similar in both procedures. Desarda repair has lower incidence of chronic pain and foreign body sensation. However, there is no signicant difference for chronic pain in Desarda group when compared in same patients operated bilaterally with different technique. This study was conducted with small sample size with short follow up. Therefore, result of late complication in the present study may insufcient to conclude the probability of occurrence as longer follow up and larger sample size is required.

Veeresh Kumar Ireddy
Varun H Kasyap
Chandan S Bhoomkar

Introduction: Acute appendicitis is one of the most common causes of urgent admission to the hospital.In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi. The rate of misdiagnosis of appendicitis and the rate of appendicular perforation has remained constant, inspite of increased use of ultrasonography, computed tomography scanning and laparoscopy. Among commonly used inammation markers of Acute appendicitis, bilirubin concentration is not well studied and thus is rarely applied. Every investigation that can contribute towards a diagnosis of appendicitis is valuable to the emergency general surgeon Aim: 1. To study the relationship between hyperbilirubinemia and acute appendicitis; and to evaluate its credibility as a diagnostic marker for acute appendicitis. 2. To evaluate whether elevated bilirubin levels have a predictive potential for the diagnosis of Appendicular perforation. Material and methods: The study was conducted in the Department of General Surgery, Navodaya Medical College & Research centre, Raichur during the period of January 2020 to December 2020.Patients admitted with clinical diagnosis of acute appendicitis or appendicular perforation under the Department of Surgery, Navodaya Medical College & Research centre, Raichur during the study period. A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation were studied. Results: .Normal bilirubin values were seen in 26% patients while, 74% had raised bilirubin levels (Hyperbilirubinemia). Of 81 patients with acute appendicitis, 71.6% had raised bilirubin levels, while 28.4% had normal levels. 19 patients were diagnosed as Appendicular perforation, 16 patients (84.21%) had raised bilirubin levels, while the remaining 03 patients (15.79%) had normal levels.Amongst the patients diagnosed with Acute appendicitis without perforation (n=81), 58 patients (71.6%) were found to have elevated bilirubin (>1.0 mg/dL) while only 23 patients (28.4%) had normal bilirubin levels (≤1.0 mg/dL). In patients diagnosed with Appendicular perforation (n=19), 16 patients (84.21%) had bilirubin elevated (>1.0 mg/dL), while only 3 patients (15.79%) had normal levels (>1.0 mg/dL). Thus, Hyperbilirubinemia was found in most of the patients diagnosed with acute appendicitis (71.6%) or Appendicular perforation (84.21%). Conclusion: The present study suggests- Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis remains essentially still - clinical. Its level come out to be a credible aid in diagnosis of acute appendicitis and would be helpful investigation in decision making. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia higher than the normal range should be identied as having a higher probability of Appendicular perforation suggesting, serum bilirubin levels have a predictive potential for the diagnosis of Appendicular perforation.

Kumar Vikram
Sanjay Kumar
Manoj Kumar
Debarshi Jana

Aim: to study the clinico-demographic-etiologic prole of the patients diagnosed with chronic leg ulcer. Materials and methods: prospective clinical study was conducted among 50 patients of lower limb ulcers who attended Surgery OPD of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. The selected cases were studied with respect to detailed history along with clinical examination and required investigations were done to reach the denitive diagnosis. Result: Most common age group involved in our study is <60 years (42%) followed by <40 years (34%). Male was the predominant sex involved accounting for 41 cases (82%) and females had the disease in 9 cases (18%). Majority of the patients i.e. 21 patients (42%) were farmers by occupation. The most common etiological type was Diabetic ulcers present in 17 cases (34%) followed by trauma 14 (28%). Diabetes Mellitus was the most common systemic disease in our study accounting for 21 patients (48%). The venous ulcers occurred more commonly in the gaiter zone (100%) whereas arterial and diabetic ulcers occurred mainly on the foot i.e., 100% and 52.9% respectively. Conclusion: The present study concluded that the most common etiologies for chronic leg ulcer were diabetes mellitus and trauma. Results of this study may benet development of clinical management policies concerning chronic wounds.

Md. Mushir Reyaz
Kumari Pallavi
C. M. Narayan
Debarshi Jana

Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies. Methods: A total 140 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of WBC count, C-Reactive protein (CRP), USG and Alvarado scoring system and were subsequently operated, were included in the present study in our institute. Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients.Most of the patients of acute appendicitis presented with more than one of above symptoms. The most common presenting symptom was right iliac fossa pain affecting 96.19% of cases (migratory 62.86% and non-migratory 33.33%), followed by anorexia (78.10%) and nausea (66.67%). The other symptoms were fever (65.71%), vomiting (46.67%), constipation (28.57%), right sided flank pain (22.86%), dysurea (19.05%), suprapubic pain (15.24%), diarrhoea (14.29%) and generalized abdominal pain (13.33%) in decreasing order of frequency. Right iliac fossa pain was the most common presentation in non-appendicitis group, followed by anorexia. There was no significant difference in symptoms among these two groups.In this study 54.29% of patients with acute appendicitis had Alvarado score between 7 – 8 and 34.29% of patients with acute appendicitis had Alvarado score between 9 – 10. On the other hand majority of the patients of non-appendicitis group had a score below 7. Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.

Swapnil Sen

Femoral hernia is a type of groin hernia, where the content protrudes through the femoral ring. Common contents in femoral hernias are, preperitoneal fat and small bowel, in some rare cases, sac containing an appendix, Meckel's diverticulum, ectopic testis, and stomach are reported.1 A femoral hernia presents as a mass or bulge below the inguinal ligament. Sometimes, femoral hernia presents as a bulge over the inguinal canal. In this case, the femoral hernia still exits inferior to the inguinal ligament through the femoral canal but ascends in a cephalad direction.2 Sometimes, femoral hernias may present in an occult manner with unexplained pain in the groin. We report a single case of Richter's type strangulated femoral hernia at a tertiary care apex institution of Eastern India. This case of femoral herniation presented atypically as groin pain without any swelling initially. This was followed by swelling with pain at the groin above the inguinal ligament after a few days.

Colorectal anatomy includes the area from the ileocecal valve to the anus. Parts of the colon are cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. A major part of the transverse and sigmoid colon is intraperitoneal. The blood perfusion of colon is supplied by superior and inferior mesenteric arteries. The branches coming from the internal iliac artery provide the perfusion of the rectum and the anal canal. Venous circulation follows the arteries and drains into the portal system through superior and inferior mesenteric vein. Middle and inferior rectal vein which provides the venous drainage of the distal rectum and anal canal drains to the systemic circulation through internal iliac vein. The lymphatics of the colon follow the vessels and are divided into four groups. Epicolic and paracolic lymph nodes are located along the intermediate and marginal arteries. Innervation is provided through the sympathetic and parasympathetic autonomic nerves. Distal part of the anal canal contains motor and sensory nerves. A good knowledge of the anatomy of this area is extremely important for the diagnosis and planning of the treatment.

Eugene Huo
Laura Eisenmenger
Stefanie Weinstein

Recognition of postoperative complications is important for the immediate diagnosis and treatment needed for appropriate patient care. Identification of postoperative complications from colon surgery requires not only knowledge of the type of procedure, but also the expected normal postoperative appearance. The purpose of this article is to discuss and review the expected anatomic changes after colorectal surgery, and the appearance of the most common postoperative complications.

Blackwell 74 Hand Surgery David Netscher and Nicholas Fiore 75 Gynecologic Surgery

L John
Burns
J Steven
S Stephen
Cornelia R Entman
Barry K Graves
Jarnagin
G Gautam

John L. Burns and Steven J. Blackwell 74 Hand Surgery David Netscher and Nicholas Fiore 75 Gynecologic Surgery Stephen S. Entman, Cornelia R. Graves, Barry K. Jarnagin, and Gautam G. Rao 76 Surgery in the Pregnant Patient E. Christopher Ellison 77 Urologic Surgery Aria F. Olumi and Jerome P. Richie Uncategorized [1]

Blackwell 74 Hand Surgery David Netscher and Nicholas Fiore