Surgery

Laparoscopic cholecystectomy in acute cholecystitis: A feasible option regardless of timing Ramya M Vishweshwara, Mallikarjuna Manangi, Dharini Dharini, CS Santhosh, Sunil V Kumar, MK Ramesh, K Seshagiri Rao Formosan Journal of Surgery 2020 53(6):205-210 Background: The optimal timing of laparoscopic cholecystectomy (LC) in acute cholecystitis still remains a debate. Recent studies emphasize that LC can be done safely within the 1st week of onset of the disease process. However, not much data are available that defines the “early” period. We observed, in our institute that, patients presenting beyond 1st week with complications or unresolving symptoms. We aim to compare the outcomes of LC performed after 1st week versus interval LC. Materials and Methods: A retrospective study of 64 patients who underwent LC from November 2017 to May 2018 was carried out. The study included one group of 32 patients who underwent LC after the 1st week (Group A) and another group of 32 patients who were operated after an interval of 6 weeks (Group B). Data were collected and compared. Results: The mean duration of surgery (71.09 vs. 84.82 min, P < 0.05), total hospital stay (7.34 vs. 13.40 days, P < 0.05), and overall cost (USD 79.40 vs. 102.34 USD, P < 0.05) was significantly lesser in Group A. Intraoperative difficulty score (5.41 vs. 4.25, P < 0.05) was more in Group A. No complications, mortality, or conversion to open surgery occurred in both groups. A case of gall bladder perforation (at 3 weeks) and Mirizzi syndrome (at 4 weeks) were observed in patients who were in interval period. Four patients in Group B had readmission during the interval period due to biliary colic and were managed conservatively and operated at 6 weeks as planned. Conclusion: LC performed even after 7 days of initial episode scores over interval LC in terms of total hospital stay, cost, morbidity and has the advantage of treating patients who would be lost to follow-up due to neglect, occupational, and financial concerns. Further studies are needed to validate our results.

Video-assisted anal fistula treatment: A single-center experience to opt the right tract M Suyambu Raja, Anoop Vasudevan Pillai, Riju Ramachandran Formosan Journal of Surgery 2020 53(6):211-215 Background: Fistula-in-Ano is common in clinical practice and is notorious for morbidity and recurrence with current treatment options. Minimal invasive procedure is being tried with encouraging results. Materials and Methods: This is a series of 35 patients who underwent video-assisted anal fistula treatment (VAAFT) in our institution from 2015 to 2018. All patients were evaluated both clinically and with magnetic resonance imaging to delineate the details of the fistula. Patients were treated by VAAFT and followed up for 12 months. The data were acquired from the hospital information system. Failure of the procedure, recurrence, and any other adverse events were recorded correlating it with the gender, comorbidity, type of the tract, linearity of the tract, and relation to the levator ani muscle. Chi-square test with continuity correction was used to find the association between recurrence and clinical parameters. Kruskal–Wallis test was used to compare the mean recurrence time among the type of fistula and tract. Results: In the 27 males and 8 females, we found 22 patients had linear fistulous tract, 6 had linear bifurcated, curvilinear tract in 6, and 1 had a blind tract. The median operation time was 58 min. Healing rate was highest (72.7%) in patients who had a linear tract, and recurrence was highest (66.7%) in patients who had a curvilinear tract. Patients with blind tracts or multiple tracts identified at the surgery and those with Crohn's disease had a higher incidence of recurrence. Conclusion: VAAFT can be recommended as an initial minimally, morbid, though expensive procedure in the management of the simple type of fistula-in-ano with an acceptable recurrence rate.

Pediatric surgery during coronavirus disease lockdown: Multicenter experience from North India Sandip Kumar Rahul, Manish Kumar Gupta, Digamber Chaubey, Deepak Kumar, Rupesh Keshri, Vijayendra Kumar, Vijai Datta Upadhyaya Formosan Journal of Surgery 2020 53(6):216-222 Background: Coronavirus disease Pandemic has affected the health-care delivery at all institutions worldwide. Analysis of multi-institutional data would reflect the impact and challenges of this pandemic in managing pediatric surgical cases. To assess the impact of lockdown due to coronavirus disease 2019 (COVID-19) on the pediatric surgical cases operated at four tertiary care institutions. Materials and Methods: Retrospective data of all patients operated at four tertiary care centers in North India in three different states during the imposition of lockdown due to COVID-19 were collected and compared to the immediate prelockdown period. The impact of following the guidelines for surgery during this period was studied. Results: All the institutions involved in the study showed a significant fall in the number and nature of patients treated during the lockdown period when compared to the prelockdown data. No elective cases were operated; 100 children were operated during this period of which neonates (56%) formed the major group; most of them were cases of congenital anomalies which could not be deferred; solid tumours (3/100) were operated on semi-emergency basis; number of trauma patients fell down drastically (1/100); one patient had bronchoscopic foreign body removal; other patients were operated for different causes of acute abdomen. Several measures in the outpatient, intraoperative, and in-patient care were adopted to lessen the spread of virus to the patient and health-care team. Conclusion: Corona pandemic severely impacted both the number and types of patients operated. Strict adherence to the protocol delayed emergency treatment and increased the cost of definitive management.

The expansion condition of amount and complexity of urologic robotic surgery in 2000 patients: A 13-year experience sharing Min-Che Tung, Yen-Chuan Ou, Chin-Heng Lu, Yu-Kang Chang, Yu-Ching Wen Formosan Journal of Surgery 2020 53(6):223-229 Background: Robot-assisted surgeries have been found to possess a number of advantages over conventional surgeries, and these benefits have promoted the expanded use of robot-assisted procedures in recent years, both in the numbers of procedures performed and the types of procedures to which robotic assistance is applied. This study sought to quantify this expanded use of robot-assisted surgeries over a 13-year period at a single surgeon in Taiwan. Materials and Methods: We retrospectively reviewed a total of 2000 patients who underwent robot-assisted urologic surgeries between December of 2005 and August of 2018. For the purposes of statistical comparison, we divided this 13-year period into four subperiods and classified the surgeries into eight types depending on the body part or parts upon which they were performed. Results: The total number of surgeries in the first, second, third, and fourth subperiods was 124, 173, 738, and 965, respectively; this represented a significant increase in the total number of robot-assisted urologic surgeries performed across the four subperiods. In addition, there were also significant increases in the numbers of surgeries for seven of the eight categories of surgeries across the four subperiods. Conclusion: These results show that our institution's experience with robot assistance in urological surgeries from 2005 to 2018 was consistent with the generally expanded use of such assistance documented by earlier studies, with both the numbers and types of robot-assisted surgeries performed increasing significantly over that period.

Cauda equina syndrome secondary to extramedullary spinal sparganosis Tzu-Hsieh Hsu, Tzu-Tsao Chung, Yi-Ani Chen, Among-Hsuan Chung Formosan Journal of Surgery 2020 53(6):230-232 We report a rare case of sparganosis presented as cauda equina syndrome. Cauda equina syndrome secondary to extramedullary spinal sparganosis infection represents a diagnostic challenge. It should be carefully considered in the differential diagnosis of patients presenting similar characteristics. Although both medical and surgical treatments contribute to the management of this condition, in cases of neurologic deficit due to the mass effect of the lesion, urgent surgical decompression should be attempted to prevent further worsening of the neurological condition.

Papillary fibroelastoma of the aortic valve Yu-Hern Tan, Chen-Yen Chien Formosan Journal of Surgery 2020 53(6):233-235 Papillary fibroelastoma (PFE) is the second most common benign primary cardiac tumor. The clinical spectrum of PFE ranges widely from asymptomatic to life-threatening thromboembolic complications. We herein report a case of a 59-year-old woman presenting with an incidentally found aortic valve tumor treated with valve-sparing surgical excision. There is no guideline for the management of PFE, but surgical excision is generally suggested for left-sided PFE.

Double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma Yi-Hsuan Hu, Yi-Chou Hou Formosan Journal of Surgery 2020 53(6):236-239 We report a patient with double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma (dpHCC-ICC) who received surgical intervention at our institute. The incidence of dpHCC-ICC is extremely low. To the best of our knowledge, only 134 of these cases have been reported in the English literature worldwide.

Compartment syndrome and acute lower limb ischemia with paralysis complicating intramuscular benzathine penicillin injection Fanomezantsoa Raherinantenaina, Tojonirina Gaël Rajaoharimalala, Irina Mamisoa Ranaivo, Stéphane Dimby Ralandison, Hery Nirina Rakoto Ratsimba, Toky Mamin'ny Aina Rajaonanahary Formosan Journal of Surgery 2020 53(6):240-243 Nicolau dermatitis (ND) is a well-known but rare adverse drug reaction involving the skin and the subcutaneous and even muscle tissues at the site of intramuscular injection (IMI). Benzathine penicillin (BP) is the most frequent medication causing serious and acute complications such as limb ischemia, compartment syndrome (CS), and nerve paralysis. The subsequent damage to the lower limb (LL) might be due to microemboli, leading to progressive deterioration of the downstream tissue bed. We describe a 7-year-old boy with a diagnosis of ND after IMI of BP and diclofenac sodium to the medial mid-right thigh. Two days earlier, the patient seemed to experience an acute suppurative complication of circumcision and underwent the aforementioned treatment (September 15, 2018). The circumcision and injection of drugs were illicitly carried out by a nonmedical practitioner. The child complained of severe pain and disability of his right LL. On admission (September 16, 2018), he was found to have acute LL ischemia and CS with cyanosis, hypoesthesia and paresis. Fasciotomy was achieved and medical therapy with heparin, corticoid, and an antibiotic was made for 7 days. Postoperative periods were uneventful. Livedoid violaceous patch and erythematous plaque and ecchymosis have evolved progressively during 10th day, with formation of a diffuse necrotic spot before healing up within 2 months. The length of hospital stay was 10 days. The rehabilitation for walking was started 2 weeks after the operation. Between 6 and 12 months of follow-up, the motor deficit involved the entire LL and persisted despite the tremendous achievement of regular neuromuscular physiotherapy. The paralysis was considered permanent.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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