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   Table of Contents - Current issue
Coverpage
November-December 2019
Volume 52 | Issue 6
Page Nos. 201-242

Online since Thursday, December 5, 2019

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ORIGINAL ARTICLES  

Demography of the remnant of omphalomesenteric duct p. 201
Dinesh Kumar Barolia, Aditya Pratap Singh, Ramesh Tanger, Arun Kumar Gupta, Vinita Chaturvedi, Neeraj Tuteja
DOI:10.4103/fjs.fjs_12_19  
Introduction: Pediatric surgeons dealt with cases of omphalomesenteric duct remnants, which presented with various symptomatic patterns. Meckel's diverticulum was the most common remnant in this study, which presented with different signs and symptoms. The aim is to study the various remnants of omphalomesenteric duct with their presenting symptoms and to introduce a new variant of patent vitellointestinal duct (PVID) and describe how to treat these variants of omphalomesenteric duct. Materials and Methods: This is a retrospective study conducted in 132 neonates and children (102 male and 30 female), who were operated at our institute and containing persistent omphalomesenteric duct and its derivatives. This study was conducted from January 2017 to June 2018 at our institute. This study analyzed the presenting sign and symptoms of various remnants of omphalomesenteric duct. The study analysis was based on the following parameters – age, sex, sign, symptom, investigation, operative finding, and postoperative complications. Results: In this study, male-to-female ratio was 3.4:1. Meckel's band obstruction was the most common presentation (n = 48, 36.36%), while umbilical cyst (n = 1, 0.75%) and umbilical sinus were least commonly present (n = 1, 0.75%) in all remnants of omphalomesenteric duct. We found a new variant of PVID, which presented with an intact omphalomesenteric duct, but the umbilical end was obliterated. This variant had not been included or reported in literature. Conclusion: Omphalomesenteric duct remnants are presenting with various sign and symptoms, like intestinal obstruction, umbilical discharge, umbilical swelling, pain abdomen etc. A new variant of PVID is named end- obliterated PVID reported here, may present with features of intestinal obstruction.
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Management of postoperative ileus after robot-assisted radical prostatectomy p. 207
Shu-Chi Wang, Cheng-Kuang Yang, Chen-Li Cheng, Yen-Chuan Ou
DOI:10.4103/fjs.fjs_95_18  
Introduction: The use of robot-assisted radical prostatectomy (RARP) for localized prostate cancer has increased in recent years. Postoperative ileus (POI) is the most common perioperative complication leading to delayed discharge after RARP. The incidence and management of prolonged POI from at our institution were reviewed. Materials and Methods: A total of 958 RARPs were reviewed. Prolonged POI was defined as intolerance of an oral diet that continued until the postoperative day 6 and beyond. All data including the patients' characteristics, comorbidities, perioperative outcome, and management of prolonged POI were assessed. Results: Seven patients experienced prolonged POI. Four of these seven patients (57%) recovered under conservative treatment. Three patients (43%) needed surgical reexploration were identified by abdominal computed tomography (CT) scan, including one adhesive intestinal obstruction and two incarcerated inguinal hernias. The laparoscopic reexplorations were successfully performed for the three patients. Conclusion: For patients with prolonged POI failing initial conservative treatment, a prompt CT survey is crucial for early detection of patients requiring surgical intervention, helps to avoid intra-abdominal adhesion during the exploratory laparotomy and reduces associated surgical complications.
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Comparison of mesh fixation and nonfixation in laparoscopic transabdominal preperitoneal repair of inguinal hernia p. 212
Behrooz Kalidarei, Mohsen Mahmoodieh, Zakaria Sharbu
DOI:10.4103/fjs.fjs_15_19  
Introduction: Application of preperitoneal mesh method in the treatment of inguinal hernia can be regarded as one of the successful methods in this regard. However, the impact of mesh fixation or nonfixation on the recurrence of hernia and the incidence of its complications have not been thoroughly investigated.The present study aimed at comparing the effect of mesh fixation and nonfixation on transabdominal preperitoneal (TAPP) laparoscopy for inguinal hernia repair. Materials and Methods: In this study, eighty patients with inguinal hernia underwent TAPP laparoscopy with mesh fixation (n = 41) and nonfixation (n = 39). Mesh was fixed using a suture in Group A and nonfixed in Group B. Then, the duration of operation, length of in-hospital stay, complications and recurrence of hernia, and pain severity 1 day after the surgery, during discharge, at the 1st and 2nd weeks, and at 1 and 6 months after the surgery were compared between the two groups. Results: The length of in-hospital stay and return to work in Group B was statistically significantly lower than that of Group A (P < 0.05). Neuralgia and urinary retention were statistically significantly higher in Group A as compared with Group B (P < 0.05). There were no and 5.1% hernial recurrence in Group A and Group B, respectively (P > 0.05). The level of pain was generally higher in Group A and was statistically significant 1 and 2 weeks after the surgery (P < 0.05). Conclusion: Mesh nonfixation causes less postoperative complications and pain in patients undergoing TAPP repair; however, in long-term follow-up, the level of chronic pain following the application of mesh fixation and non-fixation methods is not different.
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Linear accelerator-based radiosurgery in treating indirect carotid cavernous fistulas p. 221
Tun-Chen Ong, Pin-Yeh Lin, Chieh-Tsai Wu, Tiing-Yee Siow, Chi-Cheng Chuang, Cheng-Nen Chang, Hsien-Chih Chen, Zhuo-Hao Liu, Yu-Jen Lu, Hong-Chieh Tsai, Peng-Wei Hsu
DOI:10.4103/fjs.fjs_43_19  
Introduction: The purpose of this study is to determine the success and complication rates of linear accelerator (LINAC)-based radiosurgery (X-knife) for indirect carotid-cavernous fistulas (CCFs). Materials and Methods: This retrospective study was performed at the Department of Radiosurgery, Chang Gung Memorial Hospital, Taiwan, and reviewed data from May 2006 to May 2018. Thirteen patients with CCF who were treated with stereotactic radiosurgery were included, and side, volume, pathological type, origin, location, postoperative regression, and recurrence rate were evaluated with postradiotherapy. Patients were either followed up with contrast magnetic resonance imaging or angiography. Radiosurgery was considered successful if the patients' clinical symptoms improved with radiological remission or if there was a reduction in CCF flow in angiography. Results: Of the 11 patients, three (27.3%) received transarterial embolization (TAE) before radiosurgery. Successful radiological outcomes were seen in 10 (90.9%) patients, and the remaining one patient (9.1%) had stationary disease with no reduction in CCF flow. Ten patients (90.9%) had improved clinical symptoms; however, one patient (9.1%) was complicated with iatrogenic blindness after TAE treatment. No acute or subacute transient postradiation changes, optic nerve injuries, or brainstem radionecrosis were noted in any of the patients. Conclusions: In this study, LINAC-based radiosurgery for CCF was found to be an effective, safe, and successful treatment alternative to TAE treatment in patients with indirect CCF. The risk of postradiotherapy complications was low, and obliteration and regression rates were high.
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CASE REPORTS Top

Slipping rib syndrome: A neglected cause of hypochondrial pain p. 229
Yasser Ali Kamal
DOI:10.4103/fjs.fjs_49_19  
Slipping rib syndrome (SRS) is an under-recognized cause of lower chest and upper abdominal pain. We described this rare condition in a 27-year-old female with chronic right hypochondrial pain. The condition was initially diagnosed as irritable bowel. Extensive imaging studies and laboratory investigations failed to determine the underlying cause of pain for 2 years. The diagnosis was made clinically by hooking maneuver and on ultrasound. After the failure of nonsteroidal anti-inflammatory drugs therapy and intercostal nerve block to improve symptoms, surgical resection of the anterior end of the free-floating right 10th rib was performed. Awareness of SRS can help rapid diagnosis and treatment of a benign cause of abdominal upper quadrant pain.
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VACTERL association with left pulmonary agenesis in an infant p. 232
Naresh Pawar, Aditya Pratap Singh, Arun Kumar Gupta, Ramesh Tanger
DOI:10.4103/fjs.fjs_52_19  
VACTERL association is sporadic and nonrandom, with co-occurrence of various congenital malformations in a single patient due to defect in structures derived from embryonic mesoderm. The VACTERL association with pulmonary agenesis is very rare; few cases have been reported only in neonates till now in the past, as most babies could not survive longer. However, we present a rare case of VACTERL association with left pulmonary agenesis in a 9-month-old infant.
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Sacrococcygeal teratoma with unilateral renal agenesis, spinal dysraphism, lumbar hernia, CTEV and natal teeth p. 235
Rahul Gupta, Arun Kumar Gupta
DOI:10.4103/fjs.fjs_51_19  
We report a unique case of unilateral renal agenesis, spinal dysraphism, lumbar hernia, congenital talipes equino varus, and natal teeth associated with sacrococcygeal teratoma (SCT). The occurrence of this rare association in a neonate has not been reported in the literature. The theory of defective mesenchymal precursor cells from primitive node may explain the presence of associated malformations (related to defective mesenchyme) and presence of SCT.
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Glossopharyngeal neuralgia treated using stereotactic Gamma Knife radiosurgery p. 239
Ping-Hsien Hsieh, Chih-Chung Chen, Ying-Chi Tseng, David Hung-Chi Pan
DOI:10.4103/fjs.fjs_59_19  
Glossopharyngeal neuralgia (GPN) is a rare disorder of the ninth cranial nerve. It affects patients' quality of life, with the characteristic symptoms of severe paroxysmal pain affecting the throat, tongue, and ear. Traditional treatment for GPN includes medical management with anticonvulsants and analgesics and surgery with microvascular decompression (MVD) for refractory cases. However, surgical complications such as neurovascular damage may occur. Gamma knife radiosurgery (GKRS) might be a viable surgical alternative for idiopathic GPN. Although GKRS is widely recognized as an effective and minimally invasive treatment for intractable trigeminal neuralgia, its role in GPN has not yet been clearly determined. Herein, we report a 45-year-old male patient who presented with the left throat intractable shooting pain for 6 months. The pain also radiated to his left ear and was triggered by swallowing. He was diagnosed as having GPN. The patient refused for MVD treatment. Thus, we instead performed GKRS. The target was placed over the cisternal segment of the glossopharyngeal nerve, close to the meatus of the jugular foramen, with a single 4-mm isocenter. The maximal dose to the target was 86 Gy. The patient's pain completely disappeared 2-week posttreatment. No major neurological complication was noted in series follow-up. The clinical response in this case report provides evidence of the efficacy of treating GPN with stereotactic radiosurgery. GKRS is a valuable surgical alternative for idiopathic GPN, with very high efficacy and without permanent complications. Additional studies with larger numbers of patients are needed to demonstrate the long-term safety and effectiveness for this treatment.
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