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   Table of Contents - Current issue
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January-February 2021
Volume 54 | Issue 1
Page Nos. 1-38

Online since Friday, January 22, 2021

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ORIGINAL ARTICLES  

The hemodynamic and analgesic efficacy of subcutaneous dexmedetomidine versus Marcaine 0.5% in postoperative pain management following herniorrhaphy p. 1
Shirin Pazoki, Hesameddin Modir, Alireza Kamali, Amirreza Naimi, Mehdi Maktubian, Nazanin Amini
DOI:10.4103/fjs.fjs_93_20  
Background: This study addressed the comparative hemodynamic and analgesic effects of subcutaneous dexmedetomidine versus Marcaine 0.5% on herniorrhaphy scheduled patients, as well as postoperative pain management. Materials and Methods: A double-blind trial was conducted in three groups of patients (n = 120) scheduled for herniorrhaphy. The study groups were (i) Marcaine + dexmedetomidine (MAR-DEX) group, receiving Marcaine 0.5% (5 mg) + dexmedetomidine (1 mcg/kg), (ii) MAR group, Marcaine 0.5% (5 mg), and (iii) PBO group, placebo, subcutaneously. Vital signs (blood pressure/heart rate/SaO2), as well as pain scores (using the Visual Analog Scale) at recovery and certain time points (1, 2, 4, 6, 12, and 24 h postoperatively) were measured. Moreover, the overall opioid administered postoperatively and the side effects were recorded. Data were analyzed by SPSS (version 20) software by analysis of variance and repeated measurement tests. Results: Lower pain score was revealed in the MAR-DEX group and higher one in the PBO group (P < 0.001), whereas the lowest opioid use was observed in the MAR-DEX group (P < 0.001). Conclusion: Adding dexmedetomidine had benefits of relieving pain and reducing opioid use without any side effects.
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Postablation and α-1 blocker therapy in children with congenital obstructing posterior urethral membrane p. 7
Minu Bajpai, Aejaz Baba, Amit Kumar Singh
DOI:10.4103/fjs.fjs_97_20  
Background: Congenital obstructing posterior urethral membrane (COPUM) or posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in boys. Approximately one-third of boys with PUV develop end-stage renal disease. Various prognostic factors have been recognized which determines the long-term outcome of these cases. Materials and Methods: This was a retrospective case–control analysis of data from January 1998 to May 2014. All patients of COPUM with radiological evidence of bladder neck hypertrophy with follow-up of 7 years were included in the study. Patients with urethral strictures, neurogenic bladder, and incomplete records were excluded. Group I (n = 57) received selective α-1 blocker (prazosin), after valve ablation. Group II (n = 36) who had not received the α-1 blocker was treated as a control group. Investigations include renal function test, ultrasonography, micturating cystourethrography renal dynamic scan, and glomerular filtration rate. Statistical analysis was done using the paired t-test, multiple serial analyses using ANOVA. P <0.05 was considered as significant. Results: A total of 113 patients of COPUM were treated from January 1998 to May 2014. Out of these 113, 93 patients (82.3%) were included in the study. Fifty-seven (61.2%) received α-1 blocker, while 36 patients (38.8%) acted as control. Significant decrease in bladder neck hypertrophy noted in Group I as compared to Group II (P<0.001). Conclusion: Uses of alpha-1 blocker hastens the recovery in terms of clinical improvement, resolution of bladder neck hypertrophy, and improved peak urine flow rate.
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Virtual reality laparoscopic simulator: Training tool for surgical trainee in Malaysia p. 11
Hau Chun Khoo, Ian Chik, Azlanudin Azman, Zamri Zuhdi, Hanafiah Harunarashid, Razman Jarmin
DOI:10.4103/fjs.fjs_59_20  
Background: Virtual reality laparoscopic simulators were introduced to provide an optimal and safe learning environment for surgical trainees. The simulators had been validated and proven to be beneficial. Materials and Methods: The aim of this study is to assess the performance of the local surgical trainees using a validated simulator and help in the development of a training program using the simulator. Prospective repeated measures study in a single center using a validated virtual reality simulator was performed. Years 1 and 2 local postgraduate surgical trainees with limited laparoscopic cholecystectomy experience were included in the study. The trainees underwent a proposed training module, and the simulator evaluated each performance. Comparison was made between the performance before and after the training module. Results: Nine surgical trainees (eight males, median age: 33 years old) with a median of 5 years of surgical experience after graduation were included in the study. The time to complete each basic laparoscopic skill improved between 26.5% and 64.3% (P < 0.05) while the time taken to complete each of the cholecystectomy procedural task improved between 43.2% and 73.8% (P < 0.05). The time taken to complete a full cholecystectomy procedure improved from 873s to 512s (P = 0.008), and the efficiency of cauterization improved by 15.3% (P = 0.008). Analysis of the various learning curve showed the improvement plateaued between the third and tenth sessions. Conclusion: Virtual reality laparoscopic training should be implemented as part of training as it improves certain skill sets.
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Comparison of trans-abdominal preperitoneal repair with Lichtenstein tension-free hernioplasty: A prospective study p. 19
Tanweer Karim, Vivek Kumar Katiyar, Atul Jain, Gaurav Patel, Sajid Maqbul Nurbhai, Ram Bharosh Kumar
DOI:10.4103/fjs.fjs_89_20  
Background: The concept of hernial repair underwent evolution from Bassini's repair to Lichtenstein tension-free repair with the introduction of polyethylene mesh. Recently, some of the prosthetic biomaterials have been combined to form composite mesh to minimize undesirable side effects. Mesh placement can be achieved by both open and laparoscopic techniques. Although many studies have explored the relative merits and potential risks of laparoscopic surgery for the repair of inguinal hernia, most individual trials have been too small to show clear benefits of one type of surgical repair over another. Materials and Methods: A randomized comparative study, was conducted for duration of 18 months. Patients of Unilateral Uncomplicated Inguinal hernia between the age group of 18-60 years, was randomized between two groups. Patient were operated by Surgeons having requisite experience of TAPP repair and Lichtenstein repair. Results: A total of 110 patients included in this study were male with unilateral uncomplicated inguinal hernia. The mean operative time for open Lichtenstein mesh repair and TAPP was 52.85 min and 64.27 min, respectively. The postoperative pain score (as per visual analog scoring) was statistically significantly less in laparoscopic TAPP group as compared to that of open Lichtenstein group (P < 0.05). No major complications were noted in either Lichtenstein group or TAPP group. The minor complication rate was 20.0% for open Lichtenstein group and 7.27% for laparoscopic TAPP group. The mean time to return to work was earlier for TAPP group (12.97 days) as compared to that of Lichtenstein group (17.84 days). Conclusion: The results support the view that laparoscopic TAPP mesh repair is as safe and efficient as Lichtenstein inguinal hernia repair and should be an available option for all patients requiring elective hernioplasty.
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CASE REPORTS Top

Dieulafoy's lesion in small intestine p. 25
Premananda Patnaik, Rashmi Patnayak, Mohita Ray, Prateek Das, Debahuti Mahapatra
DOI:10.4103/fjs.fjs_108_19  
Dieulafoy's lesion is a rare cause of gastrointestinal (GI) bleeding. It accounts for 0.3%–1.5% of major GI bleed. It is typically found in the stomach. Small intestinal Dieulafoy's lesion is very rare. In the small intestine, Dieulafoy's lesion is most commonly seen in the jejunum. Hereby, we present one such case. A 36-year-old female attended the department of gastrosurgery with complaints of pain abdomen and generalized weakness for 15 days. She also had on and off melena and hematochezia. She was admitted with a diagnosis of obscure GI bleeding and was taken up for laparotomy. On table, enterotomy and retrograde enteroscopy was performed. There was a lesion over the distal jejunum. That segment of the intestine was resected. The specimen was sent for histopathological examination. The luminal surface of the intestine showed a small, whitish nodule measuring 0.3 cm in diameter. This nodule was noted beneath the mucosa, in the subepithelium. The overlying mucosa was ulcerated. Histopathological examination established the lesion to be of Dieulafoy's. Awareness, careful endoscopy, and histopathological examination are essential to diagnose Dieulafoy's lesion.
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Atypical telangiectatic osteosarcoma p. 28
Kevin Jonathan Adhimulia, Latsarizul Alfariq, Achmad Fauzi Kamal
DOI:10.4103/fjs.fjs_63_20  
Telangiectatic osteosarcoma (TOS) is a rare malignant bone tumor. The main clinical and radiological significance of the case presentation is TOS can be easily misdiagnosed as a benign lesion such as an aneurysmal bone cyst (ABC). In this case, we present 63-year-old male with a large mass in the left leg. Imaging modalities were obtained in this patient to define the diagnosis. In this atypical case of TOS, relatively old age presentation, slow-progressing lesion, well-demarcated lesion, and lack of periosteal reaction further accentuate the similarity between TOS and ABC or other benign lesion causing high rate misdiagnosis of TOS. The histopathological examination will finally differentiate TOS from ABC.
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Intestinal duplication in an elderly-male presented as sigmoid volvulus p. 32
Veeranadha Reddy, Naveen Eemaraka, Yendluri Jerusha Jasmine, Samir Ranjan Nayak
DOI:10.4103/fjs.fjs_60_20  
Alimentary tract duplications are uncommon congenital anomalies that are often detected in the first decade of life. However, a smaller number of cases may remain unsuspected until adulthood. These anomalies are most common in the ileum and usually present at the bowel's mesenteric border. These can also occur anywhere in the digestive tract. This article reports a case of a 74-year-old male with intestinal duplication arising from the antimesenteric border of the transverse colon, who clinically presented as sigmoid volvulus.
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HOW I DO IT Top

Retaining venous access and eliminating radiation exposure during Hickman-Broviac catheter replacement for difficult-line insertion patients with intestinal failure p. 36
Justin T Chu, Chee-Chee Koh, Yun Chen
DOI:10.4103/fjs.fjs_90_20  
Hickman-Broviac catheters are commonly used to access central veins for the purposes of intravenous nutrition delivery for intestinal failure (IF) patients. While these catheters are good options for accessing central veins, they often have to be replaced if catheter-related infection or occlusion occurs. Frequent replacement can be hampered by the limited venous access sites in these patients and reduce the access site's lifespan. In this technical note, we describe a technique to periodically replace Hickman-Broviac catheters without having to create a new venous access site. Without requiring radiation exposure by standardized guidewire insertion, we safely utilize the fibrotic pseudocapsule that forms around the old catheter to guide the new catheter to the central veins while creating a different exit site to prevent infection. The procedure should be performed periodically – we advocate annually – before catheter-related infection occurs. In this way, we hope to be able to provide a solution for IF patients who require life-long catheter usage but have limited venous access, while also reducing the risk of related injuries such as pneumothorax, arterial injury, or radiation exposure.
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