Surgery

A study of arterial pH, bicarbonate levels, and base deficit at presentation as markers of predicting morbidity and mortality in acute pancreatitis Aditya Varshney, Mohammad Aslam, Junaid Alam Archives of International Surgery 2018 8(1):1-9 Background: The development of metabolic acidosis can occur commonly during critical illness. It is a clinical disturbance characterized by a low arterial pH, a reduced plasma HCO3− concentration, and compensatory hyperventilation. An extensive search for objective tools that predict severity and outcome at the time of hospital admission remains a major challenge. Patients and Methods: Patients with acute pancreatitis presenting to our unit between January 2012 and November 2013 were prospectively studied. Arterial blood gas (ABG) analysis was done at admission, and development of organ failure, any need for intervention, and mortality were noted. The association between various parameters of ABG analysis and the development of organ failure or local complications, need for interventions (endoscopic/radiological/surgical), and mortality were analyzed. Results: In all, 100 patients (mean age: 36.25 ± 12.86 years; 47.0% males and 53.0% females) were studied. The etiology of acute pancreatitis was Gall stone disease in 52 (52.0%), Alcoholism in 35 (35%), and others in 13 patients (13%). Of the 100 patients, acute fluid collections developed in 84 patients (84%). Multiple organ failure developed in 18 patients (18%). Respiratory failure developed in 68 patients (68%) and renal failure developed in 15 patients (15%), whereas 13 patients (13%) developed shock. Seven of the 19 patients (36.84%) with pH ≤7.35 died when compared with 1 of 81 patients (1.23%) with pH >7.35 (P = 0.001). Seven of the 58 patients (13.79%) with bicarbonate ≤24 mEq/L died when compared with 1 of 42 patients (2.38%) with bicarbonate >24 mEq/L (P = 0.05). Seven of 36 patients (19.4%) with base deficit ≥−4.0 died when compared with 1 of 64 patients (1.56%) with base deficit >4.0 (P = 0.002). Conclusion: Low arterial pH, low bicarbonate levels, and higher base deficit at presentation predict an adverse outcome with more frequency of organ failure, need for intervention, and mortality.

Outcome of anterior hypospadias repair: A single center experience S Pramod, Gagan S Prakash Archives of International Surgery 2018 8(1):10-15 Background: Hypospadias is a common congenital condition affecting the male phallus. It is characterized by abnormal opening of the urethra on the ventral aspect of the penis with ventral curvature of the phallus (chordee). Various surgical techniques have been described in the treatment of hypospadias. Evaluate the surgical outcome of anterior hypospadias repair including different procedures used to repair distal hypospadias. A retrospective observational study conducted by the Department of Pediatric Surgery, Kempegowda institute of medical sciences hospital, Bangalore from January 2014 to January 2018 over a period of 4 years. Patients and Methods: All children with anterior hypospadias were included in the study. Children underwent either meatal advancement and glanuloplasty (MAGPI) or Snodgrass urethroplasty depending on the type of hypospadias. On follow–up, children were evaluated for complications. Chi square test was used to test for relationships between categorical variables. Results: Fifty children were included in the study. Age ranges of children were between 9 months to 14 years. Coronal hypospadias was the most common variety (32%). Chordee, undescended testis, inguinal hernia, and penile torsion were observed in 44%, 4%, 6%, and 4%, respectively. On preoperative ultrasonography, renal anomalies were observed in 4 (8%) children. Out of 50 children, 25 underwent MAGPI and remaining 25 underwent Snodgrass repair. Postoperative complication was seen in nine children (18%). Most common complication was urethral fistula seen in five (10%) children followed-by meatal stenosis. Of these nine children with complication, only three children required resurgery. Conclusion: Distal hypospadias is uncommonly associated with renal anomaly, which was once again reiterated in our study. Undescended testis and inguinal hernia were the most common associated anomalies with distal hypospadias. MAGPI is choice in case of glanular and coronal hypospadias with minimal chordee. Snodgrass technique is excellent choice in subcoronal and distal penile hypospadias with chordee.

Oral and maxillofacial soft tissue reconstruction using local flaps in Sokoto, Northwest Nigeria Abdurrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Adebayo Aremu Ibikunle, Micah Olalekan Gbotolorun, Mike Adeyemi, Benedict Chukwuma, Siddiq Abubakar Archives of International Surgery 2018 8(1):16-20 Background: Owing to the aesthetics and functional concern, oral and maxillofacial soft tissue reconstruction requires meticulous planning with team approach. The aim of this paper is to present our experience in the use of local flaps in the reconstruction of oral and maxillofacial defects. This was a retrospective study of maxillofacial and oral soft tissue reconstruction using local flaps. Patients and Methods: The study was carried out in the Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital in northwest Nigeria over a 4-year period. Data such as age, sex, diagnosis, types of flaps used, complications and prognosis were collected and analysed with the IBM SPSS Statistics for windows Version 20 (Armonk, NY: IBM Corp). Results: Forty-two out of 64 cases of oral and maxillofacial soft tissue reconstruction (65.6%) met the inclusion criteria for local flap utilisation. They consisted of 27 (64.3%) males and 15 (35.7%) females, with a male:female ratio of 1.8:1. Age ranged from 6 to 72 years with mean ± SD (24.2 ± 17.7). Temporomandibular joint ankylosis (TMJA) release was the main reason for soft tissue flap utilisation as an interpositional material in the maxillofacial region 30 (77.3%). Temporalis myofascial flap 19 (45.2%) was the commonest flap used. Most of our cases had no associated complications 39 (92.9%), only 2 (4.8%) patients had total flap failure. Conclusion: Where free tissue transfer is not feasible, local flaps remain a viable option. Good patient selection is essential to prevent some of the complications associated with their use.

Experience with the use of local anesthesia in maxillofacial surgery Kelvin Uchenna Omeje, Otasowie D Osunde, Benjamin Fomete, Roland Agbara, Thomas Owobu, Abdul Rasheed Suleiman Archives of International Surgery 2018 8(1):21-26 Background: Recent advances in anesthesia and the need to manage patients' perioperative anxiety along with escalating healthcare costs have resulted in an increasing number of surgical procedures being performed under local anesthesia (LA) especially as day-case surgeries worldwide. To report our experience with performing oral and maxillofacial surgeries under LA highlighting the advantages and limitations. Patients and Methods: This study was a retrospective analysis of patients who underwent maxillofacial surgical procedures under LA at Murtala Mohammed Specialist Hospital, Kano, Nigeria, over a 2-year period (January 2014–December 2015). Information collated included the patients' demographics, clinical features, diagnosis, surgical operations performed, duration of hospitalization, and complications recorded. The data obtained were analyzed using Statistical Package for Social Sciences version 15.0. Results: A total of 92 patients comprising 58 males and 34 females with varying maxillofacial conditions were operated during the period of the study. Their ages ranged from 12 to 60 years with a mean age of 32 ± 4.4 years. The complications recorded in the patients included three cases of malocclusion (3.2%), one case of wound dehiscence (1.1%), paraesthesia of the lower lip in one patient (1.1%), and cardiac arrest in one patient (1.1%). Conclusion: Maxillofacial surgery under LA is a cost-effective approach to surgery with good outcomes in this environment.

A prospective study of morbidity during adhesiolysis Hanuman Prasad Gupta, Aditya Sharma, Amit Singh, Rekha Porwal Archives of International Surgery 2018 8(1):27-31 Background: One of the most common causes of morbidity caused during adhesiolysis is inadvertent enterotomy. It is important to have awareness about the adhesiolysis-related morbidity to properly inform the patients of the risks before surgery, for surgeons to take these risks into consideration while making operative decisions, and to get better at the diagnosis of post-operative complications. Patients and Methods: We did a prospective observational study on 55 patients who underwent laparotomy for adhesiolysis at the J.L.N. Medical College, Ajmer. Study period was 24 months, from January 2015 to January 2017, including a follow-up period of 6 months. Our primary aim was to do a detailed assessment and analysis of adhesiolysis and to assess the post-operative complications related to adhesiolysis. Results: The incidence of full thickness bowel defects was 9 (16.36%). Bowel resection and anastomosis were required in five operations (55.56%). The severity of adhesions and adhesiolysis time was more with patients with two or more previous laparotomies, mean 132 ± 40.27 min. Re-admission rates were also much higher in patients who had enterotomy. Conclusion: This study has demonstrated the substantial clinical burden of adhesiolysis, particularly when a bowel defect occurs.

Maxillectomy: Indications and outcome at a tertiary hospital in Nigeria – A review of 113 cases Timothy O Aladelusi, Segun A Ogunkeyede, Victor I Akinmoladun Archives of International Surgery 2018 8(1):32-37 Background: Maxillectomy is the surgical procedure often indicated for the management of tumours and some non-neoplastic conditions arising from or involving the maxilla. This procedure is associated with significant functional and aesthetic deficits with concomitant psychological effect. The aim of this study is to evaluate maxillectomies carried out in our facility over a 16-year period. Patients and Methods: This is a retrospective study of cases of maxillectomy carried out in the Departments of Oral and Maxillofacial Surgery and the Ear, Nose and Throat (ENT) of our hospital from 2000–2016. The clinical data retrieved from the records of patients included age, gender, presentation, site of lesion, surgical intervention and rehabilitation options. Results: A total of 113 maxillectomies were performed in 52 males and 61 females. The age range was 13–82 years with a mean age of 37.4 ± 16.1 years. Majority of participants are of a low-socioeconomic status. The mean duration of symptoms before presentation was 12.4 months. Malignant lesion (59/113) accounted for the majority of cases seen. Total maxillectomy was the most frequent procedure (53.1%). Recurrence was seen in 20.4% of all cases. Major limitations to therapeutic intervention were lack of fund and late presentation. Conclusion: Delay in presentation and lack of fund remains the main challenges in the management of sinonasal tumours. Management of the maxillectomy defect remains largely limited to rehabilitation with an obturator in our environment.

Endoscopic management of massive stone load in a patient with repaired bladder exstrophy Varun Vishnu Agarwal, Mukund Gopalkrishna Andankar, Hemant Rangnath Pathak Archives of International Surgery 2018 8(1):38-40 Bladder exstrophy is a rare congenital malformation of the genitourinary system. Patients with exstrophy of the bladder who have undergone augmentation cystoplasty with Mitrofanoff procedure have a tendency of recurrent calculi formation. A 23-year-old female, with bladder exstrophy, underwent Mitrofanoff procedure and developed recurrent vesical calculi thereafter. She presented to us with a very massive stone load, which was managed successfully by endoscopic technique. She was also taught preventive measures thereafter and advised regular follow-up. The importance of the report is that it highlights urolithiasis as a recurrent complication of primary bladder exstrophy closure, which can be managed effectively and safely by modern endoscopic techniques in a hostile abdomen with reconstructed tract and inaccessible urethra.

Unusual presentation of patients with prostate cancer in Zaria: A report of four cases Ahmad Bello, Musliu Adetola Tolani, Muhammed Ahmed, Ahmed Tijjani Lawal, Dauda Eneyamire Suleiman, Balarabe Kabir, Abdullahi Sudi, Babatunde Kolapo Hamza, Oyelowo Nasir, Abdulsalam Ibrahim Khalifa, Hussaini Yusuf Maitama Archives of International Surgery 2018 8(1):41-46 Advanced prostate cancer usually presents with lower urinary tract symptoms (LUTS) or metastatic bone disease. Detection of an associated jaundice, suprapubic, or flank mass is unusual in advanced disease just as associated visceral or cutaneous metastasis is quite an uncommon presentation in prostate cancer. We report four cases in this series to highlight the unusual presentations of this cancer with a huge suprapubic mass (case 1); jaundice with associated multiple, nodal, and soft tissue metastasis (case 2); associated retroperitoneal mass (case 3); and synchronous primary renal cancer with background HIV infection (case 4). In conclusion, patients with unusual presentation of prostate cancer may constitute diagnostic dilemma, especially in the setting of retroperitoneal or suprapubic mass. Despite the fact that the findings highlighted in this series were unusual, their response to hormonal ablation was good.