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   Table of Contents - Current issue
July-September 2020
Volume 8 | Issue 3
Page Nos. 105-160

Online since Monday, July 19, 2021

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Physics behind ultrasound; what should I know as a pediatric surgeon? p. 105
Omemh Abdullah Bawazeer, Osama Bawazir
The bedside and intraoperative ultrasound are used frequently in infants and children by the treating surgeon as a part of physical examination. The fundamentals of ultrasound physics are essential for proper image interpretation and understanding common ultrasound artifacts. We aimed to cover the basic physics terminologies, ultrasound components, modes, and tissue echogenicity in this review article.
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Alopecia and zinc deficiency in postbariatric surgery patients Highly accessed article p. 110
Omar Al-Komi, Anas Hasson Alnajjar, Mohamed Abdelghafour Khalifa, Abdullah Murhaf Al-Khani, Osman Habib Basheir
Background: Bariatric surgeries form an integral part of morbid obesity management. In addition, alopecia is steadily being reported as a postoperative event. Alopecia is related to the nutritional deficiency occurring due to bariatric surgery, postoperative rapid weight loss, and major surgery-related stress. This review aims to evaluate rates of zinc deficiency as a postoperative complication of bariatric surgery and its association with alopecia. Methodology: A PubMed literature search conducted between February 6, 2020 and April 3, 2020, from which 32 studies were identified that reported zinc status and hair loss following bariatric surgery. Results: Most of the articles, 14 (48.28%) articles, 7 (24.14%) articles, reported prospective cohort and retrospective cohort studies, respectively. Moreover, 16 (55.17%) publications were about Roux-en-Y gastric bypass (RYGB) surgery, while sleeve gastrectomy was conducted in 9 (31.03%) studies. Rates of zinc deficiency were reported in 93.10% of the studies. Five studies (17.24%) included the rates of alopecia and most of them revealed female predominance. Decreased food intake was considered as a common cause of zinc deficiency after gastrectomy; on the other hand, decreased zinc absorption was a factor in RYGB patients. Conclusion: Bariatric surgery is an effective measure in managing morbid obesity and its complications. However, it could be associated by zinc deficiency and consequent alopecia, particularly in females. A meta-analysis is needed to assess this correlation more thoroughly and to determine the potential value of regularly giving micronutrient supplements to prevent such a complication.
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Technique, timing, and wound management of closure colostomy p. 118
Aamer Qais Kamil, Raafat Ahmed Al-Turfi, Sinan Shawkat Hamid
Introduction: Colostomy closure is an operation frequently performed in surgical practice, despite its benefits, it can produce significant morbidity and mortality. We have focused on the complications related to this surgery in regard to the closure technique and the optimal time for stoma closure and on the proper wound management in the postoperative period. Patients and Methods: Ninety-six patients were male between 17 and 53 years (median 35), they have been subjected to colostomy closure surgery in single-layer (52 cases) and double-layer (44 cases) closure techniques according to the surgeon preference. The interval time for colostomy closure was more than 3 months in 56 cases, while the interval time was <3 months in 40 cases, and a primary wound closure for 87 cases and delayed (after few days) wound closure for 9 cases. The colostomies were created following penetrating abdominal trauma at Al-Yarmouk Teaching Hospital in a period between October 2003 and October 2007. Results: The total number of complications was 26 (27.08%), as fecal fistula 10 cases and wound infection 16 cases. Colostomy closure more than 3 months interval had 12.5% postoperative complications versus 47.5% if <3 months interval. Regarding single-layer anastomosis, 3.84% developed fecal fistula and (11.53%) developed wound infection versus 18.18% and 22.72%, respectively, in double-layer anastomosis group. No case developed wound infection with delayed wound closure versus 16 cases (18.39%) in primary wound closure. Discussion: The incidence of complications was more in double-layer (continuous) technique of closure colostomy versus single layer. While if the interval time for stoma closure is 3 months and more, it would give good results. Regarding wound management, delayed primary wound closure resulted in a better wound healing than the conventional skin closure technique. Conclusion: Based on this experience, we believe that colostomy closure can be performed with minimal morbidity and would result in a successful surgical outcome. Providing a meticulous technique used by a single layer (continuous seromuscular sutures plus stay sutures) anastomosis, more than three months interval time and a delayed wound closure the outcome will be much better.
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Prophylactic ilio-inguinal neurectomy in open inguinal hernia repair: A randomized controlled study p. 125
Piyush Bamnodkar, Ramesh Dumbre, Arun Fernandese, Deepak Phalgune
Background: Controversies persist regarding excision of ilioinguinal nerve after inguinal hernia repair and the procedure is not widely accepted. The present study was aimed to compare outcomes and its impact on the quality of life between routine ilioinguinal nerve excision, and nerve preservation following Lichtenstein inguinal hernia repair. Materials and Methods: Eighty-six patients scheduled for Lichtenstein inguinal hernia repair were randomly divided into two equal groups of 43 patients each. Group A patients underwent prophylactic neurectomy, whereas, in Group B patients, the nerve was preserved. Follow-up was done on day one, 3 months, 6 months, and 9 months after surgery. The primary outcome measure was the incidence of chronic groin pain, whereas secondary outcome measures were an impact on the quality of life and time to return to work. Inter-group comparison of categorical and continuous variables was done using Fisher's exact test and unpaired t-test respectively. Results: The incidence of postoperative pain at 3 months was 13/43 (30.2%) and 5/43 (11.6%) in Group B and Group A, respectively (P = 0.034). The incidence of postoperative pain at 6 months was 11/43 (25.6%) and 3/43 (7.0%) in Group B and Group A, respectively (P = 0.038). The RAND 36-Item Short-Form Health Survey parameters such as mean social functioning scores at 6 months postoperatively were 88.4 and 82.9 in Group A as Group B, respectively (P = 0.037) and mean pain score was 98.7 and 95.3 in Group A as Group B, respectively (P = 0.047). The mean time to return to work was 4.5 days and 5.7 days in Group A as Group B, respectively (P = 0.002). Conclusion: A routine ilioinguinal neurectomy is a reasonable option for preventing neuralgia when performing Lichtenstein inguinal hernia repair.
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The incidence of recurrence after inguinal hernia repair: A single-center experience p. 131
Ahmed Almumtin, Hassan Alsaleem, Zahara Al-Ali, Sara Alsadah, Alaa Alshareef, Samar Alshammasi
Importance: Despite the improvement of treatment modalities and technical aspects, recurrence following hernia repair remains one of the main problems for the surgical community. More specifically, previous Cochrane Systematic Review and large database studies compared Lichtenstein repairs. However, none of the relevant published reports were representative of the Saudi population. Objective: This study's objective was to investigate the overall and gender-specific prevalence of recurrences in patients who had undergone Lichtenstein mesh repair of primary inguinal hernia (IH) in the KFHU Centre. Design: This is a retrospective record review study conducted between January 2000 and December 2014. Setting: The study was conducted at a single center located in Saudi Arabia, at King Fahed Hospital University KFHU center. Participants: Adults (≥18 years of age), with IH, operated at KFHU using standard Lichtenstein open mesh repair, and had minimum follow-up of 2 years were included in the study. Laparoscopically operated cases, recurrent and emergently operated cases were excluded from the study. Main Outcome (s) and Measure (s): Data were collected by records review and included sociodemographic characteristics (age, gender, and family history), hernia type and location, risk factors (body mass index [BMI], smoking, comorbidities, etc.), recurrence and other complications (pain, wound hematoma and seroma, infection, etc.). Results: We report a recurrence rate of 1.3% following Liechtenstein mesh repair at our center. As for patient-related factors that were found to be significantly associated with the recurrence of an IH were older age, higher BMI, the existence of hypertension, chronic cough and diabetes, in addition to smoking and lifting heavy objects. Conclusion: We have identified several likely factors associated with higher recurrence after hernia repair. A comparison of the rates of recurrence and complications between different procedures should, therefore, be an important topic to address in future studies.
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Low-cost prophylactic negative pressure wound therapy using central suction device in preventing surgical site infections in patients undergoing emergency laparotomy p. 138
Abhishek Mandal, Ipsita Aggarwal, Shouvik Das, Anmol Galhotra, Sanjay Marwah
Background: The surgical site infections (SSIs) are the most common cause of nosocomial infection in surgical patients and are associated with high morbidity, considerable mortality, longer hospital stay, and increased health-care costs. Evidence suggests that incisional negative pressure wound therapy (INPWT) can decrease wound complications, but there is scanty literature regarding INPWT for high-risk laparotomy incisions. Materials and Methods: A prospective interventional randomized study was conducted over a period of 2 years from May 1, 2018, to April 30, 2020. The enrolled patients were randomized to the study group where INPWT was applied and the control group where patients were subjected to conventional wound dressings. Results: Out of 85 patients undergoing emergency laparotomy, 36 patients were allocated to the study group and 38 patients to the control group after meeting the exclusion criteria. Baseline demographic characteristics were similar in both the groups. The relative risk (95% confidence interval) of SSI, burst abdomen, and rehospitalization was significantly more in the control group (study versus control group): 0.65 versus 1.4, 0.67 versus 1.33, and 0 versus 2.03, respectively. Conclusions: Prophylactic use of NPWT is a safe and effective method for preventing SSI and other wound complications in emergency laparotomy for peritonitis, which is a major deciding factor in final wound outcome in such cases.
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Laparoscopic cholecystectomy in a patient with situs inversus totalis p. 145
Abeer Aljahdali, Saad Almowallad, Tariq Habib
Situs inversus totalis (SIT) is a rare congenital anomaly, in which both the thoracic and the abdominal viscera are transposed to the opposite side of the body. The diagnosis of surgical diseases in patients with SIT is often delayed, leading to complications. Surgery in these patients has been reported to be more challenging for right-handed surgeons. We herein present a case of a 30-year-old woman, not known to have SIT, with a history of intermittent left upper quadrant pain related to food for more than a year. After clinical examination, chest X-ray, and abdominal ultrasound, she was diagnosed with SIT and chronic cholecystitis, and underwent laparoscopic cholecystectomy performed by a right-handed surgeon. We believe that this case report will be informative for surgeons in managing chronic cholecystitis in patients with SIT, and for physicians to always look for clues for SIT in patients presenting with abdominal pain.
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Colonic Burkitt's lymphoma related to bowel obstruction in adults: A case report and literature review p. 148
Shayma Misfer Alotaibi, Abdulrahman Misfer Alotaibi, Salma Hani Sait, Najla Mohammedsaleh Alghanmi, Abdulrahman Mohammed Sibiany
Burkitt's lymphoma (BL) is an uncommon cause of non-Hodgkin lymphoma in adults. BL-related intussusception causing intestinal obstruction in adults is rare. Symptoms are often misleading and make diagnosis difficult. We aim to present an adult case of a Colonic BL related to bowel obstruction. Here, we are presenting a case of a 29-year-old Saudi male patient who presented with symptoms of bowel obstruction. Abdominal examination found abdominal distention with a palpable mass in the right lower quadrant with mild tenderness. After chest, abdomen, and pelvic enhanced computed tomography with intravenous contrast, colonoscopy, and histopathological examination, the patient was diagnosed with colonic BL, which caused him bowel obstruction. Chemotherapy has been started based on Hyper CVAD chemotherapy protocol. After receiving the complete Chemotherapy on July 2019, patient's symptoms improved; there is no longer abdominal pain; he is passing stool, usually with no blood or mucus. Two months post last cycle of chemotherapy the patient presented again to the hospital with symptoms and images showed refractory disease to first-line chemotherapy. He passed away one month after this admission.
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Cystocholecystostomy: A new technique for management of hilar biliary disruption due to a large hydatid cyst liver - Ten years of follow-up p. 152
Sanjay Marwah, Rambeer Singh, Abhishek Mandal, Shouvik Das
A long-standing and large-sized hepatic hydatid cyst located at the liver hilum is likely to rupture into the adjoining major bile ducts. This unusual complication demands preoperative diagnosis at an early stage and adequate surgical management so as to prevent morbidity and mortality. Such cases are managed with bilioenteric anastomosis by doing Roux-en-Y cystojejunostomy. However, one such case was managed by performing side to side anastomosis between disrupted hydatid cyst at the hilum and adjoining gallbladder. This innovative surgical procedure was named “Cysto-cholecystostomy” and was reported for the first time in the English literature. This case report presents ten years of follow up of this patient along with discussion of related cases published in the literature.
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Management of congenital giant liver cyst with postoperative bile leak: A case report and literature review p. 156
Abdullah Osama Bawazir, Anies Mahomed, Nadeem Kausar, Razan Bawazir, Rayan Halabi, Irfan Mamoun, Mohammed Maimani
Congenital liver cyst is an uncommon disease in infancy and is usually asymptomatic. However, even rarer are congenital giant liver cysts which by virtue of their size are problematic. We discuss a case of a newborn with a giant hepatic cyst who was successfully treated surgically but experienced a postoperative bile leak as a complication. We review the management of this entity and propose an algorithm of care.
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