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  Most popular articles (Since February 09, 2018)

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Jivaka: The great surgeon and physician of ancient India
Ajaya Kashyap
September-December 2019, 2(3):77-79
Background: Indian civilization has been home to some of the greatest surgeons since antiquity. Jivaka has been one of the greatest. Three different systems of medicine including Indian, Thai and Chinese look up to him as one of the greatest physicians and surgeons in antiquity. Aims and Objectives: The aim of the present article was to study his contributions to modern medicine and specifically to surgical techniques. Results: Jivaka's approach to surgery was quite modern in giving due importance to pre and post surgical care. His famous cases and innovations include the surgery for fistula in ano, surgical treatment of a volvulus as well as surgery for hydrocele. He was the physician to Lord Buddha and took care of him for several ailments. Conclusion: While we study about the great surgeons in the medevial and modern times we only have to look back at great surgeons like Jivaka in antiquity to realize how it all started.
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Recurrence rates and fecal incontinence after fistulotomy or fistulectomy
Qaidzohar Kanchwala, Dinesh Jain, Deepak Phalgune
July-December 2018, 1(2):43-47
Background: In spite of the availability of various treatments for fistula-in-ano, consensus cannot be reached as to the best form of treatment with regards to recurrence and incontinence. Fistulotomy and fistulectomy remain the two most commonly practiced surgeries. The study was undertaken to compare the recurrence rates and fecal incontinence in patients undergoing fistulotomy or fistulectomy. Materials and Methods: Hundred and ten patients with primary or recurrent fistula-in-ano of low anal type were included. Fistulectomy and fistulotomy were performed in 53 and 57 patients, respectively. The final follow-up at 6 months postoperative was done to assess any recurrence. The patients were required to fill Wexner's questionnaire at the monthly follow-up to monitor incontinence. Statistical significance of the difference of categorical and continuous variables was tested using the Chi-square test and unpaired t-test, respectively. Paired t-test was used for intra-group comparison. Results: At 6th month follow-up, Wexner's score was normal in 49/53 (92.5%) and 52/57 (91.2%) fistulectomy and fistulotomy patients, respectively, which was not statistically significant (P = 0.564). Mean Wexner's score at 6 months follow-up was significantly less as compared to 1st week follow-up in both fistulotomy and fistulectomy groups. Recurrence rate was 5/57 (9.4%) and 7/53 (12.3%) in fistulectomy and fistulotomy patients, respectively, at 6 months follow-up which was not statistically significant (P = 0.763). Conclusion: Fistulotomy and fistulectomy are equally effective in the treatment of low anal fistulas with acceptable rates of recurrence and fecal incontinence at 6 months follow-up after surgery.
  8,044 347 1
Lazy S technique for uncomplicated pilonidal sinus
Shekhar Suradkar, Kunal Suradkar
January-June 2018, 1(1):1-5
Background: We present a new Lazy S technique for reconstruction of a defect resulting from excision of the pilonidal sinus. Materials and Methods: In this technique, semilunar incisions, at the opposite ends of the defect facing away from each other are made. Undermining flaps in the subcutaneous tissues is then made, for about 2 cm to facilitate tension-free closure. Results: A total of 42 males were closed by this technique, all under local anesthesia. The in-hospital stay was for 2 days in all patients. One patient (2.1%) developed hematoma and one patient (2.1%) had wound break down which was managed conservatively by secondary intention. Recurrence was seen in 4 (8.3%) patients. Conclusions: Our Lazy-S closure technique is a useful technique for the treatment of pilonidal sinus with favorable.
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Surgery for hemorrhoids: A review
Kum Kum Singh
January-June 2018, 1(1):14-16
There are various surgical options available for treatment of heamorrhoids. It essentially depends on the grade of heamorrhoids. Each option has its pros and cons. This article reviews the various surgical options
  4,405 419 1
Day care coloproctology
Naresh T Row
January-June 2018, 1(1):6-10
Introduction: The concept of day care surgery is fast catching on, with more and more surgeons practicing day care surgery. Here I discuss the feasibility of practicing day care surgery in coloproctology. Materials and Methods: Nearly 1664 (16.49%) cases of anorectal diseases (of a total of 10,089 cases) were operated at a single center over a 10 years' period from July 1, 2008 to June 30, 2018. Results: Two patients (0.12%) had complications in the form of bleeding requiring readmission. Both were managed conservatively and discharged on the next day. Conclusions: Day care coloproctology surgeries can be practiced safely and successfully in a select group of patients with specific indications.
  4,238 419 -
Perineal colostomy following abdomino-perineal resection for rectal cancer-A case report
Vasudeva Pai Hosdurg, MV Sreeharsha
January-June 2018, 1(1):26-29
The management of ultralow rectal cancers within 2 cm from the dentate line is still challenging. Abdominoperineal resection (APR) is the gold standard in the treatment of ultralow rectal cancers. Conventional APR involves the construction of a left iliac fossa (LIF) end colostomy. The taboo associated with a permanent abdominal colostomy results in a poor self-esteem and a poor quality of life. Pseudocontinent perineal colostomy (PCPC) is an alternative reconstruction technique following APR in which the colostomy is placed in the perineum and a graft of smooth colonic muscle tightly surrounds the lowered colon. We present the case of a young unmarried gentleman who underwent an APR and living with a left iliac fossa colostomy who underwent this procedure. The case is of interest since a similar case report could not be found from India and also since the PCPC in our case is done as a secondary procedure.
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A large ischiorectal fossa soft tissue sarcoma: Surgical technique (combined minimally invasive with open approach) and reconstruction with V-RAM flap
Ashish Pokharkar, Mandar Dhamangaokar, Swapna Athawle, Amit Patil, Avanish Saklani
July-December 2018, 1(2):48-51
Here, we report a rare case of large ischiorectal fossa (IRF) soft-tissue sarcoma with involvement of the rectum. The patient was operated with laparoscopic abdominoperineal resection and wide local excision of a tumor through the posterior approach. Postoperatively, the patient received adjuvant radiotherapy and chemotherapy. Surgical resection is the mainstay of treatment and includes resection of surrounding organs to get adequate surgical margins for locally advanced IRF tumors. Laparoscopic approach causes less morbidity and early recovery.
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A review of treatment for fecal incontinence
Pradeep Sharma
January-June 2018, 1(1):11-13
The treatment option for faecal incontinence varies from medical management to various surgical options. This article gives an overview of the various treatment modalities for faecal incontinence.
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President's Message
Ashok Kumar
January-June 2018, 1(1):0-0
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Message from President Elect-Dr Niranjan Agarwal
Niranjan Agarwal
January-June 2018, 1(1):0-0
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Message from Secretary
Roy Patankar
January-June 2018, 1(1):0-0
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Perineal scar endometriosis
Arshad Ahmed Baba, Asif Mehraj Dar, Arshed A Parray, Mudassir Ahmed Khan, Mushtaq Ahmed Laway, Nisar Ahmed Chowdri
January-June 2018, 1(1):30-33
Endometriosis is defined as the presence of endometrial tissue outside the uterus and is common in fertile women. Pelvis is the most frequent location of the endometriosis. Endometriosis is mostly found in peritoneal surfaces but can also involve the vagina, vulva, rectovaginal septum, and perineum usually postobstetric, gynecological, or other surgical trauma. Extrapelvic endometriosis has been reported in any region of the body including bowel, bladder, lung, kidney, extremities, perineum, and umbilicus. We present a case of a patient perineal surgical scar endometriosis. The endometriotic scar nodule was surgically excised. Postoperatively, The patient was treated with gonadotropin-releasing hormone analogs. The surgical outcome was successful, and the patient is on our close follow-up and reports that she is asymptomatic during subsequent menstrual periods unlike before.
  3,522 352 1
Effect of colon care bundle on surgical site infections in colorectal surgery
Ajaz Ahmad Bhat, Gowhar Aziz Bhat, Nisar Ahmad Chowdri, Zamir Ahmad Shah, Fazl Q Parray, Rauf Ahmad Wani
January-April 2019, 2(1):6-11
Objectives: Surgical site infection (SSI) has been recognized as the third most common health-care-associated infection. Colorectal surgeries are consistently associated with higher SSI (4%–45%) relative to other surgeries. SSI not only increases morbidity but also causes severe economic impact throughout the world. The aim of the present study was to study the effect of colon care bundle on SSI and identify the risk factors involved in SSI in colorectal surgeries. Methods: Two hundred and seventy patients who underwent elective colorectal surgery between July 2015 and June 2017 were included in the study. Patients were assigned to bundle care group (n = 150) and control group (n = 122). In the colon care bundle group, patients received aseptic cleaning of skin with chlorhexidine (night before and morning), clipping of hair before surgery, nonabsorbable oral antimicrobial agents, maintenance of normothermia during surgery, and high-inspired oxygen intra- and postoperatively. Both groups received parenteral antibiotics for 24 h. SSI was defined as per the Centers for Disease Control and Prevention. Patients were followed for 30 days postoperatively. Results: Both groups were comparable with respect to age, gender, comorbidities, obesity, and other variables. SSI in the colon care bundle group (8.7%; n = 13) was less than in the control group (18.9%; n = 23), which was statistically significant (P = 0.014); however, effect on deep and organ/space infection was not statistically significant. The incidence of SSI increases with age and superficial SSIs were more common than deep or organ/space infection in both groups. SSIs were more common in wounds of rectal surgeries than colon surgeries (46% vs. 15%, P = 0.926). SSIs were more common in patients with diabetes mellitus (39.1% vs. 23.1%), patients with increased body mass index (BMI) (43.5% vs. 38.5%), patients with decreased serum albumin (69.6% vs. 53.8%), smokers (60.9% vs. 53.8%), and patients with preoperative chemoradiation (65.2% vs. 61.5%) in both groups (control group vs. bundle group), but did not reach statistical significance. Out of 36 SSIs in two groups, 24 were culture positive with Escherichia coli, followed by Enterococcus faecalis as common organisms. Conclusion: Colon care bundle is an effective method of reducing SSI in colorectal patients. Overall SSI was found to be significantly less in the study group than in controls. On subanalysis, superficial SSI was seen more in the control group. The infections were seen more often in diabetics; smokers; and patients with increased BMI, decreased serum albumin, preoperative chemoradiation, and rectal operations, though statistically not significant. However, efficacy of individual component of care bundle on SSI remains unanswered.
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Association of colorectal surgeons of India: Past, present, and future
Chetan V Kantharia
July-December 2018, 1(2):37-38
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A rare presentation of ileal perforation due to local iron toxicity
Dilip Rajasekharan, Jayanth Bannur Nagaraja
January-June 2018, 1(1):22-25
Ileal perforation peritonitis is a frequently encountered surgical emergency in developing countries. In contrast to Western countries where lower gastrointestinal (GI) tract perforations predominate, upper GI tract perforations attribute to the majority of cases in India. Spontaneous ileal perforation remains a dreaded surgical condition in developing countries. Typhoid fever is the predominant cause of nontraumatic ileal perforation, while other causes include tuberculosis, nonspecific inflammation, obstruction, radiation enteritis, and Crohn's disease. Iron tablets, in case of toxicities, are notorious for causing erosions of the gastric mucosa due to their corrosive effect leading to perforations. The incidence of these, however, is few and far between. However, iron tablets causing erosions as a cause of ileal perforation is virtually unheard of. Literature suggests the possible perforations due to iron toxicity to be in the upper GI tract, namely stomach and duodenum, reflecting the sites of absorption. In this case report, we present a patient with an ileal perforation following acute ingestion of iron tablets. We suspect that this is probably either due to the sheer number of tablets, leading to a reduced absorption, or the fact that it may be enteric coated, which may explain the passage through the upper GI tract undigested. There are no studies to the authors' knowledge that explain such a finding. Thus, there is no consensus on the total amount of iron needed or the minimum time exposed to the toxic agent to produce such a finding.
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Neoplasms of appendix presenting as mucocele of the appendix
Rahul Raghavapuram, Fadl H Veerankutty, M Anandakumar
January-June 2018, 1(1):17-19
We report two cases of mucocele of the appendix occurring following neoplasm of the appendix. This cause is rare, the common etiology being obstruction secondary to inflammation.
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Carcinoma of the ascending colon presenting as a retroperitoneal abscess
Shantata Kudchadkar, Shireesha Chodankar, Dilip Amonkar
January-June 2018, 1(1):20-21
Patients with the right side of colonic malignancy commonly present with obstruction and bleeding. At times, in 4% of cases, they may present with perforation. Presentation with symptoms other than these is rare. Besides atypical presentations of colonic malignancy are associated with poor prognosis. We present a case report of a retroperitoneal abscess following a perforated ascending colon malignancy as a primary presentation of carcinoma of ascending colon.
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Colorectal surgery: Is there a need to recognize it as a separate super specialty in India?
Asif Mehraj, Nisar A Chowdri
January-April 2020, 3(1):16-22
Colorectal surgery is an established super specialty in most parts of the world. However, in India, this is yet to be recognized as a separate super specialty. Colorectal surgery has a vast scope and needs dedicated training to treat complex colorectal diseases. There is enough scientific evidence to prove that outcomes for such diseases are improved in the hands of dedicated colorectal surgeons. So far in India, the process of granting it the status of a separate super specialty has been initiated but it needs further efforts to formally do so and also start super specialty courses such as MCh/DNB in the field. In this review, we will give a brief historical background of the specialty of colorectal surgery, the scope of colorectal surgery, the scientific evidence to prove that better patient outcomes are achieved in the hands of dedicated colorectal surgeons and finally the journey of efforts that have been carried so far for recognizing this as a separate super specialty in our country.
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Splenic flexure volvulus: Rarest type of colonic volvulus, report of a case
CR Praveen, M Prakash, Govind Nandakumar, Adarsh Palleti
July-December 2018, 1(2):55-56
Only in 15% of cases, colonic volvulus is one of the causes of large-bowel obstruction. Splenic flexure volvulus is the rarest subtype of colonic volvulus (<1% of cases). We report one such case in a 50-year-old female, who was subjected to extended left hemicolectomy after stabilization. The histopathology report showed no evidence of malignancy.
  3,028 207 -
Contentious issues in the management of carcinoma of the rectum
Chetan Kantharia, Sharvari Pujari, Kishor Jain, Ramkrishna Prabhu
July-December 2018, 1(2):39-42
The management of Carcinoma of the Rectum is fairly standardized and protocolized, based on universally followed guidelines, including the NCCN, ESMO, and ASCO guidelines. However, there are certain advances and practices recommended which are contentiously requiring further debates and studies. The present study addresses these issues in its right perspective based on literature evidence.
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Activities of the ACRSI

January-June 2018, 1(1):34-34
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A rare case of morgagni hernia in an elderly female
Shireesha Umakant Chodankar, Shantata Jayant Kudchadkar, Guruprasad Huske, Dilip Amonkar
July-December 2018, 1(2):52-54
Morgagni hernias (MHs) are rare and constitute about 2% of all diaphragmatic hernias. Although uncommon, it has the potential for considerable morbidity if the diagnosis is missed. We present a case report of a 70-year-old elderly diabetic female, who presented in casualty with breathlessness, acute upper abdominal pain, and vomiting. Chest X-ray and contrast-enhanced computed tomography scan chest and abdomen revealed a right-sided MH with impending ischemia of transverse colon as content. The patient underwent emergency exploratory laparotomy with primary tension-free suture repair of hernia defect after reduction of contents back in the peritoneal cavity, and transverse loop colostomy was fashioned. Postoperative course was uneventful. MHs being rare in occurrence, present a dilemma in diagnosis. A high index of suspicion with radiological assistance is required while assessing elderly patients presenting with respiratory distress to prevent morbidity and mortality.
  2,788 264 -
Quo vadis COVID responder – Beat the chinese virus, carpe diem
Brij B Agarwal, Nayan Agarwal
January-April 2019, 2(1):1-2
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Tuberculous fistula-in-ano
Parmeshwar Bambrule, Mohammad Taha Mustafa Sheikh, Tarun Mittal, Asish Dey, Anmol Ahuja, Bipul Agarwal, Deepak Patel, Vinod K Mailk
September-December 2019, 2(3):97-100
Perianal tuberculosis (TB) is a rare diagnosis in cases of fistula-in-ano, especially in cases where healing has not occurred despite multiple surgical interventions. One should consider a high level of possibility of harboring TB, which may be the reason behind the failure of treatment and multiple recurrences. The histopathological finding includes epithelioid cell granulomas, and caseation necrosis would be an essential guide in such cases along with the other tests such as acid-fast bacillus staining and culture and Mantoux test. The treatment of tuberculous fistula-in-ano includes not only surgical but also the full course of four-drug anti-tubercular treatment for at least 6 months and regular follow-up to cope up with recurrence.
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Transanal minimally invasive surgery
Mohammad Taha Mustafa Sheikh
January-April 2019, 2(1):3-5
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