Surgical Review: International Journal of Surgery, Trauma and Orthopedics

Laparoscopic Anterior 180° Partial Fundoplication - Indian Perspective

2021-06-02T17:25:45+0530

Aim: To evaluate Laparoscopic anterior 180° partial fundoplication for its good long-term relief for symptoms of gastroesophageal reflux disease and association with adverse effects.

Methods:

Study design: Prospectively evaluated case series.

Settings: Tertiary care centers

Patients: The clinical outcomes were determined for all patients who had undergone a laparoscopic anterior partial fundoplication by us between January 1, 2013 to March 31, 2021.

Interventions: Clinical outcome, complications, and follow-up after laparoscopic anterior 180° partial fundoplication was obtained using a structured questionnaire.

Results and Discussion: 228 procedures were performed. The outcome at 0 to 8 years (mean, 4 years) follow-up was determined for 195 patients. 1 death was linked to the laparoscopic procedure and 2 patients died during follow-up due to unrelated causes. For 186 patients (95%) with clinical outcome data at late follow-up, gastroesophageal reflux symptoms were significantly improved following surgery and were well controlled in 9 patients (4.5%). In a subset of 85 patients with more than 5 years of follow-up, relief of heartburn was found in 59 patients (69%). Incidence and severity of heartburn were reduced after surgery in 22 patients (26%), decreased dyspepsia in 80 patients (94%). Normal belching was preserved in 84 patients (99%) and almost all patients were able to eat normally.

Conclusion: Laparoscopic anterior 180° partial fundoplication is an effective procedure for the surgical treatment of gastroesophageal reflux and is associated with a high rate of patient satisfaction at late follow-up. Compared to Nissen's fundoplication it is as good as control of recurrent reflux as well as reduced adverse effects. The patient goes home in 3-4 days. Hence we recommend it as the procedure of choice for reflux symptoms.

Open versus closed reduction and K-wire fixation for supracondylar fracture of the humerus (Gartland type 3) in children

2021-06-02T21:42:44+0530

Background: The purpose of the study was to compare the presentation and postoperative results of children treated by open reduction and closed reduction for completely displaced Gartland type III supracondylar humerus fractures (SCFs).

Method: Supracondylar fracture of the humerus is a common paediatric fracture seen in our OPD. Among them Type III fractures are displaced with no cortical contact, and reduction is difficult, and maintaining reduction is almost impossible without some form of internal fixation. Therefore during surgery of type 3 fractures, fixation is done by two methods. 1 open reduction and fixation with 2 cross k-wire 2. closed reduction and fixation with 2 cross k-wire fixation. Following pinning, the elbow was immobilized in an above elbow slab in pronation with the elbow at 75 degrees of flexion. A retrospective comparative study of 50 paediatric patients with type III supracondylar fracture of the humerus was done in our hospital (District hospital associated with ABV Govt Medical College, Vidisha). We divided the patients into two groups.

Result: The average age of patients was 5 years (age range, 3 to 10 years). The test population consisted of 18female (36%) and 32 male (64%) patients. There were 31 fractures (62%) in the right elbow and 19 fractures (38%) in the left. Group 1 patients stayed in the hospital for 5 days while Group 2 stayed for only 2 days in the hospital. Also group 1 patient required follow-up at eight postoperative days (for check dressing) and 11 postoperative days for stitch removal while group 2 patients were directly called for k-wire removal at 3 weeks postoperatively.

Conclusion: The closed reduction technique was preferred because it required less hospitalization time, less number followup, and resulted in almost no visible surgical scars.

Comparison of functional outcome and complications in Gartland’s Type III fracture Supracondylar Humerus in paediatric population by different pinning technique

2021-06-03T21:17:20+0530

Background: Fracture Supracondylar humerus is one among common fracture in children between age 5-7 years. Boys are frequently affected than girls. Extension variety is more common. The conventional approach to treat fracture supracondylar humerus (Type III) is a close reduction with percutaneous fixation. There have been controversies as to which surgical technique should be used, cross pinning or two-wire lateral pinning. This study aims to find which method of pinning is most appropriate to fix fracture supracondylar humerus.

Method and material: A Retrospective comparative study was designed to analyze the outcome of the cross pinning and lateral pinning method. A total of 60 patients were included in the study. They were divided into two groups of 30 each. Group A comprised of fixation by cross pinning method. Group B comprised of fixation by two-wire lateral pinning method. Results of both groups were analysed about Flynn’s criteria and complications.

Result: The mean age in Group A was 5.1 years and in Group B was 4.8 years. One patient was lost to follow up in Group A. On the final follow up, there was statistically no difference in terms of outcome according to Flynn’s criteria in both groups. According to Flynn’s criteria>95% of patients had a satisfactory outcome in both groups. Among Group A, there were 2 cases of iatrogenic ulnar nerve praxis whereas in group B there was one case of pin loosening.

Conclusion: On comparing both techniques there was no significant difference in the outcome. However, there is a slight increase in the chances of iatrogenic ulnar nerve injury in the cross pinning method.

Comparison of two techniques of steroid injections in the management of Frozen shoulder

2021-06-30T13:13:40+0530

Background: Frozen shoulder is a condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases.

Material and methods: This was a prospective study with 50 patients coming to our OPD. Patients of all stages were included and randomized into two groups. Group 1: Single Site Injection (SSI) group received steroid injection through posterior approach and Group 2: Novel three-site ( NTS )group received the same dose of steroid in diluted doses at three sites (posterior capsule, subacromial and subcoracoid). The second sitting was repeated after 3 weeks. Both groups had received the same physiotherapy. The patients were evaluated by the CONSTANT score at initial, 3 weeks, 6 weeks and 6 months.

Results: Patients of Group 2 (NTS group) had significant pain relief and early improvement in activities of daily living (p < 0.005) as compared to Group 1 (SSI Group). Also, although there was an improvement in shoulder movements in both the groups but in Group 2 (NTS) patients, early near-normal scores were attained and sustained even after 6 months. About 40% in Group 1 (SSI) could not attain near-normal levels and had relapses.

Conclusion: The Novel three-site approach of steroid injections in frozen shoulder provides early recovery, better pain relief and better improvement in shoulder function with fewer relapses.

A prospective study of outcome of resection anastomosis in elective GI surgeries.

2021-08-13T20:56:11+0530

Background: Bowel anastomosis is successful when there is accurate union with no tension. Previous literature has compared between hand suturing and stapling devices in retrospective and prospective designs with varying outcomes. In this study a comparison between hand suturing and surgical stapling in patients undergoing bowel surgery is done.

Methods: A prospective study design over a period of 12 months was conducted in 40 patients undergoing elective resection and anastomosis. Different time parameters for anastomisis procedure, time taken for bowel sounds to return, resumption of oral feeds, postoperative hospital stay were collected. Follow up for 30 days post-operative was done.

Results: In total forty patients were studied out of which twenty patients underwent hand sewn and twenty patients underwent stapler anastomosis. Main group analysis in mean time durations between hand sewn and stapler anastomosis were respectively; 35.25 minutes and 12 minutes for anastomosis, 3.4 days and 3.35 days for return of bowel sounds, 4.08 days and 4 days for resumotion of oral feeds, 9.35 days and 8.50 days for post-operative hospital stay. A sub-group analysis was also done.

Conclusion: Stapler anastomosis had shorter anastomosis time and total duration of operation compared to hand sewn anastomosis. However no difference was seen in return of bowel activity, resumption of oral feeds and duration of hospital stay.

Corrective Osteotomy in cubitus varus deformity in children: A prospective study

2021-08-18T14:06:18+0530

Background and Aim: Cubitus varus deformity is the most common late complication after supracondylar fracture of the distal humerus in children, incidence varying from 4% to 58%. The present study was done to evaluate the results of dome osteotomy.

Material and Methods: This prospective study was conducted in a tertiary care hospital over 16 months. In all patients humerus-elbow wrist angle was measured on both sides and the correction needed was calculated. The lateral condyle prominence index (LCPI) was calculated by anteroposterior view radiographs of the deformed and the normal elbow in full extension by (AB-BC)/AC. Dome osteotomy with para triceps approach was used. Pre and post-operative carrying angle of elbow, range of motion and lateral prominence indices were compared.

Results: The age of patients ranged from 3 to 15 years with a mean age of 8.47±3.14 years. Preoperative carrying angle of normal side ranged from 80 to 140 and that of effected side ranged from -23 to -13 and the difference was statistically significant (p<0.05). LCPI ranged from -8.4 to 5.9%. The majority of cases had LCPI >2.7%. As compared to, an improvement in carrying angle at defect side was observed to be 28.41±2.15 which was significant (p<0.05). At baseline mean LCPI was 0.39±3.87% which changed to -0.86±3.47%, the mean change of this was significant (p=0.01). baseline

Conclusion: Dome osteotomy is a relatively technically demanding technique for correction of cubitus varus deformity but with a better functional outcome without being associated with lateral condyle prominence.