Mm Harjai

Intestinal volvulus - a rare complication of ventriculoperitoneal shunt

Abstract Intestinal volvulus causing obstruction is an unusual complication of ventriculoperitoneal shunts. There are no clear guidelines on the management of this problem. In our patient exteriorization of the shunt with subsequent reinsertion at a different site led to an uneventful recovery. The extreme rarity of this complication and its challenging management are discussed.

A Prospective Randomized Controlled Study of Lichtenstein's Tension Free versus Modified Bassini Repair in the Management of Groin Hernias

BACKGROUND Bassinis repair and the Lichtensteins tension free mesh hernioplasty are commonly used hernia repair techniques. A prospective randomized controlled study of Lichtensteins tension free versus modified Bassini repair in the management of groin hernias was undertaken to compare the technique and postoperative course in the two procedures. METHODS A prospective study was conducted on patients reporting to Command Hospital (SC) Pune with inguinal hernia. One hundred and ninety six patients were included in the study, operated upon by either of technique and followed up. RESULTS Study involved 196 patients with 216 primary inguinal hernias, studied over a period of 24 months. A total of 118 Bassini repair and 98 Lichtensteins repair were done. Of the 196 patients, four were females. Bassini Repair took more time than Lichtensteins repair, though the difference was not statistically significant (p>0.05). Direct hernias took lesser time to operate than the indirect hernias. Pain on the operative day, in the evening, was similar in both the groups. The commonest complication in both the groups was scar tenderness followed by erythema, scrotal swelling, neuralgia, superficial wound infection, funiculitis and seroma formation in the order of frequency. The average hospital stay was 5.74 days for Bassinis repair as compared to 4.97 days for Lichtensteins repair. Patients undergoing Bassinis repair took longer (mean 28.4 days) to return to work as compared to those who underwent Lichtensteins repair (mean 21.4 days) and the difference was statistically significant (p < 0.05). The recurrence rate was similar in Bassinis (6.78%) and Lichtensteins repair (5.10%). CONCLUSION The Lichtensteins tension free mesh hernioplasty was comparatively better than modified Bassinis repair due to its simplicity, less dissection and early ambulation in the postoperative period. Surgeons in training found the technique easier to master than the Bassinis repair.

CONGENITAL URETHRAL FISTULA: Case Report

M ale congenital urethral fistula is most commonly seen in association with anorectal malformations [I]. Congenital posterior urethro-perineal fistula as a variant of urethral duplication is a relatively more common type of fistula. Isolated congenital urethral fistula is very rare with less than 20 cases reported in the available literature. We report here such a case and discuss its management.

PLACE OF MINILAP CHOLECYSTECTOMY IN AN ERA OF LAPAROSCOPIC CHOLECYSTECTOMY

In view of surgical and economic factors of our country, minilap cholecystectomy can be performed as an alternative to the laparoscopic cholecystectomy and offers almost similar results as laparoscopic surgery. We compared the operation time, post-operative hospital stay and return to full activity and the results were encouraging. We hope that this article justifies its claim to orthodoxy in the coming years.

MULTIDRUG – RESISTANT TUBERCULOSIS (MDRTB) IN CHILDREN

The World Health Organization has estimated that 90 million cases of tuberculosis will occur throughout the world in the 1990s and 30 million people will die from the disease [1]. Drug resistance is emerging as a major obstacle to tuberculosis control in the world and is exacerbated by the growing epidemic of Human Immunodeficiency Virus (HIV) [2]. Treatment of drug-resistant tuberculosis is complex, requiring the use of several toxic drugs over 9 to 18 months. Here we present a case of multidrug resistant tuberculosis in a child.

PAEDIATRIC HAND TUMOURS-SYNOVIAL SARCOMA : A RARE MALIGNANCY

T he rarity of soft tissue sarcoma overall and their even rarer presentation in distal portion of an extremity has limited the number of patients in most reports. Among soft tissue tumours, synovial sarcoma is uncommon & occurs rarely in children. Till date only one case of synovial sarcoma of the left palm has been reported in the English literature [I]. Here we describe another case of this rare entity and its management.

SURGERY FOR COMPLETE RECTAL PROLAPSE: A SIMPLIFIED APPROACH

Complete prolapse of rectum (procedentia) is said to occur when the full circumference of the rectal wall is everted through the anus. Numerous techniques have been developed in order to treat procedentia, an uncommon pathology that is managed occasionally by the general surgeon. A simple, safe and effective procedure is recommended for surgeons who treat procedentia recti once in a while. We describe a simple rectopexy procedure which has been used effectively in 38 patients in the last 10 years. In this prospective study we evaluated the results which are comparable to other standard operative techniques in terms of morbidity, anatomic correction and bowel function. This technique is based on sound scientific principles in the aetiopathogenesis of rectal prolapse. This procedure obliterates the abnormally deep cul de sac of rectovesical pouch and supports the anterior rectal wall by suturing it to the bladder base to prevent initiation of sliding herniation of anterior rectal wall, which causes procedentia recti. Posterior dissection fibrosis fixes the posterior rectal wall to the sacrum after healing and restores the normal posterior curve of rectal canal and corrects the pathogenic straightening of rectum which promotes prolapse. Minimal mobilization of rectum is done and lateral ligaments are not dissected hence all attendant complications e.g. impotence, urinary incontinence, constipation etc are avoided. Simplicity, effectiveness, safety and non requirement of prosthetic material makes it an ideal operation suitable for a general surgeon working in the periphery.