https://www.clinsurggroup.us/journals/journal-of-surgery-and-surgical-research A Peertechz Open Access Journal en-us 28 Jan, 2026 https://www.clinsurggroup.us/articles/JSSR-12-269.php Background: Left colon surgery represents a major component of digestive surgical practice worldwide, with colorectal cancer being the leading indication. In sub-Saharan Africa, delayed presentation and emergency surgery remain frequent, potentially influencing postoperative outcomes. Objective: To describe indications, surgical procedures, postoperative complications, and factors associated with postoperative morbidity following left colon surgery in adults in Douala, Cameroon. Methods: This was a retrospective, analytical multicenter study conducted in four referral hospitals in Douala over 11 years (January 2013–December 2023). Adult patients (≥15 years) who underwent left colon surgery were included. Data were analyzed using SPSS version 25.0. Associations between potential risk factors and postoperative complications were assessed using univariate analysis, with p &lt; 0.05 considered statistically significant. Results: Among 223 colon surgeries performed during the study period, 144 left colon procedures were included (64.6%). The mean age was 50 ± 15 years, with male predominance. Emergency admission accounted for 72.2% of cases. Neoplastic pathology represented 75% of indications, predominantly colorectal adenocarcinoma. Postoperative complications occurred in 8.3% of patients, with anastomotic fistula accounting for 33.3% of complications. The overall mortality rate was 2.8%. Emergency surgery, advanced tumor stage, and sigmoid colon localization were significantly associated with postoperative morbidity. Conclusion: Left colon surgery in Douala is largely dominated by colorectal cancer and is frequently performed in emergency settings. Emergency presentation and advanced disease significantly increase postoperative morbidity, highlighting the importance of early diagnosis and elective surgical management. 16 Jul, 2025 https://www.clinsurggroup.us/articles/JSSR-11-268.php Uterine perforation is an uncommon but serious breach of the uterine wall, which may rarely progress to bowel herniation—a life-threatening condition where intestinal loops protrude into the uterine cavity or pelvis. It is primarily a gynecological problem that often requires the intervention of a general surgeon. Most cases are iatrogenic occurring during Intrauterine Device (IUD) insertion (forty to fifty percent of perforations), Dilation and Curettage (D&C), hysteroscopy, surgical abortions or endometrial biopsies. Rarely, spontaneous perforation may occur in uterine malignancies or postpartum uterine necrosis. Complications can include Bowel obstruction or ischemia (20% of cases), peritonitis, sepsis, fistula formation, hemorrhage or infertility from delayed diagnosis. Management entails aggressive resuscitation and Immediate laparotomy for bowel reduction/resection and uterine repair (primary closure/hysterectomy if necrotic) as may be indicated by the specific presentation. Antibiotics and hemodynamic support for septic complications. Report of uterine perforation with bowel herniation is rare especially in early pregnancy as in this index case. More so if the herniated bowel is gangrenous, hence the desire to present this rare occurrence. 28 Jan, 2025 https://www.clinsurggroup.us/articles/JSSR-11-267.php An obese patient was admitted to the Department of Gastrointestinal Surgery at Xiangyang Central Hospital, an affiliated hospital of Hubei University of Arts and Sciences, in June 2024 due to a gastrointestinal stromal tumor (gastrointestinal mesothelioma) of the ascending duodenum. Complete robotic excision of the gastrointestinal stromal tumor and tubular stapler insertion into the ascending duodenum were carried out. The surgeries took 190 minutes (the docking time was 30 minutes), there were approximately 10 milliliters of intraoperative hemorrhage, and there was no duodenal stenosis or contrast agent leak on the upper gastrointestinal tract. The outcomes demonstrated the technical safety and viability of using a tubular stapler to treat ascending duodenums under a total robot, as well as offering some experience in the selection of surgical techniques for GIST in specific segments. 30 Dec, 2024 https://www.clinsurggroup.us/articles/JSSR-10-266.php Upper limb injuries after major trauma often result in severe damage to bones, vessels, nerves, and soft tissues, leading to critical challenges in management. The decision between limb salvage and amputation is complex, especially in the context of a "mangled" extremity, which significantly affects functional, psychological, and social well-being. This case report details the innovative use of oxygen-ozone therapy combined with surgical management in a 34-year-old male who suffered a catastrophic injury to the left upper limb after a car crash. The patient presented extensive soft tissue loss, multiple open fractures, and severe infection leading to septic shock and multiorgan failure. Initial treatment included surgical lavage, Vacuum-Assisted Closure (VAC) therapy, and targeted antibiotics. Given the critical condition and the high risk of limb amputation, daily oxygen-ozone therapy was introduced through major autohemotherapy. The treatment resulted in rapid clinical improvement, including hemodynamic stabilization, reduction of inflammation, and enhanced wound healing. Definitive osteosynthesis and flap grafting were performed successfully 42 days post-admission. At the one-year follow-up, the patient demonstrated preserved hand and wrist function with some limitations in flexion and pronosupination. This case highlights the potential of oxygen-ozone therapy as an adjunct in limb salvage, offering a promising alternative to amputation in severe upper extremity trauma. Future research will be necessary to validate these findings and establish standardized protocols for such novel interventions. 17 Oct, 2024 https://www.clinsurggroup.us/articles/JSSR-10-265.php Introduction and importance: Ectopic liver tissue is a rare finding, often discovered incidentally during procedures like cholecystectomy. Understanding its clinical implications, including potential malignancy and complications, is crucial for effective management and improving patient outcomes. Case presentation: A 45-year-old female presented with six months of biliary colic, worsened by fatty meals. Preoperative ultrasound revealed a gallbladder with microcalculi. During elective laparoscopic cholecystectomy, a brownish tissue fragment resembling hepatic parenchyma was found on the gallbladder fundus and removed. Histopathology confirmed ectopic liver tissue with mild steatosis and no malignancy. Clinical discussion: Ectopic liver tissue, with a prevalence of 0.47%, typically attaches to the gallbladder but can also be found in other abdominal and thoracic locations. It may be linked to congenital malformations and has a risk of degeneration into malignancy due to its incomplete vascular and ductal system. Diagnosis is usually incidental during surgery, and en-bloc removal is advised to prevent complications and potential neoplastic transformation. Identifying its vascular supply before dissection is crucial to avoid severe bleeding. Conclusion: Ectopic liver tissue, despite its rarity, requires careful management due to its potential for malignancy and complications. Timely detection and en-bloc removal are vital to prevent adverse outcomes and ensure optimal patient care. 08 Oct, 2024 https://www.clinsurggroup.us/articles/JSSR-10-264.php Cystic echinococcosis remains a serious and threatening disease in countries on all continents where it is endemic. It is a zoonosis that continues to be neglected, despite all the efforts of the teams working on it and the WHO. Therefore, it is never too much to remember the clinical management of this disease in humans. This is what we intend in this manuscript. The disease is caused by the larval stages of cestodes (tapeworms) of the genus Echinococcus found in the small intestine of carnivores, which infects humans due to accidental ingestion of eggs of these parasites. The most frequent and most widespread across all continents is cystic echinococcosis, caused by Echinococcus granulosus (sensu lato). The annual incidence of CE can range from less than 1 to 200 per 100,000 inhabitants in various endemic areas. In China and Central Asia, the population risk is more than 40 million people, with a mortality rate of about 2% - 4%. Objectives: One of the objectives of this manuscript is to recall the parasite cycle and the form of contamination, a very important public health aspect, and draw attention to this neglected zoonosis that affects millions of people, particularly in the countries of Central Asia, the Mediterranean basin and South America. Last but not least, we intend to draw attention to the correct nomenclature in relation to the terms that define the disease, the different stages, and the proper designations, particularly with regard to therapeutic modalities. Method: The manuscript also aims to describe the form of contamination of the disease, the diagnostic methods, in particular the use of ultrasound, and the therapeutic modalities, some of which, particularly the invasive ones, must be carried out in Centres dedicated to the study and treatment of this zoonosis. Conclusion: Despite these important data and the socioeconomic impact Echinococcosis remains a neglected disease. Given this situation, all forms of echinococcosis remain serious public health threats, particularly in South America, the Mediterranean basin, and Central Asia, which must deserve the attention of the states of these continents and the WHO. 04 Oct, 2024 https://www.clinsurggroup.us/articles/JSSR-10-263.php Traumatic Bone Cyst (TBC) is a rare and asymptomatic intraosseous lesion, often classified as a pseudocyst, affecting the jaws and long bones. Known by various names such as solitary bone cyst, hemorrhagic bone cyst, simple bone cyst, extravasation cyst, or progressive bone cyst, TBC’s etiopathogenesis remains elusive due to its diverse presentations. The standard treatment protocol for TBC involves surgical excision followed by curettage of the cystic cavity. This surgical intervention induces bleeding, leading to the formation of a blood clot within the cavity, which subsequently promotes the resolution of the lesion and regeneration of new bone. In this context, the use of third-generation Platelet-rich Fibrin (PRF) has emerged as a promising adjunctive therapy to enhance and accelerate the healing process of surgical wounds. PRF, a biomaterial derived from the patient’s own blood, is known for its ability to release growth factors that facilitate tissue regeneration and wound healing. This case report aims to present the surgical removal of a traumatic bone cyst in the anterior mandible of a pediatric patient, highlighting the efficacy of PRF in improving wound healing outcomes. Through this report, we seek to demonstrate the potential benefits of incorporating PRF into the surgical management of TBC, particularly in pediatric patients, to achieve faster and more effective healing. 13 Apr, 2024 https://www.clinsurggroup.us/articles/JSSR-10-262.php Objective and potential Patellofemoral Instability (PFI) is linked to different anatomical anomalies. It has been suggested that in the majority of cases of patellar dislocation, the Medial Patellofemoral Ligament (MPFL) is ruptured with a high recurrence rate, particularly in female patients. Although MPFL tear is not the primary cause of instability, MPFL reconstruction is effective in stabilizing the knee and can single-handedly prevent lateral patellar dislocation. There is limited but growing evidence that MPFL reconstruction for patellofemoral instability leads to excellent functional outcomes. In this work, we report our technique of MPFL reconstruction using the gracilis tendon with a review of recent literature concerning MPFL reconstruction and functional results in the face of objective patellar instabilities treated solely by MPFL reconstruction. 12 Apr, 2024 https://www.clinsurggroup.us/articles/JSSR-10-261.php Introduction: Breast cancer is one of the most common malignancies, treated with primary surgery, or surgery after neoadjuvant chemotherapy. Many studies indicate that the peri-operative period is critical as interference with the immune system may affect prognosis. Whether certain anesthetic agents can affect the immune response and cancer progression is still unresolved. Evidence acquisition: In the current study, we review the existing clinical and experimental studies, in an attempt to extract useful information for clinical application in the anesthesia practice for patients treated with surgery for breast cancer. A bibliographic search in PubMed and ScienceDirect related to the effects of anesthesia on cancer progression and anti-tumor immunity, published from January 2000 till today was performed. Evidence synthesis: All included studies were gathered in a list and they were analysed. A total of 34 studies were found relevant to the subject in PubMed and ScienceDirect. Conclusion: The overall experience suggests that the peri-operative management of cancer patients should focus on the reduction of surgical stress, the minimization of the use of opioids, and the adoption of regional anesthetics. This could have an impact on anti-tumour immunity and the outcome of cancer patients. 12 Feb, 2024 https://www.clinsurggroup.us/articles/JSSR-10-260.php Background and objectives: Chronic hypertension has a higher incidence in the perioperative setting. It increases the risk of complications like acute hypertension, bleeding, myocardial ischemia, and stroke. Perioperative management of these patients during vascular surgery could be challenging because of the additional co-morbidities like diabetes mellitus, vasculopathy, and cardiac disease. For these reasons, we conducted a retrospective study to observe the complications and mortality associated with chronic hypertension during vascular surgery. Materials and methods: After ethical committee approval we retrospectively review medical records of patients undergone abdominal aortic aneurysm repair surgery. Age, sex, ASA physical status, chronic hypertension (controlled or uncontrolled), type of surgery (open or endovascular; scheduled or urgent), anesthesia type, postoperative complications (acute hypertension, bleeding, acute renal failure, heart failure, stroke, and cardiac arrest) and mortality were recorded. A multivariate analysis of chronic hypertension, postoperative complications, and mortality was conducted using SPSS Software. A p - value &lt; 0.05 was considered statistically significant. Results: Our study included 544 patients undergoing abdominal aortic aneurysm repair surgery. Ninety-four percent of patients were men, mean age of 72 years old, and 67% were ASA III and IV. Seventy-three percent of patients presented chronic hypertension with appropriate control defined as the lack of target organ damage and previous complications related to hypertension in 83% of these patients. Endovascular surgery was performed in 44% and open procedure in 56% of patients. Elective surgery was carried out in 83% and urgent surgery in 17% of patients. General anesthesia was performed in 73% (combined general anesthesia with epidural analgesia in 36%) and regional anesthesia in 27% of cases. Controlled chronic hypertension was not associated with postoperative complications (CI 95% 0,581-2,982 p 0,510) and mortality (1-year mortality CI 95% 0,786-5,240 p 0,144; 2-year mortality CI 95% 0,655-3,845 p 0,306). Discussion: Chronic hypertension is largely considered a risk factor for perioperative complications of AAA repair. Conversely, our results suggest that adequate control of chronic hypertension before AAA repair leads to a low incidence of postoperative complications as well as 1 and 2-year mortality rates. 06 Jan, 2024 https://www.clinsurggroup.us/articles/JSSR-10-259.php Introduction: Perforation peritonitis is one of the most frequently encountered surgical emergencies in tropical countries like India and mostly affects young men in their prime of life. In the majority of the cases, presentation to the hospital is late with generalized peritonitis and varying degrees of septicemia. It is therefore necessary to recognize patients at risk preoperatively and prepare for an aggressive management strategy. The present study was thus planned to assess the clinical factors that could predict morbidity and mortality preoperatively in people with perforated peritonitis.  Materials and methods: 100 adult patients above 14 years of age with perforated peritonitis who underwent emergency laparotomy were evaluated. Data on demographics, comorbidities, vital signs, deranged biochemical parameters, delay in presentation to the hospital, and personal medical history were collected and analyzed for preoperative predictors.  Results: Postoperative morbidity and mortality were the key results. The findings revealed that a number of preoperative predictors like advanced age, delay in presentation to the tertiary care center, medical co-morbidities an elevated white blood cell count, and a protracted preoperative hospital stay were strongly linked with greater morbidity and mortality. Among the pre-existing comorbidities, COPD accounted for most of the deaths after surgery.  Conclusion: Early detection of preoperative predictors can assist clinicians in risk stratification by enhancing preoperative care and help in a well-directed therapy for patients who are more likely to experience postoperative difficulties and thus lower morbidity and death. A proper referral mechanism and early transportation along with adequate health education particularly for rural populations can reduce the morbidity and mortality in such patients. 30 Dec, 2023 https://www.clinsurggroup.us/articles/JSSR-9-258.php Cryptorchidism, the condition of undescended testicles, and inguinal hernia share a common embryological origin, often presenting together. This case report describes the surgical intervention for a 73-year-old diabetic male with a 20-year history of left inguinal hernia and a single right testicle. The patient presented to the emergency department due to obstructed inguinal hernia, reporting pain, bowel obstruction, abdominal distension, and vomiting. Physical examination revealed a left inguinal hernia measuring 10 cm, which was incarcerated, non-expansile, and irreducible. Intraoperative exploration unveiled a strangulated oblique external left inguinal hernia with a 10 cm sac and a narrow neck containing an ischemic, yet non-necrotic, small bowel. Orchidectomy was performed due to testicular atrophy. The hernia repair utilized the Lichtenstein technique with a polypropylene mesh. Postoperatively, the patient recovered well without complications. Follow-up at 5 months showed no hernia recurrence or mesh infection. This case highlights the importance of timely surgical intervention in managing complex cases of hernia and cryptorchidism, particularly in elderly patients, and underscores the significance of careful intraoperative decision-making for optimal patient outcomes. 25 Nov, 2023 https://www.clinsurggroup.us/articles/JSSR-9-257.php Gastrointestinal stromal tumors originating from the small bowel are uncommon. We present the case of a 45-year-old man with no prior medical or surgical history who presented to our hospital's emergency department with abdominal pain, vomiting, inability to pass gas, and no bowel movements. Physical examination revealed abdominal distention and tenderness. His white blood cell count was 10.9 x 10^3/µl, and hemoglobin levels were 13.3 g/dl. 17 Nov, 2023 https://www.clinsurggroup.us/articles/JSSR-9-256.php Omental Infarction (OI) is a rare condition that can mimic common causes of acute abdominal pain, primarily affecting individuals aged 40 to 50, with a male predominance. Imaging techniques like ultrasound and computed tomography aid in diagnosis. Treatment options range from conservative management to surgery, depending on severity and complications. OI often leads to right-sided abdominal pain in 90% of cases, with histological features including focal necrosis and fibroblastic reactions. Acute appendicitis is a common cause of acute abdominal conditions, especially in children and adolescents. Having a patient simultaneously presenting with acute appendicitis and omental infarction is extremely rare, with only three cases reported in the literature to date to our knowledge. We present the case of a 32-year-old male, a heavy smoker, who presented with epigastric pain and vomiting. Initial clinical suspicion was a perforated ulcer, but imaging revealed swollen appendicitis with adjacent fat stranding and evidence of epiploic infarction near the stomach. Laparoscopic surgery confirmed the diagnosis of acute appendicitis, with an appendectomy performed and identification of the infarcted omentum, which was preserved. After the operation, the patient had a successful recovery and was discharged on the second postoperative day. This case firstly emphasizes the rarity of the association between acute appendicitis and omental infarction in the same patient and underscores the importance of considering Omental Infarction (OI) in the differential diagnosis of acute abdominal pain. Imaging plays a crucial role in accurate diagnosis, and a high degree of suspicion and prompt diagnosis are crucial for optimal patient outcomes. 04 Nov, 2023 https://www.clinsurggroup.us/articles/JSSR-9-255.php Moll glands are sweat apocrine glands close to the eyelid margin. Tumors derived from Moll glands are rare, although Moll glands cysts are frequent. They originate from their glandular tissue or tubules. In this report we present a rare case of a lower eyelid skin tubular apocrine adenoma occurred in the right eye lower eyelid of a caucasian 45 year old woman. The lesion was nodular and dome shaped and its size was 1.5 × 3.5 × 2 mm. After a complete excision the lesion was analyzed by our pathology unit. Histologic sections were stained with haematoxylin and eosin, alcian blue, periodic acid-Schiff (PAS). Additionally, the following immunohistochemical markers were used: cytokeratin 7 (CK7), cytokeratin 8/18 (CK8/18), cytokeratin 20 (CK20), S-100 protein and gross cystic disease protein 15 (GCDFP-15) (4,5). The immunohistochemical and phenotypic features resulted suggest the diagnosis of lower eyelid tubular apocrine adenoma probably originated from Moll glands. These findings allowed us to diagnose a very rare and benign cutaneous lesion of eyelid skin. 19 Jan, 2023 https://www.clinsurggroup.us/articles/JSSR-9-254.php Objective: Various endoscopically assisted minimally invasive surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. All these techniques necessitate the use of postoperative helmets without immediate correction of the head shape. Here, we document the safety and sustainable acceptable outcomes of an endoscopic minimally invasive approach with full barrel staving without using a postoperative cranial helmet. Methods: A single-institution cohort analysis was performed on five patients who underwent endoscopically assisted minimally invasive calvarial vault remodeling without using a postoperative helmet for isolated nonsyndromic sagittal synostosis between 2017 and 2022. Variables analyzed were age at the time of surgery, gender, Estimated Blood Loss (EBL), operative time, postoperative complications, and pre-and postoperative Cephalic Index (CI). Results: Three male and two female infants were treated at our hospital in 2017–2022 with a mean follow-up of 32.6 months. At the time of the surgery, the mean age was ±3.5 months (range 10–58 months), the mean weight was 4.54 kg (standard deviation, SD ± 1.56), the mean EBL was 34.6 ml (range 20 ml – 54 ml) and mean surgical time from skin incision to dressing application was 120.7 min. The mean CI for all patients was 66.88 ± 4 (SD) preoperatively vs. 81.52 ± 2.38 (SD) postoperatively (p &lt; 0.001 by paired Student’s t - test). There were no deaths or intraoperative complications. Conclusions: We present a novel endoscopically assisted minimally invasive procedure without using a postoperative helmet. This was a safe and efficacious procedure for isolated sagittal craniosynostosis, with improvements in CI at a mean follow-up of 32.6 months. 29 Dec, 2022 https://www.clinsurggroup.us/articles/JSSR-8-253.php Claudius Amyand's hernia is defined by the incarceration of the vermicular appendix through the hernial sac. The first appendectomy was performed in 1735. It is a very rare pathology. Therefore, the frequency of this pathology is not yet established. We report the observation of a 54-year-old patient with an estimated BMI of 25.5 kg: height2 with a simple inguinal hernia that was not followed up and admitted to the emergency room with a painless and impulsive inguinal swelling when coughing. The management consisted of a conditioning and a pre-anesthetic assessment. The intraoperative exploration revealed a right inguinal hernia with caecal and appendicular contents of viable appearance. The procedure included an appendectomy and cure of the hernia using the Lichtenstein technique. The evolution was marked by a resumption of transit 24 hours postoperatively, Appendicitis complicating an Amyand's hernia is a rare pathology that often presents in an atypical clinical picture of an inguinal painful mass without the occlusive syndrome. Its preoperative radiological diagnosis, although exceptional, is of interest given the atypical presentation allowing the elimination of local pathologies that sometimes do not require emergency surgery. 15 Nov, 2022 https://www.clinsurggroup.us/articles/JSSR-8-252.php Introduction: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is excellent in predicting postoperative complications. Validation in resource-limited settings and applicability in gastrointestinal surgery is still unclear. Objective: The study aimed to determine the accuracy of the ACS-NSQIP surgical risk calculator in predicting the 30days postoperative adverse outcomes among patients who underwent laparotomy. Methods: A Single hospital-based, prospective cohort study was done at Muhimbili National Hospital in Tanzania from April 2021 to December 2021 recruiting patients aged 18 and above who underwent primary laparotomy. SR calculator variables were obtained from patients and entered manually to categorize patients into low and high-risk. Patients were followed up for thirty days for the outcome. The predicted risk was compared with actual occurrence to obtain personal risk ratios. The c-statistics of > 0.7, Brier of score < 0> 0.7) Poor discrimination was observed for the length of hospital stay (c-statistics 0.518). However, SR-calculator shows high calibration potential for all complications with a Brier score &lt; 0.25 (0.002 - 0.144) and an IPA score ranging from 0.225 - 0.969. Conclusion: The ACS -NSQIP SR-calculator accurately predicted postoperative outcomes for patients requiring laparotomy. SR-Calculator is a reliable tool for preoperative shared decision-making and counseling. The model should be adopted to strengthen the healthcare system in a low-income country. What is already known about this subject? &#10147; The ACS NSQIP surgical risk calculator is accurate in predicting the outcome of the Surgical procedure. &#10147; ACS NSQIP surgical risk calculator was validated in the USA &#10147; The SRC is associated with surgical care improvement whenever applied. What are the new findings? &#10147; The SRC accurately predicted the 30-day outcomes associated with primary laparotomy except for the length of hospital stay, discharge for other services, and veno-thromboembolic events. &#10147; The risk ratio (RR) provides a preliminary estimation of specific complications for a single patient. &#10147; Index of prediction Accuracy (IPA) reliably summarizes the discrimination and calibration of the ACS-NSQIP-SR-Calculator. &#10147; The SRC can be validated in a resource-limited setting and can be a source of surgical care improvement. How might these results affect future research or surgical practice? &#10147; The results of this study will provide a comparison between our institution and other international situations where a calculator had been tested and surgical service improvement locally. Our findings will provide insights into our loco-regional surgical institutions in the low-income country to conduct cross-specialties and institutional research toward the adoption of ACS-NSQIP-SRC into National surgical improvement programs. Informative to the surgical community on the performance of the SR-calculator outside the USA. 04 Oct, 2022 https://www.clinsurggroup.us/articles/JSSR-8-251.php Background: The diagnosis and treatment of individuals with Disorders of Sexual Development is a complex process and requires a multidisciplinary approach. Each individual should be evaluated objectively and the treatment process of each individual has its own unique differences. The aim of this study is to discuss the effectiveness of staged feminizing genitoplasty operations using the total urogenital mobilization technique. Material and methods: Hospital records of patients who underwent vaginoplasty using the TUM technique between 2014 and 2019 by a single surgeon in a pediatric surgery center of a tertiary pediatric hospital were retrospectively reviewed. Results: All ten patients who underwent TUM had 46 XX chromosomes. The TUM procedure for vaginoplasty was performed in all patients by the author. A clitorolabioplasty had been previously performed in six patients with congenital adrenal hyperplasia. The follow-up period of the patients was 1-6 years. No serious complications developed in any of the patients. Neither infection nor tissue necrosis occurred. A second surgical procedure was not required for urinary fistula, vaginal stenosis, urinary incontinence, or early suture dehiscence. Conclusion: This study shows that vaginoplasty can be performed in a single session in infancy for patients with low confluence and a short Urogenital Sinus (UGS). Apart from this, postponing vaginoplasty surgeries to the adolescence period and performing UGS mobilization surgery seem to carry successful results. 26 Sep, 2022 https://www.clinsurggroup.us/articles/JSSR-8-250.php Gliomas are neuroepithelial tumors in the brain or spinal cord that arise from glial or precursor cells and include astrocytomas, oligodendrogliomas, and ependymomas. They are the most common malignant primary central nervous system tumors, representing 75% of cases in adults and 24% of all cases of primary brain and CNS tumors [1,2]. Despite radiotherapy and temozolomide chemotherapy, which are the current gold-standard first-line treatments, patients with gliomas, particularly the highly aggressive and most common subtype glioblastoma multiforme, still have a poor prognosis with a median survival time of 15 months and 5-year survival rates of 5% [3-6]. 24 Aug, 2022 https://www.clinsurggroup.us/articles/JSSR-8-249.php Background (purpose): Surgery on patients with Carcinoid Syndrome (CS) and Carcinoid Heart Disease (CHD) is a challenge for anesthesiologists due to the high risk of developing Carcinoid Crisis (CC). The purpose of the study is to assess whether or not the use of octreotide as prophylaxis in the perioperative environment would decrease the incidence of CC (PEAK METHOD). We also try to identify CC’s precipitating factors. Material and methods (source): Research upon octreotide efficacy on CC prophylaxis was made on PubMed, Google Scholar, Cochrane, and web of science (WOS), from January 2010 to February 2021. We carried out a retrospective qualitative Systematic Review, which was developed in accordance with the PRISMA statement. Results (principal findings): Eleven articles were included in the study, five of them are retrospective studies, one is a prospective study, one is a prospective case series, two are retrospective case series, one is a meta-analysis of retrospective studies, and one is a cohort study. 5 of them are retrospective studies, 1 is a prospective study, 1 is a prospective case series and finally, 1 is a meta-analysis on retrospective studies. According to Massimino, et al. 2013; Guo, et al. 2014, Condron, et al. 2016 and Condron, et al. 2019, prophylaxis with octreotide is insufficient, it does not prevent and is inefficient in preventing CC. Tapia Rico et al confirm that due to the use of octreotide as prophylaxis, 1 patient experienced CC and 6 symptoms of CS. Fouche, et al. conclude that with prophylaxis, intraoperative carcinoid syndrome (ioCS) was mostly hypertensive. For the retrospective review that Kinney, et al. carried out, it was found that 169 patients did not experience CC. In the review carried out by Woltering, et al. it was found that out of 179 cytoreductive surgeries, prophylaxis with octreotide decreased the incidence of CC, they registered only 6 cases of CC (3,4%). Discussions and conclusions: Although octreotide constitutes the cornerstone for the prevention and treatment of CC, the current data does not support the idea that it is totally effective in preventing it. 04 May, 2022 https://www.clinsurggroup.us/articles/JSSR-8-248.php Objective: Rhabdomyosarcomas are among the malignant soft tissue tumors which may originate from primitive mesenchymal cells. These tumors may also be located in the head and neck region and may behave locally aggressive with the invasion of nearby structures. Radiation therapy (RT) may play a role as part of initial management as adjunctive therapy, or for treatment of recurrent disease. Accuracy and precision in RT treatment volume definition have gained utmost importance for achieving optimal treatment results. Herein, we assess multimodality imaging-based RT treatment volume definition for irradiation of recurrent head and neck rhabdomyosarcomas. Materials and methods: Multimodality imaging-based RT treatment volume definition for irradiation of recurrent head and neck rhabdomyosarcomas were evaluated in this study. RT target volume definition by incorporation of magnetic resonance imaging (MRI) or by computed tomography (CT)-simulation images only was assessed with comparative analysis for patients receiving RT for recurrent head and neck rhabdomyosarcomas. Results: As the main outcome of this study, ground truth target volume has been found to be identical to treatment volume definition by CT-MR fusion-based imaging. Conclusion: Optimal management of recurrent head and neck rhabdomyosarcomas may be improved by precise and accurate RT treatment volume determination. Within this context, the incorporation of MRI in the target and treatment volume definition process may be strongly recommended to achieve improved accuracy and precision in target and treatment volume determination despite the need for further supporting evidence. 29 Mar, 2022 https://www.clinsurggroup.us/articles/JSSR-8-247.php Swallowed foreign bodies are uncommon during general anesthesia. In the majority of the cases, these foreign bodies are passed spontaneously and uneventfully and the minority requires endoscopic or surgical intervention. It is recommended that every removable prosthesis should be removed, labeled, and stored in a safe place preoperatively. Furthermore, if a foreign body was missing, proper notification should be done in the immediate postoperative period to enable early detection and avoid any complications that might result from its impaction in distal places. This paper reports a case of a swallowed denture during induction of anesthesia. The clinical and imaging findings are presented along with a review of the literature. A 53-year old woman was admitted for laparoscopic cholecystectomy. A week postoperatively, the patient reported a colicky lower abdominal pain increasing in severity. Lower quadrants deep tenderness was elicited by examination. A foreign body was detected within the proximal rectum by abdominal CT scan. The foreign body was the patient’s denture that was not removed earlier during the induction of anesthesia. Endoscopic foreign body removal was done by flexible sigmoidoscopy. This case report highlights the importance of removing any removable prosthesis before induction of anesthesia and reporting any missing prosthesis such as dentures in the immediate postoperative period. 18 Mar, 2022 https://www.clinsurggroup.us/articles/JSSR-8-246.php Objective: Head and Neck Squamous Cell Carcinoma (HNSCC) is one of the most frequent cancer sites around the globe. Within the heterogeneous group of HNSCC, Oral Squamous Cell Carcinoma (OSCC) deserves the utmost attention as an important subsite. Despite multimodality management, recurrence of OSCC is not uncommon. RT may play an integral role as part of initial management or as adjunctive therapy, or for treatment of recurrent disease. In this study, we evaluate multimodality imaging-based RT treatment volume definition for irradiation of recurrent OSCC. Materials and methods: Multimodality imaging-based RT treatment volume definition for radiotherapeutic management of recurrent OSCC was assessed. RT target volume determination by incorporation of Magnetic Resonance Imaging (MRI) or by Computed Tomography (CT)-simulation images only has been evaluated and comparative analysis has been performed for patients receiving salvage RT for recurrent OSCC. Results: Ground truth target volume has been found to be identical with treatment volume definition by CT-MR fusion-based imaging. Conclusion: Incorporation of MRI in target and treatment volume definition may improve target and treatment volume definition for recurrent OSCC. 07 Feb, 2022 https://www.clinsurggroup.us/articles/JSSR-8-245.php Epinephrine is widely used in the management of severe cardiovascular instability as well as in cardiac arrest. In cardiac arrest, epinephrine has a standard dose (1mg) given at fixed intervals. We present a report on the use of high dose epinephrine (35mg in 45 minutes) during the successful management of a patient with sustained profound hypotension as a result of massive hemorrhage following laparoscopic adrenalectomy. 02 Dec, 2021 https://www.clinsurggroup.us/articles/JSSR-7-244.php The "port-site metastasis" represents a tumor recurrence that develops in the abdominal wall within the scar tissue of the insertion site of one or more trocars, after laparoscopic surgery, not associated with peritoneal carcinomatosis. This last aspect is central because in the literature some isolated cases are reported, but most cases are associated with peritoneal carcinomatosis. The first case in the literature dates back to 1978 and in the literature, the incidence varies from 1% to 21%, although most published research reports a very small number of patients. Currently, the incidence in a specialized cancer center is consistent with the incidence of recurrence on a laparotomy scar. Possible mechanisms for cell implantation at the port site are direct implantation into the wound during forced, unprotected tissue retrieval or from contaminated instruments during tumor dissection; the effect of gas turbulence in lengthy laparoscopic procedures, and embolization of exfoliated cells during tumor dissection or hematogenous spread. Probably, however, the triggering mechanism is necessarily multifactorial. To date, the only significant prognostic factor in patients diagnosed with port-site metastasis is the interval between laparoscopy and the diagnosis of the port site: in fact, patients who develop the port site within 7 months after surgery have a generally worse prognosis, as well as port-site metastasis are more frequent in advanced cancers and the presence of ascites. To reduce the risk, the following measures are proposed in the literature: 1) Select the patient who does not have a metastatic oncologic condition or friable cancerous masses or lymph node spread or attached external or intracystic vegetations, preferring well-localized, benign or low-malignant or otherwise intact tumors; 2) Use wound protectors and use of protective bags (or endo bag) for tissue retrieval; 3) Peritoneal washing with heparin, to prevent free cell adhesion, or washing with cytocidal solutions. Evaluate the utility of using Povidone-iodine, Taurolidine (which has anti-adhesion activity and decreases proangiogenic factors), and chemotherapy products; 4) Avoid removing pneumoperitoneum with trocars in place; 5) Avoiding direct contact between the solid tumor and the port site; 6) Prefer laparoscopy to laparotomy, if possible; 7) Avoid the use of gas or direct CO2 insufflation, although in literature the point is controversial and deserves more attention and study, as the initial hypothesis that CO2 increased the invasion capacity of tumor cells (in vitro and in vivo) has been refuted several times. Insufflation of hyperthermic CO2 and humidified CO2 leads to a better outcome in patients with a malignant tumor who undergo a laparoscopic procedure compared with normal CO2 pneumoperitoneum; 8) Comply with surgical protocols and techniques by updating one's surgical skills, as it has been demonstrated, as already reported here, the presence of cancerous cells on instruments, washing systems and trocars (in particular, on the trocars of the first operator). Suturing all layers of the abdominal wall decreases the risk of the port site; 9) Avoid excessive manipulation of the tumor mass during the surgical/operative procedure. 20 Aug, 2021 https://www.clinsurggroup.us/articles/JSSR-7-243.php Background- COVID-19 pandemic has wreaked havoc on Plastic Surgery practices globally. The superior forms of reconstruction or repair take long operative hours, more surgical team members and invasive post-operative monitoring which impose substantial risk of acquiring the infection. Having faced the numerous issues, we considered basic “old school” reconstructive strategies over the ideal ones during this pandemic and realized their importance. Method- In this retrospective study period of one year, the patients whom we had earlier planned for a superior form of reconstruction, but ultimately had to be managed in a basic, safe, quick and “old school” ways, were included. The details of the changed plans of reconstruction or repair, the operative time, number of team members, post-operative stay and other data were retrieved and analysed. Results- Among the 30 patients included, the mean age was 39.9 years, with male to female ratio of 3:2. The mean operative time was 64.7 minutes and the mean number of surgical team members was 2.5. The mean period of post-operative inpatient stay was 2.4 days. 16.7% of patients were infected by COVID-19 within the immediate 2 weeks of post-operative period but with no mortality. The mean period of OPD follow-up was 5.5 days after discharge with 20% overall complications. Conclusion- In this difficult time of the COVID pandemic, the basic and fundamental surgical plans of repair and reconstruction still hold their significance and should be considered to achieve the reconstructive goals. 20 Aug, 2021 https://www.clinsurggroup.us/articles/JSSR-7-242.php Globally, breast cancer is the most common incident cancer and cause of cancer deaths in women. The incidence of breast cancer suddenly increases from age 40 and continues to increase until age 84 years. These coincide with perimenopause and menopause periods. Hormone Replacement Therapy (HRT) is recognized to cause breast cancer. This causal association has become assumed with unopposed Estrogen Replacement Therapy (ERT) which is used for women who require HRT but do not require the Progestogen component. This systematic review assessed the evidence behind the belief that unopposed ERT had a causal relationship with breast cancer. Established databases were searched to August 2017 for publications that examined the relationship between unopposed ERT and breast cancer in cohort studies (prospective and retrospective), case control studies and randomized controlled studies. Unopposed ERT could be oral, transdermal patch or gel, subcutaneous or intranasal routes. All the studies were systematically assessed for the risk of bias and the measures of effect such as appropriate measures of effect [relative risk for randomized controlled studies, incidence ratio/rate for prospective cohort studies and odds ratio for retrospective cohort studies and case control studies. The quality of the evidence was assessed with GRADE methods [1]. We report on the general direction of the evidence from different types of studies over different decades in different countries using different types of unopposed Estrogens at different doses, to show whether the evidence is consistent in its direction that unopposed Estrogens do not increase the risk of Breast cancer in peri-menopausal or post-menopausal women. The evidence does not support that unopposed ERT increases the risk of breast cancer. Where an association has been reported, there was methodological association because the study was either a retrospective study as case control study or cohort study which are not study designs that are valid to show cause and effect relationships. Moreover the only randomized studies in the short term and long term show no cause and effect relationship. The implication is that as unopposed ERT does not increase the risk of breast cancer, more women can consider its use and benefits. 09 Jul, 2021 https://www.clinsurggroup.us/articles/JSSR-7-241.php Background: The ulnar nerve injury induce sever hand malfunction due to intrinsic muscle paralysis. The ulnar nerve repair in proximal area (high ulnar nerve injury) seldom leads to intrinsic muscle function because of long distance of nerve return. Therefore, the best techniques to restore intrinsic hand function in patient with high ulnar nerve injury is distal nerve transfer to minimize the regeneration time and distance. Objective: The aim of this study is to describe the surgical results obtained with the transfer of the motor branch of the anterior interosseous nerve destined to the pronator quadrates muscle to the motor division of the ulnar nerve (the deep branch of ulnar nerve). Methods: It is a retrospective study of thirty elderly patients with high ulnar nerve injury underwent a transfer of distal branch of anterior interosseous nerve to deep branch of ulnar nerve, and end to end suture of the ulnar nerve at the site of injury in Sohag microsurgery unit. Results: The mean postoperative follow-up period was 22 months (range from 12 to 38 months). At the final follow-up, twenty-seven (90%) patients showed good results according to the Highet-Zachary scheme (M3 or M4, S3+, and negative Froment’s sign). The other three patient (10%) showed a poor result (M1, S2, positive Froment’s sign). Conclusion: This technique of transfer of distal branch of anterior interosseous nerve to deep motor branch of ulnar nerve and primary repair of ulnar nerve at site of injury is effective for motor and sensory recovery of distal ulnar innervated side of the hand. 15 Jun, 2021 https://www.clinsurggroup.us/articles/JSSR-7-240.php The novel coronavirus (SARS-CoV-2) is responsible for the current pandemic and while most patients have mild symptoms, severe COVID-19 infections can have long-lasting symptoms. There is data to suggest that sequelae from COVID-19 persist for months. Viral myocarditis and cardiomyopathy related to COVID-19 have been described in the non-pregnant population. We present a case of a parturient presenting with left ventricular global hypokinesis and ejection fraction of 38% two months after initial COVID-19 infection. Pregnant patients with COVID-19related cardiomyopathy should be managed by a multidisciplinary team. We suggest considering SARS-CoV-2 infection in parturients presenting with symptoms of decompensated heart failure. 23 Apr, 2021 https://www.clinsurggroup.us/articles/JSSR-7-239.php Introduction: Treatment for Anal cancer is carried out in regional cancer centres but when chemoradiation fails or is ineffective then there is a role for salvage surgery but carries considerable morbidity and mortality. We reviewed clinicopathological outcomes for patients undergoing surgery following Chemoradiotherapy (CRT) for anal cancer. Materials and methods: A retrospective review of patient data from patients undergoing surgery for anal cancer from 2008 -2018 was performed. Patients were identified from the anal cancer MDT records and the departmental surgical logbook. Results: Forty patients were identified (72.5% female) with a median [IQR] age of 62 [18.25] years. Thirty-three patients underwent APER and seven underwent pelvic exenteration, with 25 (62.5%) having flap reconstruction of the perineum. Post-operative complications were identified in 25 (62.5%) patients, 18 (72%) of which were Clavien-Dindo I-II and 7 (18%) were III-IV. There was one 90-day mortality. The overall 1, 3, and 5-year survival was 76.4%, 47.8% and 35.2% respectively. Conclusion: Chemoradiotherapy remains the gold standard for the treatment of anal cancer, with salvage surgery preserved for cases of residual or recurrent disease, or for palliation. We report a median time from completion of CRT to surgery of 12 months, an R0 resection rate of 70%, and 5-year survival of 35.2%. The reason for low 5-year survival requires analysis. Robust prospective data collection is needed to fully quantify outcomes in this important group. 22 Apr, 2021 https://www.clinsurggroup.us/articles/JSSR-7-238.php Objective: Irradiation may be utilized for management of orbital lymphomas with successful treatment results. However, adverse radiation effects may be considered as a concern particularly in the setting of higher delivered doses despite the excellent rates of tumor control in majority of irradiated patients. Multimodality imaging may serve as a contemporary approach for precise target definition in management of orbital lymphomas. Within this context, we assessed multimodality imaging based treatment volume definition for irradiation of primary lymphoma of the orbit in this original article. Materials and methods: Treatment volume definition by multimodality imaging with incorporation of MRI or by computed tomography (CT)-simulation images only was evaluated with comparative analysis in a series of patients receiving irradiation for orbital lymphoma. Results: Available treatment planning systems at our tertiary referral institution were used for precise radiation treatment planning. Prioritization was given for encompassing of the target volumes with optimal sparing of critical structures in radiation treatment planning. Synergy (Elekta, UK) LINAC was used in RT delivery. Treatment volume determination by CT-only imaging and by CT-MR fusion based imaging was assessed with comparative analysis. As a result, ground truth target volume was found to be identical with treatment volume definition with CT-MR fusion based imaging. Conclusion: Accurate and precise target and treatment volume determination comprises an indispensable aspect of successful orbital lymphoma irradiation. Within this context, incorporation of MRI in target and treatment volume definition process may be strongly considered for improving the optimization of target and treatment volume determination for optimal irradiation. Clearly future studies are required to shed light on this issue. 21 Apr, 2021 https://www.clinsurggroup.us/articles/JSSR-7-237.php Lung cancer is the most commonly diagnosed malignancy and a leading cause of cancer related deaths accounting for 1.8 million deaths worldwide in 2018 [1]. In recent years, the investigation and management of lung cancer has significantly changed with emerging evidence that rapid investigations may improve survival. For example, the randomised controlled trial, LungBOOST compared conventional diagnosis and staging to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following staging Computer Tomography (CT). 15 Apr, 2021 https://www.clinsurggroup.us/articles/JSSR-7-236.php Background: Thrombosis of parametrial veins are rarely diagnosed by transvaginal sonography. The clinical importance of parametrial vein thrombosis is not known. We present the first fully documented case of pelvic varicosities with non-occlusive thrombosis resulting in subsequent development of pelvic pain that alleviated with the resolution of the thrombus. Case report: We present a perimenopausal woman that underwent transvaginal sonography for routine check-up. The patient sustained a thrombosis in the parametrial vein that some days later caused minor pain and dissolved spontaneously within three months. Discussion and conclusion: Transvaginal sonography should also focus on the venous pelvic system and look for thrombosis. Thrombosis of dilated pelvic veins may play a role in the pathogenesis of the pelvic congestion syndrome in a sense that pelvic vein varicosities that develop a thrombus evolve from an asymptomatic anatomic description of dilated veins to a pelvic pain disorder requiring treatment. 10 Apr, 2021 https://www.clinsurggroup.us/articles/JSSR-7-235.php Seroma formation is a common complication of any surgery producing a significant dead space or causing disruption of the lymphatic drainage. Although this is uncommonly reported in cardiac surgery. Such collections can cause localized pain, wound dehiscence, infection and can reoccur frequently, requiring multiple interventions. We present case of large sternal wound seroma after wound debridement with Computed tomography imaging for the patient, that initially underwent Coronary artery bypass grafting. 19 Mar, 2021 https://www.clinsurggroup.us/articles/JSSR-7-234.php Objective: Management options for bone metastases include surgical interventions, Radiation Therapy (RT), chemotherapy and other systemic and targeted agents. RT as external beam irradiation and by use of stereotactic radiotherapeutic approaches has been utilized for safe and efficacious management of bone metaseses. In the context of bone metastases with extraosseous soft tissue mass, the issue of irradiation target definition is a critical component of radiotherapeutic management for successful treatment. Herein, we evaluated target definition for irradiation of bone metastases with soft tissue component by incorporation of multimodality imaging. Materials and methods: RT target definition for irradiation of bone metastases with soft tissue component was assessed in this study. Results: Patients receiving palliative irradiation for bone metastases with soft tissue component were assessed for target volume determination. Treatment planning process was performed using the Elekta Precise treatment planning system &#40;Elekta, UK&#41; at our department. Definition of ground truth target volume was performed by the board certified radiation oncologists following meticulous evaluation, colleague peer review, collaboration, and ultimate consensus. Synergy (Elekta, UK) LINAC was used for irradiation. Comparative assessment in our study revealed that ground truth target volume was identical with target volume definition by CT-MR fusion based imaging. Conclusion: Incorporation of multimodality imaging in target definition of bone metastases with soft tissue component may be utilized for improving the accuracy for precise RT despite the need for further supporting evidence. 19 Mar, 2021 https://www.clinsurggroup.us/articles/JSSR-7-233.php Objective: Medulloblastoma is a frequent childhood brain tumor which may occur in the vermis, cerebellum and posterior fossa. Affected patients may suffer from a variety of symptoms due to elevated intracranial pressure and may present with headaches, nausea and vomiting, cranial deficits, truncal ataxia, titubation of the head, alterations in mental status and gait disturbances. Accuracy in target and treatment volume definition has been thoroughly studied to achieve better outcomes. Herein, we assessed posterior fossa target definition by multimodality imaging patients with medulloblastoma. Materials and methods: In this study, posterior fossa target definition with multimodality imaging by incorporation of Magnetic Resonance Imaging (MRI) or by Computed Tomography (CT)-simulation images only was evaluated comparatively for patients with medulloblastoma. Board certified radiation oncologists have outlined the ground truth target volume as the reference for actual treatment and for comparison purposes after thorough assessment, collaboration, colleague peer review, and ultimate consensus. Results: RT planning was performed by use of the available treatment planning systems at our tertiary referral institution with prioritization of target coverage and normal tissue sparing to improve the therapeutic ratio. Decision making for individualized patient management was performed by multidisciplinary evaluation of experts from neurosurgery, radiology, pediatric oncology, medical oncology, and radiation oncology. Synergy (Elekta, UK) LINAC was used for RT administration. Ground truth target volume was found to be identical with target volume definition with CT-MR fusion based imaging as the result of this study. Conclusion: Multimodality imaging should be strongly considered for improved posterior fossa RT target definition of medulloblastoma. Apparently, further studies may be needed to shed light on this issue. 10 Mar, 2021 https://www.clinsurggroup.us/articles/JSSR-7-232.php Introduction: Laparoscopic Cholecystectomy (LC), one of the most commonly performed surgical procedures worldwide, is accepted as the gold standard in the treatment of symptomatic gallstones. Generally laparoscopic cholecystectomy has low incidence of morbidity, mortality and conversion rate to open surgery, but occasionally surgeons encountered difficulty while doing Laparoscopic cholecystectomy. Preoperative prediction of “difficult Laparoscopic cholecystectomy” improve the patient safety as well as useful in reducing the cost of therapy. Aim: To study a scoring system based on various risk factors to preoperatively predict difficult Laparoscopic cholecystectomy. Materials & method: This study was conducted in Department of General surgery, Nalanda Medical College And Hospital Patna & associated All India Institute of Medical Science Patna. A total of 105 patients were included in this study. There are total 15 score from history, clinical & sonological findings. They were evaluated & scored on the basis of scoring system. Score upto 5 is defined as easy, 6-10 as difficult and 11-15 as very difficult. Result: Prediction comes true in 96.6% for easy, 87.8% for difficult & 60% for very difficult cases. Area under ROC curve is 0.96 and conversion rate is 3.8 in our study. Age >50 years, Male sex, H/o of hospitalisation due to acute cholecystitis, Palpable gallbladder, BMI >27.5, Abdominal scar, Thick walled GB (>4mm), and Pericholecystic collection were found to be significant predictive factors for difficult laparoscopic cholecystectomy. Conclusion: With the help of preoperative prediction, high risk patients may be informed & counseled before about probability of open conversion & difficulty in laparoscopic cholecystectomy. 25 Feb, 2021 https://www.clinsurggroup.us/articles/JSSR-7-231.php Suspicion of fault is toxic to a trusting relationship between physicians and patients. It is even more toxic to the interest of justice. A medical liability litigation industry rises from this suspicion of fault and prospers at the expense of physicians, patients and justice. Lawyers are part of the medical liability litigation industry; so, too, are expert witnesses, who are also physicians. Byrom vs. Johns Hopkins Bayview Medical Center is illustrative of the impact of suspicion of fault. Inductive reasoning is the conventional way lawsuits are argued. It is the critical success factor used by lawyers and expert witnesses on both sides to showcase their most favorable evidence. However, deductive reasoning is also an acceptable form of legal reasoning. It is completely consistent with the ethical requirement of doctors acting in the capacity of medical experts to remain objective. It analyzes all evidence, favorable or not. Although organized medicine has authority over doctors who are expert witnesses, until now, it does nothing to hold expert witnesses accountable to ethical obligations. The consequences are verdicts like that of Byrom vs Johns Hopkins. Healthcare management science offers a solution to this dilemma. A methodology of deductive reasoning, which is used as a best practice for medical experts, is a means to hold experts accountable to the highest principles of jurisprudence and professional ethics and separates experts from the interests of the medical liability litigation industry. 10 Feb, 2021 https://www.clinsurggroup.us/articles/JSSR-7-230.php Background: Breast cancer has the highest prevalence and incidence among cancers in women. Moreover, it is the most prevalent among all other cancers in Indonesia. Bone metastasis results in higher incidence, better overall survival, but requires higher-cost treatments than visceral metastasis. Therefore, an early predictor of bone metastasis is needed to make early interventions to be efficiently given. Instead of other biomarkers of bone metastasis, CXCR4 and RANK are highly expressed in breast cancer and correlate with bone metastasis. Hence this study is expected to prove the potential of CXCR4 and RANK combination as a predictor of breast cancer bone metastasis. Methods: In a case-control study, CXCR4 and RANK immunohistochemistry tests were done in 58 stage I-IV breast cancer Indonesian subjects. Association between marker combinations and incidence of bone metastasis was analyzed. Then, the diagnosis accuracy values were calculated. Moreover, its associations with clinicopathological factors were also examined. Results: There was a significant association of the highly expressed CXCR4 and RANK combination with bone metastasis (P &lt;0.01). Besides, the combination of CXCR4 and RANK detections resulted in 100% sensitivity and 66% specificity in predicting bone metastasis. Breast cancer's stage was significantly associated with CXCR4 and RANK expressions combination (P&lt;0.01). Conclusions: A combination of CXCR4 and RANK expressions could act as a screening method to predict the bone metastasis in breast cancer. 29 Jan, 2021 https://www.clinsurggroup.us/articles/JSSR-7-229.php As of 12/2020 I have had 34 years clinical experience as an ED RN and 20 years as a Family Nurse practitioner. I have routinely given routinely injections most work days. My goal is to share my experience to alleviate suffering at any level if possible. 18 Jan, 2021 https://www.clinsurggroup.us/articles/JSSR-7-228.php Abdominal wall reconstruction and hernia repair surgery continue to evolve with the intention to successfully repair the abdominal wall, restore muscular dynamics, and minimize recurrences. This trio of expectations is now being comprehensively defined as “Abdominal Core Health” and has many physical and mental benefits [1,2]. 21 Dec, 2020 https://www.clinsurggroup.us/articles/JSSR-6-227.php The legacy of surgery in ancient Jews included those who cared for the wounds and injuries. In light of this they were awarded the title of experts, ummanim. The aim of the paper is to introduce the history of the craft of surgery from biblical times throughout the talmudic period focusing on historical and medical perspectives. Along the way, the surgical progress made a creative advancement of anatomical studies. 17 Dec, 2020 https://www.clinsurggroup.us/articles/JSSR-6-226.php Background: The value of an additional thoracic breath-hold (BH) CT in PET-CT for detecting small nodules is controversial. Purpose: To determine the value of a BH-CT compared to the routinely used free-breathing (FB) CT, and the value of maximum intensity projection (MIP) technique in these two CT series for detection and its potential clinical relevance in staging of small lung nodules in oncology patients. Material and methods: This retrospective study included 200 patients from February to September 2016 who were referred for oncological FDG PET-CT. Thin slice (1.25 mm) and MIP (10 mm) images were analyzed for detection of small lung nodules (1-10 mm). Binominal test and descriptive statistics were analyzed. Results: It was possible to evaluate 186 patients, with a mean age of 70.0 yrs ± 11.1 yrs, range 27-96 yrs, consisting of 84 females (mean age 68.5 yrs ± 12.2, 27-90 yrs) and 102 men (71.3 yrs ± 10.1, 27-96 yrs). In FB-CT, 393 nodules were detected in thin slice CT images, with MIP in 578. In BH-CT, 534 nodules were detected and 905 with MIP (p&lt; 0,001). The extra detected nodules were considered as having a potential clinical relevance in 4.8% (9 of 186) of the patients. The total radiation dose from the routine PET-CT, including FB-CT, was 26 mSv and an additional 4 mSv from the BH-CT. Conclusion: An additional BH-CT in deep inspiration compared with FB-CT detects more small lung nodules, which potentially could alter the TNM stage. 16 Dec, 2020 https://www.clinsurggroup.us/articles/JSSR-6-225.php Anterior Cruciate Ligament (ACL) reconstructive surgery provides good to excellent (75% to 97%) outcomes overall in terms of joint stability, symptom improvement and return to pre-injury activity [1]. Between 0.7 and 20% of patients, however, undergoing surgery will experience persistent instability symptoms due to ACL graft failure [2]. Femoral and tibial tunnel malposition may cause flexion and extension deficits and ultimately lead to graft failure [3]. 05 Dec, 2020 https://www.clinsurggroup.us/articles/JSSR-6-224.php Introduction: One of the rare complications of peritoneal dialysis catheter placement is intestinal perforation, often with a late presentation. Clinical case: The case of a 28-year-old female with a history of placement of a Tenckhoff catheter in March 2019 is presented. She came to the emergency service in June 2020 for referring a catheter discharge by anal region. Conclusions: Due to the low incidence of this complication, there is no standard management. In general, removal of the catheter with primary closure of the defect appears to be the best alternative. 02 Dec, 2020 https://www.clinsurggroup.us/articles/JSSR-6-223.php A 54-year-old woman presented with one month of recurrent postprandial right sided and epigastric abdominal pain, associated with intermittent anorexia and vomiting. Her past medical history includes Crohn’s disease diagnosed in 1976, requiring total colectomy and end ileostomy in 1977 and small bowel resection for fibrotic stricture in 1980. A cholecystectomy for biliary pancreatitis was performed in 2004. 19 Nov, 2020 https://www.clinsurggroup.us/articles/JSSR-6-222.php The article substantiates the feasibility of including Hyperbaric Oxygenation (HBO) in the treatment of patients infected with SARS-CoV-2. Possible mechanisms of therapeutic influence of hyperbaric oxygen on the course of the pathological process in the body of patients infected with SARS-CoV-2 are considered. The role of urea as a non-specific antioxidant adaptogen in the mechanisms of the therapeutic effect of HBO is considered. The important role of assessing the patient's condition at the time of oxygenation for the correct choice of modes and the number of HBO sessions is shown. It is concluded that it is appropriate to include in the therapy of SARS-CoV-2 infected patients with "soft" HBO regimens (1.3-2.0 ATA, isopression time 45-90 min), regardless of the degree and duration of hypoxemia. 17 Nov, 2020 https://www.clinsurggroup.us/articles/JSSR-6-220.php Objectives: To illustrate our institutional experience about the challenges we faced and steps taken in the management of the patients with Glioblastoma multiforme during Covid 19 crises at Dr. R.P.G.MC Tanda. Methods: In the period of complete lockdown, patients were treated surgically without much delay. Patients with incomplete resection were given radiation while the ones with complete resection were started on tablet temozolamide (TMZ) alone and were sent home after counselling. At the period of partial lockdown patients below 70 years were given option of starting on hypofractionated radiation or tab temozolamide, 55% of the patients preferred radiation over temozolamide while rest continued on tablet temozolamide. Further, the patients above 70 years were continued on tablet temozolamide and were kept on telephonic check for the onset of any neurological symptoms, those developing symptoms were immediately called and started on short course radiotherapy to a dose of 40GY/15#/3 weeks or 34GY/10#/1 weeks or 25GY/5#/1 week or were treated by Stereotactic radiotherapy 8GY/5# by Volumetric Arc Radiotherapy. Results: In our institute all of our GBM patients below 70 years remained asymptomatic when started on the non standard treatment- on tab temozolamide only post surgery or on hypofractionated course of radiotherapy and only 2% patients above 70 years developed slight symptoms showed progression of disease on check MRI scan were given hypofractionated radiotherapy. Conclusion: Covid 19 pandemic has resulted in unprecedented global healthcare crises. Our institution has illustrated the challenges we faced in managing patients with highly dreadful Glioblastoma multiforme. Due to the fear of increased risk of Covid 19 infection in the cancer patients which would result in devastating complications and very poor outcome, the non standard strategy of keeping the patients on tab temozolamide only post surgery or on hypofractionated course of radiotherapy resulted in symptomatic relief in patients below 70 years of age and only 2% patients above 70 years who developed slight symptoms showed progression of disease on check MRI scan. . Though, not standard this strategy can be considered in covid-19 crises.q 27 Oct, 2020 https://www.clinsurggroup.us/articles/JSSR-6-219.php Objective: Presenting a case of maxillary sinus lifting through alveolar crest by means of bone compacting from bone densification with drills and immediate placement of the dental implant (fixture). Patients who suffer from alveolar bone insufficiency present a common problem in the recovery from osseointegration implants, when a minimum remaining bone extension is necessary for implant stability. On those patients who present great bone loss in the posterior maxilla it is necessary to perform a sinus lifting surgery. The elevation of the sinus floor can be performed in two different ways, as described in the field literature: accessing the lateral window or accessing the maxillary sinus through alveolar crest by means of bone densification, thus allowing oral rehabilitation through dental implants. 24 Oct, 2020 https://www.clinsurggroup.us/articles/JSSR-6-218.php Surgical site infection is defined as an infection occurs within 30 days after the operation if no implant is left in place or within one year if implant is in place and the infection appears to be related to the operation and infection involves deep soft tissue (e.g. fascia, muscle) of the incision and/or the infection appears to be related to the operation and infection involves any part of the anatomy other than the incision that was opened or manipulated during an operation (e.g. organs and spaces) [1]. 19 Sep, 2020 https://www.clinsurggroup.us/articles/JSSR-6-217.php Intravenous leiomyomatosis of the uterus (IVL) is a rare type of uterine leiomyoma. It is defined by the presence of benign smooth muscle within vascular spaces outside the confines of a leiomyoma, free floating within the lumen or adherent to the vessel wall. We report 10 cases of IVL to discuss the clinical, radiological, histological, therapeutic and prognostic features of this entity. We concluded that, in line with literature, IVL can have a malignant behaviour. The treatment is based on surgery. Hormonal treatment is recommended. Large sampling of peritumoral tissue in uterine leiomyomas can lead to early diagnosis of IVL. Follow up is mandatory to detect possible recurrence or extra-pelvic extension. 15 Sep, 2020 https://www.clinsurggroup.us/articles/JSSR-6-216.php On January 30, 2020, the World Health Organization announced that the new corona virus, or Covid-19, is an epidemic health crisis of international concern [1]. On April 12, 2020, more than 1796298 people were infected with Covid 19 and more than 11026 deaths were registered in the world due to this disease. Iran was ranked eighth in this epidemic with 71686 patients and 4474 deaths. 15 Sep, 2020 https://www.clinsurggroup.us/articles/JSSR-6-215.php Breast Implant Illness (BII) is a collective term used by woman who have breast implants either from breast reconstruction or augmentation and summarises a group of systemic symptoms. These systemic symptoms can include fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, body odor, anxiety, brain fog, sleep disturbance, depression, neurologic issues and hormonal issues. It is also sometimes referred to as ‘autoimmune/inflammatory syndrome induced by adjuvants’. BII is not currently recognised as an official medical diagnosis, it is poorly understood and hasn’t been studied much as a unique condition. The most widely accepted hypothesis is that the silicone within the implants may act as an autoimmune adjuvant. 07 Sep, 2020 https://www.clinsurggroup.us/articles/JSSR-6-214.php On December 31, 2019, a new strain of coronavirus (SARS CoV-2) was notified for the first time in Wuhan (China). This disease (COVID-19) spread rapidly throughout the world, being declared a global pandemic by the WHO on March 11, 2020 [1], reaching the impressive figures of 24,537,560 cases diagnosed with 832,879 deaths in the world so far [2]. The literature has been growing and diverse in the knowledge about the catastrophic nature of this pandemic, which has undoubtedly strongly affected almost every country in the world. 02 Sep, 2020 https://www.clinsurggroup.us/articles/JSSR-6-213.php The shoulder is very important for a vertical body position and cosmetic appearance particularly in women. The shoulder joint has the largest motion range of all joints in the human body. All of the shoulder procedures need adequate anesthesia and analgesia for both the comfort of the patients and an early use of rehabilitation exercise. In current clinical practice general anesthesia or nerve blocks like infiltration and interscalene can be used for shoulder surgeries. When compared the anesthesia and analgesia techniques for shoulder surgery we should consider the effectiveness of pain control, incidence of side effects, and patient satisfaction of the techniques. 04 Aug, 2020 https://www.clinsurggroup.us/articles/JSSR-6-212.php Nosocomial infection is an infection that acquired after exposure of patients to hospital for 48-72 hrs, but not present during admission. Surgical site infection is among the leading nosocomial infection that acquired after operation or admission. This review aims to determine the burden of NI in surgical site infection in Ethiopia systematically. Among a 167 mean of clinically suspected patients samples 9-92% were culture-confirmed with a mean of 70.125 and median 67. Seven studies identified 49.3-100% of culture-confirmed infection as SSI; two studies reported BSI 2.2 & 20.8 percent and one study declare UTI as 29.8 percent among 77 cultures confirmed and one study not reported about infection identified. Ward type, type of operation, wound type, being a male, site of a wound, age ≥ 51, diabetes mellitus, anaemia, antibiotic usage after surgery, 11-15 days preoperative hospital stay, postoperative hospital stay; surgical procedure, urinary catheter, mechanical vent, IV catheter, longer duration from admission to discharge, longer duration of preoperative and preoperative prophylaxis identified as potential risk factors. S. aureus and CoNS is among the leading gram-positive bacterial isolate and E. coli, Klebsiella spp, Proteus spp and P. aeruginosa are among gram-negative organisms that isolated from eight studies in Ethiopia. 29 Jul, 2020 https://www.clinsurggroup.us/articles/JSSR-6-211.php Current crisis due to new coronavirus SARS-CoV-2 pandemic, puts medical and paramedical personnel working in surgical areas at risk. Despite the fact that this pandemic has left many questions about which would be the ideal behaviors in this situation, due to the speed of spread, lack of experience and, reliable randomized or double-blind protocols; It is necessary to elaborate and apply an algorithm based on experience, common sense and references, on how to safely manage suspected or confirmed COVID-19 surgical patients, establishing and fulfilling goals and recommendations in order to reduce infection spreading, and protect health care providers and patients. In the present study, surgical management for potentially infected patients recommendations are established. 23 Jul, 2020 https://www.clinsurggroup.us/articles/JSSR-6-210.php The present communication relates to inguinal hernia repair, and more particularly to a preshaped inguinal hernia prosthetic material, polypropylene, 6×2.5 centimeters in size, (Figure 1) that has a lateral semicircular non-encircling cord locating structure in order to protect the spermatic cord and that it is interposed between the conjoined tendon and the inguinal ligament in such a way as to repair the hernia and at the same time to reconstitute the physiology of the inguinal canal. 23 Jul, 2020 https://www.clinsurggroup.us/articles/JSSR-6-209.php Background: Foreign body aspiration is a common life threatening emergency and easily preventable problem. Every year thousands of lives are endangered because of foreign body inhalation by children and teenagers. In Muslim nations, a unique group of population has recently been reported. This comprises young girls and women who put headscarf. Aim: This study presented an experience with scarf pin aspiration and discussed the unique clinical characteristics of this problem and challenges in management. Patients and methods: A prospective cohort study included 50 females with a history of scarf pin inhalation. This study was conducted in Cardiothoracic Surgery Department, Mansoura University Hospital after approval from the Research and Ethics Committee of Faculty of Medicine, Mansoura University from January 2017 to January 2019. Other forms of foreign body inhalation were excluded from this study. All patients underwent radiological work-up in the form of plain chest X-ray, both Postro-Anterior (PA) and lateral views, to confirm the presence of the pin within the tracheo-bronchial tree. Results: In one patient the pin was successfully removed Spontaneous by coughing, in 36 patients retrieved by rigid bronchoscope, In 6 patients the pin was removed by flexible bronchoscope in the same sitting. In 7 cases pin could not be retrieved at all because of penetration into lung parenchyma and hemorrhage due to initial manipulation. These patients managed by thoracotomy (5 cases of bronchotomy, 1 case of right lower lobectomy and 1 case of left lower lobectomy). Conclusion: The use of the scarf pin is a sociocultural practice that carries serious health risks in Egyptian Muslim females who wear Hijab. Rigid bronchoscopy is the preferred treatment modality. 17 Jul, 2020 https://www.clinsurggroup.us/articles/JSSR-6-208.php Objectives: Patients with stage II and III esophageal cancer are often incurable with surgery alone, suggesting the importance of optimizing other treatments such as chemotherapy and radiation. This retrospective analysis compared the survival and treatment-related toxicities of esophageal cancer patients receiving trimodality therapy to two other common clinical regimens. Methods: Patients with stage II or III esophageal carcinoma who presented for treatment between 1995 and 2016 were eligible for inclusion. Median overall and disease-free survival (DFS) was calculated and compared between those who received Trimodality therapy (T), Surgery alone (S), or Chemoradiation alone (CH + R). Results: This analysis included 358 patients. Median overall survival for T patients was superior (42.8 months, p &lt;0.001) compared to those in the CH + R (21.5 months) and S groups (19.3 months). CH + R patients had the greatest DFS of 21 months, followed by T with 15.5 months, though this difference was not significant (p=0.56). Patient gender (p &lt;0.036) and treatment toxicity (p &lt;0.002) had significant effects on outcome. Median follow-up time for all patients was 22 months (range 1-250 mos). Conclusions: Though five-year overall survival rates for esophageal cancer patients remain close to 20%, neoadjuvant chemoradiation may improve outcomes. This large study with long follow-up demonstrates that patients can be selected for appropriate therapy. Our results suggest that patients receiving trimodality therapy have a higher median overall survival without increased treatment-related toxicity. This data may help guide clinical decision-making and patient selection to improve the survival of patients with advanced esophageal cancer. 03 Jul, 2020 https://www.clinsurggroup.us/articles/JSSR-6-207.php Lymphomas constitute the most frequent hematologic malignancies. HL is a rare type of B cell lymphoma featured with Reed Sternberg cells. Treatment of HL may be considered among the greatest success stories in oncology. Improvements in treatment of HL have rendered quality of life an important aspect of management given the long life expectancy of younger patients, particularly the children and adolescents. 01 Jul, 2020 https://www.clinsurggroup.us/articles/JSSR-6-206.php Obsessive Compulsive Disorder (OCD) is a mental health disorder with characteristic features including uncontrollable, reoccurring thoughts referred to as obsessions, and excessive urges to perform repeated certain routines referred to as compulsions. Affected patients may suffer from tics, anxiety, negative social behaviours and self mutilation. Symptoms of patients may be intrusive, anxiety-provoking, and rather distressing which may significantly compromise both social and occupational functioning. Deterioration in quality of life may occur as a consequence of unemployment, marriage failure, and maladjustment in familial relationships. Initial management of OCD may include exposure and response prevention, cognitive-bahavioural-therapy, and pharmacological agents such as selective serotonin reuptake inhibitors and tricyclic antidepressants. These management strategies may be effective for the majority of patients suffering from OCD. However, approximately 20% of patients have refractory OCD unresponsive to first-line therapies and a subgroup of patients unresponsive to first-line therapies suffer from severe debilitating symptoms referred to as intractable OCD. Radiosurgery has a long history as an excellent radiotherapeutic modality for management of several intracranial disorders. Radiosurgical or gamma capsulotomy technique involving discrete, circumscribed lesions in white matter of the anterior limb of the internal capsule has been introduced by the Swedish neurosurgeon Lars Leksell. Gammaknife Radiosurgery (GKRS) system has been used as a viable alternative to open surgical anterior capsulotomy procedures and gained popularity and widespread acceptance with accumulating evidence from several centers worldwide. Herein, we provide a concise review including the definition, epidemiology and symptomotology of OCD, patient selection criteria, and management options with focus on radiosurgery. 30 Jun, 2020 https://www.clinsurggroup.us/articles/JSSR-6-205.php Purpose: Conventional Laparoscopic Cholecystectomy (CLC) is the “gold standard” approach for patients with gallstones. Single-incision Laparoscopic Cholecystectomy (SILC) was an alternative technique, purportedly offering several postoperative benefits over CLC. Studies comparing short-term postoperative outcomes of SILC versus CLC have yielded conflicting results. Our paper aims to compare the long-term postoperative outcomes of patients undergoing SILC and CLC with a minimum follow up of seven years. 27 Jun, 2020 https://www.clinsurggroup.us/articles/JSSR-6-204.php Breast cancer (Ca) remains to be the most frequent cancer among females and a leading cause of cancer associated mortality worldwide. Main modalities for management of breast Ca include surgery, Radiation Therapy (RT), and systemic treatments. Diagnosis at earlier stages of breast Ca is increasing with rigorous utilization of screening and raised public awareness. Improvements in therapy contribute to longer life expectancies for patients with breast Ca. In this context, adverse radiation effects are being a more pronounced aspect of breast Ca management recently. 15 Jun, 2020 https://www.clinsurggroup.us/articles/JSSR-6-203.php Diffuse uterine leiomyomatosis is uncommon and often associated with infertility. 15 Jun, 2020 https://www.clinsurggroup.us/articles/JSSR-6-202.php Pulmonary malignancies including Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC) are frequent cancers and remain to be a leading cause of cancer related mortality worldwide. 15 Jun, 2020 https://www.clinsurggroup.us/articles/JSSR-6-201.php Brainstem tumors constitute approximately 10% to 15% of CNS neoplasms in the pediatric population, and most common of brainstem tumors is diffuse intrinsic pontine glioma (DIPG). 13 Jun, 2020 https://www.clinsurggroup.us/articles/JSSR-6-200.php Breast cancer (Ca) comprises the most common cancer in females and constitutes a leading cause of cancer related deaths around the globe. 11 Jun, 2020 https://www.clinsurggroup.us/articles/JSSR-6-199.php Vestibular schwannoma (VS), also referred to as acoustic neuroma, is one of the common benign intracranial tumors with rising incidence due to improved and more frequent neuroimaging. 08 Jun, 2020 https://www.clinsurggroup.us/articles/JSSR-6-198.php Meningiomas comprise the most frequent intracranial benign tumors accounting for approximately one third of all intracranial neoplasms, and generally follow an indolent disease course with a typically benign nature and slow-growing behaviour. Although majority of meningiomas may follow an indolent disease course, affected patients may suffer from a plethora of symptoms with regard to lesion location. Symptoms typically occur as a result of the mass effect leading to compression of critical neurovascular structures. Headache, focal seizures, weakness in the limbs, visual disturbances, loss of smell, impaired memory or hearing functions may be observed. Advances in neurosurgery may allow for an improved toxicity profile following surgical resection as the traditional and a leading mode of management for meningiomas located at accessible brain areas. Nevertheless, vigilance is required given the morbidity and mortality risks associated with meningioma surgery particularly for elderly patients. In this context, radiation therapy (RT) may offer a viable alternative or adjunctive modality of management for meningiomas. Management of cavernous sinus meningiomas in intricate association with critical neurovascular structures pose a formidable challenge to the treating physicians. Attempting at extensive surgical procedures may be associated with substantial morbidity and even mortality. In this context, selected patients may benefit from a tailored multimodality approach including less extensive surgical resection followed by subsequent irradiation. Primary advantages of this refined therapeutic strategy may include improved toxicity profile along with improved functionality and quality of life. Herein, we assess multimodality management of cavernous sinus meningiomas with less extensive surgery followed by subsequent irradiation. 29 May, 2020 https://www.clinsurggroup.us/articles/JSSR-6-197.php In response to national and international shortages in the availability of medical ventilators, our team has developed and tested a novel low-cost (~10 USD) 3D-printed flow-driven pressure-regulated mechanical ventilator capable of basic and complex ventilation needs. This device requires no electronics and can be sustained with either O2 tanks or standard hospital 50psi O2 wall supply. The design can be printed rapidly, mass-produced and immediately deliverable to any crisis areas in need. The CRISIS Ventilator has the potential to be produced on site depending on 3D printing capabilities. Our team includes physicians, scientists, a respiratory therapist, and engineers in healthcare dedicated to developing a rapidly deliverable ventilator solution to the global COVID-19 pandemic. 28 May, 2020 https://www.clinsurggroup.us/articles/JSSR-6-196.php The Author ’s vast surgical experience in the treatment of primary and secondary peripheral lymphedema is reported. The objective is to describe the techniques and the long-lasting clinical outcomes based on more than 45 years research and clinical applications, with particular reference to staging-guided derivative and reconstructive lymphatic microsurgery at a single site, and to complementary, sequential, minimally invasive procedures of selective liposuction. 5.046 cases of patients (demographic characteristics are at length described) affected by upper and/or lower limb lymphedema, between 1973 and 2020, underwent lymphatic microsurgery and, between 2012 and 2020, Fibro-Lipo-Lymph-Aspiration according to Lymph Vessel Sparing Procedure (FLLA-LVSP), for latest stages of Lymphedema previously treated by Lymphatic Microsurgery with partial improvement of the disease. Derivative Multiple Lymphatic-Venous Anastomoses (MLVA) or, in selected cases of Phlebolymphedema absolutely contraindicating derivative procedures, lymphatic pathway reconstruction, using interpositioned vein grafted shunts (Multiple-Lymphatic-Venous-Lymphatic Anastomose - MLVLA), above all at lower limbs, were performed at a single site, either the brachial-axillary or inguinal-crural region. 20 May, 2020 https://www.clinsurggroup.us/articles/JSSR-6-195.php Background: Undescended testis is the most common anomaly of male genitalia. In these cases the testis lies at any position other than the normal scrotal position. The goal of surgery is to move the testis to scrotum, but short spermatic cord represent the big problem. Our study offers new technique for lengthening spermatic cord depends on tissue expansion theory. 16 May, 2020 https://www.clinsurggroup.us/articles/JSSR-6-194.php Introduction: Situs inversus, polysplenia, jejunas complex atresia are uncommon anomalies. Combination in a single patient is even rarer with difficulties in diagnosis and management. 14 May, 2020 https://www.clinsurggroup.us/articles/JSSR-6-193.php A lymphangioma usually appears as a partially septated, cystic mass on imaging studies including ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).Lymphangioma is a rare benign tumor that develops in the lymphatic system.“Generalized lymphangiomatosis” is term given to diffuse occurance of the disease [4].This disease usually occurs in children and involves the skin. 07 May, 2020 https://www.clinsurggroup.us/articles/JSSR-6-192.php Extramedullary Hematopoiesis (EMH) is frequently seen in the liver, spleen or lymph nodes in patients with hematologic disorders such as beta-thallasemia or hereditary spherocytosis. We report the first case of adrenal hematopoiesis in a patient with Chronic Myelomonocytic Leukemia. The patient was a 63 year-old man who was in the study of a thrombocytopenia. A CT and MRI demonstrated a unilateral adrenal mass with multiple splenic lesions. The patient underwent right adrenalectomy and splenectomy. Microscopic examination showed extramedullary hematopoiesis in the adrenal gland and spleen. 06 May, 2020 https://www.clinsurggroup.us/articles/JSSR-6-191.php Background: Electrocautery and Argon Plasma Coagulation (APC) are modes of thermal tissue destruction frequently recognized as a less expensive alternative to laser therapy. However, there are certain safety challenges concerning the use of electrosurgery and burns are the most common. According data found in the literature, burns have accounted for 70% of the injuries during use of electrocautery. The risk of complications is often linked to the surgeon's fundamental knowledge of instruments, surgical technique, safe technical equipment, etc. This study is focusing on sparking enhanced burns as a complication of monopolar electrocautery. 22 Apr, 2020 https://www.clinsurggroup.us/articles/JSSR-6-190.php Traumatic dislocation of the hip in childhood is rare. Several small series of this condition have been published. The objective of this study was to evaluate the outcome of treatment of traumatic posterior hip dislocation in children. Data from 11 children (11 hips) with traumatic hip dislocation, collected in 2 centres (2 countries), from January 2010 to January 2019 were analysed. The clinical assessment focused on symptoms and physical findings. X-rays identified the type of hip dislocation. Hip dislocations were classified according to Thompson and Epstein. Reduction was performed using three techniques: technique 1, closed reduction. Technique 2, release of the long adductor muscle, lengthening of the psoas tendon, and placement of a Kirschner wire through the femoral head into the acetabulum. Technique 3, open reduction after hip arthrolysis. X-rays were then used to determine whether the hip is concentric and to check for any other injuries that may have occurred after manipulation. There were 3 girls (27.3%) and 8 boys (72.7%) in this study. 21 Apr, 2020 https://www.clinsurggroup.us/articles/JSSR-6-189.php Aims: Post-colectomy ileitis is a common yet challenging disease entity. We present our management approach in these complex patients. Methods: We present a case series of four patients with post-colectomy ileitis in patients with Ulcerative Colitis (UC). Results: Despite optimal medical therapy, these patients underwent subtotal colectomy with end ileostomy and were discharged with tapering steroid regimen. They represented acutely (2-4 weeks) or chronically (months to years) with severe abdominal pain and/or problematic stoma output. Three patients required re-laparotomies, with two requiring further small bowel resection. Histology revealed necrosis and perforation but no granulomas. Diagnosis of post-colectomy ileitis was made. Both patients who underwent further bowel resection responded well to steroid therapy with Total Parenteral Nutrition (TPN) and remain on endoscopic surveillance. Symptomatic control was achieved with systematic/local steroid therapy in the remaining two patients. 03 Apr, 2020 https://www.clinsurggroup.us/articles/JSSR-6-188.php Sciatic nerve injuries associated with acetabular fractures is a serious and rare complication. It may be a result of the initial trauma or injury at the time of surgical reconstruction. Prevention requires attention to intraoperative limb positioning, retractor placement, and instrumentation. Patients may present with a broad range of symptoms ranging from radiculopathy to foot drop and the neurological lesions may be irreversible. 27 Feb, 2020 https://www.clinsurggroup.us/articles/JSSR-6-187.php Small bowel perforation can occur either spontaneously or due to traumatic causes. Non-traumatic spontaneous small bowel perforation can be caused by various reasons including infectious, inflammatory, congenital, metabolic, vascular or neoplastic origins. Small bowel injury due to blunt trauma is a rare phenomenon compared to other intraperitoneal organ injuries, and frequently appears in high-energy trauma. Yet, even low-energy trauma can cause small bowel perforation in the presence of an inguinal hernia. Several cases of small bowel perforation after abdominal trauma or direct trauma to the hernia site are previously reported, however perforation of the small bowels following a low-energy trauma, such as a fall while marching, is a rare condition. A 65-year-old male admitted to the ER following a sudden onset of severe abdominal pain after 4hours following a fall while marching. Physical examination revealed a reduced right indirect inguinal hernia. There was diffuse tenderness and defense in the abdomen. The patient was operated due to the acute abdomen after 6hours following a falling down, and primary repair was performed. The patient was discharged on the fifth postoperative day. With this case report, it is aimed to increase the awareness of the surgeons regarding this rare complication. 25 Feb, 2020 https://www.clinsurggroup.us/articles/JSSR-6-186.php Background: Male circumcision involves removing the foreskin that normally covers the glans of the penis. This surgery is one of the oldest and most common surgical procedures performed globally. However, in low income settings, circumcision is trivialized and sometimes done by an untrained traditional medical practitioner in the community. Methodology: We organized a campaign in the city of Yaounde, Cameroon in 2019. The health campaign started with a theoretical and practical training of some heath providers in the hospitals. We started the preparative phase with sensitization, clinical evaluation and pre-operative workup of children. 19 Feb, 2020 https://www.clinsurggroup.us/articles/JSSR-6-185.php Background: The complications after hypospadias repair still occurred in spite of much advancement of type of suture materials and suture techniques. This study offers new suture technique trying to improve the outcome of hypospadias repair. Methods: This study included 23 hypospadias cases (11 distal penile, 7 mid penile, 5 proximal penile hypospadias). The standard Tabularized Incised Plate (TIP) technique was used in all cases, but the suture technique is faraway, where the two suture limbs passed under the urethral edges. Every suture was tied faraway of urethral edges by about 1cm on one side. Then, the penile skin closed as usual. Lasheen urethral stent was used for two weeks. The mean follow up period was 12months. 24 Jan, 2020 https://www.clinsurggroup.us/articles/JSSR-6-184.php Background: The provision of quality health care is one of the priorities of every government. The quality of such care is however, limited by the human and technical resources available. The varying types of thyroidectomy for Goitres are often done under general anaesthesia, unless, there is a contraindication such as, cardiopulmonary instability. Recently, there is increasing evidence that thyroidectomy could be done under local anaesthesia with or without anxiolytics or opioid analgesia augmentation. This study reports on our experience of performing thyroidectomy under infiltrative local anaesthesia. 19 Dec, 2019 https://www.clinsurggroup.us/articles/JSSR-5-183.php Background: Immediate Breast Reconstruction (IBR) offers the best psychological and aesthetic outcome if radiotherapy is not required. If radiotherapy is required, Delayed Breast Reconstruction (DBR) may be preferable as there is less risk of complications. 02 Dec, 2019 https://www.clinsurggroup.us/articles/JSSR-5-182.php Background: Segmentation of surgical procedures may facilitate learning. The step-by-step framework segments surgical procedures in a standardized manner based on anatomy. The effects of the framework are compared to a continuous approach, on learning anatomy on an inguinal hernia model by pre-novices. 23 Nov, 2019 https://www.clinsurggroup.us/articles/JSSR-5-181.php Defects in the jaw and face area are caused by congenital anomalies and some infections. In this study, we present a case of palatal insuffi ciency after maxillectomy, treated with shutter which was applied to ensure the aesthetics, phonation and functional defi ciency of the patient. 01 Nov, 2019 https://www.clinsurggroup.us/articles/JSSR-5-180.php Purpose: To evaluate the effi cacy and safety of percutaneous cholecystostomy in acute cholecystitis cases with high surgical risk that were treated conservatively and developed perforation. 30 Oct, 2019 https://www.clinsurggroup.us/articles/JSSR-5-179.php Thick Epicardial Adipose Tissue (EAT) is not always a fi nding at operation theatre in patients undergoing Coronary Artery Bypass Grafting (CABG).But epicardial fat has a direct relationship with obesity and metabolic syndrome. Its presence is an independent risk factor for Coronary Artery Disease (CAD). 25 Oct, 2019 https://www.clinsurggroup.us/articles/JSSR-5-178.php Objective: The aim of the study was to fi nd laboratory samples for early diagnosis of anastomotic leak. Summary background data: Anastomotic leakage after rectal cancer surgery is a severe complication with high mortality. Outcome is highly dependent on early diagnosis. 13 Sep, 2019 https://www.clinsurggroup.us/articles/JSSR-5-177.php In the spectrum of myoepithelial tumors of the skin, cutaneous myoepithelioma is composed solely of myoepithelial cells. Cutaneous syncytial myoepithelioma as a rare histological variant of cutaneous myoepithelioma has been fi rst described in the last decade. This tumor is benign and rarely shows recurrence when incompletely resected. 08 Aug, 2019 https://www.clinsurggroup.us/articles/JSSR-5-176.php Background: Vascular anastomosis is a most common and important part of many reconstructive transplant procedures. Venous anastomosis can be done by using coupling devices. 08 Aug, 2019 https://www.clinsurggroup.us/articles/JSSR-5-175.php Background: Hypospadias is a relatively common congenital defect of the male external genitalia. There is much controversy about using of the urethral stent with hypospadias repair. Our study offers new urethral stent (Lasheen urethral stent) to facilitate repair procedure, more comfortable, and improve outcome. 05 Aug, 2019 https://www.clinsurggroup.us/articles/JSSR-5-174.php Aim: People living in the countryside are less to have access to health care than those Living in the city center. In addition to this, when migrants are added, it becomes more diffi cult to use health services. Although 20% of the US population lives in rural areas, only 9% of physicians work in these areas, and general surgeons seem to be inadequate in small rural towns. This study was planned to determine the general surgical procedures performed in the district state hospital. 31 Jul, 2019 https://www.clinsurggroup.us/articles/JSSR-5-173.php Background: The reconstruction of distal foot for various defects or contractures mainly over or near the toes has always been a diffi cult task. A fl ap distally based on fi rst web space is dependent upon a perforator arising from the the distal communicating artery between the fi rst dorsal and plantar metatarsal arteries, can be used for the coverage of the toe or the distal foot defects. 17 Jul, 2019 https://www.clinsurggroup.us/articles/JSSR-5-172.php Peripheral facial paralysis causes asymmetry of the face affecting the upper and lower territories. Its management requires the completion of an initial clinical assessment in order to specify the topography, the severity of the involvement, the etiological nature and the possible complications. The knowledge and the mastery of the anatomo-physio-pathological bases makes it possible to understand the different clinical pictures. 11 Jul, 2019 https://www.clinsurggroup.us/articles/JSSR-5-171.php Background: Post-operative nausea and vomiting is a common occurrence amongst surgical patients. Anecdotal reports suggest antiemetic prescribing patterns to be an area for improvement. Aim: To report the most commonly prescribed antiemetic agents in a major tertiary teaching hospital in Australia; and to assess medication dosage and compared to the current national and international guidelines with recommended multimodal therapies. 04 Jun, 2019 https://www.clinsurggroup.us/articles/JSSR-5-170.php Introduction: Gallbladder polyps (GP), especially adenomatous, is quite rare. The prevalence of GP globally is variable, its importance comes from its potential to progress to gallbladder adenocarcinoma. Methods: Cross sectional study of patients who had laparoscopic cholecystectomy, March 2009-sept 2017 in a community hospital in sulayel area in Saudi Arabia, to evaluate the prevalence of adenomatous gallbladder polyps in the pathology specimens. 17 May, 2019 https://www.clinsurggroup.us/articles/JSSR-5-169.php Alkaptonuria, a metabolic disorder with urological manifestation goes unnoticed till we are aware of it. Here we present an alkaptonuric patient with difficult catheterisation was diagnosed with a large prostatic calculus and his management. 13 May, 2019 https://www.clinsurggroup.us/articles/JSSR-5-168.php Primary tumours arising from sternum are rare. We came across two patients with primary tumours arising from sternum, one malignant (Ewings sarcoma) and the other benign in nature (giant cell tumour) which are very uncommon. After wide local excision the reconstruction was done by using autologous free rib graft in one and titanium mesh in other. In both the cases the coverage was provided with pectoralis major muscles. After six months both were disease free with chest wall integrity well maintained. We believe the reconstructive options adopted by our team for these cases are simple, bio-compatible and reproducible. 05 Apr, 2019 https://www.clinsurggroup.us/articles/JSSR-5-167.php Purpose: To identify body types and normative transformation after obesity surgery and body re-contouring. Methods: A qualitative secondary analysis was conducted involving 20 transcripts, extracted from one primary dataset containing interview data. A model of empirically grounded type construction was employed and adapted to analyse data. Results: Four emerging body types were revealed including type 1 ‘identity disruption’, type 2 ‘overcoming identity lag’, type 3 ‘refining appearance’ and type 4 ‘transformed new me’. The findings shed light on the normative transformation process and the huge challenges that patients encounter. It is crucial to acknowledge that body types 1 and 2 experienced identity disruption and emotional turmoil, post body recontouring surgery. Contrastingly, types 3 and 4 showed strong determination and resilience throughout the transformation process despite embodied turbulence. 23 Mar, 2019 https://www.clinsurggroup.us/articles/JSSR-5-166.php Rectal foreign bodies (RFBs) are an unusual emergency presentation readily confirmed via clinical examination and imaging, which must be quickly removed due to the risk of rectal wall tissue damage leading to perforation and subsequent peritonitis. Several non-operative methods are described in the literature to retrieve RFBs, however removal can be especially difficult if they not easily graspable, for example a ball-like object. We present the case of a spherical RFB successfully extracted using a vacuum-assisted delivery device. 23 Mar, 2019 https://www.clinsurggroup.us/articles/JSSR-5-165.php Lumbar hernias are a rare clinical presentation and are usually congenital, traumatic or spontaneous. We describe an unusual case of a pathological lumbar hernia due to recurrent retroperitoneal abscesses, likely precipitated by chronic tip appendicitis. A literature search of PubMed with the search terms “lumbar OR flank AND hernia” and “abscess” found only one similar published case. 21 Mar, 2019 https://www.clinsurggroup.us/articles/JSSR-5-164.php Gallbladder volvulus (GV) is a rare surgical emergency in which the gallbladder twists on its pedicle and becomes gangrenous. It most commonly presents with symptoms similar to acute cholecystitis. Investigations are seldom diagnostic, with both pathology tests and imaging often unremarkable, and as such it is often diagnosed intraoperatively. Given the potential consequence of a ruptured gallbladder leading to biliary peritonitis, it is an important condition to consider and suspected cases should proceed to cholecystectomy as soon as possible. We report the case of an elderly female patient who initially presented as having an acute coronary syndrome then was found intraoperatively to have GV, and discuss clinical points of the disease. 01 Mar, 2019 https://www.clinsurggroup.us/articles/JSSR-5-163.php Background: The aim of our study was to demonstrate if there is any relation between the neutrophil-to-lymphocyte ratio (NLR) and mortality in severe burns. Methods: The records of 366 patients who were admitted to Intensive Care Unit of Burn Center of Derince Training and Research Hospital between January 2012 and December 2015 were evaluated retrospectively. The cases who were hospitalized in service or did not require intensive care were not included in the study. The cases were divided into two groups: ex-group (Group 1) and discharge group (Group 2). In both groups demographic information such as age, gender, burn scores, neutrophil counts and lymphocyte counts during admission to the hospital were recorded. NLR is the ratio of absolute neutrophil count to the absolute lymphocyte count. 26 Feb, 2019 https://www.clinsurggroup.us/articles/JSSR-5-162.php Objectives: The formation of bacterial biofilm on implant surfaces is the primary etiologic reason for peri-implantitis. The aim of this study is to present a new formulation including erythritol powder, which is widely used in air-polishing devices, and ultrasonic scaler with polyetheretherketone-coated tips, and to compare treatment effectiveness of them by comparison with conventional plastic scaler with 0.12% chlorhegxidine decontamination. 05 Feb, 2019 https://www.clinsurggroup.us/articles/JSSR-5-161.php Objective: To determine the effectiveness of topical vancomycin in reducing the incidence of sternal wound infections (SWI) in patients undergoing coronary artery bypass graft (CABG) surgery. Study design: Randomized Controlled Trial (RCT). Material and methods: This double blinded randomized clinical trial was carried out on 276 patients scheduled for elective CABG surgery. Patients were divided into two equal groups. In patients of group A (n=138) topical vancomycin solution was used in the sternal wound, and patients in group B (n=138) topical normal saline before sternal wound closure in coronary artery bypass graft surgery. The incidence of sternal wound infection was followed over an 18 months period. Major risk factors like diabetes mellitus (DM), smoking, and prolonged operation time i,e cardiopulmonary bypass time (CPB time) and cross clamp time were also evaluated. 31 Jan, 2019 https://www.clinsurggroup.us/articles/JSSR-5-160.php Introduction: trauma is common in pregnancy; it affects one in twelve pregnancies. Abdomen represents the third anatomical region of the body most affected after the limbs and head. As pregnancy evolves, uterus increases in size and goes beyond the pelvic cavity; exposing the uterus to trauma and penetrating injuries in particular. Penetrating abdominal trauma in pregnancy requires a rigorous clinical evaluation to establish a complete assessment of obstetric and non-obstetric lesions. It is an obstetrical emergency whose management depends on the abnormalities found. In case of major trauma, it is essentially carried out in a trauma center, with a multidisciplinary team to improve the maternal and fetal prognosis. 05 Jan, 2019 Background: The satisfaction of surgical residents with their training programs is a key indicator for program effectiveness. This survey was conducted to assess the level of perceived satisfaction of surgical residents with the current training programs in eastern Saudi Arabia. Materials and Methods: Resident satisfaction was measured by questionnaire in 119 selected participants at 9 training centers in Eastern Saudi Arabia, as part of the general surgery residency program of Saudi Commission for Health Specialties. 03 Jan, 2019 https://www.clinsurggroup.us/articles/JSSR-5-158.php In this paper we analyze, through a mathematical model, the potential impact of HCV antiviral therapy on the liver transplantation waiting list (LTWL) in the State of Sao Paulo, Brazil. In previous papers, we projected the size of the waiting list by taking into account the incidence of new patients per year, the number of transplantations carried out in that year, and the number of patients that died in the waiting list. In the present work, we projected the LTWL size for the next 30 years and we introduced the anti-HCV treatment, which was assumed to half the incidence of patients in the LTWL and that the recovery of patients in the list would triple. The liver transplantation rate was assumed to not be affected by the anti-HCV treatment. Our mathematical model demonstrates that anti-HCV therapy would have a remarkable impact on the size of the LTWL, in the State of Sao Paulo, dropping from twenty-four thousand to approximately twelve hundred patients in the next 30 years. 25 Oct, 2018 https://www.clinsurggroup.us/articles/JSSR-4-156.php Background: Hospital environment is a potential reservoir of bacterial pathogens, therefore Burn patients are at high risk of developing nosocomial infection because of their destroyed skin barrier and suppressed immune system, compounded by prolonged hospitalization and invasive therapeutic procedures. 04 Oct, 2018 https://www.clinsurggroup.us/articles/JSSR-4-154.php This case report evaluates the management of acute scrotal emergency in two similar cases with presenting complaints and different outcomes post-scrotal exploration. One case of young male discusses the eventual outcome of testicular torsion and importance of urgent exploration combined with careful cord examination, whilst second case was simply a hematocele requiring excision of sac. There is overall discussion of importance of scrotal exploration, even if at times it may not yield any positive findings. 20 Sep, 2018 https://www.clinsurggroup.us/articles/JSSR-4-153.php The management of large, impacted upper ureteric calculi remains challenging for urologists. Various treatment options include extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopic lithotripsy (URSL), percutaneous nephrolithotripsy (PCNL), laparoscopic and open ureterolithotomy. ESWL has poor overall success rate in the treatment of large stones with a significant possibility of residual fragments. 20 Aug, 2018 https://www.clinsurggroup.us/articles/JSSR-4-152.php Introduction: Amongst healthcare associated infections (HAIs), surgical site infections (SSIs) are a preventable cause of increased morbidity and mortality and are associated with substantial financial costs. SSI rates are an indicator of the quality of surgical and postoperative care, which necessitates the need for robust surveillance systems for these healthcare associated infections. Patients undergoing coronary artery bypass grafting (CABG) are at a greater risk for infection due to their relatively older age and the presence of comorbid conditions like diabetes mellitus and obesity. 04 Jun, 2018 https://www.clinsurggroup.us/articles/JSSR-4-151.php Ovarian cystic teratomas consist of germ cell tumors. They appear in female patients aged 20-40 years, comprising 15% of all ovarian neoplasms. These tumors appear in 90% of cases unilateral. Benign serous cyst-adenofi bromas represent the most common ovarian epithelial tumor, with an incidence of 42%, accounting 83% of serous ovarian tumors. The mean diameter estimates among 5 and 35 cm, with a bilateral incidence of 35%. 23 May, 2018 https://www.clinsurggroup.us/articles/JSSR-4-150.php Percutaneous renal allograft biopsy is commonly performed as a protocol or diagnostic biopsy after kidney transplantation to detect rejection, recurrence of kidney disease, infection and calcineurin inhibitor (CNI) nephrotoxicity [1,2]. 30 Apr, 2018 https://www.clinsurggroup.us/articles/JSSR-4-149.php Intraventricular cavernomas (IVC) are rare entities. We report a case of incidentally detected intraventricular cavernoma (IVC) in frontal horn of the lateral ventricle in which the diagnosis was established by typical magnetic resonance imaging (MRI) features. The patient has been kept on follow up as surgical resection is not recommended in asymptomatic cavernomas. IVC should be considered in differentials of intraventricular mass to avoid unnecessary invasive diagnostic procedures and ineffi cient management of this benign lesion. 30 Nov, 2017 https://www.clinsurggroup.us/articles/JSSR-3-148.php Objective: Evaluate the characters of labrum tear morphology in recurrent anterior dislocation of shoulder via arthroscopy. 24 Nov, 2017 https://www.clinsurggroup.us/articles/JSSR-3-147.php Purpose: The elbow bone traumas are very serious lesions that can compromise the function of this joint in the future. These lesions are most severe when there is a defect of bone which affects one component of the joint. 24 Oct, 2017 https://www.clinsurggroup.us/articles/JSSR-3-146.php Sepsis associated encephalopathy (SAE) is the most common encephalopathy in ICU and may contribute to a high mortality. Few data are available on the risk and outcome of SAE after patients with gastrointestinal (GI) perforation. 06 Sep, 2017 https://www.clinsurggroup.us/articles/JSSR-3-145.php Background: Endoscopic Retrograde Pancreoticocolangiography (ERCP) is performed for resolving cholestasis by sphincterotomy and/or stone extraction and is done with deep sedation or general anesthesia. 06 Sep, 2017 https://www.clinsurggroup.us/articles/JSSR-3-144.php Aim: There are an increasing number of wound closure materials and techniques types in skin surgery. Still now, there is much controversies about optimal procedure of wound closure. This study tries to achieve this goal. 16 Aug, 2017 https://www.clinsurggroup.us/articles/JSSR-3-143.php Background: When liver bleeding cannot be controlled by conventional methods, a topical hemostatic patch can be applied during surgery. In recent years new hemostats have become available. The aim of this study was to investigate the degree of adhesion and infl ammation for three topical hemostatic patches, TachoSil®, Hemopatch™ and Veriset™. 31 Jul, 2017 https://www.clinsurggroup.us/articles/JSSR-3-142.php Introduction: Circumcision remains the commonest performed surgical procedure in outpatients. Circumcision with Plastibell is the most popular used method of circumcision among surgeons. 24 Jul, 2017 https://www.clinsurggroup.us/articles/JSSR-3-141.php To evaluate the conversion rate of lap cholecystectomy and analyze the factors leading to the conversion to open surgery. 05 Jul, 2017 https://www.clinsurggroup.us/articles/JSSR-3-140.php Introduction: According to statistics damage venous circulation of the lower extremities are among the most common diseases in the world. Although the treatment varicose veins (VV) modernized using non-invasive-endovenous procedures, forecast on short term is not quite satisfactory. 15 May, 2017 https://www.clinsurggroup.us/articles/JSSR-3-139.php Traumatic anterior shoulder instability is a typical condition in young people and athletes. There are many different injuries that may be present, producing or coexisting with shoulder instability, in addition to classic Bankart lesion. 27 Mar, 2017 https://www.clinsurggroup.us/articles/JSSR-3-138.php Inguinal hernia is a common condition with great number of referrals from primary health care to general surgeons, and the treatment is corrective surgery in practically all cases [1,2]. 13 Mar, 2017 https://www.clinsurggroup.us/articles/JSSR-3-137.php Background: This study aims to evaluate the effectiveness of 0.5% bupivacaine soaked surgicel placed in the gall bladder bed and infi ltration at port sites at laparoscopic cholecystectomy, in relieving pain during 1st 24 hours post procedure. 28 Feb, 2017 https://www.clinsurggroup.us/articles/JSSR-3-136.php Introduction: Many patients with fecal incontinence (FI) have no treatment option except diversion. Gluteoplasty can be the ultimate resort for these patients despite unsatisfactory long term functional results. Different gluteoplasty techniques were described. 27 Feb, 2017 https://www.clinsurggroup.us/articles/JSSR-3-135.php Introduction: Omental cysts are rare abdominal lesions which may be diffi cult to diagnose. The incidence of cystic lesions is about 1 per 140,000 general hospital admissions and about 1 per 20,000 pediatric hospital admissions. Most common presentation is abdominal distension. 15 Feb, 2017 https://www.clinsurggroup.us/articles/JSSR-3-134.php Background: Surgical site infections are dreaded by many as they impose a greater economic costs, morbidity and mortality that in developing countries place a burden on an already burdened healthcare system 03 Nov, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-133.php Purpose: Anastomotic leak following colorectal resection surgery is associated with short and long-term negative patient outcomes, prolonged hospitalization, and increased healthcare costs. Various patient related and surgical factors are known to contribute to the development of post-operative anastomotic leaks. This study systematically reviewed the literature to assess the incidence of post-operative leak and identify patient factors associated with the development of leaks. 18 Oct, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-132.php Aim: To investigate the level of vessel ligation in splenic flexure cancer (SFC) in term of oncology outcome and overall survival. 25 Jul, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-131.php Purpose: Anastomotic leak following colorectal resection surgery is associated with high rates of morbidity, infection, and escalated healthcare expenditures. One method to prevent leaks includes early detection through intra-operative testing. This study employed systematic review of the literature to estimate the rate of intra-operative anastomotic leaks in colorectal resection surgery. 16 Jul, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-130.php Introduction: Although mesh techniques are used with increasing frequency, they are correlated to major long-term complications such as chronic inguinal pain (8.6%) and recurrence (1.6-8.6%). It is due to a non-development of an ideal mesh, which simultaneously ensures inguinal wall strength and a lower inflammatory foreign body reaction, which also seems to be correlated to the use of a non-absorbable mesh. 04 Jul, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-129.php Surgical management of portal hypertension has changed according to time, evolving from just complete shunts to selective shunts and to liver transplantation. The outcomes also greatly improved owing to better understanding of portal hemodynamics and disease nature. Introduction of selective shunts showed promising results just to be challenged by poor outcome with development of “pancreatic siphon” which then studies in detail. This intra-pancreatic and peri-pancreatic collateral veins which connected portal and splenic veins formed basis of systemic loss of portal flow and thus ending up in failure of selectivity. Pancreatic siphon was found to be associated with increased rates of hepatic encephalopathy post selective shunting along with increased rates of hepatic failure. In addition to this pancreatic siphon led to metabolic sequel like new onset of diabetes, ischemic or compressive pancreatic ductopathy and intrapancreaic cholangiopathy. 04 Jun, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-128.php Background: Fistula in ano is a common disease seen in the surgical outpatient department. Many procedures are advocated for the treatment of fistula in ano. However, none of the procedures is considered the gold standard. Aim of this study was to evaluate our procedure in the managing high perianal fistula. 27 May, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-127.php Background: The impact of systemic inflammatory response on carcinogenesis and tumor progression has recently gained much attention. Biochemical markers such as albumin, pre-albumin and C-reactive protein (CRP) are currently used to predict prognosis in several cancer types, and the usefulness of these biomarkers in gastric cancer has become an emerging topic of research. The present study aims to assess the correlation between tumor stage and the levels of pre-albumin, albumin and CRP in patients who underwent surgery for gastric cancer. 25 May, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-126.php In 2001 a woman underwent a cholecystectomy in Strasbourg, France. What was new? The surgical team who performed the operation was 14,000 km away, in New York [1]. It was the first case of remote robotic surgery. The operation had no complications and the patient had a decent postoperative follow-up. This epoch-making event was dedicated to Charles Lindbergh, the pioneering American aviator who flew across the Atlantic in 1927. 12 May, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-125.php Background: The increasing demand for robotics in general surgery has prompted academic institutions to train general surgery residents toward the acquisition of basic robotic skills. Our current robotic training curriculum begins in the PGY-3 year and is based on the use of surgical simulators in a risk-free environment, in which each resident must show proficiency prior to advancing to training on an animate model as PGY-4. Our unpublished data on the curriculum indicates that PGY-3s required additional remediation training on the robotic simulator, suggesting room for improvement in our teaching paradigm [8]. Because of resident duty hour restrictions, we could not provide remediation by simply increasing the number of training sessions. 30 Mar, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-124.php Introduction: The diseases most frequently found in the elderly are E.I. (inguinal hernia)* and BPH. (Prostatic hypertrophy non-neoplastic)*. The latter causes an effect on the abdominal wall to the increase in abdominal pressure from cervical-urethral obstruction, leading to the onset of the inguinal hernia pathology due to abdominal pressure which is higher, the greater as the residual bladder urine. The purpose of the study is to provide information on the surgical strategy and on timing in the presence of the simultaneous two diseases. 16 Mar, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-123.php Introduction: The improved living and environmental conditions have resulted in an increase in life expectancy with greater observation of breast cancer in elderly. The present study, through a retrospective analysis of our series, compares the results of treatment in two similar groups of patients under 75 (65-75) and over 75 (76-85) years of age, evaluating the efficacy and complications of loco-regional and general therapy in relationship to biological age, associated diseases, and also the influence on the results of the cultural level and lifestyle. 27 Jan, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-122.php Objective: To demonstrate the characteristic of high-voltage electrically head injury patients presenting underlying calvarial osteomyelitis. 19 Jan, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-121.php Introduction: The familial adenomatous polyposis of the colon (FAP) is a rare hereditary disease, transmitted as an autosomal dominant trait due to the mutation of the APC gene. The purpose of the study is to assess, even according to the data of our experience, the possibility of clinical application of the results of the new genetic research, linking the problem to prevention and/or treatment. Some operative remarks conclude the study. 07 Jan, 2016 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-2-120.php This is a case report of an open depressed and compound elevated skull fracture that located in the area where superior sagittal sinus lies beneath. This is a very rare variant of skull fractures. This patient was admitted to our Department of Neurosurgery Hasan Sadikin Hospital, Bandung Indonesia. He is a 14 years old male with motor vehicle accident and diagnosed with compound elevated and depressed skull fracture. A CT Scan demonstrated an Epidural hematoma with suggested cerebral prolapse. The initial GCS was 15 with slight hemiparesis and the patient underwent an emergency surgery. The elevated skull compound was fixated by a titanium mesh but we left the prolapse untouched, then the procedure followed by duraplasty using a pericranial flap. After 7 days of post-op treatment he was discharged without any neurological deficit. With proper emergency surgery, and by preserving the prolapsed brain tissue with fixation on the elevated skull fracture to prevent further injury may give a good results on this patient. 17 Dec, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-119.php 5-year survival rates of Non-Small Cell Lung Cancer (NSCLC) remain unsatisfactory after surgery with curative intent and disease recurrences, including distant metastases, are frequent. Only a minority of this heterogeneous disease is positive for EGFR mutations and suitable for Tyrosine Kinase-Inhibitor biological agents, which however present limits in terms of stable response to treatment, due to the acquired drug resistances. A few trials administrating EGFR inhibitors combined with surgery, in neoadjuvant or adjuvant settings, have been reported with lack of evidence. The third-generation EGFR inhibitors, with the amelioration of techniques of gene profiling and the knowledge of pathways could extent the spectrum of complementary-to-surgery treatments in NSCLC at high risk of relapse. 19 Nov, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-118.php Hydatid cyst is a parasitic infection of liver. One of frequent reason of liver mass is hydatid cyst in tropical and rural countries. In some cases rapidly grow up of cyst mimic liver masses. A sixty years old female admitted our hospital with abdominal pain. Abdominal ultrasound showed 74x75 mm in segment two, 115x91 mm in segment six and 115x62 mm in segment four type four hydatid cysts. Patient was admitted for surgery; pericystectomy and omentoplasty performed. In multiple cysts surgical management is sometimes difficult. It is better to drain all the cysts at the same time. Surgical interventions can prevent complications and spread of Echinococcosis also gives chance of curative treatment. 19 Nov, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-117.php Introduction: Vascular compromise causes hand pain, and physical examination requires to differentiate vascular causes from isolated ulnar nerve compression. Diagnostic studies visualize vascular abnormalities such as CT scans, MRA scans, and AV fistulograms. Ulnar artery aneurysms are quite rare discoveries, related to repetitive trauma, vasculitis, anatomic abnormalities, or infections. It is essential to repair any aneurysm when flow impediment causes significant symptoms. Blunt injury to the ulnar artery and superficial palmar arch damages the arterial wall and forms an aneurysm. The sensory branch of the ulnar nerve becomes compressed. Treatment here is to resect the thrombotic segment to relieve the compression. It is interesting to note, in this particular case, that a high origin and superficial ulnar artery had coursed along the forearm and entered along the ulnar side of the hand. The presence of such anatomic variations are essential in medical practice. 05 Nov, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-116.php Background and purpose: During knee joint distraction (KJD) treatment, using an external fixation-frame, pin-tract infections frequently occur. These local skin infections, although treated successfully with oral antibiotics, might lead to latent infections. This raises concern about subsequent placement of a total knee prosthesis (TKP). This study evaluates the first five cases in which patients had to be treated with TKO after KJD failure. 28 Oct, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-115.php Cystic Echinococcosis (CE) is a zoonotic infection caused by larval form of the parasite Echinococcus granulosus. The adult tapeworm inhabit the small intestine of some carnivores (called definitive or final hosts), and the larval phase, or “metacestode” develops in the herbivores (intermediate hosts). The presentation form of the larval phase is the development of cysts, called hydatid cysts. Although all of us know the vital cycle of the parasite and the different aspects of the disease, the designations around the parasite, its evolution and some therapeutic procedures is not uniform. In fact we frequently see the use of inappropriate terms, based on incorrect concepts. 28 Oct, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-114.php Indroduction: Neuroendocrine tumors (NEN) of the gastro-entero-pancreatic tract (GEP) are a group in themselves very heterogeneous of tumors that are different for the site of localization in the digestive tract (foregut, midgut and hindgut), both in relation to the pathological aspects, functional activity and nosographic classification. 28 Oct, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-113.php Background: To investigate clinic-pathological characteristics, hormonal receptors and HER2 receptor of male breast cancer. 15 Oct, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-112.php Introduction: The appearance of a framework for occlusive colorectal tumor raises complex issues and difficult. We need to ensure a resumption of normal bowel function in patients often in extreme conditions. Emergency surgery flounders in a derivation and a resection with restoration of intestinal transit. The progress of digestive endoscopy can now make available a medical procedure can solve the framework occlusive both as palliation both as a bridge to safer surgery. The purpose of this study is to evaluate the indications and limitations of the method of colon prosthesis with self-expandable stents. 10 Sep, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-111.php Background: To synthesize the concept of muscle-sparing thoracotomies for major pulmonary resections and to explore the relationship between Kraissl’s lines and skin incisions perpendicular to them. 02 Sep, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-110.php Anterior rectus sheath haematoma is a rare condition that typically arises from rupture of the inferior epigastric artery in patients with coagulation disorder, on anticoagulation, or after abdominal trauma. We report an unusual case of spontaneous rupture of the superior epigastric artery following a violent paroxysm of coughing in a young adult with no known coagulopathy. This case highlights the importance of radiology in clinching the diagnosis and aiding in successful conservative management with complete resolution. 24 Aug, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-109.php Natural Orifice Specimen Extraction (NOSE) maintains the benefits of minimally invasive surgery obviating the need to extend the port site incisions for specimen extraction. We describe the technique of transvaginal extraction of a laparoscopic right hemicolectomy specimen in sexually active 63 year old female. 10 Aug, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-108.php On Sep 3, 2012, several rhinology specialized medical staff members in Shenzhen Pengcheng Hospital were stabbed by a patient with blood-covered hands; on Oct 25, 2013, a chief physician of the otolaryngology department of the first People's Hospital of Wenling, was killed in his clinic while working on a patient. 09 Jun, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-107.php A 58-year-old woman was referred for elective coronary bypass graft surgery (CABG). As an incidental finding, the coronary angiogram showed a radio-opaque linear foreign body in the superior vena caval-right atrial region; additionally to a significant flow-limiting multivessel coronary artery disease (Panels A, B). 29 May, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-106.php A hydatid cyst, or echinococcus, is a zoonosis frequently formed by the larvas of Echinococcus granulosus. The disease appears as a slowly growing cystic mass and is asymptomatic. The disease is common in the Eastern, Southeastern, and Central Anatolia regions of Turkey. The rate of incidence of the disease in Turkey is reported as 5.7 out of 100,000 individuals. 27 Apr, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-105.php Background: Dual Kidney Transplant (DKT) of marginal kidneys has expanded utilizing the extended criteria donor (ECD) organs. The aim of this study is to report the outcomes of dual kidney transplant in our institute and review the surgical techniques of DKT in the Literature. 23 Apr, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-104.php Introduction: Preoperative complexity estimation helps deciding whether to proceed with a minimally invasive approach, perform an open procedure or make a referral to a more experienced surgeon. Laparoscopic cholecystectomy outcome is particularly affected by the presence and severity of inflammation, advancing age, male sex and greater BMI. 22 Apr, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-103.php Partial meniscal defects can be the cause of knee joint line pain. Synthetic meniscal scaffolds have been used as substitutes for the meniscal defect. CMI (Collagen Meniscus Implant, Ivy Sports Medicine, Grafelfing, Germany) was the first product designed and Actifit (Orteq Bioengineering, London, United Kingdom), a polyurethane scaffold, is a more recent one. Both implants have been proven safe and clinically efficient so far. The indications, surgical technique, postoperative regime, results and complications are discussed. 13 Apr, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-102.php Introduction: Organ reinnervation and functional recovery following peripheral nerve injury still remains a major challenge and return of functional recovery to the preinjured level rarely occurs. The aim was to evaluate the effect of locally administered insulin-like growth factor (IGF I) on nerve regeneration. 06 Apr, 2015 https://www.clinsurggroup.us/Surgery-Surgical-Research/JSSR-1-101.php Vascular complications of liver hydatidosis are infrequent but severe. We present a case with severe vascular problems due to a recurrence of a liver hydatid cyst. A 39 year-old male consulted the Emergency Department after frank hematemesis due to esophagealvarices. He had undergone surgery at the age of seven in his native country for liver and lung hydatid cysts. Abdominal CT showed a 20 cm multivesicular cyst, occupying segments IV, V and VIII of the liver, displacing and partially compressing a dilated portal vein and causing portal hypertension and obstruction of the inferior cava vein. A subtotal cystectomy was performed. After surgery, portal vein flow was normal and esophagealvarices disappeared, but caval obstruction remained. We review the vascular complications due to liver hydatidosis, focusing on therapeutic management.