Online ISSN: 2515-8260

Keywords : post operative complications


Efficacy of Sub Fascial Endoscopic Perforator Surgery (SEPS) in the Treatment of Lower Limb Varicosities with Perforator Incompetence

N.Ashok Vardhan Kumar, Hareesha Jaggari,J. Parthasarathi, Md Shadab Jaseem

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2443-2450

Background:To study the efficacy of sub fascial endoscopic perforator surgery (SEPS) in the treatment of lower limb varicosities with perforator incompetence.
Materials and Methods: The present study is A Prospective Comparitive Study Between SepsAnd Open Perforator Ligation To Know The Efficacy Of Seps In Treating Varicose Veins done at Kamineni institute of medical sciences,Narketpally from October 2017-september 2019. 50 cases of varicose veins with perforator incompetence were studied,the statistical data and analysis of the cases studied during this period are presented in the study.
Results: In the present study, One thirds (16/50 i.e 32%) of the patients in our study were in the age group of >60 years. The ratio of male to female was 2.33:1. In our study 36%(i.e.18 patients) had involvement of left lower limb out of which 9 patients underwent SEPS and 9 underwent open ligation. Right lower limb involvement was seen in 42%(i.e.21 patients) out of which 15 underwent SEPS and 6 underwent Open ligation. Both limbs involvement was seen in 22%(i.e.11 patients) out of which 1 underwent SEPS and 10 underwent OPEN LIGATION. In our study 100% of the patients had dilated veins and discomfort as presenting symptoms. Itching was present in 88% of patients; skin pigmentation in 46%; edema 82% and ulceration in 14% of patients. 7 patients (14%) amongst the 50 patients had an active ulcer at the time of presentation. All were having single ulcers, most of them(4/7) less than <1 yr duration. 4 among 7 patients with venous ulcer underwent seps,3 underwent open ligation. In SEPS group, 3 perforators were ligated in 10 out of 25 patients and more than 3(4-5) perforators were ligated in 15 out of 25 patients. In open perforator ligation group, 3 perforators were ligated in 17 out of 25 patients and more than 3(4-5) perforators were ligated in 8 out of 25 patients. In our study no post, operative complications were observed in the seps group but in open perforator ligation group 2 patients developed complications like haematoma, wound infection and wound dehiscence. Post operativepersistance of dilated veins and discomfort was noted only in one patient out of 50 and belonged to open ligation group. The ulcer healed in all the 4 patients who underwent SEPS, but in open ligation group out of 3 patients ulcer healed only in 2 patients and persisted in one. In SEPS group, edema subsided in 11 out of 25 patients but persisted in 14, while in OPEN perforator ligation group edema subsided in only 2 out of 25 patients and persisted in 23 patients. Post operative stay-Among 25 patients who underwent SEPS 24 patients stayed for <10 days, whereas in open ligation group all the 25 patients stayed for > 10 days and 3 of them stayed for >20 days.
Conclusion: SEPS should be an added procedure along with conventional varicose veins surgery in order to reduce long term recurrences of the venous ulcer and promote wound healing. Hence with the favourable and significant ulcer healing rate with improvement and  reduction in clinical severity suggests that SEPS plays an important role in surgical   management of advanced stages of venous insufficiency.

To Evaluate The Role Of Early Vs Delayed Laparoscopic Cholecystectomy In Mild And Moderate Acute Gall stone Pancreatitis

Dr Sandip kumar Chaudhari, Dr Nayan Pancholi, Dr Latif Bagwan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 54-59

Aim: To evaluate the role of early Vs delayed laparoscopic cholecystectomy in mild and
moderate acute gallstone pancreatitis
Methods:This randomized prospective study conducted in the Department ofSurgery after
taking the approval of the protocol review committee and institutional ethics committee. 100
patients were included in the study. They were divided into two groups with 50 patients in
each group. Patients with mild and moderate acute gallstone pancreatitis were included in this
study.

Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis: A randomised prospective study

Dr. Abu Noaman, Dr. Mahesh Choudhary, Dr.Balkeshwarkumar Suman

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1860-1867

Aim: To study the outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis:
Methods: 80 patients were included in the study. They were divided into two groups with 40 patients in each group. Group A: (40) patients who underwent laparoscopic cholecystectomy after 48 hours from day of admission. Group B: (40) patients who discharged home after resolution of the acute phase and underwent laparoscopic cholecystectomy after 6 weeks. Both groups were compared as regard: operative time, intraoperative findings and complications, conversion to open surgery, use of abdominal drains, hospital stay, post operative complications, readmission after discharge.
Results:  The mean age of patients in group A was 36.29 ± 10.33 years (range= 20-55 year) while in group B     was 37.58 ± 10.22 y (range= 20- 53 y). The majority of the patients were female. 24 patients (60%) in group A and 32 patients (80%) in group B. In group A the operative time ranged from 46 minutes to 89 minutes with a mean of 67.5±11.69 minutes, while in group B operative time ranged from 39 minutes to 76 minutes with a mean of 57.5±9.98 minutes . P value was significant 0.014. In group A 5 patients (12.5%) have intraoperative finding of acute cholecystitiswhere as none of group B express acute cholecystitisintraoperatively, with no statistically difference (p value 0.069). There was no significant difference in intraoperative complications between both groups. The difference between the two groups is significant (0% vs. 40%, p < 0.0001). 7 patients (17.5%) required hospital readmission due to severity of the symptoms. 10 patients (25%) had biliary colic, 3 patients (7.5%) developed acute cholecystitis, and 4 patients (10%) had recurrent biliary pancreatitis.
Conclusion:  We concluded that the early cholecystectomy in patients with mild acute biliary pancreatitis has no added risk of intra or post operative complications than delayed cholecystectomy. Also it significantly reduces the risk of recurrent biliary problems and length of hospital stay which has a great impact on the patients and health care resources .