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Gastrointestinal stromal tumour (GIST) is the most common non-epithelial mesenchymal tumour and comprises 0.1-3% of all GI tract tumours. They express tyrosine kinase and are potentially malignant. Therefore, early diagnosis and surgical resection is the key for good outcome. This is a retrospective analysis of medical records of five patients of gastroduodenal GIST who were managed in the department of surgery between 2014 and 2015. Demographic profile, clinical presentation, laboratory parameters, diagnostic imaging, treatment details, histopathology and long-term outcome was analysed. Patients were followed up regularly in surgery outpatient clinic. Last follow up was in December 2022. All were female; three of them presented with melena and two with lump abdomen. Patients with gastric GIST underwent sleeve resection in two and antrectomy in one patient. Patient with duodenal GIST underwent excision of tumour with primary repair of duodenum. Fifth patient had metastatic duodenal GIST; Imatinib was started in view of irresectable disease at presentation. However, there was tumour progression and she expired seven months after treatment initiation with Imatinib. Histopathology revealed low grade GIST in two, intermediate grade in one and malignant in one. Patient with malignant GIST received Imatinib for 2 years. All four patients are well on follow up with no sign of local and distant recurrence.

Background: Gallstone disease (GSD) is a very common condition worldwide and the key event in the cholesterol stone formation is the supersaturation of bile with cholesterol. The role of trace elements like iron, calcium has been suggested in the pathogenesis of gallstones. Both iron deficiency and GSD are more prevalent in India. With this background, we studied the frequency of iron deficiency anaemia in GSD patients.Methods: This prospective observational study enrolled 150 adult patients undergoing laparoscopic cholecystectomy for symptomatic GSD in a north-Indian tertiary care hospital. Complete hemogram, serum ferritin, iron and unbound iron-binding capacity (TIBC) were performed in all patients. To simplify interpretation, anaemia was defined as Hb

Background: The pandemic has imposed a prodigious limitation on surgical training and has disrupted hospital procedures, hindering continuing medical training. We have established an online classroom platform at our institute to pursue medical education, which has been a new experience for our residents and consultants.Method: Across-sectional survey was conducted in the department of general surgery to know the perception of surgical consultants/registrars and junior residents regarding online classes and conventional teaching methods. Survey was conducted online, wherein questionnaires related to online teaching were circulated to resident surgeons and consultants/registrars.Results: A total of 91 surgery residents and 26 surgical supervisors consisting of faculty members and registrars completed the survey. Junior residents provided encouraging feedback and supported online education in the COVID-19 period; they felt that courses were well discussed, except clinical case presentation. A total of 84.6% of surgery residents and all the surgical supervisors felt that lack of a functional operating theatre impeded their training. Majority of surgical supervisors (66%) were moderately satisfied by the quality of online training, whereas junior residents (79%) were very to extremely satisfied and most (83%) approved online classes in future. Majority of junior residents (90%) found the virtual platform very easy to use, opposite to surgery supervisors.Conclusions: Our study demonstrated that online education is a feasible way to train surgical residents. However, since surgical specialties depend heavily on practical experience, it is very important to implement new ways of acquiring practical skills.

COVID-19 was declared as a public health emergency of international interest on 30 January 2020; and as a pandemic on 11 March 2020.1 In order to minimise the spread and to optimize the health care resources Indian government announced national lock down with suspension of all routine hospital activities (outpatient clinics, routine surgeries) on March 24, 2020. Only emergency services were allowed along with diversion of all available resources to COVID centre.

Background: Focused parathyroidectomy is the adequate treatment for primary hyperparathyroidism for localised disease. Adequacy of resection is confirmed by the availability of intraoperative parathormone assay (iOPTH). In the absence of availability of iOPTH assay, the radio guided surgery is an option. The aim of this study was to evaluate the feasibility of radioguided parathyroidectomy in tertiary care centre in India and to compare the overall success rate, operative time, hospital stay and postoperative outcome between focused open and radioguided parathyroidectomy.Methods: This was a prospective study which included 30 primary hyperparathyroidism patients with a single gland disease localised on Tc99m Sesta MIBI scan. Patients were randomized into two equal groups, and they underwent focused open or radioguided parathyroidectomy. Patients were followed up for three months.Results: All patients achieved biochemical cure as evident by the normalization of serum calcium and parathormone levels after surgery. The mean incision length, and operative time in this study was significantly better for radioguided parathyroidectomy (p=0.0001

Background: Laparoscopic cholecystectomy is the recommended standard of care for symptomatic gall stone disease. We report our experience of day care laparoscopic cholecystectomy in terms of safety, feasibility and cost factor. Methods: A retrospective analysis was performedon data collected from June 2014 to December 2018 from a single unit at PGIMER, Chandigarh, India. Patients who were graded I and II on the ASA score, accompanied by at least one attendant and able to come to hospital by their own arrangements in case of any problem wereselected for day care laparoscopic cholecystectomy. Results: Out of 1054, 826 (78.4%) were female and 228 (21.6%) were male patients. Mean age of the study cohort is 43.3 years with minimum and maximum age being 13 and 80 years respectively. GSD with chronic cholecystitis were present in maximum number of patients (875, 83.01%) and GSD with chronic liver disease in minimum number of patients (5, 0.47%). There was no common bile duct injury. A total of 9 (0.85%) patients got converted to open surgery requiring admission. There was no mortality. On evaluating the cost factor, cost saving of Rs. 8200/- was found between DCLC group and private ward patients while of Rs. 365/- between DCLC group and general ward patients. Conclusion: Day care laparoscopic cholecystectomy is safe in carefully selected patients and has the advantage of cost factor. This will help us in increasing patient turnover and thus reducing waiting time for wait listed patients.

Gossypiboma or retained surgical sponge is an entirely preventable surgical complication; it is associated with significant morbidity to patient and medico legal issues to the surgeon. Clinical presentation depends upon location of the foreign body and tissue reaction to the foreign body. Pre-operative diagnosis is the most difficult part and treatment of choice is surgery. A 30 year female presented with 16 months history of gradually increasing lump on left side of lower abdomen following a caeserian section. Ultrasonography was suggestive of infected mesenteric cyst and contrast enhanced computed tomography scan of abdomen was suggestive of either chronic abscess or gossypiboma. She was treated surgically; intra-operatively there was a 10×10 cm well circumscribed lesion in sigmoid mesentery which was adherent to sigmoid colon. It was a single surgical sponge with about 1000 ml of pus. Gossypiboma is an entirely avoidable surgical complication which is associated with significant morbidity and medico-legal implications. Meticulous counts with thorough exploration of site before closure can lessen the undue morbidity or mortality. Radio frequency identification verification by barcode scanner can reduce the error rate.