Search

Background: Chronic pancreatitis being one of the most distressing medical condition, is often complicated by common bile duct obstruction, fibrosis and acute inflammation of the pancreas. Pain, weight loss and diabetes are common in these patients. Surgery is the ultimate option after medical treatment fails to solve the distress. Longitudinal Pancreatico-jejunostomy is widely practiced all over the world as the option of choice. Pancreatico-gastrostomy is also being practiced by a few surgeons in a few centers. Here we practice Longitudinal Pancreaticogastrostomy (LPG) for chronic pancreatitis patients in our setup. This study was aimed to analyze the outcomes and privileges of LPG. Method: This prospective study was monitored and guided by the Department of Hepatobiliary and Pancreatic Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka over a period of 18 months. A total of 36 patients with chronic pancreatitis were allocated for Longitudinal Pancreatico-gastrostomy (LPG) surgery. Study tools included pain gradation, body weight, investigation profiles- serum lipase, blood sugar, USG of abdomen, CT Scan and MRCP. Duration of surgery, blood loss, hospital stay, assessment of post-operative pain relief and surgical complications were the parameters of the study. For pain relief assessment patients were divided into three categories, complete (no complaint pain), satisfactory (mild tolerable pain with normal daily activities) and unsatisfactory (moderate to severe pain requiring medication and hampered daily activities). Results: 36 patients in the group underwent LPG. Mean age in group was 22.94 ± 3.76 years. Majority of the patients had unknown etiology. The mean duration of illness in group was 4.27 ±0.96 years. LPG was easier to perform, took less time, less blood loss and hospital stay was short with less post-operative complications. Pain relief was satisfactory with most patients showing complete pain relief. Diabetes patients got much better glycemic control after surgery. Weight gaining was also significant. Conclusion: LPG is an easier and safer surgery which achieves good pain relief, glycemic control and nutritional improvements. Large volume studies should be done to establish its dominance against other surgical procedures. J Shaheed Suhrawardy Med Coll 2021; 13(1): 58-62

Background: The management of high and complex anal fistulas remain a therapeutic challenge as it is often associated with recurrence and anal incontinence. The oldest and theoretically the simplest technique is to use a seton. The aim of this study is to find out the outcome of seton in the treatment of complex fistula in ano. Materials and methods: This cross-sectional study was done in surgical units of ShSMCH and colorectal surgery units of BSMMU from September 2014 to August 2015. Fifty patients with high anal fistula having internal opening above dentate line and with multiple fistulas tract were included by purposive sampling. Patients with low anal fistula, fistula in ano associated with Crohn’s disease, active abdominal tuberculosis, carcinoma of rectum, previous radiation therapy, with recurrent fistula in ano and in whom the internal opening could not be located were excluded. After initial evaluation, the fistula tract and opening were located. The skin and anoderm overlying the fistulous tract were incised. This double-strand seton was then tied over itself on the sphincter without excessive tension. The long end of each suture was tapped to the patient’s medial thigh. Postoperatively warm sitz bath after each bowel movement was advised. The patients were informed in detail about the presence of seton prosthesis and they were warned about the possible serous discharge that would continue until the seton dropped, and the wound healed. Data were recorded on the predesigned questionnaire and analyzed using SPSS version 16. Results: Among 50 cases mean age was 41 years, M: F was 4.5:1. Discharge from perianal sinus, pain, swelling and itching were common clinical presentation. All of the patients were discharged on the third postoperative day. None required readmission or needed narcotic analgesics after discharge. The average time for the seton to cut through the sphincter was 1 to 3 months. 28% had complete healing at 1 month and 66% at 3 months postoperatively. Flatus Incontinence was noted 16% cases followed by recurrence (6%), liquid stool incontinence (4%) and postoperative anal stricture was (2%) of cases. Conclusion: This study found that the seton is a safe and low morbidity option for the treatment of high and complex fistula-in-ano, having higher healing rates, with good quality of life. It can therefore be recommended as the standard treatment for complex fistula-in-ano. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 15-19

Background: Post-surgical outcomes are very crucial for acute intestinal obstruction following laparotomy. Objective: The purpose of the present study was to identify the causes and risk factors that influence the outcome of post laparotomy acute intestinal obstruction and also to assess their management and outcome. Methodology: This cross sectional study comprising fifty patients irrespective of age and sex with diagnosis of Acute intestinal obstruction following laparotomy who attended at the Department of Surgery in different tertiary Hospital of Dhaka city, within the time period of July 2017 to June 2019. All these data were analyzed and tried to find out the outcome of management of acute intestinal obstruction following laparotomy. Results: All the 50 patients had undergone some conventional surgeries in previous instance. Acute intestinal obstruction was found in 80.0% of cases who had undergone emergency surgery and 20.0% cases were after routine surgery. The reasons behind Laparotomy for burst appendix (16.0%) followed by laparotomy for blunt trauma abdomen (12.0%) and classical appendicectomy (12.0%). After conservative management complication rate was low (21.0%) and the most prominent complication was UTI (28.57%) whereas mortality was 14.29%. After surgical management complication rate was higher which was in 56.25% of cases. Conclusion: Post laparotomy of acute intestinal obstruction can improve the outcome and reduce the chance of relaparotomy, surgical morbidity. Journal of Current and Advance Medical Research 2020;7(2): 73-79

Introduction: Intussusception is very common in childhood between the ages of 5 months to 1 year. In adults it is a rarity, in whom it commonly presents with a nonspecific, repeated, chronic or subacute intestinal obstruction. Ninety percent of them have a variable number of secondary pathological ‘lead point’- from benign lesion to malignant.5 Objective: This study aims to find out the variations & the commonest ‘Lead points’ in rare adult intussusceptions. Methodology: Study period was from January 2015 to June 2019. All patients of adult intussusceptions, admitted in Shaheed Suhrawardy Medical college Hospital, were examined, investigated, & analysed peri-operative findings with post-operative histopathological results, in this prospective observational study. Result: In this study, among 15 patients, GIST found to be the commonest (46%) Lead point in adult intussusceptions. Others include Adenocarcinoma, Leiomyomatous polyp, Meckel’s Diverticulum, intestinal TB, etc. Male was mostly sufferer (67%). Ileoileal (II) variety was found more in male & Ileocecal (IC) variety in female. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 138-141

Laparoscopic inguinal hernia repair has become popular as an alternative to open surgery. The classical TEP technique is the laparoscopic technique of hernia repair which is considered closest to ideal for inguinal hernia repair, but this technique has several drawbacks such as limited space for dissection and mesh placement, restricted port placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique. Extendedview modification, the eTEP technique, which overcomes several of these drawbacks. The eTEP approach can quickly and easily create an extraperitoneal space, enlarge the surgical field, provide a flexible port setup adaptable to many situations, allow unencumbered parietalization of the cord structures , ease the management of the distal sac in cases of large inguinoscrotal hernias, and improve tolerance of pneumoperitoneum, which is a common complication. The purpose of this study was to evaluate the safety and effectiveness of eTEP procedure with placement of polypropylene mesh and fixation by tackers. Method : It was a observational study of 25 cases. The study was conducted in Shaheed Suhrawardy Medical College Hospital, Dhaka from July 2018 to June 2019. Sociodemographic status, operation time, peroperative blood loss, unwanted events like peritoneal tear, vessel injury, nerve injury, duration of hospital stay, postoperative pain and urinary retention were recorded. All the patients were followed up for at least 3 times at the end of 1st week, 1st month and 3rd month. Any surgical site infection, mesh infection, seroma, scrotal swelling, severity of pain according to visual analogue scale, haematoma and recurrence within this time was recorded. All the data were analyzed on SPSS. Result : Among the 25 patients average time of operation was 1 hour and 35 minutes, peroperative blood loss was below 20 ml in all patients, peritoneal tear occurred in 2 patients, 1 vessel injury but no nerve injury was observed during the procedure. One patient had mild chronic pain even after the end of 3rd month. One patient developed scrotal swelling which subsided by the end of 1st week. No SSI, mesh infection, seroma, wound hematoma, and recurrence found within this period. Conclusion : This study showed that, eTEP procedure is cost effective, has minimum complication with easier learning. In the hands of an experienced surgeon, eTEP repair can be safe and effective. New study can be done to find out it’s effectiveness in incisional hernia in lower abdomen and bilateral inguinal hernia. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 96-100

Idiopathic Sclerosing Encapsulating Peritonitis (or abdominal cocoon) is a rare cause of small bowel obstruction, especially in adult population. Diagnosis is usually incidental at laparotomy. We report one such rare case, outlining the fact that an intra-operative surprise diagnosis could have been facilitated by previous investigations. Journal of Surgical Sciences (2015) Vol. 19 (2) : 75-79

Gastrointestinal stromal tumours are rare mesenchymal neoplasms of gastrointestinal tract with a malignant potential and unpredictable behavior and stomach is the commonest location involved. However coexistence of gastric carcinoma and GIST is very rare. A 32- year-old male patient who presented with upper abdominal dyspeptic symptoms, was evaluated with Upper GI Endoscopy which revealed an ulcerated lesion in the antral part of the stomach. Biopsy was taken and histopathological examination revealed the lesion as poorly differentiated adenocarcinoma. Distal radical gastrectomy revealed another 3cm of submucosal mass of GIST along with the existing adenocarcinoma. Journal of Surgical Sciences (2015) Vol. 19 (1) : 31-34

Introduction: Male breast malignancy is a relatively rare condition among all the malignancies. It accounts for 0.2% of all malignant cases & less than 1% of all breast cancer. Methods and Materials: A retrospective observational study was done among the male patients with breast malignancy, admitted in Surgery ward in Shaheed Suhrawardy Medical College Hospital, Bangladesh from January 2014 to December, 2018. Results: Our series includes 09 patients. The mean age of the patient was 60 years. Most of the patients complaint breast lump with some degrees of skin colour changes. One has previous history of breast surgery (lumpectomy). Eight (8) patients went under simple mastectomy with axillary clearance after tissue diagnosis. One (1) patient got neo- adjuvant chemotherapy followed by surgery. Specimen was sent for histopathological & receptor study. Among them Infiltrating was ductal carcinoma was found in 07 cases, Sarcoma was in 01 (one) case & papillary carcinoma in 01 (one) case with 66.6 % positive oestrogen and progesterone receptor activity. Conclusion: Surgeons should be kept in mind that male breast malignancy is not uncommon and all male breast lumps should be evaluated properly before surgery. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 48-51

Crossed testicular ectopia (CTE) is an extremely rare anomaly in which deviation of testicular descent results in unilateral location of both testes. It usually presents as an inguinal hernia on the side of a fully descended testis and an impalpable testis with undeveloped hemiscrotum on the contralateral side. Most often the diagnosis of CTE is not made until surgical exploration. Few reports are available regarding CTE in infants or younger children. Though the patients of CTE usually present at a younger age, we report a case of crossed testicular ectopia in a 65-year-old male who was admitted in the department of surgery, Shaheed Suhrawardi Medical College Hospital (ShSMCH) with right sided inguinal hernia. Journal of Surgical Sciences (2015) Vol. 19 (1) : 39-41

A trichobezoar is a bezoar ( a mass found tapped in the gastrointestinal system) formed from the ingestion of hair. Trichobezoars are often associated with trichotillomania (compulsive hair pulling). Trichobezoars are rare, but can be fatal if undected1,2. Surgical intervention is often required. Gastric outlet obstruction (G.O.O) is one of the presenting complaints of trichobezoars in the stomach. Patients with this condition often have an underlying psychiatric illness & history may not be easily forthcoming. This condition mainly occurs in young female. We are presenting a case of gastric outlet obstruction in a young female of 25 years old. After taking history, clinical examination, necessary investigation it seemed to be a case of trichobezoar. Laparatomy done under general anaesthesia, then opened the stomach and found it was a case of trichobezoar.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 85-87

Background: Intussusception in adult patients is occurred in different reasons. Objectives: The purpose of the present study was to see the spectrum of etiology among adult intussusception patients. Methodology: This case series was performed in the Department of Surgery at Shaheed Suhrawardy Medical College, Dhaka from July 2014 to June 2015 for a period of 1(one) year. All the patients presented with intussusceptions were selected as study population. A detailed history was obtained from each patient. Patients with the age of ?18 years, regardless the symptoms like onset, duration, intensity, progression were included for this study. Per-operative diagnosis was further confirmed by histopathology of the resected specimen. Result: A total number of 11 cases were recruited after fulfilling the inclusion and exclusion criteria. Gastro intestinal stromal tumour (GIST) was the most common etiology of intussusceptions which was 5(45.5%) cases followed by adenocarcinoma which was 2(18.2%) cases. Meckel’s diverticulum, Intestinal TB, Lipoma and Leiyomyomatous polyp were also found in 1 case each. Conclusion: Adult intussusception is most commonly occurred due to gastro intestinal stromal tumour followed by adenocarcinoma. Journal of Science Foundation, January 2016;14(1):3-7

Background: Laparoscopic cholecystectomy (LC) is one of the most common general surgical procedure. Objective: The purpose of the present study was to observe the surgical outcomes of the patients after clipless laparoscopic cholecystectomy. Methodology: This case series were performed in the Department of Surgery at Shaheed Suhrawardy Medical College & Hospital, Dhaka from June 2014 to April 2015. After several modifications, the success of intracorporeal “separate knotting of cystic artery and duct” was observed with Vicryl and was successfully used separate ligation of cystic artery and duct (SLAD) with Vicryl 1/0 in symptomatic cholelithiasis patients. Result: A total number of 50 cases were undergone elective laparoscopic cholecystectomy. Most of the patients were female (80.0%). Average age of patients was 39 yr (15-65). There was no bile leak or other complications related to ligature. The time taken for tie varied from 2 to 4 minutes (average 3 min). There were 10(25.0%) acute calculus cholecystitis, including empyema, gangrenous cholecystitis. No patient had port infection. Conclusion: Clipless LC is a safe and effective method.Journal of Science Foundation, 2015;13(1):11-14DOI: http://dx.doi.org/10.3329/jsf.v13i1.27828