12^th International Conference on Anesthesiology and Critical Care November 11-12, 2019 Istanbul, Turkey

Biography:

Mohammad M R Miah has completed his MRCS in 2016 from Royal College of Surgeons of England. He is working in Surgery as a middle grade Surgeon under NHS England. He has completed multiple audits and quality improvement project as a lead Auditor and presented in many national and international conferences.

Abstract:

Continuation of DAPT until CABG increases the risk of excessive perioperative bleeding, transfusions and re-exploration for bleeding as shown in RCTs observational studies and meta-analyses. Th erefore, it is recommended that the P2Y12 inhibitor be discontinued whenever possible before elective CABG. Alternatively, elective operations may be postponed until the DAPT treatment period is completed. For Clopidogrel, it was shown in the CABG sub-study of the CURE trial that discontinuation ≥5 days before CABG did not increase the risk of bleeding complications. For Prasugrel, a longer time interval (7 days) is recommended due to the longer off set time compared to Clopidogrel. In patients on P2Y12 inhibitors who need to undergo non-emergent cardiac surgery, postponing surgery for at least 3 days aft er discontinuation of Ticagrelor, at least 5 days aft er Clopidogrel and at least 7 days aft er Prasugrel should be considered. We collected prospective data on 150 consecutive patients who were admitted with ACS from 1st October 2017. 21 patients were on Clopidogrel, 8 patients were on Ticagrelor and only 1 patient was on Prasugrel. 10 patients Clopidogrel was stopped less than 5 days before surgery. Ticagrelor and Prasugrel were paused appropriately. However, there was signifi cant delay in between stopping and the day of surgery in multiple patients. Th e safe discontinuation interval varies between the diff erent P2Y12 inhibitors due to variations in platelet inhibitory eff ect and pharmacodynamics and pharmacokinetic properties. Appropriate stopping of P2Y12 inhibitors should be considered before surgery according to the guidelines to achieve successful perioperative haemostasis.

Biography:

Muhammad Alvi grew up in Karachi, Pakistan and moved to UK aged 18 to study medicine at Trinity College, Oxford. After graduation, he moved to Machester University teaching Hospital for Two years of foundation training. During this time he successfully secured an competitive Otolaryngology themed “Core Surgical Training Post” which he is now completing in New Castel University of Teaching Hospitals. His aim is to be an Otolaryngologist.

Abstract:

Neoplasms of the skull base represent a signifi cant challenge for surgical management. Th ey are rare and include a variety of histological subtypes. By defi nition these tumors exist at the interface between the intra and extra-cranial space and therefore are adjacent to critical structures. Skull base surgery is a recent entity. Th e fi rst description of a craniofacial approach in the literature dates from Ketcham, et al. 1963 describing a combined transfacial approach. Th e principles of this initial strategy have undergone modifi cations over the years to minimize morbidity and brain handling whilst achieving disease free-margins. Th e goal remains en-bloc resection. Th e open approach to resection of these neoplasms remains the goldstandard. Improvements in neuroimaging, microvascular reconstructive options and surgical techniques have established Craniofacial Surgery (CFS) as a safe and eff ective treatment. Approaches to the skull base include a subcranial approach and a frontal/transfacial approach. A multidisciplinary should include a neurosurgeon and an otolaryngologist due to the extra and intra-cranial considerations when exposing the skull base. Th e choice of approach depends on the location of the tumor as well as expertise and experience of the surgeon. Aesthetic considerations on the patient’s part will also play a role. Th is review will begin with a brief consideration of the diff erent tumors of this region, including common routes of spread for these tumor subtypes. Th is will be followed by a discussion of clinical fi ndings and imaging modalities. Finally there will be a description of the diff erent surgical approaches used for treatment.

Biography:

She is specialist nurse on surgical oncology and breast cancer navigation nurse in her institution and responsible for pretreatment education of the breast cancer patients. Marmara University Pendik Trainig Hospital is a reference hospital. She had presenated many oral talks and attended EONS Masterclass in Berlin.

Abstract:

Aim: Th e aim of this presentation is to explain the role of the cancer navigation nurse during radiotherapy for breast cancer patints since these patients have high anxiety and therapies have severe side eff ects. Method: Recent literature and materials of European Oncology Nurse Society education materials are reviewed. Discussion: Cancer navigation nurses are patient educators and advocates, care coordinators, system navigators, and community ambassadors on a mission to improve the cancer experience for each patient. Patient education is a dynamic part of medicine. Radiation oncology is a complex treatment dicipline. Patient education is a part of quality of care. Radiotherapy, chemotherapy and surgery are eff ective treatments for malignant cancers, and nearly half of all cancer patients undergo radiotherapy. Anxiety is one of the most common psychological response during cancer therapy for radiotherapy. Th e use of educational media, internet, applications are eff ective approaches to pretreatment education. Th ere are existing more information about radiotherapy on the web. Cancer navigation nurse can also perform symptom management during radiation treatment, with ap¬plications for pre-treatment education. Conclusion: Radiotherapy, following chemotherapy or breast surgery, is a complicated process and need to be well managed. Th e patients with complaints of previous treatments are vulnerable to radiation therapy side eff ects. Cancer navigation nurse can help for optimization of multiple therapies by close monitoring these patients.

Biography:

Abstract:

Background & Aim: Th e use of urinary catheterization in neck of femur fracture patients is oft en debated as common best practice to manage and appropriate fl uid assessment. Routine catheterization increases the risk bacteraemia, genitourinary injury, worsening mobility, risk of pressure sores and predisposition to delirium and falls. Th ere is a need for increased awareness of urinary catheterization management in conjunction with healthcare-associated infections. NHS improvement has issued a letter aiming to half healthcare-associated Gram-negative bacteraemia, the majority of which is catheter-related. Th is project aims to identify barriers to safe catheter care in the orthopedic population by determining if management of urinary catheters is complaint with NICE quality standards (QS61). Introduction: Appropriate perioperative care can help manage the associated risk of neck of femur fractures. Th e British Hip Society and British Orthopedic Association have provided little guidance on postoperative care and risk management. Appropriate catheter care will improve overall patient care but reducing mortality and associated morbidity by shortening stay by early mobilization and management of complications. Method: All catheterized trauma and orthopedic patients in a district general hospital over one month (February) were included 67% of which had sustained neck of femur fractures. Data from nursing and doctors’ records on the following parameters were collected: Demographics, the reason of admission, indication/location for catheterization and responsible clinician; the number of days catheterized, the reason for the retention of catheterization and management of suspected/confi rmed catheter-related infection. Data were collected in April following the implementation. Intervention: A urinary care pathway was launched based on the Houdini algorithm and educational seminars for medical and nursing staff were conducted. Results: Mean age of patients was 78. Initial data was suggestive of poor documentation and prolonged, inappropriate retention of urinary catheterization and not in accordance with current guidance. Data was recollected in April aft er the launch of the pathway; data was indicative of marginal improvement of catheter care management, reduced time of catheter retention, improved documentation likelihood of review. Conclusion: Incorporating a catheter care pathway in managing orthopedic patients has shown improvement in the overall documentation and management of urinary catheterization. Despite this improvement demonstrated, implementation of the pathway is still substandard. Th is pathway will be incorporated into an innovative integrated neck of femur pathway in June.

Biography:

Mohammad Ummair completed his MBBS at the Khyber Medical College of Pakistan and has recently fi nished his foundation training in the UK. He is currently enrolled in a post-graduate certifi cation (clinical education) with the University of Dundee. He has published one paper in a peer-reviewed journal and his future aspirations are to pursue a career in surgery.

Abstract:

Background & Aim: Laparoscopic cholecystectomy is the most common, minimal invasive procedure in general surgery and has replaced the invasive procedure of open cholecystectomy in the treatment of gall stones. In this study, we wanted to determine the frequency of conversion to open cholecystectomy in elective cases that underwent laparoscopic procedure. Materials & Method: Th is was a retrospective study conducted in surgical department of Northwest General Hospital and Research Center, Peshawar, Pakistan. All the cases were performed by a single experienced General and Laparoscopic Surgeon. All patients who underwent laparoscopic cholecystectomy (n=531) from September 2012 to April 2018 were identifi ed from the medical records maintained in the Department of Health Information and Management Systems. Th ey were considered as 'converted' if laparoscopic cholecystectomy was started initially but due to any reason it could not be continued safely and a conversion to open was necessitated. Cases that required conversion to open procedure in laparoscopic cholecystectomy were analyzed. Th e frequency of conversion to open and the factors responsible for such conversion were also noted. Results: A total of 531 patients were included in the study. Th e mean age was 48.82 years with a standard deviation of 15.06 years. Male and female patients were included in the study. Gender distribution among the 531 patients was analyzed and showed that 115 (21.7%) of those recruited were male and the majority 416 (78.3%) were female. All patients were given standard laparoscopic surgery protocol under general anesthesia. 54 (10.2%) patients were converted to open cholecystectomy whereas 477 (89.8%) ended up with planned laparoscopic procedure. Conclusion: Th e conversion rate to open cholecystectomy in laparoscopic cholecystectomy in our study was 10.2%. Th e most common cause of conversion was gall bladder empyema and adhesion around gall bladder.

Biography:

Edmund Tan Wooi Keat has completed his Bachelors of Medicine and Bachelors of Surgery (MBBS) in 2016 from University of Malaya with Best Overall Achievement Award. In addition, he also completed his MRCS exams held by Royal College of Surgeons Edinburgh in 2018 and currently a Member of the Royal College of Surgeons. Currently, he is working as a Medical Offi cer in General Surgery Department, Sengkang General Hospital.

Abstract:

Osteomas are slow growing bone tumors and are oft en asymptomatic and slow growing. Rarely, they can be present in the temporal bone - only few cases had been reported, with incidence of 0.1-1%. We describe a case of an osteoma of the temporal bone (retromastoid) found in a 40 year old female, who presented with a slow growing swelling behind the right ear for 9 years. Diagnosis was made on non-contrast Computed Topography (CT) of the skull. Osteomas are primary benign bone tumors. Most osteomas are asymptomatic, have a tendency to grow slowly. Surgical resections are mainly performed in symptomatic cases with constant pain, neurological symptoms and extension to adjacent structure or cosmetic alterations.

Biography:

Hetish M Reddy is a Budding Surgeon and alumni of KIMS, Bengaluru. He has worked in the Department of Emergency Medicine and Nephrology as a Junior Resident in St. John's Medical College, Bengaluru. He is currently doing his Residency in Surgery from SMS Medical College, Jaipur. He has one publication to his credit.

Abstract:

Introduction & Aim: Pancreaticoduodenectomy (Whipple procedure) is the procedure of choice for tumors in and around the periampullary region. Th is major procedure consists of three important anastomoses, namely the hepaticojejunostomy, gastrojejunostomy and Pancreaticojejunostomy (PJ) or Pancreaticogastrostomy (PG). Our objective is to assess the outcome of PG in comparison with PJ in our center in terms of postoperative complications, duration of procedure, hospital stay and mortality. Methods: All the patients diagnosed with periampullary mass and found to be resect able were included in our study aft er obtaining due consent and randomly allocated into two groups for PG (Group-A) and PJ (Group-B). CT with pancreatic protocol was performed for all patients along with routine pre-operative workup. Demographic data, operative time and postoperative complications like Pancreatic Fistula (PF), duration of hospital stay and outcome were documented. All patients were followed up for minimum period of 90 days. Results: 25 patients in Group-A (17 males and 8 females) had a mean age of 52.6 years while 25 patients in Group-B (19 males and 6 females) had a mean age of 58.5 years. In Group-A, 4 patients (16%) and in Group-B, 6 patients (24%) developed PF which was confi rmed by drain fl uid analysis. Mean duration of hospital stay was 12.3 days in Group-A and 13.7 days in Group-B. Early mortality (during hospital stay) was much higher in Group-B (3 patients, 12%) than Group-A (1 patient, 4%) while there was no signifi cant diff erence in 90 day mortality. Mean operative time for Group-A was 5.4 hours and 5.3 hours for Group-B. Conclusion: Even though both PG and PJ are routinely done during Whipple procedure with almost similar outcomes in literature, in our study PG was found to be better than PJ in terms of overall post-op complications, duration of hospital stay and early mortality although there was no signifi cant diff erence in operative time and overall mortality

Biography:

Massimo Pezzatini has obtained his Residency Diploma in General Surgery in 2014 from the University of Rome “La Sapienza” and later worked in the University Hospital for several years as a Researcher in the Department of Surgery. Presently he is a part of the Surgical Team of the Surgical Oncology Division of the Regina Apostolorum Hospital in Albano Laziale. He has published more than 25 papers in reputed journals.

Abstract:

ERAS protocol and Indocyanine Green Fluorescence Angiography (ICG-FA) represent the new surgical revolution minimizing complications and shortening recovery time in colorectal surgery. As of today, no studies have been published in the literature evaluating the impact of the ICG-FA in the ERAS protocol for the patients suitable for colorectal surgery. Th e aim of our study was to assess whether the systematic evaluation of intestinal perfusion by ICG-FA could improve patients outcomes when managed with ERAS perioperative protocol, thus reducing surgical complication rate. Th is is a retrospective case-control study. From March 2014 to April 2017, 182 patients underwent laparoscopic colorectal surgery for benign and malignant diseases. All the patients were enrolled in ERAS protocol. Two groups were created: Group-A comprehended 107 patients managed within the ERAS pathway only and Group-B comprehended 75 patients managed as well as with ERAS pathway plus the intraoperative assessment of intestinal perfusion with ICG-FA. Two board-certifi ed laparoscopic colorectal surgeons jointly performed all procedures. Six (5.6%) clinically relevant Anastomotic Leakages (AL) occurred in Group-A, while there was none in Group-B, demonstrating that ICG-FA integrated in the ERAS protocol can lead to a statistically signifi cant reduction of the AL. Mean operative time between the two groups was not statistically signifi cant. In fi ve cases (6.6%), the demarcation line set by the fl uorescence made the surgeon change the resection line previously marked. Th e prevalence of all other complications did not diff er statistically between the two groups. Our study confi rms that combination between ICG and ERAS protocol is feasible and safe and reduces the anastomotic leakage, possibly leading to consider ICG-FA as a new ERAS item.

Biography:

Shubhanshu Gaurav is currently a Resident Doctor pursuing Post-graduation in General Surgery from Sawai Man Singh Medical College, Jaipur, India. He is a proactive and high performing professional with expertise in ICU management, trauma, critical care, tetanus and emergency surgeries. He has three publications to his credit.

Abstract:

Introduction & Aims: Pancreaticoduodenectomy is the preferred treatment of periampullary tumors. Our objective is to assess the long-term outcome of laparoscopic pancreaticoduodenectomy and to identify preoperative and intraoperative factors infl uencing the outcome. Methods: All the patients diagnosed to have periampullary mass were consented and included in our study randomly, irrespective of histology. CT scan with pancreatic protocol was performed in every patient for preoperative workup along with routine blood investigations and liver functions. Demographic data, operative time, intra operative complications, length of hospital stay, post-operative complications and pathologic analysis of resected specimen were recorded. Patients with carcinoma head of pancreas, duodenum or contraindicated otherwise were not included in our study. Results: Ten patients underwent total laparoscopic pancreaticoduodenectomy for periampullary tumor. Th ere were three females and seven male patients with a mean age of 45 years. Th e mean operative time was 6 hours. Postoperatively, there were no complication and a mean length of post-operative hospital stay was 8 days. Th e histopathological result includes adenocarcinoma with negative resected margins and negative nodes in all the patients. Conclusion: Total laparoscopic pancreaticoduodenectomy is a better alternative to the standard Whipple procedure with decreased length of hospital stay, quick recovery, improved quality of life, and lesser complications.

Biography:

Puneet K Agarwal has completed his MBBS degree and Masters in Surgery (MS) from Jawaharlal Medical College, a reputed medical school affi liated to Aligarh Muslim University, Aligarh. Presently he is working as an Associate Professor in Department of Surgery in All India Institute of Medical Sciences Bhopal, an autonomous institute of national importance and affi liated to Government of India. He has published more than 25 articles in different journals.

Abstract:

Introduction: Gallbladder agenesis is a rare congenital abnormality of the biliary tract. Th e diagnosis is usually made during surgery. It has been proven to be very diffi cult to make a correct preoperative diagnosis of agenesis of the gallbladder in symptomatic patients. Th e purpose of this presentation is to share our experience about a case of middle-aged lady who presented with symptoms of biliary colic. Ultrasound examination revealed cholelethiasis with contracted gallbladder. On Contrast CT examination gallbladder could not be visualized. On further imaging as MRCP diagnosis of gallbladder agenesis could be confi rmed. Th is helped in avoiding unnecessary surgery and patient was conservatively treated. Clinical Case: A middle-years lady presented to surgical department with symptoms of right upper abdominal pain and dyspepsia. On examination she was hemodynamically stable and there was no fever. On examination abdomen was soft with negative Murphy’s sign and active peristalsis. Laboratory tests were within normal limits. Ultrasound imaging revealed cholelethiasis with contracted gallbladder. Subsequently the Contrast CT scan of abdomen was done which revealed non-visualization of gallbladder and cystic duct. Further to confi rm MR cholangiogram was done and the gallbladder and cystic duct were found to be absent with rest of the extra hepatic biliary tree to be normal. Conclusion: Agenesis of the gallbladder is a very rare condition and can create diffi culties for surgical team when diagnosed during Laparoscopic Cholecystectomy. With the development of better imaging modalities it has been possible to diagnose gallbladder agenesis before surgery. Correct preoperative diagnosis can help to avoid unnecessary surgeries and reduce exploration complications. Discussion: It is estimated that 23% of patients with gallbladder agenesis present with symptoms of biliary colic. Out of these patients, 90.1% will present colicky pain in the right hypochondrium, 66.3% with post prandial nausea and vomiting, 37% with acid peptic symptoms and 27% CBD stones. Th ese symptoms can be attributed to the theory of biliary dyskinesia. It is well known that ultrasound is the imaging technique of choice to assess the gallbladder; but diffi culty in reporting arises when gallbladder is either contracted or atrophic. WES ((Wall, Echo and Acoustic shadow) triad was described for diagnosis of gallstones. Some ultrasound examinations performed on patients of agenesis of gallbladder can report cholelethiasis and this can be explained owing to the fact that radiologist can misdiagnose the periportal tissue, subhepatic peritoneal folds, duodenum or calcifi ed hepatic lesions with the WES triad.

Biography:

Rajendra Bagree is a Senior Professor in the Department of General Surgery, SMS Medical College, Jaipur, India. Working in this fi eld since 20 years, he has an experience of 17 total laparoscopic Whipple's procedures. He has an incredible experience of performing more than 5000 laparoscopic cholecystectomies. He has 15 publications so far and another 8 in the pipeline.

Abstract:

In the era of refl ex diseases of GIT, the laparoscopic Heller’s cardiomyotomy with Dor’s repair is the gold standard treatment for achalasia cardia aft er failure of the medical management. We reviewed our results of laparoscopic cardiomyotomy over a 30 month period. In series of 25 cases of GI refl ex disease which was reported to us aft er failure of medical management, typically presented with bird beak appearance in barium swallow. Every patient was investigated thoroughly and planned for laparoscopic Heller’s cardiomyotomy with Dor’s repair (5 cm esophageal and 1 cm cardiomyotomy). Duration of surgery was approximately 60 minutes without any complications and patient started orally clear fl uids on same day postoperatively and semisolid started on day-2 post-operatively. Patient is discharged on 2-3 days of hospital stay with excellent outcomes. To conclude the laparoscopic Heller’s cardiomyotomy with Dor’s repair is the gold standard surgical treatment, which reveals better cosmetics, prompt recovery with least morbidity and early resumption of work with expertise.

Biography:

Mohammad M R Miah has completed his MRCS in 2016 from Royal College of Surgeons of England. He is working in Surgery as a middle grade Surgeon under NHS England. He has completed multiple audits and quality improvement project as a lead Auditor and presented in many national and international conferences.

Abstract:

Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax as a result of injury to the Internal Mammary Artery (IMA). Isolated internal mammary injury is a very rare cause of massive haemothorax and associated with high mortality. Massive tension haemothorax resulting from penetrating internal mammary artery injury, managed with anterior minithoracotomy with uneventful recovery, as in our case, has not been reported yet. Nevertheless, injury to IMA is infrequently reported in literature. It can be a result of penetrating or blunt trauma but still with serious consequences. We are presenting this 32 year old gentleman who sustained a thoracic stab wound. He was in hypovolemic shock with a blood pressure of 80/45 mm Hg and pulse rate of 120 beats per minute. Stab wound was noted in his right anterior chest wall medial to mid-clavicular line and in right parasternal area at 3rd inter costal space measuring about 3 cm × 1 cm with intra thoracic extension. He had an emergency right anterior mini-thoracotomy by extending the stab wound rather than standard thoracotomy or sternotomy and discharged with no complication. Th is potentially life threating injury can be managed by mini-thoracotomy with enhanced recovery; however, it is case specifi c and needs proper judgement.

Biography:

Abstract:

Background: Sentinel lymph node biopsy is used widely for the management of breast cancer. Axillary lymph node involvement is a very good prognostic indicator in breast cancer. It is the fi rst node draining the primary tumor and is the fi rst node to be involved by the cancer. Objectives: Th e purpose of this study was to fi nd out the accuracy, sensitivity and specifi city of this procedure in our setting by using methylene blue dye. Study Design: Case series. Duration: From February 2017 to December 2017 at Sir Ganga Ram Hospital Lahore. Sampling: Purposive simple random technique. Methods: Forty two (42) patients were selected with diagnosis of breast carcinoma and impalpable axillary nodes clinically. Sentinel lymph node biopsy was performed by using 01% methylene blue dye in subareolar region followed by axillary clearance with mastectomy at the same time. Th e blue stained lymph node and the breast tissue with axillary dissection was sent for histopathology. Results: Out of 42 patients true positive results were in 39 cases i.e. metastasis detected in 16 cases in sentinel node and so in the axillary nodes, in 33 patients no metastasis found in sentinel as well as in axillary nodes, only in 3 cases false negative results seen there were no false positive. Sensitivity was 92% and specifi city 99%. Conclusion: Sentinel lymph node biopsy using methylene blue dye is a safe, feasible and cost eff ective procedure to identify the sentinel lymph node in patients of breast cancer with impalpable axillary nodes. In our study this technique is proved to be eff ective in staining the sentinel lymph node by which unnecessary axillary dissection can be avoided in breast cancer surgery.

Biography:

Mohammad M R Miah has completed his MRCS in 2016 from Royal College of Surgeons of England. He is working in Surgery as a middle grade Surgeon under NHS England. He has completed multiple audits and quality improvement project as a lead Auditor and presented in many national and international conferences.

Abstract:

Atrial fi brillation is the most common heart rhythm disorder. Postoperative Atrial Fibrillation (POAF) is oft en self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. AF has been reported in up to 15 to 40% of patients in the early postoperative period aft er CABG. In patients undergoing CABG, the consistent use of β-blockers was associated with a lower risk of long-term mortality and composite cardiac and cerebrovascular events. β-blockers administration reduces the incidence of POAF from 30-40% to 12-16% aft er CABG. In the European Society of Cardiothoracic Surgery 2006 guidelines the perioperative use of β-blockers is recommended as the fi rst choice in all patients undergoing CABG, unless otherwise contraindicated. Retrospective data were collected for consecutive 400 patients treated with isolated CABG between August 2017 and October 2017. According to the standard guidelines all patient undergoing CABG should receive β-blockers on immediate postoperative period that is within 24 hours. So, those patients who received β-blockers on the day of surgery or the following morning met the standard guidelines. Th us, according to the data 32% of the patients met the standard guideline. Th e rate of AF was signifi cantly higher in those who were without β-blockers in their postoperative period. In patients undergoing CABG, the consistent use of β-blockers is associated with a lower risk of long-term mortality. β-blockers signifi cantly reduce the incidence of AF aft er CABG. Considerable attention must also be focused on understanding and improving β-blocker use at perioperative period.

Biography:

Khayria Hamid Tahir has completed MBBS from Batterjee Medical College in Saudi Arabia and procedeed to take her Internship at Saudi German Hospital Group Jeddah branch. During her internship she took her electives in General Surgery and Cardiology.

Abstract:

ERAS is the acronym for “Enhanced Recovery Aft er Surgery”, this term is used to describe a set of multimodal interventions that improve post-operative outcomes through reducing complications and accelerates recovery. Th is article gives a brief history and defi nition of ERAS in addition to discussing how ERAS works in improving postoperative outcomes and steps included in the protocol. Furthermore, this paper uses systemic review and meta-analysis methods by collecting and comparing diff erent studies conducted internationally to determine the eff ectiveness of the protocol and whether it should be applied as a measure to optimize operative outcome in Saudi Arabia. Th e article also displays results of seven studies comparing ERAS groups to traditional perioperative care groups in complications, length of stay, reoperation, readmission and total hospital costs.

Biography:

Gaurav Jalendra is a currently a General Surgery Resident at SMS Medical College, Rajasthan, India. He has completed his MBBS from Government Medical College, Kota, Rajasthan. He has published one case report to his credit.

Abstract:

Aims: Inguinal hernia is among the most common entity encountered in surgical OPD and in the era of minimal invasive surgery Total Extraperitoneal Repair (TEP) is procedure of choice. In this study we are comparing extraperitoneal dissection by plain telescopic and balloon dissection in terms of complications (intraoperative and postoperative including post-op pain and recurrence) and duration of hospital stay. Methods: 50 cases of inguinal hernia, suitable for laparoscopic procedure, were randomly allocated into two groups, 25 in each, Group-A (Balloon dissection) and Group-B (Plain telescopic dissection) aft er obtaining written informed consent. Glove fi nger was used as balloon for dissection in Group-A. Intraoperative, postoperative complications, operative time and hospital stay were documented and patients were followedup for a year for recurrence. Results: Group-A had 24 males and 1 female with mean age of 55.4 years and Group-B had 23 males and 2 females with mean age of 57.2 years. 55% of inguinal hernia were bilateral. Peritoneal breach was noted in 10 patients in Group-A and 16 patients in Group-B. Two cases were converted in TAPP in Group-B. Postoperative complications like pain, which was measured by Visual Analogue Scale (VAS) at 6 hour post-op had mean value of 2.7 for Group-A and 4.1 for Group-B, Scrotal edema (16% in Group-A and 24% in Group-B) and seroma (12% in Group-A and 56% in Group-B). Mean operative time was 1.68 hours in Group-A and 1.40 hours in Group-B. Conclusion: Aft er meticulous data analysis we found that balloon dissection has lesser rate of complications both intra and postoperatively, while there was no signifi cant diff erence in hospital stay. Th e operative duration was slightly higher in Group-A. Th us we conclude that balloon dissection in TEP is better approach than plain telescopic dissection.

Biography:

Chryssa Wei Yin Neo is currently pursuing MSc in Surgical Sciences at the University of Edinburgh, UK

Abstract:

Aneurysm of the iliac arteries, especially of the internal iliac artery is rare. Clinically, patients like these pose a challenge to clinicians. Th ey can mimic other more common pathologies due to the site of pain and clinical parameters at presentation. We have described a case of a 75-year-old man who presented overnight with collapse and back pain radiating to left iliac fossa. As a small district general hospital, one of the main limitations compared to those of larger tertiary centres, is the access to on-call specialist services including that of radiology. He was fi rst treated as intra-abdominal sepsis, however, following unsuccessful fl uid resuscitation, an urgent CT scan was requested, which revealed an actively leaking left internal iliac aneurysm with a large retroperitoneal haematoma. Th is case highlights the importance of the diagnostic uncertainty to identify vascular lesions as it may require a diff erent approach in terms of management plan.

Biography:

Syed Ghazanfar Imam is a Budding Surgeon and alumni of LLRM Medical College, Meerut, India. He has worked in Department of Forensic Medicine and Biochemistry as a Junior Resident in AIIMS Delhi. He is currently doing his Residency in General Surgery from SMS Medical College, India. He is a proactive and high performing professional with expertise in ICU management, trauma, critical care, tetanus and emergency surgeries. He has one publication to his credit.

Abstract:

Aim: In the era of minimal invasive surgery, we share our experience of 10 hydatid cyst cases, which was laparoscopically managed irrespective of the involved primary organ like liver, spleen, kidney and lung. Methods: All the patients diagnosed with hydatid cyst were consented and included in our study randomly. USG and CT scan was performed in every patient for pre-operative workup along with routine blood investigations. Demographic data, operative time, intra-operative complications, duration of hospital stay and post-operative complications were recorded. Results: 10 patients underwent laparoscopic hydatid cyst drainage with deroofi ng and marsupialization of cyst, there were 6 female and 4 male patients with mean age of 30 years. Th e mean operative time was about 45 minutes, post-operatively there were fewer complications which was managed successfully and mean hospital stay duration about 5 days. Conclusion: To conclude the hydatid cyst management reveals excellent with laparoscopic management with better outcome.

Biography:

Alistair Moore Littlewood is a Foundation Year 2 Doctor currently working in Glasgow, Scotland in the Emergency Department. He has graduated from the University of Exeter in 2018 with a Bachelor of Medicine Bachelor of Surgery degree. He is currently undertaking a Diploma in Expedition Medicine and has an active interest in orthopedic surgery.

Abstract:

A 55-year-old-man presented to the Dumfries and Galloway Royal Infi rmary with right knee pain aft er falling from a swing. X-rays showed a separated bipartite patellar but with persistent pain and swelling, clinical suspicion was raised for an additional quadriceps tendon rupture. Subsequent ultrasound imaging confi rmed this and the patellar and tendon rupture was repaired without complication. Aft er searching the literature, we only found 6 reported cases of combined bipartite patellar fracture along with a ruptured quadriceps tendon. Th is case highlights the diagnostic uncertainty attributed to patients such as these and the importance of a good clinical approach to accurately guide treatment.

Biography:

Aim: Laparoscopic unilateral inguinal hernia repair is perceived to have longer operating times. However, laparoscopic inguinal hernia repair is known to be equally safe and more effi cient when compared to open repair in short term outcomes. We evaluated the procedure times in Royal Oldham Hospital. Method: We retrospectively analyzed the prospectively maintained data on the Operating Room Management Information System (ORMIS) looking at the operating times for both laparoscopic Transabdominal Preperitoneal (TAPP) and open repair of unilateral and bilateral inguinal hernia repair. We looked at the operations between 2014 and 2019 done by four surgeons who each had more than 5 years of laparoscopic experience, performing more than 40 hernia repairs each year. Data included total 308 procedures, 172 TAPP (55.8%) of which 133 unilateral (77%) and 136 open repairs (44.2%) of which 126 unilateral (96%). Results: Average time for unilateral TAPP was 44.08 minutes ranging from 25 to 106 minutes compared with 54 minutes for open repair ranging from 23 to 103 minutes. Conclusion: Our study shows TAPP repair is on average quicker than open repair. We can say that aft er passing the learning curve of laparoscopic surgery, it becomes signifi cantly quicker than open repair.

Abstract:

Biography:

Ashfaq Ahmed did his Bachelor in Medicine and Surgery at age of 22 years from Khyber Medical University, Pakistan. Then He did Master in Public Health From Sarhad Universty ,Pakistan. After that he did FCPS in Orthopedics and Spine Surgery from College of Physicians and Surgeons, Pakistan. At 2018. Currently he is working as a Senior Registrar at Ghurki Hospital, Pakistan as well as Fellowship in Spine Surgery. He is also running Research Department at his own Hospital. He has attended multiple national as well as International Conferences and presented papers. He has published upto now 48 papers at National and International Papers. During his bachelor degree ,He was awarded multiple Gold medals during his student life.

Abstract:

Background: Tibiotalocalcaneal arthrodesis is a salvage and procedure of choice for hindfoot problems that aff ect both the ankle and subtalar joints. Th e indications for this surgery are arthritis, neglected ankle trauma, osteonecrosis of the talus, severe mal-alignment deformities and signifi cant hindfoot bone loss. Objective: To determine the clinical and radiological outcome of tibiotalocalcaneal arthrodesis with retrograde intramedullary sign nail in patients with tibiotalar and subtalar joint pathologies. Materials & Methods: It was descriptive case study on 100 patients from September 2012 to December 2016 admitted either through OPD or Emergency at Orthopedics Unit of Ghurki Trust Teaching Hospital Lahore. Aft er taking detailed history, clinical examination and investigations, the patients underwent ankle arthrodesis using retrograde sign nail under image control. Patients were discharged on 2nd or 3rd post-operative day and followed in Out Patient Department. Splint was advised for 2-3 weeks and non-weight bearing for 6 weeks. Radiographs were done on follow up visit to assess the alignment and later to assess healing. Patients were allowed weight bearing aft er 6 weeks. Outcome measures were assessed in the form of radiological bony union, AOFAS score, patient satisfaction score and post-operative complications related to the procedure. Data were initially entered on preformed pro forma and later on SPSS 17.0 version were used for data analysis. Results: Th ere were 100 patients who underwent arthrodesis and fi xation. Th ere were 82% male and 18% female with mean age of 41.5±4.5 years. Th e patients who need this procedure having diff erent pathologies; among them 23 having rheumotoid arthritis, 59 were post-traumatic, 11 having degenerative osteoarthritis and 7 having neuropathic pathology. Aft er 12 months radiological union were found in 91 patients (91%), non-union in 4 patients (4.0%) and 5 patients were lost in follow up. Pain improves in all 91 (91%) patients who having radiological union and were fully satisfi ed with the procedure. Among 4 patients with non-union, 3 patients having wound infection and they need revision surgery. Mean follow up time was 4.5 months (2-7 months). 90% of the patients achieved radiological bony union at last follow up. Th e mean improvement in the AOFAS score was 73 and visual analogue score were 88±5. Conclusion: Arthrodesis is an end stage procedure should be considered only aft er all conservative treatments fails. Tibiotalocalcaneal fusion with retrograde nailing and bone graft ing is a successful salvage procedure in severe ankle and hindfoot arthrosis with deformity. Patient satisfaction rate is high, though infection is major problem and precautions should be taken to reduce its incidence.

Biography:

Mohd Abdul Hadi Mohd Anuar is currently pursuing Masters of General Surgery in University of Malaya, Kuala Lumpur. He has completed MBBS degree in University of Malaya in the year 2011 and has been working as Surgical Trainee for 6 years.

Abstract:

Overall incidence rate for colorectal cancer was 21.3 cases per 100,000 population and venous thromboembolism occurs in 100/100,000 population/year. Abdominal and pelvic malignancy surgery and prolonged immobilization aft er surgery further increase risk for DVT. Colorectal cancer patients going for a curative surgery are categorized in a moderate risk group to develop DVT. Today, DVT prophylaxis has proven signifi cant reduction of surgery related DVT risk and its complications. Early mobilization aft er surgery in modern practice has proven to reduce risk of DVT, resulting in shorter hospitalization. Suffi cient data is not available for this group of patients in Malaysia. Th is single centre, non-randomized cohort study was designed to evaluate the incidence of DVT in colorectal cancer surgery patients receiving shorter duration of DVT prophylaxis as a result of shorter average length of hospital stay. 57 patients were recruited and 1 excluded from the study. Only 1 (1.8%) patient was diagnosed with symptomatic DVT at day 7 post-operation despite receiving standard local practice of DVT prophylaxis and none were diagnosed with asymptomatic DVT. No relation between shorter duration of DVT prophylaxis as a result of shorter hospital stay with risk of developing DVT was seen within the study period. Hence, early mobilization and return to pre-morbid activities are essential in preventing DVT for these patients.

Biography:

Abstract:

Background & Aim: Endotracheal intubation is one of the basic prerequisites of general anesthesia. Recovery of patients is delayed due to the development of post-operative nausea, vomiting, sore throat and shivering. Th is study was conducted to determine role of dexamethasone for improved recovery of patients. Methods: Th is randomized controlled trial was performed in the Department of Anesthesia, Ayub Teaching Hospital, Abbottabad from June to November 2018. 112 consenting patients of both genders, aged between 18 to 60 years, American Society of Anesthesiologists (ASA) I and II, scheduled for general surgeries of 60 minutes to 180 minutes duration under general anesthesia were included. Patients with long duration surgeries, anticipated diffi cult airways, nasogastric tube in situ, upper respiratory tract infections, on steroid therapy and critically ill and emergency surgeries were excluded. Th ey were randomly allocated into two groups by lottery method as dexamethasone (Group-A, n=61) or Placebo (Group-B, n=61). Post-operative nausea, vomiting, sore throat were observed at 2, 12 and 24 hours, shivering was observed at 2 hours only and patient satisfaction at 24 hours post-operatively. Results: Group-A patients had statistically proven better outcomes at 2, 12 and 24 hours for post-operative sore throat, nausea and vomiting, shivering was controlled in 24.5% p-value (0.006). Patient satisfaction was found in 83.6% of Group-A patients. Conclusion: Th us dexamethasone is eff ective drug for prevention of postoperative nausea, vomiting, sore throat and shivering in general surgical procedures thus improving patient satisfaction and their early discharge.

Biography:

Ashfaq Ahmed did his Bachelor in Medicine and Surgery at age of 22 years from Khyber Medical University, Pakistan. Then He did Master in Public Health From Sarhad Universty ,Pakistan. After that he did FCPS in Orthopedics and Spine Surgery from College of Physicians and Surgeons, Pakistan. At 2018. Currently he is working as a Senior Registrar at Ghurki Hospital, Pakistan as well as Fellowship in Spine Surgery. He is also running Research Department at his own Hospital. He has attended multiple national as well as International Conferences and presented papers. He has published upto now 48 papers at National and International Papers. During his bachelor degree ,He was awarded multiple Gold medals during his student life.

Abstract:

Introduction: Magnetic resonance imaging is necessary pre-operatively to assess the prevalence of structural and functional abnormalities within the spinal cord in patients with scoliosis. Th ere is no consensus on the use of MRI in these patients pre-operatively. MRI, echocardiography and ultrasound should be a part of routine evaluation in all these patients before surgery, no matter positive clinical fi ndings were found or not. Objective: Th e main objective of this study was to analyze the occult spinal pathologies associated with diff erent types of scoliosis. Methodology: Th is was a prospective study include 89 patients who was diagnosed as a case of scoliosis and were planned for scoliosis surgery from January 2015 to December 2018 aft er Hospital Ethical Committee approval and written informed consent from the patients. Th e patients who were unfi t for surgery or managed conservatively were excluded from the study. All the patients underwent magnetic resonance imaging preoperatively. Th e MRI fi ndings of these patients were initially recorded on a pre formed pro forma and then analyzed using SPSS 21.0 version. Results: Th ere were 29 (33.37%) males and 58 (66.67%) females with male to female ratio of 0.5:1 and with mean age of 14.54±2.34 years. Th ere were 56 (64.4%) idiopathic and 31 (35.6%) congenital scoliosis. Among diff erent pathologies, 4 (04.59%) patients were having diastomyelia, tethered cord in 2 (2.29%) patients, syringomyelia in 10 (11.49%) and Chiari malformations in 2 (2.29%) patients; no patients having diplomyelia and lipoma, dural defects in 2 (2.29%), conus 9 (10.34%) and 1 (1.15%) foramen magnum compression. Among other rare anomalies, hydromyelia was found in 3 (3.44 %), tonsillar ectopia in 2 (2.29%) and OS odontoideum in 1 (1.14%). Only 5 (5.74%) of patients having neurology involved while having neurology intact. Conclusion: Patients with scoliosis having diff erent pathologies that cannot be determined on examination and X-rays. Pre-operative magnetic resonance imaging is essential to determine these diff erent types of pathologies found in these patients before undergoing any surgical intervention.