Journal of Surgical Research and Reviews (ISSN: 3041-4857)
The Journal of Surgical Research and Reviews (ISSN: 3041-4857) is an international, open-access scientific journal dedicated to publishing high-quality research, reviews, case reports, and scholarly articles in the field of surgery and allied disciplines. The journal was originally published by Wisdomgale Publishing, Belgium, under the ownership of Assoc. Prof. Recai Ogur, MD, PhD., and manage by eJManager online journal management system. On 21 June 2026, the complete transfer of publication rights was formally signed with the International Medical Publishing Group (IMPG), India. With effect from the date of transfer, the publication and management of the journal will continue on the International Medical Publishing Group (IMPG), India platform. The journal will operate under the editorial supervision of Dr. Pravesh Verma (Managing Editor, Email: editor@internationalmedicalpublishing.com) & Dr. Abhishek Gupta (Publishing Editor), Assistant Professor, Department of Molecular Medicine, University of Texas Health Science Center, San Antonio, TX, USA. (Email:Guptaa4@uthscsa.edu). The journal remains committed to promoting ethical, transparent, and high-quality scientific publishing, with the aim of advancing surgical knowledge and supporting researchers, clinicians, and academicians worldwide. All previously published issues of the journal are available in the archive at https://www.wisdomgale.org/jsrr/
International Medical Publishing Group (IMPG), India
Pre-intubation Shock Index as a Predictor of Post-intubation Hypotension in Adult Patients Undergoing Emergency Endotracheal Intubation: A Retrospective Observational Study
Introduction: Post-intubation hypotension (PIH) is a common complication of emergency endotracheal intubation and is associated with increased morbidity and mortality. Early identification of high-risk patients may enable timely hemodynamic optimization. The Shock Index (SI), calculated as heart rate divided by systolic blood pressure, is a simple bedside marker of circulatory instability. Aim & Objective: This study evaluated the incidence, predictors, and clinical impact of PIH, with emphasis on the predictive value of pre-intubation SI. Materials & Methods: This retrospective observational study included adult patients undergoing emergency endotracheal intubation at a tertiary care emergency department. Of 435 patients screened, 280 met the inclusion criteria. Demographic, clinical, hemodynamic, and outcome data were obtained from the institutional airway registry and medical records. Independent predictors of PIH were identified using multivariable logistic regression, and receiver operating characteristic (ROC) analysis was used to assess the predictive performance of SI. Results: PIH occurred in 62 patients (22.1%). Patients with PIH were significantly older and had a higher prevalence of chronic obstructive pulmonary disease, chronic renal insufficiency, and diabetes mellitus. They also had higher pre-intubation heart rate, lower systolic blood pressure, and higher SI. PIH was associated with increased vasopressor use, post-intubation cardiac arrest, and in-hospital mortality. Pre-intubation SI was the strongest independent predictor of PIH (adjusted OR 48.6, 95% CI 11.2–210.0; P<0.001). ROC analysis demonstrated good predictive performance (AUC ≈0.75), with an optimal SI cutoff of 0.80 (68% sensitivity, 80% specificity). Conclusion: PIH is a frequent complication of emergency intubation with significant adverse outcomes. Pre-intubation SI is a simple, rapid, and reliable predictor that may facilitate early identification of high-risk patients and guide pre-intubation hemodynamic optimization. REFERENCES Tayal VS, Riggs RW, Marx JA, Tomaszewski CA, Schneider RE. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med. 1999;6(1):31-37. https://doi.org/10.1111/j.1553-2712.1999.tb00091.x Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31(3):325-332. https://doi.org/10.1016/s0196-0644(98)70342-7 Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive Care Med. 2008;34(10):1835-1842. https://doi.org/10.1007/s00134-008-1205-6 Mort TC. Complications of emergency tracheal intubation: hemodynamic alterations-Part I. J Intensive Care Med. 2007;22(3):157-165. https://doi.org/10.1177/0885066607299525 Jones AE, Yiannibas V, Johnson C, Kline JA. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. Chest. 2006;130(4):941-946. https://doi.org/10.1016/s0012-3692(15)51124-0 Heffner AC, Swords D, Kline JA, Jones AE. The frequency and significance of postintubation hypotension during emergency airway management. J Crit Care. 2012;27(4):1-5. https://doi.org/10.1016/j.jcrc.2011.08.011 Lin CC, Chen KF, Shih CP, Seak CJ, Hsu KH. The prognostic factors of hypotension after rapid sequence intubation. Am J Emerg Med. 2008;26(8):845-851. https://doi.org/10.1016/j.ajem.2007.11.027 Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med. 1994;24(4):685-690. https://doi.org/10.1016/b978-2-294-73408-3.00204-5 Rady MY, Rivers EP, Nowak RM. Resuscitation of the critically ill in the emergency department: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med. 1996;14(2):218-225. https://doi.org/10.1016/0300-9572(96)89045-9 Keller AS, Kirkland LL, Rajasekaran SY, Cha S, Rady MY, Huddleston JM. Unplanned transfers to the intensive care unit: the role of the shock index. J Hosp Med. 2010;5(8):460-465. https://doi.org/10.1002/jhm.779 Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma. 2009;67(6):1426-1430. https://doi.org/10.1097/ta.0b013e3181bbf728 Marks PL, Domm JM, Miller L, Yao Z, Gould J, Loubani O. The use of vasopressors to reduce post-intubation hypotension in critically ill adult patients undergoing emergent endotracheal intubation: a scoping review. Can J Emerg Med. 2024;26(11):804-813. https://doi.org/10.1007/s43678-024-00764-7 Adisasmita AC. Association between shock index and post-emergency intubation hypotension in patients who called the rapid response team at Dr. Cipto Mangunkusumo Hospital. Indones J Anesthesiol Reanim. 2023;5(1):27-36. https://doi.org/10.20473/ijar.v5i12023.27-36 Smischney NJ, Seisa MO, Schroeder DR. Association of shock indices with peri-intubation hypotension and other outcomes: a sub-study of the KEEP PACE trial. J Intensive Care Med. 2024;39(9):866-874. https://doi.org/10.1177/08850666241235591
Post-intubation hypotension; Shock Index; Emergency endotracheal intubation; Rapid sequence intubation; Hemodynamic instability; Emergency medicine
Copyright (c) 2026 Journal of Surgical Research and Reviews (ISSN: 3041-4857)
Histopathological Spectrum of Gallbladder Lesions & Factors Associated with Metaplastic Changes: A Cross-Sectional Study
Introduction: Gallbladder diseases are among the most common disorders requiring surgical intervention, with chronic cholecystitis and cholelithiasis accounting for most cholecystectomy specimens. Chronic inflammation induced by gallstones may result in metaplastic epithelial changes that represent important precursor lesions in gallbladder carcinogenesis. Aim & Objective: The present study evaluated the clinicopathological spectrum of gallbladder lesions and identified factors associated with metaplastic changes. Materials & Methods: This hospital-based observational cross-sectional study included 100 consecutive cholecystectomy specimens received in the Department of Pathology over 9 months (September 2024–May 2025). Clinical, demographic, dietary, and radiological data were collected from patient records. Histopathological examination was performed on hematoxylin and eosin-stained sections. Associations between clinicopathological variables and metaplastic changes were analyzed using the Independent Student's t-test, Chi-square test, or Fisher's exact test, followed by multivariable binary logistic regression. Results: Chronic cholecystitis with cholelithiasis was the most common histopathological diagnosis (57%), while metaplastic changes were identified in 14% of specimens. Patients with metaplasia were significantly older than those without metaplasia (p=0.048). Fat-rich diet (p=0.006), frequent fast-food intake (p=0.015), multiple gallstones (p=0.018), increased gallbladder wall thickness (p<0.001), abnormal body habitus (p=0.043), and weight loss (p=0.019) were significantly associated with metaplastic changes. Multivariable logistic regression identified increasing age (AOR 1.06), fat-rich diet (AOR 3.42), multiple gallstones (AOR 4.58), increased gallbladder wall thickness (AOR 1.87), and weight loss (AOR 2.94) as independent predictors of metaplastic changes. Conclusion: Chronic cholecystitis with cholelithiasis constituted the predominant gallbladder pathology. Metaplastic changes were significantly associated with chronic inflammatory and dietary risk factors, particularly multiple gallstones and increased gallbladder wall thickness. Routine histopathological examination of all cholecystectomy specimens is essential for the early detection of premalignant lesions and may facilitate timely identification of patients at increased risk for gallbladder carcinoma. REFERENCES Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-187. https://doi.org/10.5009/gnl.2012.6.2.172 Shaffer EA. Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981-996. Sharma P, Singh A, Singh S, et al. Gall bladder, cholelithiasis, cholecystitis, dysplasia, cancer. Natl J Lab Med. 2023;12(3):19-24. Parikh B, Parikh S, Upadhyaya P, Halpati M, Damor K, Vora V. Histopathological spectrum of gallbladder lesions and outcome of routine histopathological examination of cholecystectomy specimens. BJKines NJBAS. 2023;15(1):35-41. https://doi.org/10.56018/2023066 Jha V, Sharma P, Mandal KA. Incidental gallbladder carcinoma: utility of histopathological evaluation of routine cholecystectomy specimens. South Asian J Cancer. 2018;7(1):21-23. https://doi.org/10.4103/2278-330x.226802 Kalita D, Pant L, Singh S, Jain G, Kudesia M, Gupta K, et al. Impact of routine histopathological examination of gall bladder specimens on early detection of malignancy: a study of 4,115 cholecystectomy specimens. Asian Pac J Cancer Prev. 2013;14(5):3315-3318. https://doi.org/10.7314/apjcp.2013.14.5.3315 Reshetnyak VI. Concept of the pathogenesis and treatment of cholelithiasis. World J Hepatol. 2012;4(2):18-34. Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA. 1983;250(17):2323-2326. Seretis C, Lagoudianakis E, Gemenetzis G, Seretis F, Pappas A, Gourgiotis S. Metaplastic changes in chronic cholecystitis: implications for early diagnosis and surgical intervention to prevent the gallbladder metaplasia-dysplasia-carcinoma sequence. J Clin Med Res. 2014;6(1):26-29. https://doi.org/10.4021/jocmr1689w Duarte I, Llanos O, Domke H, Harz C, Valdivieso V. Metaplasia and precursor lesions of gallbladder carcinoma: frequency, distribution, and probability of detection in routine histologic samples. Cancer. 1993;72(6):1878-1884. Albores-Saavedra J, Henson DE, Sobin LH. The WHO histological classification of tumors of the gallbladder and extrahepatic bile ducts: a commentary on the second edition. Cancer. 1992;70(2):410-414. Roa JC, Tapia O, Cakir A, Basturk O, Dursun N, Akdemir D, et al. Squamous cell and adenosquamous carcinomas of the gallbladder: clinicopathological analysis of 34 cases identified in 606 carcinomas. Mod Pathol. 2011;24(8):1069-1078. https://doi.org/10.1038/modpathol.2011.68 Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014;6:99-109. Furlan A, Ferris JV, Hosseinzadeh K, Borhani AA. Gallbladder carcinoma update: multimodality imaging evaluation, staging, and treatment options. AJR Am J Roentgenol. 2008;191(5):1440-1447. https://doi.org/10.2214/ajr.07.3599 Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006;118(7):1591-1602. https://doi.org/10.1002/ijc.21683 Schmidt MA, Marcano-Bonilla L, Roberts LR. Gallbladder cancer: epidemiology and genetic risk associations. Chin Clin Oncol. 2019;8(4):1-14. https://doi.org/10.21037/cco.2019.08.13 Jain K, Sreenivas V, Velpandian T, Kapil U, Garg PK. Risk factors for gallbladder cancer: a case-control study. Int J Cancer. 2013;132(7):1660-1666. https://doi.org/10.1002/ijc.27777 Ali MA, Maslehuddin M, Jawed S, Ahmad MN, Jain SK, Narain NP. Role of demographic and dietary factors in predicting gall bladder carcinoma: findings of a case-control study. Int J Health Sci. 2022;6(6):2726-2739. https://doi.org/10.53730/ijhs.v6ns6.9919 Shukla VK, Chauhan VS, Mishra RN, Basu S. Lifestyle, reproductive factors and risk of gallbladder cancer. Singapore Med J. 2008;49(11):1-4.
Gallbladder; Cholecystitis; Metaplasia; Histopathology; Gallbladder carcinoma.
Anesthesia for non-cardiac surgery in obese patients in a secondary hospital located in an urban-rural area: A retrospective cohort study
Background and Objectives: Anesthesia in obese patients is associated with increased morbidity and mortality but has never been studied in our setting. This study investigated the complications associated with different grades of obesity. Methods: This paper was a retrospective cohort study conducted from January 2011 to December 2024 at Monkole Hospital. Perianesthetic data from all obese adult patients anesthetized for non-cardiac surgery were collected and analyzed with SPSS 26.0 using appropriate statistical tests for p < 0.05. Ethical guidelines were respected. Results: Of 13,226 anesthetized patients, 1,668 were obese (12.6%), including 1,162 (69.7%) moderately obese, 384 (23%) severely obese, and 122 (7.3%) morbidly obese. Cardiovascular comorbidities, difficulties with intubation and venous access, and hyperglycemia predominated in the morbidly obese. The morbidly obese patients significantly more frequently underwent major surgery and general anesthesia, using intubation, propofol, and suxamethonium. Intraoperative complications were more frequent in morbidly obese ORa 2.98 (2.29–3.86) and influenced by Mallampati grades II to IV ORa 1.63 (1.06–2.66), ASA4 class ORa 2.55 (1.06–6.24), and major surgical procedure ORa 2.70 (2.06–3.55). Obesity grade was not associated with mortality or postoperative complications, which included the following factors: the presence of a history of hematological disease (ORa 2.79 (1.7–3.78), ASA class 4 (ORa 3.09 (1.32–9.28), severe anemia (ORa 3.12 (2.11–4.21), hyperglycemia (ORa 3.92 (1.27–5.07), and major surgery (ORa 2.88 (1.84–3.85). Conclusion: This study indicates that obese patients of all grades benefit from anesthetic procedures in our setting, and we need to improve their management. Intraoperative complications are more frequent in cases of morbid obesity, requiring us to double our attention in this type of patient. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India after the change of Publisher.
Anesthesia; obesity; noncardiac surgery; urban-rural setting
Evolving strategies in the surgical management of rheumatic heart disease in lowresource settings: A Nigerian perspective
Rheumatic heart disease (RHD) remains a significant public health burden in Nigeria and other low- and middle-income countries (LMICs) despite being virtually eliminated in high-income countries. The disease usually affects adolescents and young adults, who usually present with advanced lesions. Surgical management in this region is complicated by the prohibitive cost of cardiac surgery, delayed presentations, and limited access to specialized care. This review highlights the evolving surgical strategies for managing RHD in Nigeria. It discusses the burden and epidemiology of RHD, challenges in surgical care, traditional surgical methods, and emerging strategies to improve access and outcomes. It also presents the progress made in building local capacity, reducing reliance on international missions, and formulating sustainable approaches tailored to low-resource settings. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India after the change of Publisher.
Rheumatic heart disease; valve surgery; low-resource settings; Nigeria; cardiac surgery access; health system challenges
Management of frontal bone fractures in a resource challenge setting: A report of 2 cases and literature review
Traumatic injuries to the frontal bone and sinus, can lead to severe life-threatening complications due to their closeness to critical intracranial and orbital structures. These injuries can significantly impact both function and appearance. When depressed fractures of the frontal bone occur, especially in high-velocity maxillofacial trauma, it results in obvious facial deformity if not properly addressed. Treatment options are diverse, ranging from conservative measures to open reduction and internal fixation utilizing plates and screws, use of mesh, acrylic, and tailored to the injury nature, context, available resources and operators expertise. We present two compelling cases of depressed frontal bone fractures (FBFs) involving the anterior table. In these instances, fractures were effectively reduced and stabilized using titanium mesh and mini plates. Both cases resulted in excellent surgical outcomes, with smooth postoperative recovery and no complications. This study highlights the successful management of FBFs in a resource-limited setting and also offers a concise review of pertinent literature. Open reduction and internal fixation with titanium mesh or miniplates stand out as robust options for managing FBFs, effectively restoring the natural contour of the forehead and minimizing long-term complications. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India after the change of Publisher.
Frontal bone; fracture; mesh; open reduction; mini plates
Systematic approach to awake fiberoptic intubation in a post-hemimandibulectomy patient with distorted airway anatomy
Dear Editor We present the case of a 38-year-old man [American Society of Anaesthesiologists (ASA) Physical Status II] scheduled for wide local excision and modified neck dissection with radial artery forearm flap reconstruction. Preoperative airway evaluation revealed significantly limited mouth opening and marked anatomical distortion (Fig. 1), prompting the decision to perform an awake nasotracheal fiberoptic intubation (Plan A). The ENT team was on standby, considering tracheostomy under local anesthesia to secure the airway before administration of general anesthesia as plan B in case of failure of fiberoptic bronchoscope (FOB) intubation. The patient was counselled and explained about the difficult airway requiring fiberoptic intubation with all the risks and complications, and a written informed consent was taken for the same, along with see on symptom tracheostomy. All standard ASA monitors were applied in the operating room, and 100% oxygen was administered via a face mask. Nasal mucosa was decongested with 0.1% xylometazoline drops. Airway anesthesia was achieved using a combination of 4% nebulized lidocaine (4 ml), 10% lidocaine spray (two puffs in each nostril), and a transtracheal injection of 3 ml 2% lignocaine. Intravenous midazolam (0.02 mg/kg) was given for sedation. A 5-mm FOB was carefully inserted through the right nostril. The vocal cords were visualized, and an additional 2% lidocaine was administered using the spray-as-you-go technique. The bronchoscope was advanced into the trachea, and a 7.5-mm flexometallic nasotracheal tube was successfully railroaded over it. Correct placement was confirmed with endtidal CO₂ monitoring and direct FOB visualization. Following intubation, general anesthesia was induced with intravenous glycopyrrolate (0.2 mg), fentanyl (2 mcg/kg), propofol (2 mg/kg), and vecuronium (0.1 mg/kg), followed by intermittent top-ups. Anesthesia was maintained with 1.5% sevoflurane in a 50:50 air–oxygen mixture. The surgery proceeded without complications, and a tracheostomy was performed at the conclusion. After reversal of neuromuscular blockade, the patient was transitioned to a T-piece delivering oxygen at 2 l/minute and shifted to recovery in stable condition. During subsequent follow-up over the course of approximately 1 month, the PVC tracheostomy tube was replaced with a metallic tracheostomy tube, followed by successful tracheostomy closure. Managing a difficult airway in patients with prior head and neck surgeries, radiation, or malignancy-related distortion remains a critical anesthetic challenge. Awake nasal fiberoptic intubation is the preferred technique in such cases, enabling spontaneous ventilation and continuous airway visualization [1]. Success hinges on effective topical anesthesia, patient counselling and cooperation, and uninterrupted oxygen delivery [2]. In our case, comprehensive preparation and a stepwise approach facilitated smooth airway access and minimized risk [3,4]. This case highlights the importance of structured planning in managing complex head and neck airways. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India after the change of Publisher.
Endoscopic adenoidectomy using suction-diathermy ablation in a Nigerian private healthcare institution: A review of 136 cases
Background: Endoscopic-assisted adenoidectomy is a natural progression of a newer technology that allows a more complete adenoidectomy. The most common indication for adenoidectomy is adenoid hypertrophy with obstructive sleep apnea. Techniques and instruments for adenoidectomy have evolved over time, especially with the use of endoscopes, electrocautery, and power-assisted instruments. This study aims to review the experience with endoscopic power-assisted adenoidectomy, demonstrating its safety and efficacy. Patients and Methods: This was a cross-sectional study conducted in the Shepherd Specialist Hospital, Sokoto, Nigeria, from January 2018 until November 2023. A preoperative diagnostic rigid nasal endoscopy with a 0° endoscope was done to assess the grade of the adenoid hypertrophy and to help select the candidate for surgery. Statistical analysis was carried out using SPSS version 25.0. Results: The mean age of the patients was 5.05 ± 1.99 SD. Obstructive sleep apnoea in 54 patients (39.7%), nasal obstruction in 49 (36.0%), and snoring and breathing by mouth in 19 patients (14.0%) were the most common indications for the surgery. Every patient had one or more of these complaints. More males 85 (62.5%) participated in the study than females 51 (37.5%) with a male-to-female ratio of 1.7:1. Conclusion: Although nasal endoscopes are fast becoming basic tools, powered instrumentation like the microdebrider is not common. The need for special equipment and the cost of the procedure have to be borne in mind. The newer method of endoscopic-assisted powered adenoidectomy was found to be a safe and useful tool for adenoidectomy. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India after the change of Publisher.
Endoscopic adenoidectomy; bipolar suction diathermy; microdebrider; shepherd Sokoto
Early post-operative complications after metabolic and bariatric surgery in Misurata, Libya: Retrospective cross-sectional study
Background: Bariatric procedures are generally safe and effective, but can be associated with complications. Early complications may include bleeding, leakage, venous thromboembolic events (VTE), wound infection, abdominal wall hematoma, and dehydration requiring admission. Aim: This study aimed to assess the incidence, clinical presentation, risk factors, and management of early postoperative complications within 30 days. Methods: In this cross-sectional retrospective study, data were collected for all patients who underwent one of the following bariatric surgical operations: sleeve gastrectomy, one-anastomosis gastric bypass, Roux-en-Y gastric bypass, or single anastomosis sleeve ileal (SASI) from some Misurata hospitals between January and December 2024. Results: The total number of patients was 992; of them, 648 (65.3%) were females and 344 (34.7%) were males. The patient’s body mass index (BMI) was 46.2 kg/m². The most common procedure done was sleeve gastrectomy, 606 (61%), followed by bypass surgery, 341 (34.3%), and 45 (4.6%) were revisional procedures. The most common early complication was abdominal wall hematoma, which occurred in 31 (3.1%) patients, followed by dehydration in 24 (2.4%) and postoperative bleeding, which occurred in 19 (1.9%) patients; of them, 14 (1.4%) patients experienced extra-luminal bleeding and 5 (0.5%) patients intraluminal bleeding, wound infection in 11 (1.3%) patients, VTE, as well as leakage, occurred in 6 (0.6%) patients, and prolonged ileus in 2 (0.25%) patients. Two cases died, with a mortality rate of 0.25%. Noticeably, the leakage was strongly related to higher BMI (p < 0.01), while bleeding was significantly associated with hypertensive patients (p < 0.05). Conclusion: The incidence of early complications after bariatric surgery remains within the acceptable range in comparison with the other published studies. Most of the early complications could be managed conservatively, while surgical treatment might be required for some patients, especially with hemodynamic instability. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India after the change of Publisher.
Bariatric; obesity; patient; postoperative; surgery
Buccal mucosal graft for recurrent cervical oesophagogastric anastomotic stricture: A case report
Background: Corrosive oesophageal strictures are a common clinical challenge in children, particularly in developing countries where the domestic production of soap is prevalent and often involves caustic agents. Surgical options for managing complications from corrosive ingestion include gastric pull-up, colonic interposition, and jejunal substitution. Case Presentation: An 11-year-old boy with complications of corrosive oesophageal injury presented with severe malnutrition. Following nutritional rehabilitation, he underwent a gastric pull-up procedure using the Orringer technique. Postoperatively, he developed an anastomotic stricture that was successfully managed with a buccal mucosal graft. Conclusion: Buccal mucosal graft stricturoplasty represents a viable surgical option for managing recurrent anastomotic strictures following gastric pull-up procedures, particularly in settings with limited access to advanced endoscopic or surgical alternatives. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India after the change of Publisher.
Buccal mucosal graft; oesophageal stricture; anastomotic stricture; corrosive ingestion; paediatric oesophageal surgery.
Timely pain management with administration of analgesics in triage room
Background and Aim: Pain management is crucial in emergency departments, and the timely administration of analgesics significantly impacts patient satisfaction. However, many hospitals lack standardized protocols for analgesic administration in triage rooms by nurses. This study aimed to assess the impact of analgesic administration in the triage room on timely pain management in traumatic patients with extremity bone fractures. Methods: A cohort study was conducted in the emergency department, enrolling patients with traumatic extremity bone fractures. Upon triage, eligible patients were observed based on whether they received ketorolac or no analgesic (control group). Pain severity was evaluated using the Numeric Analogue Scale, and adverse effects and patient satisfaction were also assessed. The collected data were coded and entered into SPSS version 24 for statistical analysis. Descriptive statistics were used to describe the data, and comparisons between the exposed (ketorolac) and non-exposed (control) groups were performed using the chi-squared test (χ²), independent t-test, and paired t-test, with a significance level set at p < 0.05. Results: The study included a total of 1,000 traumatic patients. The ketorolac group exhibited significantly lower pain severity at 30 min and 60 min compared to the control group (p < 0.001). There was no statistically significant difference in adverse effects between the two groups (p = 0.468). Additionally, patients who received ketorolac required fewer subsequent analgesics and reported higher satisfaction with the intervention (p < 0.001). Conclusion: The findings demonstrate that ketorolac administration in the triage room resulted in a significant reduction in pain severity among traumatic patients with bone fractures, and it was associated with increased patient satisfaction. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India after the change of Publisher.
Analgesics, fractures, multiple trauma, pain, triage.
Silicone rod versus autogenous fascia lata for frontalis suspension surgery
Aim: In this study, we aimed to assess the functional outcomes of the use of silicone rod (SR) versus autogenous fascia lata (AFL) for frontalis suspension surgery (FSS) and compare the results with each other. Methods: The medical records of 36 eyes of 29 patients with blepharoptosis, who underwent FSS during 1999 and 2003 were retrospectively reviewed. Two groups were defined according to the sling material utilized in FSS; AFL group and SR group. Results: A total of 29 patients were included in the study (mean range 9 months–28 years). Twenty-four eyes of 18 patients (mean age 12.2 years, range 4 years-28 years) were included in the AFL group and 12 eyes of 11 patients ( mean age 5.6 years, range 9 months-12 years) were included in the SR group. The mean follow-up time was 16.4 months. AFL group yielded 91.7% satisfactory results with no recurrence in ptosis. In contrast, SR group yielded 83.3% satisfactory results and 16.7% recurrence in ptosis. In terms of satisfactory results, there was not a significant difference between the groups (p > 0.05). Conclusion: Over the age of 3 years, we recommend AFL as the material of choice for FSS due to better functional results. However, in patients less than 3 years old and in selected cases who have the risk of postoperative exposure keratopathy, SR should be preferred due to the ease of management postoperatively. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India, after the change of Publisher.
Frontalis suspension surgery; blepharoptosis; autogenous fascia lata; silicone rod
Gastric sleeve versus lifestyle modification for weight reduction in Western KSA: Cross-sectional study
Background: Obesity is a growing public health concern in Saudi Arabia, with increasing prevalence rates and associated risks such as diabetes, cardiovascular diseases, and reduced quality of life. Lifestyle modifications and bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), are two commonly employed strategies for weight reduction. This cross-sectional study compares the effectiveness of LSG and lifestyle modifications in achieving weight loss and improving quality of life among individuals in the Western region of Saudi Arabia. Objective: To evaluate and compare the outcomes of gastric sleeve surgery and lifestyle modification for weight reduction, focusing on weight loss outcomes, health improvements, and patient satisfaction. Methods: A cross-sectional study was conducted in Saudi Arabia from November 2022 to January 2024, involving 200 participants aged 14 years and older with a Body Mass Index (BMI) of 25 or higher. The participants were either following a lifestyle modification regimen or had undergone gastric sleeve surgery. Data were collected through an online questionnaire, which included 15 open-ended and multiple-choice questions covering demographics, personal information, BMI, chronic disease status, weight loss, and the perceived advantages and disadvantages of the interventions. Statistical analyses, including both descriptive and inferential methods, were performed with a significance level set at p < 0.05. Results: Among the participants, 82.5% were female, and the mean BMI was 28.9 ± 6.9 kg/m². The study found that gastric sleeve surgery resulted in greater weight loss, with 87% of participants losing more than 20 kg. In contrast, lifestyle modification led to more modest weight loss, with 35% of participants losing more than 10 kg. Both methods were associated with improvements in self-confidence, control of chronic diseases, and overall quality of life, though surgical patients reported a higher incidence of complications such as gastroesophageal reflux disease and skin redundancy. Conclusion: Gastric sleeve surgery is more effective for achieving significant weight loss compared to lifestyle modification. However, both methods offer health benefits, with surgery leading to more rapid results. These findings underscore the importance of personalized weight management strategies in the Western region of Saudi Arabia, taking into account patient preferences, health status, and potential risks. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India, after the change of Publisher.
Obesity; gastric sleeve surgery; lifestyle modification; weight reduction; Saudi Arabia; cross-sectional study
Orofacial haemangioma: Series of two cases managed at University of Maiduguri Teaching Hospital and review of literature
Haemangioma is a benign vascular proliferation of blood vessels commonly found in children. Head and neck haemangioma constitute about 60%–70% but those in the orofacial region are relatively rare. Whereas some categories of these lesions involute over time, some definitely require medical or surgical intervention or both. We present two cases of vascular lesions in two patients who presented with a history of discoloration and painless progressive facial swelling clinically, radiologically, and histologically diagnosed as haemangioma. Both cases were successfully treated with sclerosant therapy as well as surgical excision. There was uneventful healing and favorable clinical outcome during the postoperative period and subsequent follow up. Additionally, relevant literature in terms of clinical presentation and management has also being highlighted. Surgical treatment following oral propranolol and intralesional triamcinolone has shown to be a very effective treatment modality.Haemangioma is a benign vascular proliferation of blood vessels commonly found in children. Head and neck haemangioma constitute about 60%–70% but those in the orofacial region are relatively rare. Whereas some categories of these lesions involute over time, some definitely require medical or surgical intervention or both. We present two cases of vascular lesions in two patients who presented with a history of discoloration and painless progressive facial swelling clinically, radiologically, and histologically diagnosed as haemangioma. Both cases were successfully treated with sclerosant therapy as well as surgical excision. There was uneventful healing and favorable clinical outcome during the postoperative period and subsequent follow up. Additionally, relevant literature in terms of clinical presentation and management has also being highlighted. Surgical treatment following oral propranolol and intralesional triamcinolone has shown to be a very effective treatment modality. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India, after the change of Publisher.
Haemangioma; sclerosant; vascular tumour; buccal mucosa
Normal pregnancy outcome after emergency ovarian cystectomy for ovarian cyst torsion in the first half of pregnancy: A case report
Background: Ovarian cysts are fluid-filled sacs on the ovary, with a global incidence of 16.7% and higher prevalence in women of reproductive age. Complications include torsion, hemorrhage, rupture, or infection. Torsion is the most common and serious complication often presenting in the first trimester of pregnancy. Case Presentation: A 24-year-old primigravida presented with severe lower abdominal pain at 10 weeks gestation. She was diagnosed with a torsioned ovarian cyst coexisting with an intrauterine pregnancy. Emergency laparotomy with ovarian cystectomy was performed, and she had a normal pregnancy outcome. Discussion: The majority of ovarian cysts in pregnancy are functional and rarely malignant. Diagnosis can be incidental through prenatal ultrasound. Ovarian torsion commonly presents with abdominal pain, nausea, and vomiting. Ultrasound is the preferred diagnostic tool, with magnetic resonance imaging reserved for inconclusive cases or for precise characterization of larger masses. Surgical care with cystectomy and detorsion is the most common treatment option. Conclusion: Torsion of an ovarian cyst in pregnancy poses challenges due to the need to balance the safety of both mother and child. Surgery is the recommended treatment modality for ovarian cyst torsion presenting with acute abdomen. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India, after the change of Publisher.
Ovarian cyst; torsion; adnexal mass; pregnancy; ovarian cystectomy
Transmigration of surgical gauze: A rare case of intraluminal gossypiboma
Gossypiboma, a rare but significant complication of retained surgical gauze, can lead to considerable morbidity and presents diagnostic challenges. We describe the case of a 40-year-old female who presented with a 3-day history of generalized abdominal pain, accompanied by bilious vomiting and bowel obstruction. Her medical history included an open cholecystectomy 7 months earlier. An abdominal X-ray suggested a linear radioopaque foreign body, which was confirmed as gossypiboma by contrast-enhanced CT. During an exploratory laparotomy, a 30 × 30 cm surgical gauze was found within the ileum and successfully removed. This case highlights the ongoing risk of retained surgical items, even with modern advancements in surgical practice and technology. It underscores the importance of meticulous surgical technique, including accurate surgical counts, and adherence to standardized protocols. This case serves as a critical reminder for all surgical teams to maintain heightened vigilance throughout all phases of surgery. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India, after the change of Publisher.
Gossypiboma; retained surgical gauze; intraluminal migration
Enhancing post-surgical pain relief: comparing lidocaine, bupivacaine, and their combination for Laparotomy by MGS (Mouse Grimace Scale)
Pain management after surgery is crucial for improving the condition of patients in veterinary and human medicine. Analgesics are commonly administered via subcutaneous infiltration injection before the start of surgery. This study investigates post-anesthesia recovery and pain levels following subcutaneous injections of lidocaine and bupivacaine drugs, as well as their combination, after abdominal surgery. The study utilized lidocaine doses of 0.1 and 0.15 mg/kg-1, bupivacaine doses of 1 and 2 mg/kg-1, and a combination of 0.1 mg/kg-1 lidocaine and 1 mg/kg-1 bupivacaine. The study data was evaluated using the Rodent Face Finder software, a novel method for assessing pain during animal model recovery based on clinical changes. These changes include ratings in eye-opening (orbital changes), various ear angles (ear changes), whisker stance (whisker changes), and cheek angle (cheek changes). Videos were captured at 0, 2, 4, 8, 12, and 24 hours post-surgery, and analyzed using software and statistical evaluation. The results obtained 2 hours after surgery in the combined drug group (mixed drugs) showed a significant difference compared to all other groups (p < 0.05), while the remaining groups did not exhibit significant differences (p > 0.05), indicating indifference due to their effects. Pain levels before and after anesthesia can be justified. At 4–8 hours, the lidocaine and bupivacaine groups did not show significant differentiation from each other (p > 0.05), but the treatment groups differed significantly (p < 0.05). At 12 hours, the lidocaine groups and the 0.09% saline group showed significant differences (p < 0.05), while the remaining groups did not exhibit differences (p > 0.05). At 24 hours post-surgery, only the control group showed a significant difference from the other groups (p < 0.05). The study demonstrated that the specified doses of combined anesthetic drugs provided adequate analgesia in the initial hours after surgery, leading to proper recovery compared to other treatment groups. Additionally, varying rates of postoperative analgesia at 4–8 hours after surgery did not significantly impact the analgesia process. Anesthetic drugs can significantly affect the initial recovery process. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India, after the change of Publisher.
Pain; analgesia; lidocaine; bupivacaine; recovery
The potential of artificial intelligence for personalized surgical planning: A letter to the editor
This letter explores the potential of artificial intelligence (AI) in personalized surgical planning. AI offers a powerful toolkit to create patient-specific roadmaps, enhancing preoperative analysis, decision-making, and surgical simulation. Traditional surgical planning relies on subjective interpretations of medical images and can be impacted by surgeon fatigue or anatomical variations. AI-powered analysis with deep learning algorithms can dissect complex images, identifying subtle anatomical variations and enabling more precise surgical targeting. Predictive analytics, leveraging vast surgical datasets, anticipate potential intraoperative risks, allowing surgeons to proactively prepare. Additionally, AI facilitates personalized surgical simulations using 3D virtual models, optimizing surgical strategies and minimizing tissue damage. Integration of AI into surgical planning promises significant improvements in patient outcomes, including increased precision, improved efficiency with shorter operating times, and enhanced patient safety through risk identification. However, challenges remain, including data quality and mitigating bias in AI algorithms, ethical considerations regarding patient privacy and surgeon autonomy, and the need for robust regulatory frameworks. The future of AI in surgery hinges on continued research and collaboration. Standardized data collection, development of explainable AI models, and rigorous clinical trials are crucial for unlocking AI’s full potential. This surgeon-AI partnership has the potential to revolutionize surgical care, offering a personalized approach that optimizes outcomes for each patient. Disclaimer: This article was originally published by WisdomGale Publishing, 14 Rue de Grand-Bigard, 1082 Brussels, Belgium, and was migrated to International Medical Publishing Group(IMPG), India, after the change of Publisher.
3D virtual models; artificial intelligence; machine learning; personalized surgical planning; personalized surgical simulations; patient privacy; surgeon autonomy