9^th International Congress on Surgery August 27-28, 2018 Tokyo, Japan

Biography:

Dr. Ahsen Nazir Ahmed is Professor of Surgery at Sharif Medical and Dental College, Lahore, Pakistan. He has over 27 years of work experience both in Pakistan and internationally, in medical schools and accredited hospitals. While trained as a general surgeon, he has a special interest in breast surgery and hernia surgery, along with extensive experience performing laparoscopic surgeries as well. Dr. Ahmed is a Fellow of the American College of Surgeons, as well as the Royal College of Surgeons, Glasgow, and is a Course Director for Advanced Trauma Life Support, having taught over 200 accredited courses of BLS, ACLS, and ATLS. He also has numerous research publications to his name. His current passions include promulgating medical awareness in the general population and arming the next generation of medical professionals with both quality tools and techniques, while also teaching them respect for patients and their rights.

Abstract:

Study objective: To compare the outcomes of self-fixation mesh for open hernia repair, with TEP suture free mesh repair, in terms of patients with post-operative pain one month after surgery and in terms of the recurrence rate of hernia.

Methods and Material: The study was conducted at Sharif Medical & Dental College, Lahore, Pakistan. 100 cases of inguinal hernia were operated on. In 50 patients (Group A) open hernia repair was done. In another 50 cases (Group B) TEP mesh repair was done. Data was analyzed using IBM SPSS 24. Post-operative surgical outcomes in terms of patients with pain one month after surgery, and hernia recurrence, were studied in two groups. Descriptive statistics (frequencies and percentages) were calculated. Chi-square test of statistical significance for quantitative variables was applied.

Result:  In Group B only 1/50 patients suffered from post-operative pain one month after surgery as compared to 21/50 patients in Group A. Similarly, the incidence of hernia recurrence was 1/50 in Group B, as compared to 8/50 in Group A. Both for post-operative pain and hernia recurrence there was a statistically significant difference between the two groups. In Group A, the number of patients with post-operative pain one month after surgery and those with hernia recurrence was significantly high than in Group B (p< 0.001, p< 0.05).

Conclusion:  In terms of post-operative pain one month after surgery, and the incidence of hernia recurrence, TEP suture free repair is a superior method of hernia repair as compared to conventional open repair.

Biography:

He has completed MS from Grants Medical College, Bombay University, India  and Fellowship in MAS from Sir Gangaram Hospital, New Delhi. He is an Associate Consultant in the Department of General and Laparoscopic Surgery. He has published many papers in reputed journals including index journals and currently Assistant Professor in GRIPMER, the academic wing of the hospital.        
 

Abstract:

Aims and Objectives: Total rectal prolapse is a disorder that affects both sexes in all age groups causing debilitating symptoms along with constipation, incontinence or both and results in a poor Quality of Life. We present our experience of laparoscopic rectopexy for procidentia.

Methods: 15 patients underwent laparoscopic rectopexy for complete rectal prolapse in our unit from January 2013 to January 2016.  Preoperative and postoperative constipation, incontinence and Quality of Life scores have been followed up prospectively for a period of 18 months. Other outcomes measured were major and minor complications, length of hospital stay and recurrence.

Results: During the study period, 15 patients underwent laparoscopic rectopexy, and the median age was 42 years (range, 18-72 years).  There were no conversions to open procedure. Incontinence was present in all patients of which improvement was seen in 86.7%. Improvement in constipation was seen in 53% of the patients who had preoperative constipation. Retrograde ejaculation was seen in 2 patients in the 20-30 year age group. One patient recovered partially in 6 months and the other was lost to follow up. There was no incidence of recurrence in the median follow-up period of 18 months.

Conclusion:Laparoscopic rectopexy for rectal prolapse is associated with good post operative outcome as far as incontinence and constipation is concerned. There is significant improvement in Quality of life and associated with a low risk of recurrence. The risk of sexual complications in ‘Posterior rectopexy’ occurs among sexually active males and can be a major source of dissatisfaction.

Biography:

He work as the director in Department of Head & Neck Surgery of Sichuan Cancer Hospital & institute now. He has been working as a doctor in prevention and treatment of head and neck surgery for more than 10 years. He is an expert in head and neck cancer surgery and one of academic leader of Sichuan Provincial Health and Family Planning Commission. He published more than 100 papers, won 12 provincial and municipal science and technology awards and obtained 11 national patents. His clinical study of thyroid cancer makes me win the first prize in the National Oncology Conference in 2014.

Abstract:

Objectives:   The incidence of Differentiated Thyroid Cancers DTC in China is increasing, and this has been attributed to increased diagnosis of early stage disease by Ultrasound. In addition to an increase in early stage Cancer, a simultaneous increase in the Locally Advanced disease such as larger tumours (>4 cm), adverse features, and extrathyroid extension (ETE) .it presents an operative challenge for both the clinician and patient. The aim of this study is to report our experience at the Sichuan Cancer Centre; with the management of locally advanced DTC and to further analyse factors predictive of outcome within this group.

Methods: Overall survival outcomes were not analysed due to the relatively slow disease progression in thyroid cancer. Disease-specific survival (DSS) was calculated from the time of cancer diagnosis to the date of first disease recurrence. Distant recurrence-free probability (DRFP) was calculated from diagnosis to date of first distant disease recurrence, while locoregional recurrence-free probability (LRRFP) was calculated from diagnosis to the date of first thyroid bed or cervical lymph node recurrence. The median follow-up was 53 months (range 1–270 months).Outcomes data were calculated at 5 years. Recurrence events were recorded for all patients. Because progression of local disease in patients who had an R2 resection is not comparable with patients with R0 and R1 resections, patients with R2 resections were excluded from analysis of locoregional recurrence. Statistical analysis was carried out using SPSS (Version 21, IBM Corp, Armonk, NY).Variables were compared between R0, R1, and R2 groups using the Pearson χ2 test. DSS, DRFP, and LRRFP were analysed using the Kaplan-Meier method. Factors predictive of outcome were determined by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards method.

Results: A total of 137 patients underwent total thyroidectomy, 35 had thyroid lobectomy, and 6 patients underwent subtotal thyroidectomy with a portion of the contralateral lobe preserved. The median age of the 122 patients with extra thyroidal DTC was 43 years (range 9–82 years), 50 men and 72women. 21 patients were M1, and 101 patients were considered M0 after initial therapy. Nine of the M1 patients were identified preoperatively and 16 postoperatively on RAI scan within 5 months of thyroidectomy. With a median follow-up of 60.1months (range 1–270 months), 41 patients died, 15of whom died with active disease. There were 4 local recurrences, 18 cervical nodal recurrences, and 17 distant recurrences.

Conclusions: Locally advanced (T4) DTC is rare. The gross ETE predicts worse survival. In patients with T3 disease due to minimal extension to the overlying strap muscles, end block removal of strap muscles with the underlying thyroid gland achieves equivalent outcomes to patients with T1/T2 disease. The approach, accurate,preoperative assessment of patients with suspected advanced DTC is crucial. Assessment includes identifying a history of changes in voice, compromise of the airway, dysphagia, or hemoptysis. The examination should include looking for a mass fixed to the airway, paralysis of the vocal cord, or intraluminal disease visible on flexible laryngoscopy. Preoperative investigation should include US routinely. For this reason, multidisciplinary management teams must select the most appropriate treatment strategies to optimize both oncologic and functional outcome.

Biography:

Dr Da Wei Thong completed his medical degree (MBBS) at Monash University, Australia in 2013. Dr Thong is currently pursuing a Master (MSc) in Surgical Sciences with University of Edinburgh, UK and is in his final year of study. He is currently working as an unaccredited surgical registrar at Gold Coast Health, Australia.  His main clinical interests lie in General Surgery. He is affiliated with Griffith University as a lecturer to medical students and is an active advocate of surgical research works. He had previously published and presented in conferences in Asia.

Abstract:

Aim

The primary outcome is to investigate surgeons’ compliance to antibiotics guidelines for management of appendicitis in Australia peri and postoperatively, with the secondary outcome looking at predictors of post-operative complication; surgical site infection(SSI) and intra-abdominal abscess in 30 days.

Methods

A multicentre, prospective, observational study was conducted in a period of 2 months between June and October 2016. A database with prefilled variables are completed by each local principal investigators with a protocol guidance. Patients whom underwent laparoscopy with the intention of appendicectomy were recruited in the study.

Results

A total of 1189 patients were recruited. Therapeutic guidelines antibiotic version 15 (Australian Clinical Practice Guidelines, 2014) is used to compare compliance. Guidelines endorses all patients receive antibiotics peri-operatively; 1081(92.1%) received antibiotics in this study. The rate of peri-operative antibiotic use increases with the severity of appendicitis. Highest use was in the gangrenous group, 81(98.1%) followed by complicated, 191(93.2%) and non-appendicitis, 156(85.7%). 593(51.0%) and 379(32.6%) patients received post-operative intravenous(IV) and oral antibiotics respectively. Following simple appendicectomy, only 391(56.6%) patients did not receive post-operative antibiotics as per guidelines. However, in gangrenous and complicated appendicitis, it is reassuring to see 89(98.9%) and 198(97.1%) patients received antibiotics post-operatively. Aboriginal and Torres-Strait-Islander(5.5x) and laparoscopy converted open appendicectomy(9.5x) increases the odds of SSI. This is also statistically significant post multivariable logistic analysis (p<0.05). Complicated appendicitis, operated by senior surgeon and received IV or oral antibiotics post-operatively increases the odds of intra-abdominal abscess.

Conclusion

We recommend more awareness and implementation are required for antibiotics prescription guidelines for optimal management of appendicitis in Australia.

Biography:

PremKumar completed his Masters in surgery in 2007.He has been working as faculty at Bangalore medical college since 2008. He is currently pursuing my PhD in minmal access surgery. He has special interst in mininmal access surgery ,endocrine surgery and bariatric surgery.

Abstract:

Background:

Minimal access surgery is an imperative element of ERAS and has significantly improved the outcomes. Enhanced recovery after surgery (ERAS) programs synonym “fast track” surgery “was first conceived by Dr Henrich Kelhet. Largely described for colorectal surgery and reported to be feasible and useful for maintaining physiological function and smooth the progress of recovery. Most of the patients who present for surgical emergency are not adequately prepared and many are not in normal physiological state. The feasibility of ERAS protocol in such emergency minimal access surgery remains indistinct. This study was designed to validate an ERAS program in patients who undergo emergency minimal access surgery.

Methods:

The subjects were patients who underwent emergency minimal access surgery between June 2016 and august 2017 at the Victoria hospital, Bangalore. They received perioperative care according to an ERAS program. All data were collected and analyzed. The end point was the incidence of hospital stay, pain and postoperative complications.

 Results: A total of 135 patients were studied. According to the Clavien-Dindo classification, the incidence of ≥ grade 2 postoperative complications was 10.8% and that of ≥ grade 3 complications was 3.9%. Nearly all patients did not require delay of meal step-up (95.1%). Only 6 patients (3.0%) underwent reoperation. The median postoperative hospital stay was 9 days. Only 4 patients (2.0%) required readmission. There was no mortality.

Conclusions: Our results suggest that our ERAS program is feasible in patients who undergo emergency minimal access surgery.

Biography:

Frank Battaglia is in the midst of completing his MD  from the University of Ottawa after studying Physiology at McGill University. He is a student researcher at the University of Ottawa Heart, specializing in General and Cardiac Surgery. He has published 2 papers, presented 6 research projects, is the head of his school’s Surgery Interest Group and President of his Medical Student Society at the University of Ottawa.

Abstract:

Background

Across many industries, the varying disparities between genders in who is hired or promoted have been well identified. When appraising the field of academic general surgery, it is important to see if there is an overall gender inequity in those entering the field, as well as if there is an underrepresentation of gender at ascending academic or leadership ranking. Furthermore, it is important to elucidate the factors that could be leading to this inequality.

Study Design

Data was collected from general surgical departments offering residency training in USA and Canada. The information gathered about faculty members included gender, quantification of bibliometrics, and academic achievement. Frequency and percentages were noted for the qualitative variables; median and ranges were reported for the quantitative variables. The chi-square test (χ2) was used to determine any association between gender and academic ranking, as well as gender with leadership ranking.

Results

There were a significantly higher number of men [3094 (79.39%)] among the academic faculty in the specialty of general surgery in North America, compared to women [803 (20.61%)] (χ2=55.046; p-value≤0.001). This trend was also seen in leadership roles, where there were significantly more men [463 (84.03%)] than women [88 (15.97%)] (χ2=8.35; p-value=0.004). When the h-index was adjusted by the years of research conducted by the faculty members of general surgery (m-index), we found that women outperform men in academic productivity at every level of academic appointment.

Conclusions

Women make up the minority of senior surgical faculty and leadership in the U.S. and Canada, despite the fact they are more academically productive for every year for which they are involved in research compared to men. This suggests that institutions are not considering research productivity equally to inform promotion, or whether academic productivity is considered secondary to other factors.