Day 1 :
Keynote Forum
Adhishwar Sharma
Fortis Merorial Reaserch Institute ,Gurugram, India
Keynote: Brachial Plexus surgery Journey So Far
Time : 9.50-10.20
Biography:
Adhishwar Sharma has completed his MBBS at the age of 25 years from Berhampur University and post graduate taining from PGIMER.He was Senior Resident in surgery in same department.He did his plastic surgery training from Safdurjang hospital under Delhi University. He has done fellowship in microvascular surgery from Amrita institute Kochi . He is in practice sine 2012, He is regularly presenting his work in various conference.At present he is working in FMRI Gurugram India .
Abstract:
Brachial plexus inuries is a major challenge in devloping country like India. Both adult and birth palsy are present . Disease load is significant and facilities to treat these are far and few. Trained doctors , anaesthesia ,nerve monitoring facillites are major challenges . In my practice the brachial plexus injuries are significant part of work .In brachial plexus surgery we basucally work to restore shoulder and elbow movements .One nerve transfer for shoulder and one nerve transfer for elbow .Elbow flexion is fine but getting shoulder to move it becomes tricky. It takes almost eight muscle to move shoulder, so plan was to do two nerv transfer for shouder. This showed good results as shoulder abduction improved . So I made part of my practice to do two nerve transfer for shoulder function and on transfer for elbow function.
Keynote Forum
Rajneesh Kumar
Punjab Institute of Medical Sciences [PIMS]Punjab,India
Keynote: Tightening of seton using Roeder’s knot in Complex Fistula - in - ano : with knot pusher (specially designed)
Time : 10.20-10.45
Biography:
Rajneesh Kumar is an Associate Professor in Department of surgery at Punjab Institute of Medical Sciences [PIMS]
Abstract:
Objective: There are two main complications after surgery of complex fistula-in-ano: i.e. faecal incontinence and recurrence.
Summary Background Data: To prevent incontinence of stools and flatus we require saving the anal sphincter muscle with tightening of seton using Roeder’s knot with specially designed Rajneesh’s seton knot pusher.
Method: The study includes 40 patients who had undergone treatment of complex and high fistula-in-ano at Civil Hospital, Jalandhar from January, 2010 to September 2012 and from September, 2012 to January, 2017 at Punjab Institute of Medical Sciences (PIMS).
Results: 40 patients of complex fistula-in-ano were taken up for study with the age (mean ± standard deviation) of 35 ± 10.6 years. The Roeder’s knot was tightened with a median of 5 times (3-10 times) as OPD procedure. All the patients were on follow up for minimum period of 6 months and none of the patient had any incontinence. Recurrence occurred in one case. There was breakage of thread at knot site with knot pusher in two cases.
Conclusion: Tightening of seton using Roeder’s knot with Rajneesh’s knot pusher is safe, cost effective treatment for complex fistula-in-ano and follow up is easy. Tightening of fistula is an outdoor procedure rather than replacing the loose seton. Patients were on follow up every week and seton with Roeder’s knot tightened in O.P.D after application of 2% xylocain jelly. Incontinence was assessed according to wexner’s score.
- General Surgery and its Specialties
Session Introduction
Dr. Ahsen Nazir Ahmed
Sharif Medical and Dental College, Lahore, Pakistan
Title: Outcomes of Self-fixation Mesh for Open Hernia Repair
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.
Session Introduction
Ashish Dey
Sir Gangaram Hospital, New Delhi, India
Title: Laparoscopic Posterior Rectopexy for Complete Prolapse of Rectum: Our Experience
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.
Chao Li
Department of Head and Neck Surgery, Sichuan Cancer Centre
Title: Surgical Management of Locally Advanced, Differentiated Thyroid Cancer
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.