A.R.Surgery

Good news for Day Care Surgeons …..

A great news for Day Care Surgery cases.Though many Day Care Surgery patients deserved early discharge, they were made to stay in the hospital for the sake of Insurance claim.Now the consumer affairs ministry said it will take up the issue with Insurance regulator IRDAI and department of financial services DFS.

October is Breast Cancer Awareness Month

Breast Cancer Awareness Month\ Part 1 As per WHO that is World Health Organization, the month of October is Breast Cancer Awareness month. The aim of the increased awareness is to detect the brea...

https://youtu.be/s4Qgj-FORnQ

Artificial Intelligence and Robotic Hernia Surgery at AWR Conference This video is about my experience at AWR Deep Impact conference conducted at New Delhi. Here I describe about the waiting period of more than three years bec...

Recently attended a AWR conference in Delhi.
The high light was Robotic Hernia Course…
Very useful for my future Robotic Hernia Surgeries

Hernia Update continues even after a decade….…This workshop was done in 2012….

Change in practice of overnight fasting

Carbohydrate loading and early enteral feeding are important components of the Enhanced Recovery after Surgery (ERAS) program.

This program aims to reduce the body's response to surgery, which is characterized by its catabolic effect and can lead to negative outcomes such as protein catabolism, weight loss, muscle wasting and nitrogenous loss.

The stress response is initiated by various physical insults, such as tissue injury, infection, hypovolemia or hypoxia. Autonomic afferent impulses from the area of injury or trauma stimulate the hypothalamus-pituitary-adrenal axis, leading to increased cortisol levels and insulin resistance. This can result in hyperglycemia, which is a significant finding and can influence length of stay, poor wound healing and increased risk of infective complications.

Methods that reduce insulin resistance include adequate pain relief, avoiding a prolonged period when oral intake is interrupted, and the use of carbohydrate loading. The practice of fasting patients from midnight is commonly used to avoid pulmonary aspiration after elective surgery, however, there is no evidence to support this. In fact, preoperative fasting can increase metabolic stress, hyperglycemia, and insulin resistance.

A review of 22 randomized controlled trials comparing different perioperative fasting regimens and perioperative complications revealed that there is no evidence to suggest a shortened fluid fast results in an increased risk of aspiration, regurgitation or related morbidity compared to the standard fasting from midnight policy. Furthermore, if patients are allowed to take solids up to 6 hours preoperatively and clear fluids up to 2 hours, there is no increase in complications. This forms the basis of preoperative guidelines adopted by the Royal College of Anaesthetists and the American Society of Anesthesiologists.

The use of carbohydrate loading can attenuate postoperative insulin resistance, reduce nitrogen and protein losses, preserve skeletal muscle mass, and reduce preoperative thirst, hunger, and anxiety.

It involves the use of clear carbohydrate drinks the day prior to surgery and up to 2 hours before. In addition to the metabolic effects, it facilitates accelerated recovery through early return of bowel function and shorter hospital stay, ultimately leading to an improved perioperative well-being.

As a result, it is an important element of the nutritional aspects of ERAS and should replace the practice of overnight fasting.

https://youtu.be/LekbrZUrZvY

Hernia- A modified approach of old repair After the advent of Laparoscopic surgery, many surgeries also done with minimal incision with maximum benefits. One such procedure is Lichtenstein Repair. Th...

https://youtube.com/shorts/C36yI9WkcDY?feature=share

Laparoscopic Retractor- A useful instrument in Difficult Laparoscopic Cholecystectomy

https://youtu.be/EZL7dZFkGQo

Difficult “Lapchole” - Use of Laparoscopic Retractor It was a small stone obstructing the Gallbladder, resulting in Empyema of Gallbladder and in Acute Gangrenous Cholecystitis. The use of Laparoscopic retracto...

A small stone obstructing
the cystic duct and causing such a big mucoccele of Gallbladder.
Highly oedematous GB due to infection.
Laparoscopic cholecystectomy done ✅

Great CME program at ESI medical college, Coimbatore….

Simple but interesting….
60 year old man came with c/o bleeding per re**um and painful defaecation. On examination, patient had two small threads protruding though a**s.
Patient failed to give us any sort of treatment anywhere else.
We decided to go for examination on the table under anaesthesia.
On examination under anaesthesia in lithotomy position, there was fissure in Ano with sentinel pile with a thread tied to the base of the sentinel pile.
We excised the fissure, sentinel pile and the thread.
In the post operative period, he told us, he had gone for treatment with an alternative medicine doctor.
Even now people are trying to treat the piles by tying a knot at the base of the piles with a thread.
Really surprising….!!!!!!

Day Care Surgery - Need of the Day

https://youtu.be/ZCZABpXCseM

Giant Lipoma involving Thigh and Retroperitoneum This video is about a large lipoma, we removed few days back. This case is a giant lipoma, dumb bell shaped involving thigh and retroperitoneum. Because of i...

https://youtu.be/g89CvjKRHsY

Covid19 Third Wave/What the Curves indicate? There is lot of discussion about Covid19 third wave among the public.In this video we will try to get a clear information about the Third wave from WHO direc...

https://youtu.be/oMpKiMhVImE

Appendicitis presenting as Diarrhea - Surgeon's nightmare Acute appendicitis usually presents with pain and tenderness in the right lower abdomen. Associated with nausea and anorexia. It may have an atypical present...