Corrosive upper aerodigestive tract strictures are conventionally treated by open surgery. Surgical advancements permit these strictures to be addressed with minimal invasion. Corrosive strictures treated minimally invasively over a 2-year period (2014-2015) were audited. Colonic mobilization and retrosternal tunneling were performed laparoscopically. The left colic vessel-based isoperistaltic colonic/ileocolonic segment was transposed substernally into the neck, aided by miniceliotomy. Proximal anastomosis was side-to-side esophagocolic in all patients except those who underwent pharyngolaryngectomy or partial laryngectomy, where pharyngocolic/pyriform fossa-ileal anastomosis was employed. Distal anastomoses were colo-jejunal and colocolic/ileocolic in all the patients. Enteral nutrition and ambulation were commenced on the first postoperative day. Oral nutrition was commenced following a normal contrast swallow on the seventh postoperative day. Patients were followed up on an outpatient basis. Ten adults, aged between 19 and 40 years, were treated for acid-induced strictures. Esophagus and stomach were multiply strictured in all patients. Additionally, duodenum was involved in two patients while pharynx and larynx were strictured in three patients. Two patients underwent pharyngolaryngectomy. One patient underwent partial laryngectomy. The average operative time was 240 minutes (range: 210-300 minutes). The mean blood loss was 150 mL (range: 100-200 mL). One patient (10%) had cervical anastomotic leak on the ninth postoperative day, which was resolved spontaneously. One patient (10%) had proximal anastomotic stricture, requiring dilatation thrice. One patient (10%) had the transient left recurrent laryngeal nerve paresis, which was resolved spontaneously. All the patients are on oral solid diet. The followup ranged from 5 months to 2 years. Minimal access substernal colonic transposition is feasible and efficacious in restoring alimentary continuity in corrosive strictures.

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Background: Numerous incisions are described for abdominal operations. However, opinion is divided regarding the correct choice of incision for major upper abdominal surgeries. Material & methods: Experience of 3 surgical centres with the use of modified Makuuchi incision, for major upper abdominal surgeries, from Mar 2014- Dec 2018, was audited. Results: 144 patients [76 Males: 68 Females] with an average age of 48.25 years underwent surgery using modified Makuuchi incision. ’J’ and ‘L’ incisions were used in 96 and 48 patients, respectively. Further extension of the incision was necessary in 2 patients. Adequate exposure and enhanced surgical ergonomics was observed in all cases. Surgical site infection was seen in 19 patients [13.2%]. Incisional hernias was observed in 6 patients [4.2%], on an average follow up of 27.78 months. Conclusions: Modified Makuuchi incision proves efficacious for major upper abdominal surgeries.

Because organ scarcity persists, additional pressure will build to use a greater proportion of the existing donor pool. The study, although small, clearly indicates that marginal livers can assure a normal early functional recovery after transplantation.

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Background: Extensive use of antibiotics is prevalent throughout India, and this is a matter of serious concern. There are several reports linking antibiotic usage to resistance. Towards addressing this problem, assessment of current prescribing pattern of antibiotics needs to be undertaken to monitor its appropriate use. This study was meant to assess the utilization of cephalosporins and its compliance towards the hospital antibiotic policy in surgery ward of a tertiary care teaching hospital.Methods: A prospective observational study was conducted with 250 inpatients of surgery ward. The demographic details, lab investigations, clinical diagnosis and current treatment were noted. The collected data was analysed for utilization of cephalosporin using World Health Organization (WHO) core prescribing indicators and defined daily dose per 100 bed-days. The hospital antibiotic policy was used as a benchmark for analyzing compliance of therapy.Results: Out of 250 patients, 69% was male and 31.2% was female population with mean age of 42.12±17.33 years. Majority of cases were clean-contaminated (36%) followed by clean (30.4%) and contaminated (17.6%) wounds. The average number of overall antibiotics and cephalosporins per encounter was 2.1 and 1 respectively. Among the total parenteral antibiotics, 63.9% were cephalosporins. Cephalosporins utilization was 2.68 DDD per 100 bed-days. Compliance with all the stated criteria was observed only in 124 (49.6%) patients.Conclusions: The rate of prescribing of cephalosporins has increased evidently which may result in the occurrence of bacterial resistance. A suboptimal rate of compliance recommends a strict monitoring in the usage of cephalosporins with periodical updation of policy.

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