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A four years old female child presented after 2 months of ingestion of battery fluid (sulfuric acid) accidently with stricture of the distal esophagus, esophagogastric junction, and fundus as well as proximal portion of the body of the stomach. Corrosive stricture involving the distal esophagus with the proximal stomach is not a frequently encountered condition. Side to side esophagogastrojejunostomy without removal of the strictured esophagus or stomach (side to side esophagogastrojejunoplasty) can be done in such patient hence preserving the stomach which is important physiologically as a reservoir and for the secretion of gastric juices. In review of literature in search engines like MD Consult, PubMed, Cochrane Library, and Embase and standard textbooks of surgery, we could not find such procedure had been performed till date, so that it is the innovative approach with support of literature and surgical principles.

This is a study of 100 cases of corrosive stricture of esophagus managed with colon interposition within duration of seven years. With improved knowledge after review of literature and experience of more frequent procedures, we changed our technique of surgery with decreased operative time and better understanding of ABSTRACT Background: The purpose of this study is to represent the change in our concept of principles and techniques of esophagocoloplasty (midcolon esophagocoloplasty) with repetitive performance of the operation and approach of early surgical intervention (within 4-6 month of corrosive ingestion) in place of repetitive trials of dilatations and medical management, provides early better quality of life with lesser period of suffering and saving expenditure of treatment. Methods: This retrospective study comprises of consecutive 100 patients operated for colon interposition for corrosive stricture of esophagus done at two university linked government teaching hospitals during March 2011 to March 2018. Out of 100 patients, 77 female and 23 male (3:1), mean age 30.6 years (range from 21 to 47 years), mean hospital stay was 14.5 days (range 10 to 25 days) and mean operative duration was 4.5 hours (range 2.5 to 7 hours). Results: The 30 day in hospital mortality rate was 9%. There were 14 instances of leak at the esophagocolic anastomosis (14%), graft necrosis occurred in 01 patient, 08 patients (8%) developed stenosis at the esophagocolic anastomosis. More than 90% patients (n=77) had 'Good' result, 06 patients had 'Fair' and 02 had 'Poor' result. Conclusions: Midcolon graft is a solution for confusion in judgment of adequate length of graft and offer uniformity in procedure with effectively lesser operative time. Early (4-6 months after ingestion) operative intervention is advantageous to patients suffering from crippling dysphagia with repeated admission and expenditure from multiple endoscopic dilatations.

Background. In 1911, Vuillet and Kelling independently described the anatomical and surgical bases of esophageal replacement with the colon. An important complication, in particular in later follow-up, is redundancy of the interposed colon, seen more after retrosternal interposition. The best treatment is prevention by a meticulous surgical technique and measurement of the length of the colon needed to replace the esophagus. Methods. This was a retrospective study of innovative surgical technique. A total of 25 patients with corrosive stricture of the esophagus undergoing two-point fixation in retrosternal colon interposition were included in the study. Preventive Operative Technique. After straightening of conduit by pulling very delicately over both sides, first fixation point we considered cervical anastomoses and second fixation point was made in subxiphoid space, taking two seromuscular stiches from the antimesenteric border of the colon to falciform ligament situated on the right side of the conduit. Results. There were 07 male and 18 female patients with M:F was 1:2.5; mean age was 29 years (range: 23-45 years) and mean hospital stay was 14 days (range: 10-23 days). In this study, we did not encounter any subjective or objective evidence of redundancy in any patients in follow-up barium swallow after 2.5 years of follow-up. Conclusion. Our Two-point fixation technique is refinement of already performed and tried fixation techniques to prevent redundancy of the colon conduit considering kinetics, anatomical alignment, and pathology.

Background: Anal fistulas are abnormal communication between the anal canal and perianal skin or result of anal gland obstruction, with secondary abscess formation and external rupture of the abscess perineum. Fistula in ano rarely heals spontaneously and requires surgical therapy to achieve a cure. Surgical techniques like fistulotomy, fistulectomy, primary closure after excision of tract and staged operations have rendered the postoperative period uneventful, short and steep fall in recurrence rate.Methods: In this retrospective study, 30 patients were selected with diagnoses of fistula in ano admitted in New Civil hospital, Surat, Gujarat during April 2016 to April 2017. Patient underwent definitive treatment. Data related to the objectives of the study were collected from case sheets retrieved from hospital records with permission of competent hospital authority and after approval from ethical committee of institute. Appropriate surgical management were performed. Postoperative findings were noted.Results: Maximum number of patients were in the age group of 30 to 60 years. There were 27 (90%) male patients, 3 (10%) female patients indicating that the disease is more common in male with a ratio of male to female is 9:1. In the study the commonest symptom is discharge in all patients with pruritus in 2 (6.66%) patients and Pain or perineal discomfort in 20 (66.6%) of patients. The commonest sign is presence of external opening in all cases and internal opening in 21 (70%) of patients. Regarding the procedures performed, the majority of the patients 20 patients (66.66%) underwent fistulectomy, while 06 patients (20%) underwent fistulotomy. Seton was tried in 04 patients (13.33%) out of which in 02 patients associated fistulectomy was done.Conclusions: We  concluded  that  the  previously burst  opened  or  surgically  drained  perianal  abscess  is the main aetiological  factor for  fistula-in-ano. Operative morbidity is usually low. There is a male preference for the disease and the fistulectomy remains the commonest procedure in our study series.

Background: Locally advanced breast cancer presents with a difficult management problem. It remains a challenge to achieve local and distant control of locally advanced breast cancer. Over the last decade preoperative/ neoadjuvant chemotherapy has emerged as the standard of care for these patients. Successful reduction in the size of the tumor is associated with increased rate of operability. The objective of this study is to observe the response of neoadjuvant chemotherapy in locally advanced breast carcinoma in form of outcome and complications. The outcome is measured as down staging or downgrading of tumor, results of surgery and its complications, disease free survival and recurrence.Methods: This is the observational prospective study of consecutive 30 cases of locally advanced breast cancer admitted in department of general surgery during a period from May 2017 to August 2018 at new civil hospital, Surat. Neo adjuvant chemotherapy were given every three weekly and the response of therapy calculated in form of reduction in the size of tumor or getting the margin free from skin or pectoral muscles or reduction in the axillary lymph node mass.Results: In this study about 93% of cases responded to neoadjuvant chemotherapy with 10% of cases shows complete clinical response where tumor becomes completely free from skin or pectoral muscles or negative axillary lymph nodes.Conclusions: With the evidence from the literature and study conducted earlier, our observations of clinical response of neoadjuvant chemotherapy in patients with locally advanced breast cancer had corroborative evidence.

Extraskeletal Ewing sarcoma (EES) is a rare tumor of the soft tissue that looks the same as skeletal Ewing sarcoma (ES). A male in his 50s was diagnosed with extraskeletal Ewing sarcoma (EES) of the right shoulder, which had infiltrated the muscles around the shoulder joints. Although uncommon, all members of the ES family of tumors, including EES, were treated following the same general protocol for sarcoma tumors. Due to the significant tumor size in this patient and local invasion, wide local excision and a latissimus dorsi flap were required. This case highlighted the management of EES, including the surgical removal of the mass on the right shoulder, followed by chemotherapy, which led to a successful outcome.

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