Faculty of General Surgery

A comparative study between stapler hemorrhoidopexy and conventional hemorrhoidectomy

2026-05-16T04:40:58Z

A comparative study between stapler hemorrhoidopexy and conventional hemorrhoidectomy Susmitha K. Reddy , Vikram Sindagikar , Mallikarjun B. Patil , Dayanand Biradar , Anand Suntan , Veena Korishetty Background: Hemorrhoids are common anorectal disorders that frequently require surgical intervention. Conventional hemorrhoidectomy is effective but often associated with significant postoperative pain and prolonged recovery. Stapled hemorrhoidopexy has emerged as a less invasive alternative aimed at improving postoperative outcomes. Objectives: To compare stapled hemorrhoidopexy and conventional hemorrhoidectomy with respect to operative parameters, postoperative pain, analgesic requirement, hospital stay, and postoperative complications. Methods: This prospective comparative study was conducted in 50 patients with Grade II and III hemorrhoids who were divided into two groups: stapled hemorrhoidopexy (n = 25) and conventional hemorrhoidectomy (n = 25). All patients underwent standardized preoperative evaluation and surgery under spinal anesthesia. Operative duration, postoperative pain (visual analogue scale (VAS) score), duration of hospital stay, and complications were recorded. Results: Baseline demographic and clinical characteristics were similar in the groups. Operative time was significantly shorter in the stapled group, with all procedures completed within 20 minutes, compared to longer durations in the conventional group (p < 0.001). VAS scores were significantly lower in the stapled group (2.40 ± 0.58 vs. 4.72 ± 0.46; p < 0.001), with reduced analgesic requirement. Hospital stay was significantly shorter following stapled hemorrhoidopexy (1.40 ± 0.58 vs. 2.38 ± 1.14 days; p < 0.001). Postoperative complications were more frequent in the conventional group, though differences were not statistically significant. Conclusion: Stapled hemorrhoidopexy offers significant advantages over conventional hemorrhoidectomy in terms of operative efficiency, postoperative pain, analgesic requirement, and hospital stay, with comparable safety in patients with Grade II and III hemorrhoids.

Thenar flap: a workhorse flap for fingertip injuries

2026-05-16T04:30:54Z

Thenar flap: a workhorse flap for fingertip injuries Vijaykumar Huded, Gazal Gautam Introduction: Fingertip injuries are the most common type of upper limb trauma, frequently involving volar oblique or transverse defects with exposed bone or tendon. The thenar flap, first described in 1926, remains a reliable and aesthetically favorable option for reconstruction, particularly for index, middle, and ring finger injuries. Despite concerns about joint stiffness and donor site morbidity, refinements in surgical technique have improved outcomes. Methods: A retrospective study was conducted at a tertiary care center from January 2023 to January 2025. Twenty-five patients with traumatic fingertip injuries involving pulp loss or volar oblique/transverse defects underwent reconstruction using tailored thenar flap techniques. Functional recovery was assessed via range of motion (ROM) at the metacarpophalangeal joint (MCPJ) and the proximal interphalangeal joint (PIPJ) and static two-point discrimination (2PD). Aesthetic and subjective satisfaction were measured using a five point Likert scale during a 6-month follow-up. Results: Among 25 patients (76% male, median age 25 years), the most common injuries were volar oblique (40%) and involved the index finger (56%). Successful flap survival was noted in all cases, with minimal complications. Mean ROM at the MCPJ and PIPJ was 99.92° and 95.36°, respectively. Mean 2PD over reconstructed fingertips was 5.49 mm. Aesthetic satisfaction was high, with 88% of patients rating outcomes as "satisfied" or "very satisfied." Only one patient developed a flexion contracture due to physiotherapy noncompliance. Conclusion: The thenar flap remains a versatile, safe, and effective option for fingertip reconstruction when performed with proper technique and rehabilitation. It offers excellent functional recovery and aesthetic outcomes, making it a valuable tool across varying age groups.

Reliability and validation of three scoring systems in the assessment of diabetic foot ulcers

2026-05-12T10:50:43Z

Reliability and validation of three scoring systems in the assessment of diabetic foot ulcers Mruthunjaya S. Bevinamarad , Ramakanth Baloorkar , Shivanagouda S. Patil , Shailesh Kannur , Kanishk Kanishk , Nagaraj Biradar , Bhuvaneshwari Gachinmath Introduction Diabetic foot ulcers represent a major cause of morbidity and are frequently associated with infection, delayed healing, and limb loss. Accurate risk stratification using standardized scoring systems is essential for predicting outcomes and guiding management decisions. The present study aimed to evaluate and compare three ulcer scoring systems (Diabetic Ulcer Severity Score (DUSS), Site, Ischemia, Neuropathy, Bacterial Infection, Area, and Depth (SINBAD) scoring, and University of Texas classification) in predicting clinical outcomes, specifically secondary healing, requirement of split-thickness skin grafting (STSG), and lower limb amputation, among patients with diabetic foot ulcers. Materials and methods This prospective observational study included 107 patients aged ≥35 years with diabetic foot ulcers treated at a tertiary care centre over two years. Ulcers were assessed at baseline using the Diabetic Ulcer Severity Score, the University of Texas (UT) classification, and the SINBAD scoring system. Patients were followed until a definitive outcome. Clinical outcomes were categorized as secondary healing, requirement of split thickness skin grafting, or lower limb amputation. Non-parametric statistical analysis was performed using the Kruskal-Wallis test, and a p-value <0.05 was considered statistically significant. Results The mean age of participants was 56.84 ± 12.32 years, with a male predominance (84, 78.3%). Most ulcers were located in the midfoot (45, 42.1%) and forefoot (44, 41.1%). STSG was required in 84 (78.5%) patients, amputation was performed in 18 (16.8%), and secondary healing occurred in five (4.7%). DUSS and UT classification did not show statistically significant differences across outcome groups. In contrast, SINBAD scores were significantly higher in the amputation group (median 5, IQR 4-6) compared to the STSG group (median 4, IQR 3-5) and secondary healing group (median 2, IQR 1-2) (H=8.02, p=0.018), demonstrating better discriminatory ability. Conclusion Among the evaluated scoring systems, SINBAD showed superior predictive performance for adverse clinical outcomes and may serve as a practical tool for risk stratification in diabetic foot ulcer management.

A prospective comparative study between stapler and handsewn gastrointestinal anastomosis

2026-05-12T10:36:38Z

A prospective comparative study between stapler and handsewn gastrointestinal anastomosis Gollapudi Sai Viswanth , Dayanand Biradar , Mallikarjun B. Patil , Vikram Sindagikar , Anand Suntan , Veena Korishetty Introduction: Gastrointestinal (GI) anastomosis is a critical step in bowel surgery, and the choice between stapled and handsewn techniques remains debated. Differences in operative efficiency and recovery have been reported, but complication rates appear comparable. This study compared stapled and handsewn GI anastomosis with respect to operative time, postoperative recovery, and complications. Materials and methods: A prospective observational comparative study was conducted over two years in a tertiary care center. A total of 52 patients undergoing GI anastomosis were included, with 26 in the handsewn group and 26 in the stapler group. Technique selection was surgeon-directed. Baseline demographic and clinical variables were recorded. Primary outcomes included anastomosis time, time to oral feeding, and hospital stay. Secondary outcomes included anastomotic leak, surgical site infection (SSI), wound dehiscence, morbidity, and mortality. Continuous variables were analyzed using an independent t test and categorical variables using a Chi-square test, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between groups. Anastomosis configuration differed significantly, with side-to-side performed in 26 (100%) stapled versus five (19.2%) handsewn cases (p < 0.001). Anastomotic leak occurred in two (7.7%) handsewn and three (11.5%) stapled cases (p = 0.638). SSI was seen in eight (30.8%) versus six (23.1%) (p = 0.532), and wound dehiscence in three (11.5%) versus zero (0%) (p = 0.074). The mean anastomosis time was significantly lower with stapling (5.81 ± 4.21 vs 25.62 ± 5.29 minutes, p < 0.001). Oral feeding was started earlier (2.31 ± 0.74 vs 4.27 ± 0.67 days, p < 0.001), and hospital stay was shorter (9.50 ± 2.18 vs 12.38 ± 2.12 days, p < 0.001). No mortality occurred. Conclusion: Stapled anastomosis significantly improves operative efficiency and recovery while maintaining comparable complication rates.