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Feb04
Liposuction in Delhi for Fat Removal by Dr Ashish Khare
Body contouring with liposuction surgery is a popular procedure for removing fat from areas such as the waist, abdomen, hips and thighs. Liposuction is especially effective for people with localized pockets of fat that diet and exercise cannot seem to remove. For those looking for Liposuction near me, there are many experienced surgeons in Delhi who specialize in body contouring with liposuction.

Liposuction is a surgical procedure that sucks fat from the body by using a suction device. Local, or general anesthesia can be used depending on the area and size of the area being operated on. The procedure involves making small incisions in the targeted area and sucking out the fat cells to contour the body. It usually takes 1-2 hours depending on the extent of the operation.

When performed by a qualified surgeon, liposuction will remove fat cells permanently. Patients should be aware that some amount of fat may come back if they are not aware of their diet and exercise regime. After surgery it is important to keep the affected area clean and dry to allow the area to heal properly.

Overall liposuction is a safe and effective way to improve body shape and contour.

To avail the benefits of liposuction in Delhi, book a consultation with Dr. Ashish Khare today!

Get more info at: https://www.kalosaaesthetics.com/liposuction/

Disclaimer: All the text, videos, techniques, and images available on this post are for awareness purposes only. It must not be considered as a substitute for medical advice. Results may vary from person to person, depending on the medical needs.


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Jan30
A Breast Lift Can Improve the Position of Your Breasts
A breast lift is a cosmetic surgery procedure that helps improve the shape and position of breasts by removing excess skin, reshaping tissue, and possibly repositioning the nipples. Breast lifts can be done to one or both breasts with the aim of restoring the appearance of perkier, more youthful breasts. As one of the fastest growing cosmetic surgeries, the treatment has become increasingly popular in Delhi in recent years, with patients eager to benefit from a breast lift surgery.

The breast lift surgery in Delhi can be tailored to each patient’s specific needs, allowing you to achieve your desired outcome. By removing excess skin, a breast lift can raise the breasts so they sit higher on the chest wall, giving you a more youthful look. The nipples can also be re-positioned to a lifted, more natural position. After the breast lift procedure, your breasts will look firmer and perkier, helping you feel more confident and attractive in your body.

The benefits of a breast lift go beyond improving your appearance; it can also help you feel more physically and emotionally comfortable in your own skin. Choosing to undergo a breast lift in Delhi is a highly personal decision, and you should talk to your surgeon to ensure it is the right!

To avail the benefits of best cost of breast lift treatment in Delhi, book a consultation with Dr. Ashish Khare today!

Contact Us
Kalosa Aesthetics & Cosmetic Gynaecology Clinic
Tara, B - 33, 34, Crescent Rd, Qutab Institutional Area, New Delhi - 110016
Phone: +91-8619751479, +91-9818816485
Email: info@kalosaaesthetics.com
Website: https://www.kalosaaesthetics.com/breast-lift/

Disclaimer: All the text, videos, techniques, and images available on this post are for awareness purposes only. It must not be considered as a substitute for medical advice. Results may vary from person to person, depending on the medical needs.


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Jan27
6 Signs You Need to See an Orthopedic Doctor | Dr. Ashwini Gaurav
6 Signs You Need to See an Orthopedic Doctor
Do you have knee or back pain daily? Do you feel sore after sleeping or inactive for a long time? Do you have an injury that doesn’t seem to be healing? These are some common 6 Signs You Need to See an Orthopedic Doctor. But what are some other reasons? An orthopedic doctor specializes in the treatment of the musculoskeletal system. The musculoskeletal system includes bones, joints, tendons, muscles, ligaments, and cartilage. Orthopedic doctors treat injuries through both surgical and non-surgical means and will help you decide the right course of treatment. Let’s get over some of the common reasons explained by Dr. Ashwini Gaurav about When you need to see an Orthopedic Doctor. He is known as the Best Orthopedic Doctor in Patna.

You have difficulty performing everyday activities:
Bad posture, age, and overall lifestyle can bring bone and joint pain, which can be a block to your daily activities. You may struggle to do the easiest of tasks like climbing stairs or even walking. Orthopedic issues may cause difficulty in walking or standing. If you have instability or feel shaky when walking, standing up, sitting down, or remaining standing, an Orthopedic doctor can help diagnose the problems and treat them. They may recommend physical therapy or surgery to improve your quality of life and restore your ability to perform essential activities
You have a fracture:
Orthopedic surgeons can fix broken bones and injuries to tendons and muscles and help improve function and decrease or eliminate pain. If you have serious fractures or breaks, you have referred to an orthopedic surgeon to have the right treatment. Some fractures can be fixed by wearing a cast or splint to immobilize the area, but other fractures are more complex, such as compression fractures or stress fractures. Fractures in the wrists, hips, vertebrae, and kneecaps are not as easy to treat as a simple fracture in the arm. An orthopedic doctor can treat these types of fractures with surgery or other methods.
You have soft tissue injury not improved in 48 hours:
Have you just suffered from a soft tissue injury, such as a twisted knee, sprained ankle, or busted wrist? Use the RICE method to see if the pain and swelling decrease within two days. If you have not noticed any major improvements after the first 48 hours, you .should seek medical attention. If there is an injury to the muscles, tendons, ligaments, or bones, Orthopedic doctors can diagnose and treat the problem.
Your range of motion is limited:
Are your joints supposing tighter and tighter as the days go by? If pain and stiffness are keeping you from moving freely, then orthopedic doctors can help with that. Limited motion is often a symptom of arthritis, injury, and other joint conditions. You should seek treatment when you notice that you are losing range of motion so that the condition does not get more destructive and require more aggressive treatment.
You experience orthopedic trauma:
If you are in an accident, have a fall, or have a sports injury, you may show signs or symptoms consistent with a traumatic injury. You should be examined and monitored by an orthopedic doctor promptly to confirm that there is no irreversible harm to your bones, joints, or muscles.
You have chronic pain:
Chronic pain is defined as any pain staying more than 12 weeks. Experiencing a few days of pain is one thing but after several weeks and months of it. that’s a sign you should see a doctor.
How to Book An Appointment?
If you face any problem regarding joint pain then you must visit the best orthopedic doctor in Patna. For more information about our comprehensive treatment options, or to request an appointment with Dr. Ashwini Gaurav, call 9386737895 or Click on Book Appointment for online booking.


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Jan19
Best Trauma surgery Surgeon in Patna | Trauma Surgery Doctor: Dr. Ashwini Gaurav
What is Trauma?

Trauma is that the injuries suffered when an individual experiences a blunt force or a penetrating injury. You will also hear trauma named as “major trauma.” Many trauma patients are the victims of car crashes, stabbings, and gunshot wounds. Trauma may also be caused by falls, crush type injuries, and pedestrians being struck by a car.

Traumatic injuries can affect internal organs, bones, the brain, and therefore the other soft tissues of the body. No area of the body is resistant to trauma, but trauma can range from minor (hitting your finger with a hammer) to major (being hit by a car traveling at a high rate of speed or fall off of a building).

What do we do in Trauma Surgery?
In the case of severe trauma like a car crash and fall off from a building the surgery team not only includes trauma surgeons but also general surgeons, orthopedic surgeons, vascular surgeons, and other surgeons as needed. The trauma includes not only surgeons but also paramedics, nurses, anesthetists, respiratory therapists, radiographers.

Trauma physicians are highly trained to diagnose and stabilize patients who are having traumatic injuries. They have to address things in a particular order. We have to fix which of the patient’s injuries need treatment first.

Usually, the first stop the bleeding.
Then, they eliminate any contamination threat to the wounds.
Next, whether the patient is stable enough for immediate surgery or if the patient should be sent to the intensive care unit (ICU).
Traumatic injuries often include the following:
Spine fractures and spinal cord injury
Sudden amputation
Traumatic brain injury (TBI)
Crush injury
Acoustic trauma
Broken or dislocated jaw
Concussion
Skull fracture
Severe cuts and puncture wounds
Cost of Trauma Surgery
Dr. Ashwini Gaurav is a well-known orthopedic doctor and trauma surgeon in Patna. We, not only understand the complexity of major trauma but also treat them with an advanced treatment approach.

The cost of trauma surgery depends upon the patient’s medical condition. We provide the Best and Affordable Trauma / Fracture Surgery services in Patna. Feel free to contact us, we are always there to serve you.


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Jan09
Types of bariatric surgery
Bariatric surgery is considered the most effective treatment for obesity in terms of long-term weight loss and improvement in obesity-related co-morbidities.
<a href="https://drsaggu.com/best-bariatric-surgeon/">Best Bariatric Surgeon in Delhi</a> procedures cause weight loss by limiting the amount of food that can be held in the stomach, causing malabsorption of nutrients or a combination of gastric restriction and malabsorption. Bariatric procedures also bring about desirable hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).

How do I know if I am eligible for slimming surgery?

Weight loss surgery is only recommended if you can't lose a lot of weight and keep it off with diet, behavior changes, and exercise alone. Doctors often use body mass index (BMI) and health conditions such as type 2 diabetes and high blood pressure to determine which patients are most likely to benefit from weight loss surgery. Patients with concomitant comorbidities such as diabetes, etc., or with a BMI greater than 37.5 kg/m2, with or without concomitant comorbidities.


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Nov09
D-backs Exchange Deadline programs
PHOENIX -- Just before opening their 4-recreation sequence with the Giants upon Thursday, the D-backs dealt outfielder Tim Locastro towards the Yankees within just change for Very little League specifically-hander Keegan Curtis.Even at the time their 5-3 acquire around the Giants at Chase Business, the D-backs locate them selves buried deep in just the Nationwide League West with a 23-60 history. It was specifically Arizona 3rd acquire within just its closing 27 video games and all 3 of these online games were being started out via Merrill Kelly, who authorized a few operates previously mentioned 7 innings with 7 strikeouts. Josh Reddick and Pavin Smith paced the offense as each individual homered off Giants newbie Johnny Cueto.Though there will virtually undoubtedly be further moves just before the July 30 Exchange Deadline, enthusiasts anticipating in the direction of perspective a carefully substitute D-backs staff members within just August are almost certainly in direction of be frustrated.I put on't check out any large transformation of our latest roster, reported assistant GM Amiel Sawdaye, who is taking care of the personnel working day-towards-working day functions even though GM Mike Hazen is upon a bodily go away of deficiency. "I have on't imagine we need a complete teardown. I can comprehend why followers need a entire teardown https://www.arizonapetsstore.com/Riley_Smith_Dog_Jersey-40 . I dress in't feel we need to have that. I consider coming into this calendar year we sure didn't be expecting this personnel in direction of visual appeal such as this, yet I moreover believe it's a great deal less difficult towards say, Oh, accurately rip it aside and rebuild. It's not that very simple toward do that. Generating trades is not an basic point toward do within just the league.That doesnt signify there wont be some alterations.There incorporate been rumors linking infielder Eduardo Escobar, who is within just the best calendar year of his deal, in the direction of the White Sox, still the D-backs are not merely moving toward offer you him absent.There much too been sound above Arizona becoming open up in the direction of working David Peralta, who would be a small more durable in direction of stream than Escobar as the outfielder is down below deal all through the 2022 time, manufacturing $7.5 million within the supreme yr of his package.Catcher Stephen Vogt is a no cost consultant at period finish as is outfielder Reddick, who consists of a lot of postseason encounter.However it not as basic as a workers boasting it desires in direction of exchange avid gamers."For each and every Arizona Diamondbacks vendor that is out there, there are other groups that are marketing that consist of superior avid gamers, as well, and a constrained selection of groups that purchase, Sawdaye stated. It's a current market, instantly? On your own've acquired towards consist of potential buyers and distributors https://www.arizonapetsstore.com/Custom_Dog_Jersey-12 . That's aspect of the problem at moments."Whilst it will come toward avid gamers that groups would nearly completely be fascinated inside, these as outfielder Ketel Marte or catcher Carson Kelly, either of whom are upon the hurt record, the D-backs imagine they are gamers who may be element of the main of a potential contending personnel.At the close of April, we observed Carson Kelly with a 1.000 OPS, and if we imagine inside that, it's not simple in the direction of locate a catcher towards switch Carson https://www.arizonapetsstore.com/Stone_Garrett_Dog_Jersey-104 , who we felt includes rather occur into his individual as a rather Fantastic defensive catcher and was likely, prior to he bought problems, upon his path in the direction of remaining an All-Star https://www.arizonapetsstore.com/Corbin_Carroll_Dog_Jersey-101 , Sawdaye reported.Kelly, who as well strike an RBI solitary in opposition to San Francisco, would surely focus groups as he consists of a rather economical employees preference for 2022 at $5.25 million, still all over again, he could possibly be unachievable for the D-backs towards aspect with presented that he is their highest regular newbie.It's additionally relevance holding inside of thoughts that the D-backs put on't consist of in the direction of do all their business enterprise ahead of the Exchange Deadline -- the offseason is frequently an less difficult season in direction of offer avid gamers quite than in just the warm of a time.On your own use't merely require in direction of press components during at the Deadline simply just towards press them all through considering the fact that it's the Deadline, Sawdaye explained. I do believe that there may be option dynamics at enjoy inside the offseason than there may perhaps be within just the upcoming 3 or 4 months."


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Oct19
Efficacy of surgical techniques and factors affecting residual stone rate in the treatment of kidney stones
Original Research
Efficacy of surgical techniques and factors affecting residual stone rate in
the treatment of kidney stones
Dr. Anil Haripriya


1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to assess efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. Materials & Methods: 102 patients of kidney stones of both genders were divided
into 3 groups. Group I patients underwent open stone surgery, group II patients underwent percutaneous nephrolithotomy
(PNL) and group III underwent retrograde intrarenal surgery (RIRS). Surgical techniques complications were evaluated.
Results: In group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9 cm2
. The mean
operative time in group I was 84.2 minutes, in group II was 118.4 minutes and in group III was 78.6 minutes. There were 9
cases in group I, 7 in group II and group III was 5 cases. There were 7 cases of fever in group I, 4 in group II and 2 in group
III, infection 2 in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II.
The difference was significant (P< 0.05). Conclusion: PNL and RIRS have been seen as safe and effective methods as
compared to open method in case of kidney stones.
Key words: Percutaneous nephrolithotomy, Retrograde intrarenal surgery, Kidney stone.
Received: 13 September, 2020 Accepted: 18 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College,
Jabalpur (M.P.), India
This article may be cited as: Haripriya A, Baghel A. Efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. J Adv Med Dent Scie Res 2020;8(12):55-58.
INTRODUCTION
Urinary system stone disease is one of most
frequently encountered diseases in the urology
practice. The stones are frequently observed in the
renal localization, and most of them require
intervention.1 Kidney stone disease, also known as
urolithiasis or renal calculi contributes to one of the
most common health problems in the daily lives of
men and women. It occurs when a solid piece of
material (stone) forms in the urinary tract.2
Approximately 12% of men and 6% of women in the
USA and 10 to 15% of people in Europe and North
America are affected by it. Calcium oxalate (CaOx) is
found to one component of the most common kidney
stones. It has been proposed that the most likely stone
formation mechanism for people with idiopathic
CaOx stones is caused by CaOx overgrowth in renal
papillary Randall’s plaque.
3
Preventive measures such
as dietary therapy and therapeutic treatments such as
drugs and surgical techniques have been verified to be

effective in the treatment of renal calculi. Dietary
modification is a safe and economical preventive
measure for dietary therapy, and in some cases, drugs
are important to reduce the risk of stone formation.
Unfortunately, since the 1980s, there have been no
new drugs developed for the prevention of renal
calculi after the introduction of potassium citrate.4
Some of these methods include percutaneous
nephrolithotomy (PCNL), extracorporeal shockwave
lithotripsy (SWL), retrograde intrarenal surgery
(RIRS), etc. Extracorporeal shock wave lithotripsy
(ESWL) into clinical practice after 1980s, a new era
had begun in the treatment of urinary system stone
disease. In recent years, percutaneous
nephrolithotomy (PNL) has taken increasingly greater
part in the treatment of stone disease with success
rates nearing to 80 percent.5 The present study was
conducted to assess efficacy of surgical techniques
and factors affecting residual stone rate in the
treatment of kidney stones.
Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Treatment of kidney stones.

56

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
MATERIALS & METHODS
The present study was conducted among 102 patients
who underwent surgical treatment of kidney stones of
both genders in the department of general surgery in a
medical college hospital. All were informed regarding
about the study and their consent was obtained.
Data such as name, age, gender etc. was recorded.
Patients were divided into 3 groups. Group I patients
underwent open stone surgery, group II patients
underwent percutaneous nephrolithotomy (PNL) and

group III underwent retrograde intrarenal surgery
(RIRS).
Endoscopic stone surgery was performed for stone
fragmentation in all patients using pneumatic
lithotriptor or Holmium: YAG laser. Surgical
techniques complications were evaluated. Stones
equal or larger than 4 mm were considered as residual
stones. The dimensions of the stones were calculated
and measured in cm2

. Results thus obtained were
subjected to statistical analysis. P value less than 0.05
was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II Group III
Methods Open stone surgery PNL RIRS
M:F 34 34 34

Table I shows that group I patients underwent open stone surgery, group II patients underwent PNL, and group
III underwent RIRS. Each group had 34 patients.
Table II Assessment of parameters

Parameters Group I Group II Group III P value
Stone burden (cm2

) 3.2 2.5 1.9 0.01
Operative time (mins) 84.2 118.4 78.6 0.001
Length of hospital stay 3.2 3.0 1.4 0.05
Cases with residual stone 9 7 5 0.02
Table II shows that in group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative timein group I was 84.2 minutes, in group II was 118.4 minutes and in group III was
78.6 minutes. There were 9 cases in group I, 7 in group II and group III was 5 cases. The difference was
significant (P< 0.05).
Table III Assessment of complications in groups

Complications Group I Group II Group III P value
Fever 7 4 2 0.02
Infection 2 0 3 0.05
Urine leakage 0 0 5 0.05
Persistent pain 6 1 0 0.001

Table III, graph I shows that there were 7 cases of fever in group I, 4 in group II and 2 in group III, infection 2
in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II. The
difference was significant (P< 0.05).
Graph I: Assessment of complications in groups

0
1
2
3
4
5
6
7

Fever Infection Urine leakage Persistent pain
7

2

0

6

4

0 0

1

2

3

5

0

Group I
Group II
Group III

Haripriya A et al. Treatment of kidney stones.

57

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
Currently, a diverse range of non-invasive, minimally
invasive and invasive methods have been reported as
treatment approaches for renal calculi. Recent studies
have reported that flexible ureterorenoscopy
(URS)/holmium laser lithotripsy can be an alternative

treatment for patients with renal calculi. The micro-
percutaneous nephrolithotomy (microperc) is a

recently described technique in which percutaneous
renal access and lithotripsy are performed in a single
step. Microperc has been found to be safe and
effective in removing small renal calculi in the adult
and pediatric populations with a high stone-free rate
and lower complication rate.6 Despite all the new
approaches, shock wave lithotripsy (SWL) remains
the first line treatment modality that is widely used for
renal, ureteral and intermediate-size renal calculi. Its
success rates from contemporary series vary from 60
to 90%. However, during an SWL procedure,
physicians should consider the association between
SWL-related pain and patients’ positioning, which
may negatively affect the SWL success rate as well as
its potential complications. PCNL can be divided into
two types: minimally invasive percutaneous
nephrolithotomy (mini-PCNL) and standard
percutaneous nephrolithotomy (standard PCNL).7
Mini-PCNL has a higher efficacy and better safety in
the management of small renal calculi, while standard
PCNL is still regarded as the conventional technique
for the treatment of large renal stones in the upper
urinary tract. However, in the recent years, there has
been a shift in trend to favor a mini-PCNL approach
in order to reduce the morbidities.8The present study
was conducted to assess efficacy of surgical
techniques and factors affecting residual stone rate in
the treatment of kidney stones.
In present study, group I patients underwent open
stone surgery, group II patients underwent PNL, and
group III underwent RIRS. Each group had 34
patients. Ayedemir et al9

included records of 109
cases of kidney stones. Patients were divided into
three groups in terms of surgical treatment; open stone
surgery, percutaneous nephrolithotomy (PNL) and
retrograde intrarenal surgery (RIRS). Patients’ history,
physical examination, biochemical and radiological
images and operative and postoperative data were
recorded.The patients had undergone PNL (n=74;
67.9%), RIRS (n=22;20.2%), and open renal surgery
(n=13; 11.9%). The mean and median ages of the
patients were 46±9, 41 (21–75) and, 42 (23–67) years,
respectively. The mean stone burden was 2.6±0.7 cm2
in the PNL, 1.4±0.1 cm2 in the RIRS, and 3.1±0.9
cm2 in the open surgery groups. The mean operative
times were 126±24 min in the PNL group, 72±12 min
in the RIRS group and 82±22 min in the open surgery
group. The duration of hospitalisation was 3.1±0.2
days, 1.2±0.3 days and 3.4±1.1 days respectively.
While the RIRS group did not need blood transfusion,
in the PNL group blood transfusions were given in the
PNL (n=18), and open surgery (n=2) groups. Residual

stones were detected in the PNL (n=22), open surgery
(n=2), and RIRS (n=5) groups.
We found that in group I mean stone burden was 3.2
cm2
, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative time in group I was 84.2
minutes, in group II was 118.4 minutes and in group
III was 78.6 minutes. There were 9 cases in group I, 7
in group II and group III was 5 cases. Stone-free rate
in percutaneous nephrolithotomy can vary dependent
on the stone location, and size, as reported in the
literature, it increases up to 90 percent. In the AUA
guideline, this rate has been given as 78 percent. In
our study, in 74 patients, a 70.3% stone-free rate has
been detected. Size, location, composition of the
stone, anatomy of the affected kidney, and experience
of the surgeon are effective on success, and
complications of PNL.10
We found that there were 7 cases of fever in group I, 4
in group II and 2 in group III, infection 2 in group I
and 3 in group III, urine leakage 5 in group III and
persistent pain 6 in group I and 1 in group II.
Lingeman et al11reported 88–91% success rates for
stones with a diameter of 1–3 cm, mean success rate
decreased to 75% in stones larger than 3 cm in
diameter. Still Clayman et al12reported success rates
as 89.2, and 97–100% for stone with a stone burden of
>2, and <2 cm2

, respectively.
CONCLUSION
Authors found that PNL and RIRS have been seen as
safe and effective methods as compared to open
method in case of kidney stones.
REFERENCES
1. Karatag T, Buldu I, Inan R, Istanbulluoglu MO: Is
MicropercutaneousNephrolithotomy Technique Really
Efficacicous for the Treatment of Moderate Size Renal
Calculi? Yes. UrolInt 2015;95:9-14.
2. Kim BS: Recent advancement or less invasive treatment
of percutaneous nephrolithotomy. Korean J Urol
2015;56:614-623.
3. Hyams ES, Munver R, Bird VG, Uberoi J, Shah O:
Flexible ureterorenoscopy and holmium laser lithotripsy
for the management of renal stone burdens that measure
2 to 3 cm: a multi-institutional experience. J Endourol
2010;24:1583-1588.
4. Sabnis RB, Ganesamoni R, Ganpule AP, Mishra S,
Vyas J, Jagtap J, Desai M: Current role of microperc in
the management of small renal calculi. Indian J Urol
2013;29:214-218.
5. Knoll T, Buchholz N, Wendt-Nordahl G: Extracorporeal
shockwave lithotripsy vs. percutaneous nephrolithotomy
vs. flexible ureterorenoscopy for lower-pole stones.
Arab J Urol 2012;10:336-341.
6. Capitanini A, Rosso L, Giannecchini L, Meniconi O,
Cupisti A: Sepsis complicated by brain abscess
following ESWL of a caliceal kidney stone: a case
report. IntBraz J Urol 2016;42:1033-1036.
7. Kim JK, Ha SB, Jeon CH, Oh JJ, Cho SY, Oh SJ, Kim

HH, Jeong CW: Clinical Nomograms to Predict Stone-
Free Rates after Shock-Wave Lithotripsy: Development

and Internal-Validation. PLoS One 2016;11:e0149333.

Haripriya A et al. Treatment of kidney stones.

58

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
8. Kang JH, Lee SW, Moon SH, Sung HH, Choo SH, Han
DH: Relationship Between Patient Position and Pain
Severity During Shock Wave Lithotripsy for Renal
Stones With the MODULITH SLX-F2 Lithotripter: A
Matched Case-Control Study. Korean J Urol
2013;54:531-535.
9. Aydemir H, Budak S, Kumsar Ş, Köse O, Sağlam HS,
Adsan Ö. Efficacy of surgical techniques and factors
affecting residual stone rate in the treatment of kidney
stones. Turkish journal of urology. 2014 Sep;40(3):144.
10. Wong C, Leveillee RJ. Single upper-pole percutaneous
access for treatment of > or = 5-cm complex branched

staghorn calculi: is shockwave lithotripsy necessary? J
Endourol. 2002;16:477–81.
11. Lingeman JE, Coury TA, Newman DM, Kahnoski RJ,
Mertz JH, Mosbaugh PG, et al. Comparison of results
and morbidity of percutaneous nephrostolithotomy and
extracorporeal shock wave lithotripsy. J Urol.
1987;138:485–90.
12. Clayman RV, Mcdougall EM, Nakada SY. Endourology
of the upper urinary tract: percutaneous renal and
ureteral procedures. In: Wals PC, Retik AB, Vaughan
EJ, Wein AJ, editors. Campbell’s urology. Philadelphia:
WB Saunders; 1998; 2789–874.


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Oct19
A comparative study of laparoscopic appendectomy versus open appendectomy for the treatment of acute appendicitis
Original Research
A comparative study of laparoscopic appendectomy versus open
appendectomy for the treatment of acute appendicitis
Dr. Anil Haripriya



1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to compare open versus laparoscopic appendectomy in acute appendicitis.
Materials & Methods: 68 cases of acute appendicitis were divided into 2 groups. Group I patients were subjected to laparoscopy
appendectomy and Group II patients subjected to open appendectomy. Results: Symptoms were nausea/vomiting seen 28 in
group I and 26 in group II, abdominal pain 32 in group I and 33 in group II and fever in 25 in group I and 21 in group II. The
difference was non- significant (P> 0.05). Oral feed started postoperatively at mean of 5.9 days in group I and 2.6 days in group
II, average hospital stay was 5.6 days in group I and 4.2 days in group II. Wound abscess was seen in 3 days in group I and 4
days in group II and wound infection 2 days in group I and 8 days in group II. The difference was significant (P< 0.05).
Conclusion: Laparoscopic appendectomy is effective method of acute appendicitis as compared to open appendectomy.
Key words: Acute appendicitis, Laparoscopic appendectomy, Oral feed
Received: 11 September, 2020 Accepted: 16 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur
(M.P.), India
This article may be cited as: Haripriya A, Baghel A. A comparative study of laparoscopic appendectomy versus open
appendectomy for the treatment of acute appendicitis. J Adv Med Dent Scie Res 2020;8(12):42-45.
INTRODUCTION
Acute appendicitis is the most common emergent
abdominal condition requiring surgical intervention.
Appendicitis is inflammation of the appendix.
1
Symptoms commonly include right lower abdominal
pain, nausea, vomiting, and decreased appetite.
However, approximately 40% of people do not have
these typical symptoms. Severe complications of a
ruptured appendix include widespread, painful
inflammation of the inner lining of the abdominal wall
and sepsis.
2
Appendicitis is the most common cause of the acute
abdomen in the United States, with an estimated
lifetime risk between 5 and 20%. In fact, appendectomy
is the most common non-elective operation performed
by general surgeons. Although it has been over 115
years since Reginald Heber Fitz first demonstrated the

natural history and pathophysiology of appendicitis and
advocated early appendectomy in his landmark article,
appendicitis continues to present challenges for the
surgeon today.3
Appendectomy is the most commonly performed
operation in the world, 6% of all the surgical procedures
and is done as emergency procedure wherever possible,
the only exception is formation of appendicular mass or
abscess. In these cases, interval appendectomy is
performed as elective procedure.4
Laparoscopic appendectomy gives a better evaluation of
the peritoneal cavity than that obtained by open
approach and also facilitates other differential
diagnosis. Advantages of laparoscopic approach include
less operative time, less postoperative pain, reduced
analgesia, less surgery associated complications, shorter
hospital stay, faster recovery, reduced wound infection

Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

43

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
and minimal scarring.5 The present study was
conducted to compare open versus laparoscopic
appendectomy in acute appendicitis.
MATERIALS & METHODS
The present study was conducted in the department of
general surgery in a medical college hospital. It
comprised of 68 cases of acute appendicitis. Patients
were informed regarding the study and written consent
was taken.

Patient information such as name, age, gender etc. was
recorded. Patients were diagnosed on the basis of
physical examination, laboratory tests and ultrasound
examination (USG). Patients were divided into 2
groups. Group I patients were subjected to laparoscopy
appendectomy and Group II patients subjected to open
appendectomy. Patients were monitored for pulse rate,
blood pressure, temperature, respiratory rate, bowel
sounds and urinary output. Patients were put on follow
up at 1 week, 2 weeks and 4 weeks after surgery. P
value less than 0.05 was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II
Number Laparoscopy appendectomy Open appendectomy
Number 34 34

Table I shows that group I patients were subjected to laparoscopy appendectomy and group II patients subjected to
open appendectomy.
Table II Assessment of symptoms

Symptoms Group I Group II P value
Nausea/vomiting 28 26 0.97
Abdominal pain 32 33 0.94
Fever 25 21 0.91

Table II shows that symptoms were nausea/vomiting seen 28 in group I and 26 in group II, abdominal pain 32 in
group I and 33 in group II and fever in 25 in group I and 21 in group II. The difference was non- significant (P>
0.05).
Table III Assessment of parameters

Parameters Group I Group II P value
Oral feed started postoperatively 5.9 2.6 0.01
Average hospital stay 5.6 4.2 0.05
Wound abscess 3 4 0.05
Wound infection 2 8 0.01

Table III, graph I shows that oral feed started postoperatively at mean of 5.9 days in group I and 2.6 days in group II,
average hospital stay was 5.6 days in group I and 4.2 days in group II. Wound abscess was seen in 3 days in group I
and 4 days in group II and wound infection 2 days in group I and 8 days in group II. The difference was significant
(P< 0.05).
Graph I Assessment of parameters

0
1
2
3
4
5
6
7
8

Oral feed started
postoperatively

Average hospital
stay

Wound abscess Wound infection

5.9 5.6

3

2

2.6

4.2 4

8

Group I
Group II

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

44

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
The diagnosis of acute appendicitis is often difficult,
and challenging. The most common cause of surgical
abdomen is appendicitis affecting all the age groups.6
The maximum incidence is documented to be about 7-
10 % of the general population in the second and third
decades of life.7 Appendectomy is the operation which
is most commonly performed by the general surgeons.
The Laparoscopic appendectomy was first performed
by Semm K, German Gynaecologist.8

It has gained
acceptance with the technological advances of the past
two to three decades as a diagnostic and treatment
method for acute appendicitis. From that time, this
procedure has been used widely. In spite of its wide
acceptance, there remains a continuing debate in the
literature related to the most appropriate way of
removing the inflamed appendix.9 The present study
was conducted to compare open versus laparoscopic
appendectomy in acute appendicitis.
In present study, group I patients were subjected to
laparoscopy appendectomy and group II patients
subjected to open appendectomy. Burra et al10 in their
study a total 140 patients admitted with clinical
diagnosis of acute or recurrent appendicitis. They were
divided into two groups: open appendectomy (OA)
group with 70 patients in each) and laparoscopic
appendectomy (LA) group (70 patients in each). OA
was performed through standard Mc Burney incision. A
standard 3-port technique was used in this study for the
laparoscopic procedure. It is found that laparoscopic
appendectomy is as safe and effective as the open
procedure. The pain score was reduced in laparoscopic
which is 3.4±1.8 and in open 4.2±1.4. This difference
was found to be statistically significant at p value of
0.05. The duration of analgesics was also reduced in
laparoscopic with mean value of 4.81±3.6 and
10.32±4.2 and this difference was found to be
statistically significant at p value of 0.05.
We found that symptoms were nausea/vomiting seen 28
in group I and 26 in group II, abdominal pain 32 in
group I and 33 in group II and fever in 25 in group I and
21 in group II. Gupta et al11 compared and evaluated the
open and laparoscopic method of appendectomy in
acute appendicitis. The subjects undergoing
appendectomy were evaluated for age, sex, episode
number, duration of pain before presentation in
hospital, operative time, conversion rate, wound
infection, post-operative intra-abdominal abscess
formation, and stay in hospital. It was found that
average operative time in open surgery was 67.5
minutes and 104 minutes in laparoscopic surgery, with
a conversion to open in about 20% of the cases. Oral
feeding in the open group was around the 5th day while
it was around 2nd day in the laparoscopic group.
Average hospital stay was also low in the laparoscopic
group, being only around 5 days in laparoscopic group

and around 8 days in the open group. Overall
complications were also low in the laparoscopic surgery
group.
We observed that oral feed started postoperatively at
mean of 5.9 days in group I and 2.6 days in group II,
average hospital stay was 5.6 days in group I and 4.2
days in group II. Wound abscess was seen in 3 days in
group I and 4 days in group II and wound infection 2
days in group I and 8 days in group II.
Another study by Garg CP12 which studied a total of
110 patients, 61 of whom underwent open
appendectomy and the rest 49 underwent laparoscopic
appendectomy. Operative time was noted to be higher
in laparoscopic surgery, also it was noted that
laparoscopic surgery was associated with less analgesic
use, shorter hospital stay.
The shortcoming of the study is small sample size.
CONCLUSION
Authors found that laparoscopic appendectomy is safer
and effective method for patients of acute appendicitis
as compared to open appendectomy.
REFERENCES
1. Chiarugi M, Buccianti P, Celona G, Decanini L,
Martino MC, Goletti O et al. Laparoscopic compared
with open appendectomy for acute appendicitis: A
prospective study. Eur J Surg 1996; 162(2): 385–390.
2. Garbutt JM, Soper NJ, Shannon W, Botero A,
Littenberg B. Meta-analysis of randomized controlled
trials comparing laparoscopic and open appendectomy.
Surg Laparosc Endosc. 1999; 9(4):17-26.
3. Akshatha Manjunath, Aparajita Mookherjee.
Laparoscopic versus open appendectomy: An analysis
of the surgical outcomes and cost efficiency in a tertiary
care medical college hospital. International Journal of
Contemporary Medical Research 2016; 3(6):1696-
1700.
4. Di Saverio S. Emergency laparoscopy: a new emerging
discipline for treating abdominal emergencies
attempting to minimize costs and invasiveness and
maximize outcomes and patients’ comfort. J Trauma
Acute Care Surg. 2014; 77(1):338–50.
5. Hansen JB, Smithers MB, Schache D, Wall DR, Miller
BJ, Menzies BL. Laparoscopic versus open
appendectomy: prospective randomized trial. World J
Surg 1996; 20(5): 17–21.
6. Klingler A, Henle KP, Beller S, Rechner J, Zerz A,
Wetscher GJ. Laparoscopic appendectomy does not
change the incidence of postoperative infectious
complications. Am J Surg 175(3): 232–35.
7. Kurtz RJ, Heimann TM. Comparison of open and
laparoscopic treatment of acute appendicitis. Am J Surg.
2001; 182(6):211–4.
8. Chung RS, Rowland DY, Li P, Diaz J. A metaanalysis
of randomized controlled trials of laparoscopic versus
conventional appendectomy. Am J Surg. 1999;
177(1):250–6.

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

45

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
9. Hellberg A, Rudberg C, Kullmann E, et al. Prospective
randomized multicentre study of laparoscopic versus
open appendectomy. Br J Surg. 1999; 86(4):48–53.
10. Burra Viswa Chaitanya, Rama Chandra Mohan
Mallapragada. Comparative evaluation of laparoscopic
with open appendectomy among patients of
appendectomy - A prospective study. International
Journal of Contemporary Medicine Surgery and
Radiology. 2019;4(3):C18-C22.
11. Gupta A, Singh AP. Comparative Evaluation of Open
and Laproscopic Method of Appendectomy in Acute
Appendicitis. Journal: Academia Journal of Surgery.
2020(1):8-11.
12. Garg CP, Vaidya BB, Chengalath MM. Efficacy of
laparoscopyin complicated appendicitis. Int J Surg.


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Jul26
Dr. Prashant Jain provides the Treatment for Anorectal Malformation in India
Imperforate Anus/Absent Anal Opening Treatment Delhi, India
Imperforate anus or absent anal opening, also called anorectal malformation, is a birth defect that happens during the development of baby in early in pregnancy, when the baby is still developing. In this defect, the baby’s anal opening (where stool exits) and the rectum (the last part of the large intestine), do not develop properly, preventing the child from to pass stool.

The condition affects one in 5,000 babies, and it is slightly more common in males than in females. In a baby with anorectal malformation, any of the following can happen:

The anal opening is too small or in the incorrect location
The anal opening is absent and the rectum enters other parts like urethra, the bladder, vestibule or vagina, which can lead to infections and bowel obstruction.
The anal opening may be absent and the rectum, reproductive system, and urologic system form a single common opening called a cloaca, where both urine and stool are passed.
At birth, doctors check the position and size of anal opening. New-borns pass their first stool within 48 hours of birth, so internal malformations are detected quickly. If an issue is found, we do a number of tests to better understand the problems and develop a long-term plan for the best outcome. This problem can be associated with other malformations. Various tests which are performed include:

X-rays of the abdomen to show how far the rectum reaches, and to see if there are any problems with the way the lower backbone has developed.
Abdominal ultrasound to find any problems in kidney.
Spinal ultrasound or MRI to look at the spine for a tethered spinal cord, which can cause neurological problems, such as incontinence and leg weakness as the child grows.
Echocardiogram to find heart defects.
These malformations will always require surgical repair by pediatric surgeon in single or multiple stage, but the exact procedure will depend on the type and severity of the defect, any associated health conditions, and the child’s overall health. Depending on the type and severity these babies may require a stoma formation (a temporary diversion of stools from abdominal wall).

Even though corrective surgery may restore some function, important nerves and muscles that tell your child when the rectum is full of stool and help keep the contents inside may be missing or damaged, so we start a bowel management program when they reach toilet-training to help them become clean.


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Jul26
Dr. Prashant Jain Provides The Treatment For Thoracoscopic Surgery In Children
Thoracoscopic Surgery For Children
Thoracosopic surgery, is a Minimally Invasive Surgery which uses multiple small incisions, and is suitable for children who need to undergo surgery for various chest conditions. Thoracoscopy is now very frequently used for various simple and complex surgical chest conditions. Since a Minimally Invasive Surgery can be done with small incisions, this avoids injury to chest wall muscles and nerves. On the contrary, large incisions as used in open surgery are painful and can cause chest wall deformity in long run. Minimally Invasive Surgery have shown great results, with lesser pain, reduced hospitalization, lesser complications and a better cosmetic result as compared to traditional thoracotomy. However, Thoracotomy will still be needed in some select cases. Dr. Prashant Jain, is one of the best paediatric surgeon in Delhi (India), who has achieved excellent results in the removal of chest tumors through minimally invasive surgery. Following are some other procedures that he performs:

Excision of mediastinal tumors: Thoracoscopy has been found to be very useful in excision of mediastinal tumors/ masses like neuroblastoma, thymoma, teratoma etc. The advantage of thoracoscopy is it gives excellent magnified vision which helps in complete excion without damaging adjacent vital structures.
Excision of Mediastinal cysts: Various mediastinal and lung cysts can be safely removed in newborns, infants and pediatric patients with excellent results. This include bronchogenic cyst, enteric duplication cyst, thymic cyst, hydatid cyst etc. Some of these cyst are diagnosed during antenatal period.
Lung Malformations: Thoracoscopy excision of lung malformation involves CCAM, CLE and lung sequestration.
Empyema: Empyema is an infection due to pus formation in the chest cavity or the pleural space. Children with empyema requires treatment with antibiotics, thoracostomy and thoracoscpic decprtication. For thoracoscopic decortication, three to four small incisions (3-5mm) are made to access the pleural space. Following which, the pleural space is cleansed off all debris and infected material, using a camera to see inside. Thus making the lung re-expand. Thoracoscopy addresses the symptoms and aids in a faster recovery, thereby reducing the patient’s stay in the hospital, especially when it is done in the initial stages of the illness.
Lung Biopsy: Lung Biopsy is carried out for children with chronic lung conditions, which may be difficult to diagnose, even after numerous tests. The Lung Biopsy is done using three small incisions, through which, the targeted area of the lung is biopsied. Diagnosis is achieved in almost 95% of the biopsies. It eliminates the requirement a large incision and its associated complications, while providing the same amount of tissue for analysis, as that of thoracotomy. Due to limited post-operative pain, and discomfort which does not compromise respiration, this procedure is well tolerated, even in children with advanced lung disease.
Spontaneous Pneumothorax: Pneumothorax is a life-threatening condition in which the lung collapses. Teenagers progressing through their adolescent growth spurt and children with underlying lung diseases, like apical cysts or cystic fibrosis are more prone to pneumothorax. The lungs need to be re-expanded to allow healing and removal of symptoms. Thoracoscopy is recommended for children with a recurring pneumothorax. The apical cysts (if present) are removed with an endoscopic stapling device. To carry out this procedure, three small incisions of 5mm – 12mm are made. To avoid air leaks in the future, the pleural cavity lining is abraided so that the lung adheres to the chest wall.


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