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  1. Article: Incidence and Risk Factors of Postoperative Complications in General Surgery Patients.

    Dharap, Satish B / Barbaniya, Priya / Navgale, Shantanu

    Cureus

    2022  Volume 14, Issue 11, Page(s) e30975

    Abstract: Background Postoperative complications, which are undesirable consequences of surgery, need to be minimized to ensure the quality of surgical care. In this study, we aimed to estimate the incidence and identify the risk factors for postoperative ... ...

    Abstract Background Postoperative complications, which are undesirable consequences of surgery, need to be minimized to ensure the quality of surgical care. In this study, we aimed to estimate the incidence and identify the risk factors for postoperative complications which may help in planning appropriate preventive measures. Methodology A prospective observational study was conducted in the general surgery department of a tertiary care hospital in a metropolitan city in India. Patients undergoing elective or emergency surgery were included. Patients transferred postoperatively from other hospitals and those undergoing day-care operations or endoscopic procedures were excluded. Age, gender, body mass index (BMI), comorbidities, surgical risk as per American Society of Anesthesiologists (ASA) grading, scheduling of surgery (emergency, semi-emergency, or elective), approach (open or laparoscopic), intraoperative complications, operative blood loss, the extent of surgery (superficial or deep cavity), indication (diagnostic, therapeutic, or palliative), duration of surgery, wound class (clean, clean-contaminated, contaminated, or dirty), and duration of hospital stay in days were recorded. Patients were followed up for 30 days postoperatively for complications (defined as any undesirable, unintended event as a direct result of an operation). Clavien-Dindo classification was used to grade the severity of complications. The chi-square test was used for categorical data, and the t-test was used for numerical data. P-values <0.05 were considered significant. Results Postoperative complications were observed in 31.50%; minor complications (Grade I and II) in 19.75% and major complications (Grade III and IV) in 8.0% of patients. Postoperative mortality (Grade V) was 3.75%. Significant risk factors were the presence of comorbidities, higher ASA grade, higher BMI, emergency surgery, open surgery, palliative surgery, deeper cavity surgery, higher intraoperative blood loss, prolonged surgical duration, intraoperative complications, and contaminated surgical wounds. Postoperative complications significantly prolonged the hospital stay. Conclusions Understanding risk factors can guide surgeons to adopt appropriate strategic measures to reduce postoperative complications and improve the quality of surgical care. Three key measures emerging from this study are (1) preoperative patient optimization; (2) diligence during surgery to reduce operative time, blood loss, and intraoperative complications; and (3) implementation of infection control practices.
    Language English
    Publishing date 2022-11-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.30975
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Non Operative Approach to Isolated Traumatic Pancreatic Duct Disruption.

    Kamath, Sheshang U / Dharap, Satish B

    Journal of clinical and diagnostic research : JCDR

    2016  Volume 10, Issue 3, Page(s) PD08–10

    Abstract: Management of isolated traumatic pancreatic duct disruption remains challenging due to associated morbidity and mortality. Two children with isolated pancreatic ductal disruption were treated conservatively. Both developed a pseudocyst which resolved ... ...

    Abstract Management of isolated traumatic pancreatic duct disruption remains challenging due to associated morbidity and mortality. Two children with isolated pancreatic ductal disruption were treated conservatively. Both developed a pseudocyst which resolved spontaneously due to the atrophy of the distal pancreas in a five-year-old girl while remained persistent and was treated by endoscopic cystogastrostomy in an eight-year-old boy. Non-operative management may be pursued in patients with pancreatic ductal injury in the hope of a pseudocyst formation which may spontaneously resolve or may be treated later with a minimally invasive procedure. However, the literature review precludes its practice as a standard due to high incidence of associated complications of non-operative management.
    Language English
    Publishing date 2016-03-01
    Publishing country India
    Document type Case Reports
    ZDB-ID 2775283-5
    ISSN 0973-709X ; 2249-782X
    ISSN (online) 0973-709X
    ISSN 2249-782X
    DOI 10.7860/JCDR/2016/16605.7451
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Does Treatment of Fistula-in-Ano by Ligation of Intersphincteric Fistula Tract Offer any Advantage over Standard Fistulectomy or Fistulotomy?

    Pallavi V Ayyar / Satish B Dharap

    Journal of Clinical and Diagnostic Research, Vol 12, Iss 12, Pp PC01-PC

    2018  Volume 04

    Abstract: Introduction: Standard surgical treatment of trans-sphincteric fistulae by fistulectomy or fistulotomy has a morbidity of leaving a large perianal wound which needs prolonged care and has risk of incontinence and recurrence. Ligation of Intersphincteric ... ...

    Abstract Introduction: Standard surgical treatment of trans-sphincteric fistulae by fistulectomy or fistulotomy has a morbidity of leaving a large perianal wound which needs prolonged care and has risk of incontinence and recurrence. Ligation of Intersphincteric Fistula Tract (LIFT) technique for fistula-in-ano has been reported to have less morbidity and recurrence. Aim: To assess if the use of LIFT technique for the treatment of trans-sphincteric fistulae offers any advantage over standard fistulectomy or fistulotomy technique. Materials and Methods: The prospective comparative study was carried out at Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India, after obtaining approval from the Institutional Ethics Committee. Sixty patients of trans-sphincteric fistula of cryptoglandular origin undergoing either LIFT or fistulectomy/ fistulotomy were included and prospectively observed for operative time, postoperative pain, hospital stay, time taken for wound healing, incontinence and early recurrence (within three months of the operation). Statistical analysis was done by unpaired t-test and chi-square test using SAS® software. Results: Patients operated by LIFT showed significantly shorter operative time (mean of 32.50 minutes vs. 40.17 minutes) and hospital stay (mean of 1.64 days vs. 2.53 days), decreased severity of pain and faster wound healing (mean 5.74 weeks vs. 6.89 weeks) compared to patients undergoing fistulectomy/fistulotomy. Though more patients had recurrence in the LIFT group (five patients in LIFT vs. three patients in fistulotomy/fistulectomy) this difference was not statistically significant. There was no incidence of incontinence (temporary or permanent) in patients of LIFT while three patients of fistulectomy had temporary flatus incontinence. Conclusion: LIFT offers the benefit of a shorter operative time, decreased postoperative pain, shorter hospital stay and faster wound healing with very low incidence of incontinence compared to fistulectomy or fistulotomy with a recurrence rate ...
    Keywords anal fistula ; incontinence ; sphincter preserving surgery ; trans-sphincteric fistula ; Medicine ; R
    Subject code 616
    Language English
    Publishing date 2018-12-01T00:00:00Z
    Publisher JCDR Research and Publications Private Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Scoring system to preoperatively predict choledocholithiasis.

    Kamath, Sheshang U / Dharap, Satish B / Kumar, Vineet

    Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology

    2016  Volume 35, Issue 3, Page(s) 173–178

    Abstract: Background: The incidence of common bile duct (CBD) calculi has been reported to be 8 % to 20 % among the patients with cholelithiasis. Failure to detect CBD stones on the part of the surgeon not only fails to relieve symptoms but also subjects them to ... ...

    Abstract Background: The incidence of common bile duct (CBD) calculi has been reported to be 8 % to 20 % among the patients with cholelithiasis. Failure to detect CBD stones on the part of the surgeon not only fails to relieve symptoms but also subjects them to potentially life-threatening complications such as cholangitis, pancreatitis or obstructive jaundice. Modalities for detection of CBD stones have evolved over time from CBD exploration based on clinical and operative findings to intraoperative cholangiography (IOC), to endoscopic retrograde cholangiopancreaticography (ERCP) and, recently, to magnetic resonance cholangiopancreaticography (MRCP) and endoscopic ultrasonography (EUS). We felt a need for a scoring system to predict a patient population having a higher risk of choledocholithiasis so that these modern interventions can be selectively utilized.
    Setting: This study was performed in a tertiary care medical college hospital in a metropolitan city.
    Design: This is a prospective observational study.
    Methods: All patients with symptomatic cholelithiasis admitted to the hospital were included. Patients were diagnosed as having choledocholithiasis either by ultrasonography (USG), computed tomography scan, MRCP, EUS or ERCP and were followed up for at least 6 weeks.
    Results: The prevalence of choledocholithiasis among the 275 patients with symptomatic biliary colic in our study was 18.9 % (n = 77). On bivariate analysis, dilated bile duct on USG (>6 mm), raised total bilirubin, raised alkaline phosphatase (ALP), raised amylase, raised SGPT and SGOT were significantly associated with choledocholithiasis (p < 0.05). On multivariate analysis also, all these factors except amylase and SGPT showed a significant correlation with choledocholithiasis (p < 0.05). These observations were used to build a scoring system consisting of four factors: dilated bile duct on USG (>6 mm), total bilirubin >2 mg/dL, ALP >190 IU/L and SGOT >40 IU/L.
    Conclusion: A positive predictive value of 3 or more factors was over 95 %, necessitating an endoscopic intervention. A negative predictive value of the absence of any factor was 100 %, which ruled out CBD calculi. If only one or two factors are positive, then further evaluation is recommended preferably using non-minimal or minimal invasive investigations like EUS or MRCP.
    MeSH term(s) Adult ; Aged ; Alanine Transaminase/blood ; Alkaline Phosphatase/blood ; Amylases/blood ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; Biomarkers/blood ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis/diagnosis ; Choledocholithiasis/diagnostic imaging ; Choledocholithiasis/epidemiology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Prospective Studies ; Time Factors ; Young Adult
    Chemical Substances Biomarkers ; Aspartate Aminotransferases (EC 2.6.1.1) ; Alanine Transaminase (EC 2.6.1.2) ; Alkaline Phosphatase (EC 3.1.3.1) ; Amylases (EC 3.2.1.-) ; Bilirubin (RFM9X3LJ49)
    Language English
    Publishing date 2016-05-05
    Publishing country India
    Document type Journal Article ; Observational Study
    ZDB-ID 632595-6
    ISSN 0975-0711 ; 0254-8860
    ISSN (online) 0975-0711
    ISSN 0254-8860
    DOI 10.1007/s12664-016-0655-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Laparotomy for blunt abdominal trauma-some uncommon indications.

    Dharap, Satish B / Noronha, Jarin / Kumar, Vineet

    Journal of emergencies, trauma, and shock

    2015  Volume 9, Issue 1, Page(s) 32–36

    Abstract: Trauma laparotomy after blunt abdominal trauma is conventionally indicated for patients with features of hemodynamic instability and peritonitis to achieve control of hemorrhage and control of spillage. In addition, surgery is clearly indicated for the ... ...

    Abstract Trauma laparotomy after blunt abdominal trauma is conventionally indicated for patients with features of hemodynamic instability and peritonitis to achieve control of hemorrhage and control of spillage. In addition, surgery is clearly indicated for the repair of posttraumatic diaphragmatic injury with herniation. Some other indications for laparotomy have been presented and discussed. Five patients with blunt abdominal injury who underwent laparotomy for nonroutine indications have been presented. These patients were hemodynamically stable and had no overt signs of peritonitis. Three patients had solid organ (spleen, kidney) infarction due to posttraumatic occlusion of the blood supply. One patient had mesenteric tear with internal herniation of bowel loops causing intestinal obstruction. One patient underwent surgery for traumatic abdominal wall hernia. In addition to standard indications for surgery in blunt abdominal trauma, laparotomy may be needed for vascular thrombosis of end arteries supplying solid organs, internal or external herniation through a mesenteric tear or anterior abdominal wall musculature, respectively.
    Language English
    Publishing date 2015-07-29
    Publishing country India
    Document type Case Reports
    ZDB-ID 2461111-6
    ISSN 0974-519X ; 0974-2700
    ISSN (online) 0974-519X
    ISSN 0974-2700
    DOI 10.4103/0974-2700.173866
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Non Operative Approach to Isolated Traumatic Pancreatic Duct Disruption

    Sheshang U Kamath / Satish B Dharap

    Journal of Clinical and Diagnostic Research, Vol 10, Iss 3, Pp PD08-PD

    2016  Volume 10

    Abstract: Management of isolated traumatic pancreatic duct disruption remains challenging due to associated morbidity and mortality. Two children with isolated pancreatic ductal disruption were treated conservatively. Both developed a pseudocyst which resolved ... ...

    Abstract Management of isolated traumatic pancreatic duct disruption remains challenging due to associated morbidity and mortality. Two children with isolated pancreatic ductal disruption were treated conservatively. Both developed a pseudocyst which resolved spontaneously due to the atrophy of the distal pancreas in a five-year-old girl while remained persistent and was treated by endoscopic cystogastrostomy in an eight-year-old boy. Non-operative management may be pursued in patients with pancreatic ductal injury in the hope of a pseudocyst formation which may spontaneously resolve or may be treated later with a minimally invasive procedure. However, the literature review precludes its practice as a standard due to high incidence of associated complications of non-operative management.
    Keywords blunt injury ; children ; conservative ; pancreas ; treatment ; Medicine ; R
    Language English
    Publishing date 2016-03-01T00:00:00Z
    Publisher JCDR Research and Publications Private Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Laparotomy for blunt abdominal trauma-some uncommon indications

    Satish B Dharap / Jarin Noronha / Vineet Kumar

    Journal of Emergencies, Trauma and Shock, Vol 9, Iss 1, Pp 32-

    2016  Volume 36

    Abstract: Trauma laparotomy after blunt abdominal trauma is conventionally indicated for patients with features of hemodynamic instability and peritonitis to achieve control of hemorrhage and control of spillage. In addition, surgery is clearly indicated for the ... ...

    Abstract Trauma laparotomy after blunt abdominal trauma is conventionally indicated for patients with features of hemodynamic instability and peritonitis to achieve control of hemorrhage and control of spillage. In addition, surgery is clearly indicated for the repair of posttraumatic diaphragmatic injury with herniation. Some other indications for laparotomy have been presented and discussed. Five patients with blunt abdominal injury who underwent laparotomy for nonroutine indications have been presented. These patients were hemodynamically stable and had no overt signs of peritonitis. Three patients had solid organ (spleen, kidney) infarction due to posttraumatic occlusion of the blood supply. One patient had mesenteric tear with internal herniation of bowel loops causing intestinal obstruction. One patient underwent surgery for traumatic abdominal wall hernia. In addition to standard indications for surgery in blunt abdominal trauma, laparotomy may be needed for vascular thrombosis of end arteries supplying solid organs, internal or external herniation through a mesenteric tear or anterior abdominal wall musculature, respectively.
    Keywords Abdomen ; blunt ; indications ; internal hernia ; laparotomy ; trauma ; traumatic abdominal wall hernia ; vascular injury ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; Medicine ; R
    Language English
    Publishing date 2016-01-01T00:00:00Z
    Publisher Medknow Publications
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Ready, steady, go or just go? - The question of stabilization before transport for trauma victims.

    Kumar, Vineet / Suryawanshi, Pritam / Dharap, Satish B / Roy, Nobhojit

    Injury

    2013  Volume 44, Issue 11, Page(s) 1654–1655

    MeSH term(s) Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Patient Transfer ; Transportation of Patients ; Wounds and Injuries/mortality
    Language English
    Publishing date 2013-11
    Publishing country Netherlands
    Document type Comment ; Letter
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2012.03.036
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: The great Indian invisible railroad disaster.

    Kumar, Vineet / Suryawanshi, Pritam / Dharap, Satish B / Roy, Nobhojit

    Prehospital and disaster medicine

    2012  Volume 27, Issue 2, Page(s) 216

    MeSH term(s) Accidents/history ; Disasters/history ; Humans ; Railroads/history
    Language English
    Publishing date 2012-04
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 1025975-2
    ISSN 1945-1938 ; 1049-023X
    ISSN (online) 1945-1938
    ISSN 1049-023X
    DOI 10.1017/S1049023X12000544
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Early prediction of outcome in very severe closed head injury.

    Jain, Sandeep / Dharap, Satish B / Gore, Madhuri A

    Injury

    2008  Volume 39, Issue 5, Page(s) 598–603

    Abstract: Background: People with severe head injury and admission Glasgow Coma Scale (GCS) score < or =5 have a poor outcome and greatly strain limited resources.: Aim: To identify patients with the best chances of survival, using routine clinical measures.!## ...

    Abstract Background: People with severe head injury and admission Glasgow Coma Scale (GCS) score < or =5 have a poor outcome and greatly strain limited resources.
    Aim: To identify patients with the best chances of survival, using routine clinical measures.
    Methods: People attending the trauma intensive care unit, who had isolated blunt head injury and GCS< or =5 and who had survived > or =4h, were included in the study, resuscitated and clinically assessed. The GCS score was followed serially after admission. Bivariate analysis of various parameters with outcome was performed using the chi-square test. Serial GCS scores were compared with admission GCS by paired t-testing.
    Results: Of the 102 patients who were studied prospectively, 78 (76.5%) died and 24 (23.5%) survived. Age, gender, pre-hospital delay and admission GCS scores were comparable between the two groups. Adequate spontaneous respiration, brisk pupillary light reactivity on admission and increase in GCS by at least 2 at 24h after admission significantly affected the outcome (p<0.05). In the presence of all these factors, the survival rate increased from 6.1% to 57.1% (p<0.001).
    Conclusions: People with GCS score < or =5 still have a reasonable chance of survival, so all patients should be aggressively managed initially. Better survival was observed among those with adequate spontaneous respiration, good pupillary reaction and improvement in GCS of at least 2 at 24h. These clinical parameters can help to predict survival and thus make best use of limited resources.
    MeSH term(s) Adolescent ; Adult ; Aged ; Child ; Epidemiologic Methods ; Female ; Head Injuries, Closed/diagnosis ; Head Injuries, Closed/mortality ; Humans ; Male ; Middle Aged ; Prognosis
    Language English
    Publishing date 2008-05
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2007.06.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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