Background: COVID-19 disease caused by SARS-COV-2 has become a pandemic. Outcome of surgical patients infected with COVID-19 is not very clear.Methods: Retrospective analysis of the surgical outcome of COVID-19 infected patients admitted in emergency and elective surgical settings in a designated COVID care center.Results: Total 53 patients were included. Surgery was done in 47.16% (n=25) patients and 52.84% (n=28) patients were managed non-operatively. Overall mortality was 37.7 % (n=20). In operated group it was 52% (n=13) and 25% (n=7) in the non-operative group (p=0.043). The total leukocyte (p=0.018), serum CRP (p=0.031), urea and creatinine level (p=0.025) were higher in the mortality group. Patients aged more than 50 years had a significantly higher mortality compared to less than 50 years (p=0.010). Patients having multiple comorbidities had higher mortality (p=0.159).Conclusions: COVID-19 infection has a definite adverse impact on the outcomes of surgical patients.

Sisira Jayaratnam, Cherring Tandup, Yashwant Raj Sakaray, Kailash Chand Kurdia, Ashish Gupta, Lileswar Kaman. Ann Hepatobiliary Pancreat Surg 2024;28:358-63. https://doi.org/10.14701/ahbps.24-016

Surgical site infection continues to be a major problem after laparotomy for perforation peritonitis, as it increases morbidity and hospital stay and decreases the quality of life. Intra-abdominal drain placement is a routine practice in perforation peri-tonitis. The aim of our study is to compare the incidence of surgical site infection in two groups of patients who were operated for perforation peritonitis: The first group received the intraperitoneal drain, while no drain was placed in the second group. The present single-center, prospective, non-randomized study was conducted in the Department of General Surgery at the Postgraduate Institute of Medical Education and Research, India. A total of 122 patients underwent exploratory laparotomy for gastroduodenal and small bowel perforation peritonitis, of which 100 participants were included in this study, based on specified cri-teria for inclusion and exclusion. A total of 50 participants each were included in the drain group and the no drain group, respectively. A drain was placed in every alternate patient with perforation peritonitis who received primary closure or resection anastomosis. Patients with diabetes, renal failure, and hemodynamic instability and those who presented more than 72 h since symptom onset were excluded from the study. Peritoneal fluids were cultured. The primary endpoint was to identify the incidence of surgical site infections (SSIs) in the two groups. We also compared the time taken for the return of bowel movements, duration for which a nasogastric tube was inserted, whether any intervention was performed under local or general anesthesia within 30 days of surgery, the duration of hospital stay, and the ease of diagnosing repair leak in the post-operative period in both the groups. Demographics of participants in both the groups were matched. No significant difference was observed between the drain and no-drain groups with respect to the incidence of surgical site infection (p=0.779). The duration of surgery and length of hospital stay were significantly lower in the no drain group. A significant difference was observed between the two groups concerning the peritoneal culture growth, and increased bacterial growth was seen in the drain group. No significant difference in morbidity was noted between the two groups, which was classified according to the Clavien-Dindo classification. Routine use of intra-abdominal drains was not found to be effective in preventing SSIs, but a selection bias cannot be ruled out. Patients with no drains had a significantly shorter duration of hospital stay.

Anatomic variation of the hepatic artery is common and often seen in patients with periampullary carcinoma undergoing a pancreatic duodenectomy. Replaced right hepatic artery from the superior mesenteric artery is the most common variant encountered. Here we present a rare case of an unclassified pattern of the variant anatomy of replaced right hepatic artery originating from the celiac trunk along with an accessory left hepatic artery arising from the left gastric artery in a patient with periampullary carcinoma undergoing pancreaticoduodenectomy.

Kailash Chand Kurdia, Ambuj Aggarwal, Cherring Tandup, Divya Dahiya, Subrata Podder, and Arunanshu Behera. Ann Hepatobiliary Pancreat Surg 2021;25:283-6. https://doi.org/10.14701/ahbps.2021.25.2.283