Background: Various preoperative and intraoperative risk factors associated with anastomotic leak have been extensively analyzed. Albumin is considered as the gold standard preoperative marker of nutrition, but recently pre-albumin is found to be a better indicator of nutrition. The main aim of this study was to analyze the preoperative risk factors including pre-albumin to predict anastomotic leak following small and large bowel anastomsois.Methods: This was a prospective observational, quality improvement study in a cohort of 100 patients undergoing small and large bowel resection in the Division of Surgery at Christian Medical College, Vellore. Univariate and multivariate analysis was done to show the significant variables associated with anastomotic leak.Results: In present study, leak rate was 21% (21/100). In univariate analysis, 6 factors had significant association with anastomotic leak, age >45 years, ASA score of II, hemoglobin ≤9.0 gm/dl, serum albumin ≤3.0 gm/dl, serum pre-albumin ≤20 mg/dl and preoperative diagnosis of malignancy. Age >45 years, ASA score of II, serum pre-albumin ≤20 mg/dl and malignancy were found to be independent risk factors of anastomotic leak. In present study prelbumin, was found to be a better indicator of anastomotic leak when compared to albumin and it was statistically significant (p=0.002).Conclusions: Serum pre-albumin is superior to albumin as an acute marker of malnutrition and help us to identify those at risk of anastomotic leak and adequately build nutrition preoperatively and decrease the morbidity.

Background: Mycetoma is a chronic granulomatous infection of skin, subcutaneous tissue and bone caused by either fungi (eumycetoma) or bacteria (actinomycetoma). Here we present our experience in the management of this rare condition.Methods: Patients managed for mycetoma foot from August 2011 to January 2018 in authors’ general surgery department were included. The data was collected retrospectively from the hospitals electronic database.Results: Eight patients were recruited with the mean age of the patient was 52years and had male predominance. Most common clinical presentation was swelling with discharging sinuses in the foot. Imaging performed were X ray foot and MRI. Osteomyelitis was noted in 4 patients (50%). Eumycetoma and actinomycetoma were equal in distribution. Out of 4 patients with eumycetoma, one had grown Acremonium species in the culture and out of 4 actinomycetoma patients, 3 had grown Actinomadura pelletieri and one had Nocardia. Surgical procedures performed were 3 biopsies (37.5%), 3 debridement (37.5%) and 2 amputations (25%). Eumycetoma patients were treated with Itraconazole monotherapy and actinomycetoma patients were treated with Trimethoprim-Sulfamethoxazole and cyclical administration of amikacin. Good response was noted in 6 patients and two patients with Eumycetoma had progression of disease with medical therapy and underwent amputation.Conclusions: High clinical suspicion and tissue for histopathological and microbiological evaluation is mandatory to confirm the diagnosis. Medical therapy plays a major role in the treatment of mycetoma foot even if the bone is involved. Surgical procedures like debridement and amputation are indicated only for failed medical therapy with progression of disease (seen most often with eumycetoma) and if there are secondary bacterial infections.

Background: The recent trend being towards spleen preservation, it is necessary to critically analyse the indications for splenectomy and assess if the desired preoperative outcomes are achieved by splenectomy.Methods: This was a retrospective study and patients who underwent elective or emergency splenectomy for various indications in the surgical unit from September 2011 to July 2016 were included. The data was collected from patients records and hospital electronic database.Results: From September 2011 to July 2016, totally 68 patients underwent splenectomy.  The indications for therapeutic intervention were splenic abscess (2), splenic cyst (4), trauma (8), ITP (20) and anemia (12). The indications for diagnostic splenectomy were pyrexia of unknown origin in 7 patients and splenomegaly with anemia or pancytopenia in 15 patients. The objective of the operation was achieved in 43 patients (63%). The success rate for each indication: diagnosis (12 of 22 patients, 55%), thrombocytopenia (12 of 20 patients, 60%), anemia (5 of 12 patients, 42%) and as a primary treatment (12 of 14 patients, 86%). Postoperative morbidity within 30days of surgery was seen in 9 patients (13%) and 2 patients (3%) died within 30days of surgery.Conclusions: The indication for splenectomy should be individualized after exploring all other treatment options and based on outcome.