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Background: The term gender dysphoria describes a heterogenous group of individuals who express varying degree of dissatisfaction with their anatomical gender and the desire to possess the secondary sexual characteristics of the opposite sex. For these individuals, gender reassignment surgery (GRS) plays a pivotal role in relieving their psychological discomfort. The literature is limited in terms of the outcome of surgery. In this study, we present surgical outcome and post-operative complications in Male to Female GRS.Methods: This is a retrospective cohort study on consecutive patients who underwent male to female (MtF) GRS at the Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India from March 2015 to July 2017 and demographic profile along with surgical complications were registered and analysed.Results: During the study period, a total of 59 MtF GRS were performed. The median age of the patients was 25.4 years (range 19-39). Major complications like rectovaginal fistula and pulmonary embolisms and deep venous thrombosis were not observed. The most common complications were wound infection and reactionary bleeding from the urethra.Conclusions: Gender reassignment surgery plays a pivotal role in relieving the psychological discomfort of Gender Dysphoria individuals. MtF GRS can be performed with a low rate of complications. The collaborative effort between the surgeon, behavioural scientist, and a medical physician responsible for hormonal therapy is recommended. Our short-term analysis revealed the low rate of complications. Surgical experience is the key factor to minimize the complication rate.

Background: Gender dysphoria is a condition in which there is discrepancy between a person's gender identity and that person's sex assigned at birth. Gender reassignment surgery (GRS) has an important role in alleviating the distress caused by gender dysphoria and it is medically necessary. The literature on quality of life (QoL) of transgenders post-GRS is limited in India.Methods: This is a prospective study on transgender women who volunteered to undergo male to female (MtF) GRS from March 2015 to August 2017. The demographic details and the surgical complications were registered. The Quality of life using the WHOQOL-BREF questionnaire was measured both before and a year after the surgery. The data were compared and presented.Results: A total of 62 GRS were performed during the study period. In that, 43 patients are literate (69.35%) and only 31.93% are employed in a socially respectable position. Our study shows significant improvement in physical, psychological and social health domains after the Surgery. Highest improvement was observed in the psychological health domain. There were no major complications observed in our study group.Conclusions: The surgical management improved the QOL in the first three domains of WHOQOL-BREF instrument namely physical health, psychological health and social relationship. Among these three domains, there is a significant improvement in psychological health. Hence, GRS has an important role in relieving the psychological distress caused by gender dysphoria and significantly improves the quality of life postoperatively.

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

Desmoid fibromatosis is a rare but locally aggressive tumour comprised of myofibroblasts. It is histologically benign but can behave aggressively. They do not have the ability to metastasize but can cause significant morbidity and mortality by local invasion. These tumours may occur anywhere on the body, but are commonly found on the abdominal wall and within the intestinal mesentery. Mutations in either the β-catenin or the adenomatous polyposis coli (APC) genes are usually the cause for the development of desmoid tumours with the former comprising the sporadic development of tumours and the latter being associated with familial adenomatous polyposis syndrome. Surgical resection with histologically negative margins has been the cornerstone of therapy for this disease, but this paradigm has begun to shift. It is now common to accept a microscopically positive margin after resection as recurrence rates may not be significantly affected. This case report intends to describe the clinical, diagnostic and pathologic features of a post-traumatic fibromatosis involving left side chest wall in a 45 years old female and causing worsening pain. The surgical management was successfully undertaken.