The PROCESS 2020 Guideline: Updating Consensus Preferred Reporting Of CasESeries in Surgery (PROCESS) Guidelines

INTRODUCTION

The PROCESS Guidelines were first published in 2016 and were last updated in 2018. They provide a structure for reporting surgical case series in order to increase reporting robustness and transparency, and are used and endorsed by authors, journal editors and reviewers alike. In order to drive forwards reporting quality, they must be kept up to date. As such, we have updated these guidelines via a DELPHI consensus exercise.

METHODS

The updated guidelines were produced via a DELPHI consensus exercise. Members from the previous DELPHI group were again invited, alongside editorial board members and peer reviewers of the International Journal of Surgery and the International Journal of Surgery Case Reports. An online survey was completed by this expert group to indicate their agreement with proposed changes to the checklist items.

RESULTS

A total of 53 surgical experts agreed to participate and 49 (92%) completed the survey. The responses and suggested modifications were incorporated into the previous 2018 guidelines. There was a high degree of agreement amongst the PROCESS Group, with all but one of the PROCESS items receiving over 70% of scores ranging 7-9.

CONCLUSION

A DELPHI consensus exercise was completed and an updated and improved PROCESS Checklist is now presented.

Laparoscopic Fundoplication for Gastro-esophageal Reflux Disease and Hiatus Hernia: A Short Term Outcome of First 8 Cases

Background: Acute gastro-esophageal reflux disease is a common ailment in kashmiri population. Most of these patients are managed by gastroenterologist, physicians and surgeons in daily outpatient basis. Majority of them settle by medical management with the help of proton pump inhibiters, prokinetics and antacids., laparoscopic Nissen’s fundoplication (LNF) is currently the procedure of choice for the surgical management of GERD. Aims and Objectives: The aim of this study was to know the feasibility of laparoscopic fundoplication for hiatus hernia and acute gastro-esophageal reflux disease in terms of operative time, post operative pain, length of hospital stay, conversion rate and recurrence of symptoms. Materials and Methods: The present prospective observational study was conducted in the Post-Graduate Department of General Surgery and minimal access surgery Government Medical College Srinagar from June 2013 to June 20117. The patients that were included in the study had symptomatic gastro-esophageal reflux (documented by endoscopy) with either persistent symptoms despite adequate and prolonged medical treatment, CT documented hiatus hernia and patients, who wanted to avoid long-term medical treatment. The duration of reflux symptoms ranged from 9 months to 30 years (median 6 years). Patients who were excluded from the study were those unfit for anesthesia. Informed consent was taken before surgery in the language, the patients understood. Results: This study includes 8 patients, with median age of 40 years (range 20-70 years). In the study group, 5 were males and 3 were females. The mean operative time was 90 minutes (range 60 t0 120 minutes). There were no major intra operative and post operative complications. The post operative pain was minimal as compared to open surgery. The median hospital stay was 3.5 days (range 3 -6 days). Two patients developed symptoms of bloating, early satiety, nausea and diarrhea. However these symptoms improved within weeks with a good response to appropriate medication. The median time until normal physical activity resumed was 2 weeks (range 3 days to 4 weeks). Median follow-up was 6 months (range1-12 months). The overall short-term results in appropriately selected patients were excellent. The recurrence of symptoms was not observed in any patient within follow up of 6 months. Conclusion: We conclude from our early series of 8 cases, that patients having long standing GERD not responding to medical management who are at a threat to develop barrettes esophagus should be given the benefit of laparoscopic fundoplication. However proper evaluation, patient selection is mandatory. The choice of fundoplication should be dictated by the surgeon’s preference and experience. Currently, the main indication for laparoscopic fundoplication is represented by PPI-refractory GERD, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained by impedance-pH monitoring.

The SCARE Statement: Consensus-based surgical case report guidelines

INTRODUCTION

Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.

METHODS

The CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.

RESULTS

In round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7-9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.

CONCLUSION

We present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports.

A medical school experience with three port laparoscopic cholecystectomy with a new modification in technique

INTRODUCTION

The three port laparoscopic cholecystectomy is a recognized entity in the surgical management of gallstone disease. We report our experience and feasibility of three port laparoscopic cholecystectomy with a new modification in technique.

METHODS

To assess the feasibility and safety of three-port laparoscopic cholecystectomy with a different port placement, we undertook a prospective study with 50 patients at government medical college, Srinagar, Kashmir, India between Jan 2010 and Jan 2011. Our study offered a benefit of concealed third port designed around umbilicus over the conventional three port laparoscopic cholecystectomy. A single surgeon did all the cases and definite criteria of simple cases of gallstone disease patterned on clinical and radiological grounds.

RESULTS

50 cases of gallstone disease were subjected to the new technique of three port laparoscopic cholecystectomy during a period one year. 34 cases were females and 16 were males. The age range of our patients was between 20 and 55 years with the median age of 33 years. Mean Body mass index 30 (range 25-35). Mean operative time was 30 min (range 15-45 min) and a follow up [period ranged from 9 to 12 months]. No cases were converted to open though two cases required an additional port in the right hypochondrium for retraction. We did not encounter any untoward mishaps during surgery.

CONCLUSION

Three port laparoscopic cholecystectomy with our modification of the third port placement at a different site received good results and patient satisfaction. Moreover the placement of third port at a consealed area around umbilicus apparently gives it an appearance of two port laparoscopic cholecystectomy with an addition of technical ease.

Is fourth port really required in laparoscopic cholecystectomy?

Since the advent of four-port laparoscopic cholecystectomy, many modifications regarding port number and size have been tried. The feasibility of three-port technique has been found comparable to the conventional four-port laparoscopic cholecystectomy. To assess the feasibility and safety of three-port laparoscopic cholecystectomy in a prospective study. Between March 2007 and March 2009, fifty patients with cholelithiasis aged between 15 and 56 years underwent three-port cholecystectomy in a prospective study in Government medical college, Srinagar. A single surgeon did all the cases and there was no criterion for the patient selection. These were consecutive fifty surgeries done by the surgeon. The outcome was assessed in terms of intra-operative and post-operative parameters. The mean (range) age was 45 (15-56) years and there were thirty-nine females and eleven males in the study. All the procedures were completed successfully without any conversions to open or any major complications; though three patients needed the addition of a fourth port as in conventional laparoscopic cholecystectomy. The mean (range) operative time was 55 (30-90) min and the average blood loss was 30 ml. The mean (range) hospital stay was 1 (1-3) days. All patients returned to routine work within 1 week of surgery. The mean follow-up was 5 (2-7) months. We conclude, from the results above, that three-port laparoscopic cholecystectomy is safe and feasible. There are only two visible surgical scars, better cosmetic appearance with no increased risk of bile duct injury. It reduces the manpower in the form of a second assistant. Thus, it can be recommended as a safe alternative procedure to conventional four-port laparoscopic cholecystectomy.

Laparoscopic exploration of the common bile duct and removal of dead worm in a patient of cholangitis after endoscopic retrograde cholangiopancreatography failure

We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis. The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure. Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.

Extra luminal colonic gastrointestinal stromal tumor: a case report

Introduction

Gastrointestinal stromal tumors are the commonest mesenchymal tumors of the gastrointestinal tract, the stomach and small intestine are the favored sites of occurrence. They rarely occur in the colon, rectum and esophagus. GIST is neoplasm of mesenchymal origin originating from precursors of the interstitial cells of cajal. The symptoms of gastrointestinal stromal tumor depend on the site and size of the tumor, and may include abdominal pain, gastrointestinal bleeding or signs of obstruction; small tumors may, however, be asymptomatic. Majority of the patients with gastrointestinal stromal tumor have bloody stools and abdominal pain as the commonest manifestation. We describe a young female with extra luminal colonic gastrointestinal stromal tumor presenting as mass abdomen.

Case presentation

We describe 34-year-old female from north Indian state of Jammu and Kashmir who had presented with history of slowly increasing epigastric lump associated with abdominal discomfort of 4 months duration. She had no features of luminal obstruction. Her contrast enhanced computed tomography abdomen revealed a large extra-colonic mass in relation to transverse colon. The tumor was resected and histology was suggestive of gastrointestinal stromal tumor.

Conclusion

Extra luminal colonic gastrointestinal stromal tumors are very rare and can present as mass abdomen. Resection is the treatment of choice.