Interview with Surgeon - Dr Chanchal Raj Chhallani
Hyperbaric Oxygen Therapy - Controversies Arosen!
Short Note on Surgical Training
Rare Experiences in Surgeon's Life
How Did They Die? !!!!
Laparotomy: Scoping Systematic Review
Classifieds | Trivia | Upcoming Events
Dr. Kalaivani.V President
Table of Contents
Dr. Sreekar Pai A Hon. Jt. Secretary
Dr. Manish Joshi Hon. Treasurer
June 2020
Dear Esteemed Member of SSB,
‘SUSHRUTA’ is a monthly newsletter, creating a platform where in the members and surgical postgraduates can publish original articles, case reports, surgical guidelines or any other material of surgical relevance, This will be made available online for all the members.
I request everyone to make use of this platform to disseminate, share or acquire knowledge.
Dr Kalaivani V President SSB KSCASI CC
Editorial

Request all the SSB members to actively contribute, participate and wholeheartedly appreciate this new initiative "Sushruta - official newsletter of the Surgical society of Bangalore"
Regards, The Editorial team of Sushruta
Academic Articles Non-Academic
Please send articles, guidelines, humour, stories, trivia, quiz questions and interesting
Case report or case series with Review of literature for academic purposes.
Inviting articles - That may be appropriate and interesting to the SSB members. Examples: life beyond surgery, my daily routine, how I manage
stress, interesting place I traveled, books I recommend etc.
Opportunities / Classifieds Feedback / Suggestions
Relevant Jobs, Ad's and upcoming events can be included at a nominal fee as per the
discretion of the Editorial team.
Any other suggestions for improvements, feedback, letters to the editor, inputs are
welcome.
Send your article to : editorssb@gmail.com WhatsApp - 8197910166
Dear All,
Kindly encourage this new monthly initiative of the SSB.
Please mark all your contributions via emails, WhatsApp with the heading for Sushruta and
mention your name, designation and institution.
June 2020
Dr.Kalaivani, Dr.Venkatesh & all the E.C. Members, I don’t need any other Honours than
this , I am Touched & Moved . A Very Big Thnx to the Entire Executive Com Members with
special Thnx to Dr. Manish Joshi our EDITORIAL Chief for the interview.
- Dr Ashok Kumar K V
Letters to the Editor
Newsletter of Surgical Society of Bangalore
Great effort! Proud of SSB Nice write up of Ashok Kumar Sir
- Dr. M Ramesh
Very nicely done. Many Congratulations to you and your Editorial team Kalaivani!!. -Dr Arvind Gubbi
June 2020
a very interesting & varied reading.
Congratulations to the whole team
- Dr. Srinath
I am expessing my sicere NAMASKARS to the Sushruta editorial board for putting in the news letter. Regards -Dr S A Subramani
Great interview Sir. A good read for everyone and surgeons in particular. Great effort Dr Kalaivani and team. Well
done. - Dr Rajshekar Nayak
Dr Rajiv Lochan’s article “Sunshine” makes us to reflect more on our actions. Many times we face such dilemmas.
Surgical practice has many faces- medical, moral, ethical, social etc.
Sad part is...by the time we understand all or some of this, we would have crossed 60 ! or may not think about it at all !! Thanks & congratulations Dr Rajiv & team. - Dr Shivaram HV
You are a great good example for every one in younger generation sir. Great initative by dr Kalaivani and team
-Dr Nagesh NS
Thank-You Dr. B.R Ambedkar Medical College and Vydehi Institute of Medical Sciences for organising this MCM
Thank Dr Ramesh from Vydehi institute and Dr Ramesh from AMC for a very good scientific session.
Dr Kalaivani
Send your News, Articles, Event details, Classifieds, etc. to "editorssb@gmail.com"
Feedback & Comments
Sushruta
Thank you Dr. Ramesh of AMC & Dr. Ramesh Reddy of Vydehi for the excellent Scientific Meeting.. Congratulations
Dr Murali
Dear all Drs. of SSB. I am very happy to see the pictures of Surg. Clinical Meeting of June 2020.I should thank & Congratulate for good proceedings & pictures sent. For senior citizens there will be some technical difficulty in viewing live programmes. I am very happy you have sent pictures & I was able to see early morning. Let this continue. My suggestion is even after Clinical Meetings start with Dinner & Drinks also this typing of sending pictures & Description on paper continue as it will help those unable to attend the Clinical Meetings. Let this go on with other meetings also. Thanks.
Dr. B. G. S. Murthy 9343207939.
Congratulations both Ramesh. Very good session
-Dr Srikanth KN
June 2020
A 30 year old male presented with complains of abdominal pain and distension from 2 days, with Vomiting 2-3 episodes, immediately after food, associated with H/o breathing difficulty since 2 day, on examination patient was conscious and oriented, pulse 100bpm and BP 150/100mmHg. Spo2-90% at RA, with RR of 24c/m, per abdomen was diffusely distended with epigastric tenderness, guarding and rigidity, bowel sounds sluggish. Lab investigation showed only raised total leucocyte counts, remaining parameters were normal, x- ray chest showed abdominal contents in left hemi-thorax, x-ray erect abdomen showed double air fluid level. CECT was s/o diaphragmatic hernia with deviation in stomach axis, patient was taken up for exploratory laparotomy intraoperatively stomach was grossly distended and mal-rotated (organo-axially)which couldn’t be de-rotated, 1cm gastrotomy made on the stomach and 7.5 litres of partially digested food aspirated, ligaments of stomach released and stomach is de-rotated to its anatomical position. Colon and omentum are reduced into the abdominal cavity from thorax. Diaphragmatic defect noted and plication done, prolene mesh placed 15 x 15 cm. Anterior gastropexy was done with prolene sutures. And FJ performed. ADK drain placed. ICD placed in the left hemithorax. ICD removed on POD3. POD5 patient developed burst abdomen and tension suturing done. Patient sent home with FJ in situ, later removed after 4 weeks. Patient recovered well, with no recurrence of symptoms till 6 months.
Online Monthly Clinical Meeting - Presentations
Page 5
Gastric volvulus, Challenges & Solution in Management: Case Report
Presenters : Dr.Tinnu George, Dr. Ravi Kumar.H, Dr. Sai Kalyan Guptha A,
Department of General Surgery, Vydehi Institute of Medical Sciences and Research Center - Bangalore
Gastric volvulus is a rare condition. Cardia and the pylorus are the fixed points. The clinical presentation depends on the degree of rotation and time of onset. Acute volvulus usually presents with abdominal or chest pain, severe vomiting and epigastric distension. Borchardt triad (pain, retching and inability to pass a nasogastric tube) occurs in up to 70% of cases. Torsion occurs along the stomach’s longitudinal axis (organo-axial) in 70% of cases, vertical axis (mesentro-axial) in 30% cases and combined. Type 1 (primary) idiopathic is due to laxity of gastro-colic, gastro-splenic, gastro-phrenic and gastro-hepatic ligaments. It’s also associated with congenital asplenia and wandering spleen. Type 2 (secondary) is associated with congenital or acquired abnormalities like diaphragmatic defects and post hepatic transplant.
Discussion
Gastric Volvulus is an unusual entity, often not recognized at an early stage, which can become a surgical emergency. Gastric Volvulus presents more frequently with intermittent symptoms. Timely diagnosis and treatment of acute gastric volvulus can potentially decrease morbidity and mortality
Conclusion
Gastric Volvulus is twisting of all or part of the Stomach by more than 180 degrees with obstruction of the flow. In 1886 Berti was the first to describe a gastric volvulus after performing an autopsy on female patient. Usually associated with diaphragmatic defect. Incidence is equal in both genders. About 20% of cases occur in children or after the 5th decade of life. Gastric volvulus is an uncommon cause of gastric obstruction (closed loop obstruction) but its intermittent nature and vague symptoms may make diagnosis difficult.
Case Report
Dr Tinnu George
Page 6
FOURNIER’S GANGRENE: A RECONSTRUCTIVE CHALLENGE – OUR EXPERIENCE
Presenter - Dr Sanyal Sumbul Rana (P.G.Student) Department of General Surgery
Dr B R Ambedkar Medical College - Bangalore
Fournier’s gangrene is an acute, rapidly progressive and potentially fatal, necrotizing fasciitis. Reconstruction of the scrotal, penile and perineal defect after the initial debridement is a challenge as these organs have unique texture, contour and function. Extensive destruction of the surrounding skin, over the abdominal wall, thigh and the gluteal region, limits the skin available for the reconstruction. Proximity to anus and contamination with urine, contributes to poor results. There is no consensus on the best method of reconstruction. To avoid erroneous reconstruction , in 2015 Karian et al proposed a simple algorithm based reconstruction. We have improvised the algorithm to add anal sphincteroplasty and vaginal reconstruction and we aim to study the algorithm based various options in reconstruction and their outcome.
Background
Sushruta
Methods Our Aim of the study was to study the algorithm based choice of reconstruction options, their indications and outcome in terms of hospital stay, functional outcome and the cosmesis of the surgery with patient satisfaction. This was a retrospective study of a duration of 2 years with a total number of 35 patients. All patients admitted with a diagnosis of Fournier’s gangrene at Dr B R Ambedkar Medical College and Hospital were evaluated.
In our study 32 patients were male and belonging to the age category of 50+years. The most common organism isolated was E.coli(34.28%) and majority of the patients had extension into the perineum (57%). There were 3 patients ( 8.5%) with defects that healed by primary closure, 5(14.3%) with secondary intention, 10(28.5%) with local flaps, 3 (8.5%) with distant cutaneous flaps, 9 (25.7%) patients underwent musculocutaneous flap placement and 5 (14.3%) with free flaps. 3 of our patients had anal sphincteroplasty and 1 had vaginal reconstruction as per our algorithm. The mean time from disease occurrence to defect reconstruction was 18 days. The average hospital stay was 8.6 days. The major complication that we encountered was poor cosmesis and the most common minor complication was seroma formation.
Results
Conclusion Losses of up to 50% of skin can be repaired with local flaps. This is the most cosmetic and functional reconstruction. More than 50% of the skin loss patients benefitted from musculocutaneous flaps. The ideal method differs for each patient. As a lot of  patients have associated co-morbidities, a single stage surgery/anaesthesia is preferred and a vascularised flap provides the best results. Gracilis myocutaneous flap is the workhorse for post Fournier’s defect as it can cover the deeper, larger and contaminated areas. It is robust, reliable, easy to harvest, provide better testicular protection with low incidence of contraction and low donor site morbidity. An algorithm-based approach will definitely help the surgeons to decide.
June 2020
Page 7
Day Care Laparoscopic Cholecystectomy - Factors Influencing Same Day Discharge : An Observational Study
Presenters : Dr Nischitha TJ, Dr Ramesh Reddy G, Dr Vinay HG, Dr Kiran Kumar, Dr Swetha R Chandra
Department of General Surgery, Vydehi Institue of Medical Science and Research Centre, Bangalore
Patient who met the criteria had a successful DCLC and day care pathway was considered to be achieved. Our study concluded that PONV, Pain, difficult Calots dissection, need of conversion to open, need of subtotal cholecystectomy, drain and RT requirement post operatively, anxiety, responsible care taker, reassurance by the treating surgeon, dedicated surgical and anaesthesia team and patient‘s education in understanding necessary post-operative discharge instructions all played a vital role in achieving DCLC.
Results
DCLC is safe, feasible, equally effective as elective LC, providing early recovery, return to work, good hospital bed utilization, as it has high same day discharge rate, and low complications which can be easily managed at home by patient education and low readmission rates. Provided patient are selected with caution, skillful surgical techniques  and safe anesthesia. PONV and post-operative pain require high attention and management protocols during immediate perioperative period.
Conclusion
Laparoscopic cholecystectomy (LC) has been routinely performed since 1989 and it is now considered the gold standard treatment for symptomatic gallstones and cholecystitis.
This is a prospective observational study performed in Vydehi Institute of Medical Sciences and Research Centre from January 2018 to June 2019. 53 patients presenting with chronic calculous cholecystitis were included in the study. Patients underwent laparoscopic cholecystectomy. Six hours post operatively patients were encouraged to mobilize and  take  oral fluids if they were not nauseated. Six hours of observation was done in all patients prior to discharge.
Materials & Methods
Abstract
To identify the surgical and clinical factors which could be the determinants in decision to discharge patients‘ same day. Determine the recovery of DCLC, thereby accessing the safety and feasibility of DCLC.
Objective
Best Paper
Worked in Bengaluru in various hospitals since 1992 including Mallya Hospital,
June 1983 to 1992 July - Worked in Benghazi - Libya
Feb 1989 – July 1992 – lecturer at Al Arab University Benghazi, Libya.
Feb 1987 – Jan 1989 – assistant lecturer at Al Arab University Benghazi, Libya.
June 1983 – Jan 1987 – senior registrar in ministry of health, Benghazi, Libya.
April 1981 – May 1983 – civil assistant surgeon and i/c referral primary health center
Teacher for undergraduate students from American board medical college (2006-2009)
Teacher for undergraduate students from international medical school (2009-till date)
Postgraduate teacher for DNB students from 2006
Faculty at Best Institute & Research Center for Laparoscopic training at Bengaluru from (1998-2016)
Dr. Chanchal Raj Chhallani
Present Designation: Senior Surgeon and Head of Department, General and Minimally invasive surgery – Bhagwan Mahaveer Jain Hospital and Santosh Hospital – since 1992.
Past Service:
Nimaj- Rajasthan
Page 8
Sushruta June 2020
Internship (1974-75): Dr S.N. medical college and M.G.Hospital – Jodhpur
Civil Assistant Surgeon Govt. of Rajasthan – 1976 to 1977
MS General Surgery (1977-80): Safdarjung Hospital – New Delhi and Dr S.N.Medical
college Jodhpur (Rajasthan university)
Training in GI endoscopy and laparoscopic surgery from AIIMS – New Delhi – 1994.
Interview with Surgeon - Dr. Chanchal Raj Chhallani
Page 9

Three children –
Son – Abhishek, MS- Mechanical Engineering (Germany) – working in Bosch
Personal Life
Birth & Education
June 2020
Page 10
Your Mentors -
How and why did you choose Surgery?
1. Prof S.K. Pandey – HOD Surgery and Superintendent of M.G.Hospital and
Dr.S.N. Medical College Jodhpur and My Guide.
2. Prof V.C.Bothra - Prof Surgery – Dr. S.N. Medical College – Jodhpur
3. Prof A.K.Kripalani – Prof Surgery AIIMS – New Delhi
4. Prof Satyanand – Safdarjung Hospital – New Delhi
5. Prof Joe Devadatta – Former Prof Surgery CMC, Vellore.
Since my younger days, I always had the ambition to be a surgeon someday. With
much dedication, hard work, perseverance and patience I was able to join surgery
after waiting for 2 years even though I had the choice of anesthesia, radiology
and ENT).
One of my professors Dr S.K.Pandey was my mentor and inspired and guided me
always through this journey of becoming a surgeon.
There is a saying in our medical fraternity that goes (with due respect)
“physicians are physicians, however surgeon plays the role of a physician as well
as a surgeon”.
Sushruta
Interview with Surgeon - Dr. Chanchal Raj Chhallani What surgeries are your favourite ?
My preference includes challenging surgeries like major abdominal, neck and
chest trauma- blunt, penetrating, gun shot, including vessel injuries.
Other abdominal surgeries like mesenteric vascular thrombosis, peritonitis,
perforation of hollow viscus, appendicular perforations.
All types of obstructed and strangulated hernias.
Thyroidectomies.
for carcinoma breast, benign breast lumps.
All types of hernias – large and very large incisional hernias, paraumbilical
hernia, inguinal and femoral hernias.
Gastric surgery for benign and malignant.
Small and large bowel surgery for benign and malignant diseases.
Haemorrodectomy, fistulectomy, fistulectomy with seton tie and fissurectomy.
Laparoscopic surgeries – lap cholecystectomy, lap appendicectomy, abdominal
hernias, lap assisted bowel resection, sometimes gynecological surgery.
What are your less liked surgeries ?
Surgeries involving recurrent complex fistulae
Intestinal fistulae
Release of dense adhesions
Mutilating surgeries in advance malignancy.
What would you do different if you get a chance to relive PG days ?
I am a general surgeon with experience in all types of surgeries.
a.
b.
c.
d.
e.
We learned how to enjoy our lives along with lots of hard work, responsibilities and
experiences. "WORKED LIKE A DONKEY AND ENJOYED THE LIFE LIKE A KING ".
And there was a lot of love and respect we earned in the hospital as well as in our
families and society. I would love to relive those days.
However, we lacked such advanced technology and digitalization in those days. That
would be something I would like to add, if I had to relive those PG days.
Page 11
June 2020
Interview with Surgeon - Dr. Chanchal Raj Chhallani
Page 12
Interests beyond surgery :
Organizing social gatherings and picnics for associations.
Organizing free medical and surgical camps by hospitals and NGO’s.
Balance my life with yoga and listening to soothing old Hindi melodies.
I love spending time with my family.
Favourite food :
Favourite book
Favourite place of travel:
We are as a family love to visit places of historical places, religious and
otherwise.
My bucket list includes travel to Eastern Europe, Russia and Parts of Gujarat
and Rajasthan.
Favourite quote:
Karmay-Evdhikras te m Phalehu Kadchana – one must keep performing
their duties, without worrying or expecting the fruits of success.
One satisfied patient will bring ten more patients and an unsatisfied patient
will take away hundred patients.
Any regrets: None.I am satisfied as I got whatever I have dreamt of and achieved
even though sometimes with delay and struggle.
Key to your success: Hard work- No Shortcuts
a.
b.
c.
d.
I relish home cooked vegetarian food. My favorites include authentic Rajasthan
cuisine and being in South India for so many years developed a liking for fresh Idlis
with chutney and sambar, North Karnataka Jowar and Bajra meals served on banana
leaf. And ofcourse main favorites are green salad and fruits.
Of course books related to surgical field, but I also love reading the newspaper,
magazines like India today, readers digest, few books on culture and religious
a.
b.
c.
a.
b.
c.
Page 13
Key to your success:
Join surgery if that’s your ambition and dream.
Always follow ethical practices with honesty, sincerity and hard work.
Set goals and work hard, success will come to you.
Come prepared when you come to assist or perform surgery
Always read before and after case presentations, seminars and surgery.
Be informed and updated about recent advances in surgery, attend workshops,
Do your work with a service motive and bring respect and pride to your family,
Be faithful, truthful to your patient and institution
Always respect your seniors and show affection to your juniors
Be soft spoken and a good listener
DOCUMENTATION, DOCUMENTATION, DOCUMENTATION is mandatory. Right
from history, clinical examination, OT notes, ward rounds and each procedure
done in the ward. It was important in the past but in the present scenario, it is
important to save yourself.
Take care of your patients with affection and compassion.
For surgeons whenever you have time eat and take rest during PG time.
In future balance your life between work and family.
There is no replacement for honesty, sincerity and hard work for me in whatever I do.
Since my childhood, one important learning that has kept me progressing is “what
could be more worse than a no”
I Hence kept trying and look at everything as an opportunity and not to give up.
My message to younger surgeons would be
conferences and keep presenting scientific papers and attending journal clubs.
institution and guide.
June 2020
We all surgeons are aware of hyperbaric oxygen therapy and indications for which it was developed. As years passed, many researchers claimed this therapy to be beneficial in variety of condition ranging from diabetic foot to Alzheimer’s disease, stroke, etc. However, various controversies also arouse as many felt that experts were misleading people on usage of hyperbaric oxygen therapy.
From past 2 decades, it was also seen that most expert were showing excellent outcomes in diabetic foot with hyperbaric oxygen therapy by claiming that this machine reduces amputation. However, the recent few studies have put a huge question mark on it. It’s believed that this machine was cleared by FDA only for decompression sickness and most of the people have wrongly propagated usage of this machine for other conditions and many doctors started believing this to be a “wonder machine” as it was shown by many doctors to have excellent results. This has resulted in a tremendous increase in diabetic foot patients being subjected to undergo weeks to months of therapy spending lakhs of rupees because the healthcare professional scares the already scared patient that he will lose his limb if he doesn’t undergo this therapy and the vicious cycle of unethical practices begins.
In one of the largest cohort studies done by Margolis et al, it was shown that hyperbaric oxygen therapy neither improved wound healing nor decreased the amputation in diabetic foot. In a recent systematic review by Thrane et al, it was shown that HBO was not effective even in necrotizing fasciitis and the previous studies done on it were poor and highly biased questioning the efficacy of this machine. It is often seen that many have invested huge sum of money costing millions on this machine and often they are the one who claim it to be excellent machine.
As one of the diabetic foot practitioner over a decade, the sad part noticed over past few years is that many healthcare professional are subjecting  patients to this machine to reverse gangrene, or for diabetic foot abscess and even for a trophic ulcer which are and were never a indication for hyperbaric therapy but I guess it’s a market driven industry.
One should be extremely cautious in using this expensive machine and should subject the patient only if needed/indicated and no other option left as we know that time is tissue and delay can lead to amputation. Most of our patients are of middle class and lower class and adding a burden of lakhs of rupees on an adjuvant therapy with controversial role will not only dent the backbone of the patient but also will lead the entire family towards economic loss from which they may not recover. There need to be regulations on usage of this machine in India as currently there is not control body to oversee this issue of rampant and blind usage of this machine and over last 3-4 years, one has seen that most hospitals are increasingly purchasing this machine and enforcing the healthcare professional to achieve the target.
Newsletter of Surgical Society of Bangalore
HYPERBARIC OXYGEN THERAPY – CONTROVERSIES AROSEN!
Prof. Amit Jain, Dept of surgery, RRMCH
Sushruta June 2020
Short Note on Surgical Training
Dr. U Vasudeva Rao
The surgical training has three main components – The trainee, the trainer and the subject
The subject has two components – Knowledge and skill
Knowledge is assimilated from many sources – text books internet lectures etc
Skill can be related to procedure or it can be soft skill like communication, audit, ethics etc
The primary objective of a trainer is to make sure that the trainee acquires good amount of knowledge and becomes proficient in skills which are needed to become a fully competent specialist. The primary objective of trainee is the learn the art and science of surgery within the given period of time with reasonable effort and complete the course and the assessment.
Most of the trainees develop the interest in the specialty soon after their induction and enhance their goal further during the course. There are of course instances where a candidate has joined the course for reason other than academic in which case, he may not have any career related goal.
The art and science of surgery has undergone a sea change over the years with advances in technology new disease entities more complex procedures and increasing competitiveness. Added to these changes are the requirement of effective communication, ethics, patient safety etc. Research also has become an integral part of the training but exactly how much role research has played and in what manner it is incorporated in surgical training is subject of debate.
In the past the bedrock of postgraduate training is mentorship which means the trainee acquires the bulk of the knowledge and the surgical skill from the professor or consultant under whom he works. Additional knowledge used to come from attending clinics journal club lecture etc. The only requirement other than abovementioned learning tools is submission of thesis. This was the only research component during the training and there was wide variation in the manner in which the thesis was carried out. The so-called eminence-based practice was in vogue for a long time and the practicing surgeons never bothered to audit their work or the outcomes under the false impression that whatever has been done was done by their masters which gave good results.
Though the training methods have evolved to some extent the trainee’s perspective has remained more or less the same. He wants to complete the course and obtain a degree! (with minimum effort and withing the given period of time) but the goals of all trainees are not the same.
June 2020
Page 16
Short Note on Surgical Training
Dr. U Vasudeva Rao
Some may just want to get in to practice either independently or join his elder relative or friend. Some others may decide to enter into higher surgical training and become super specialist and nowadays there are many sub specialities to choose from.
Some of the others may want take up the academic career either teaching or research or both.
However, it is difficult from the trainer’s point of view to categorise the training tools based on the individual needs and the components of surgical training and the requirements need to be uniform.
The surgical curriculum all over the world and the method of assessment has undergone significant reforms but not much has happened in our country except for additional requirements of a trainee to publish an article and present papers in conferences in addition to his thesis.
There are two different training programs with few commonalities – One which is undertaken by the colleges and universities and the other conducted by National Board which is somewhat similar to the speciality boards overseas
I will not go in to the details of the differences in two systems but there is an element of research in both
That brings us to the question of research in surgical training.
Surgical research is an essential component of modern evidence-based practice and is the cornerstone of profession (1)
R&D is the cornerstone of advances made in any field of human endeavour and the same is true for art & science of medicine. Research in healthcare is necessary to adopt evidence-based medicine. (1)
Many believed that teaching institutions focus mainly on acquisition of surgical skills and leave research training to universities.
But the trend of opinion and practice in many parts of the world seem to favour integration of training in to residency training. (1)
Present day surgical training is a multifaceted process. They need to be good clinicians & technicians, good communicator, scholar health advocate and a professional.
June 2020
Short Note on Surgical Training
Dr. U Vasudeva Rao
Critical analysis – literature review Scientific writing Presentation skills Research methods – trial design statistics etc Knowledge & Exposure to national & international meetings Competitiveness Time away from clinical work What are the drawbacks if any? It may prolong the training period Navigating bureaucracy – Obtaining data sample collection etc Perception – If you get involved too much in to research you may get side lined Those who cannot operate teach who can’t teach do research – True to some extent but not an excuse to neglect research There are critics of including research in surgical training but not many (3) Some feel that compulsory research does not necessarily produce good science or encourage self-education in later life- ref It is waste of resources and contribute to significant and avoidable problems. It is felt that the goal could be better accomplished by offering a choice of two distinct career paths
The benefits of training in research are (2)
  From the foregoing discussion it is evident that there has to be an element of research in the existing training programs.
What then is the role of full-time research during surgical training – Should all trainees undertake an extended period of research or should this be limited to those who are academically inclined (2)
In some universities and specialty boards the trainee need devote a full year exclusively to research as part of the training but the feasibility of this approach is controversial. In UK it is not uncommon for a trainee to take break from clinical work once he completes the clinical training to involve in some research activities so that when he re-joins the clinical activity it will be easy for not only to get better placement but also engage further in research. In conclusion integration of research into surgical training should be in such a way that it doesn’t side line the basic need of a trainee that is professional knowledge and skill. It also mandates commitment not just by the trainee but also from the faculty and administration. The trainee should not be burdened too much with research work in the middle of carrying his clinical and operative work especially when he is not given time off to carry out such activity.
June 2020
Page 18
Short Note on Surgical Training
Dr. U Vasudeva Rao
Having associated with surgical training on and off for the last three decades and having been actively associated with reforms in training under ASI many years ago and also having spent a short period as head of the university postgraduate teaching program, I have following suggestions to make. I must confess, I am no expert in this field and there are many others who are veterans with vast knowledge and who are up to date with current scenario   1) All trainees should be trained in conducting research during their postgraduate course. This can be in house with involvement of experienced faculty or with the help of external experts.
2) The training should be structured like any other subject – It should not be just one or two lectures just for completion sake
While all trainees should attend these lectures, the assignment can be graded as per the year of training
First year – Audit & case reports, Poster presentation, topic or subject review presentation (this will help in improving the quality of presentation slide preparation etc)
Second year – Retrospective analysis Data collection Literature review Statistics.
Final year – Prospective and or randomised studies (He would have by now collected the data and analysed for final presentation) Publications / Presentations
3) The trainee would engage in all aspects of research right from the beginning once he chooses the topic for this thesis. But it will be unfair to expect him to give a presentation to an audience straightaway without having any knowledge of what is required. He should just present a case which may be relevant to his thesis or even a short review of the topic.
In fact, in many departments including our won (when I was the HOD) the exercise begins with a trainee giving an overview of the topic for which he is going to do research with review of literature. Even other trainees are expected to have some knowledge of the subject which is being discussed.
A reputed professor of a leading teaching institution would not allow his trainees to attend a conference and present paper unless he is fully satisfied which means the trainee has to present at least ten times and modifies the presentation each time I used to insist on this for every postgraduate so that the mistakes are minimised during the final presentation and he is well prepared to face the crowd.
June 2020
Short Note on Surgical Training
Dr. U Vasudeva Rao
Finally, the proposal by SSB to help trainees acquire necessary skills in scientific presentations and clinical research is laudable and I am sure the HOD’s of teaching institutions will welcome this move. Of course this will no way infringe upon the responsibility of the faculty who are the ultimate mentors for the trainee but it will lessen their burden so that they can focus more on other aspects of training. The society just provides a platform for the trainees to get the experience of facing the audience and opportunity to correct mistakes if any. The senior mentors while pointing out the lapses should not be too critical as the trainee may be facing the situation for the first time and he is bound to commit mistakes Even these mistakes can be minimised by prior exposure to the basic elements of research and this is exactly what Surgical Society intends to do with cooperation from the HOD’s of respective teaching institutions.
References:
1 The intersection of research & Surgical Training: Akinyinka O Omigbodun Journal of West African College of Surgeons Vol 2 No Mar 2012
2 Tark Sammour, Andrew G Hill : Fulltime research during Surgical Training: Career killer or stepping stone?
3 Is there a place for research in Surgical Training? Frank Arnold Postgrad Med J (1992) 68 978-980
June 2020
I am Dr. B.G.Srinivasa Murthy, Born on 20th August 1945. Did M.B.B.S. from Bangalore Medical College –1968, M.S. Gen. Surgery from Mysore Medical College in the year 1976. F.I.C.A. USA in 1983
My KMC registration No. is 6772. My Phone No. is 9343207939
I became a Surgical Society Bangalore member in the year 1989. On my transfer in State Government service from Mysore to Bangalore.
I was an active member in the Surgical Society of Bangalore. Then served as E.C. member for about 10 years. Then became Treasurer for two years in the years 2007 and 2009.
I used to attend all Clinical meetings and E.C.meetings. I used to attend  the office of S.S.B. off and on to enquire difficulties, welfare and do official Treasurer work.
I was instrumental in making new members of S.S.B. One example I made Dr. K. S. Hanumanthaiah a new member of S.S.B. in the year 2009. Then he served in different capacities and became a President in 2017.
I served in Karnataka State Government service from 1970 to 2003. (Age of retirement – 58 yrs then)
In the beginning of my service I was working in District Hospital – Sri Jayachamarajendra Hospital, HASSAN, in various departments from 1970 to 1973.
At HASSAN in the year 1971 on a Sunday afternoon I was asked to do Post Mortem on a lady on the spot. A 28 year old lady was murdered by a male who attempted to Rape on her, in a remote isolated land near Belur- a historical place. He had pressed his foot powerfully on the Right 2nd and 3rd Ribs area anteriorly, resulting in sudden death of the lady. And the murderer had removed her golden ear rings and made a theft also.
In the Post Mortem report I had written fracture of Right 2nd and 3rd Ribs Anteriorly with slight Haematoma as the cause of death of the lady.
In the Hassan District Court murder by that person was not proved for want of eye witnesses. Theft of the ear golden ornaments was proved. He was sentenced to 5 years Rigorous imprisonment in the Judgement.
Page 20
Dr. B.G. Srinivasa Murthy
Rare Experiences in Surgeon’s Life
Dr. B.G. Srinivasa Murthy
I felt very unhappy that the difficult Post Mortem done in a remote place far away from Hassan was not proved as murder done by him. But I felt happy that the theft was proved and he was sentenced to be in Jail for 5 years.
June 2020
After my M.S. I have served in the District Civil Hospital, Belgaum from 1976 to 1981. I was also attached to J.N.M.C. Medical College Belgaum.
At Belgaum in 1979 I had admitted a patient with all signs and symptoms of Chronic Peptic Ulcer. There was no doubt in the diagnosis. He was posted for surgery with no further investigations.  Those days there was a quota for taking  X-rays. Only when there is a doubt we used to take X-ray. As there was no doubt in the diagnosis no X-ray taken.
On the Major O.T. table Operation was very difficult. While opening the abdomen by Upper Midline Incision there was trouble at the place of Peritoneum touching the Liver. With difficulty Peritoneum was incised and abdomen opened. Patient had SITUS INVERSUS TOTALIS with Chronic Duodenal Ulcer. Trunkal Vagotomy and Anterior G.J. was done successfully. As Posterior G.J. was difficult in this case, which we used to do regularly for Peptic Ulcer.  Usually in those days Trunkal Vagotomy and Posterior G.J. used to be done.
Because of drugs for Peptic Ulcer, Surgery on Peptic Ulcer is less performed these days since about 20 to 30 years.
Statistics of the Hospital showed that this was the only case of SITUS INVERSUS TOTALIS in the past 10 years. But there was one case every year of DEXTRO CARDIA in the past 10 years.
This case was presented in the Surgical Clinical Meeting at Belgaum in that month. It was very well appreciated, as a very rare case.
At Belgaum in 1979 I have conducted Post Mortem examination on the body of a famous film Actress. She had died in a faraway place from BELGAUM. The body was brought to District Hospital, Belgaum.The District Surgeon called and ordered me to dothe Post Mortem. There was a rumour that She had died because of swallowing Diamond. I immediately went home to study Medico Legal text book regarding Diamond swallowing. Text Book mentions that Diamond can only injure Oesophagus, but it will not produce death. On Post Mortem I did not find any Diamond or any injury to Oesophagus or any other Gut areas. The cause of death was due to poisoning by swallowing lot of Sleeping Tablets as per Bio Chemical reports. There was no trouble by the General Public.
Page 22
Dr. B.G. Srinivasa Murthy
From 1981 to 1983 I was deputed to serve in Government of Iran Hospitals by orders of Govt. of India and Karnataka State Govt. offices, as Iranian Govt. was not having enough Doctors to serve their people and there was Iran-Iraq war during that time. During Iran-Iraq war time some Iranian doctors used to be posted to war areas and Indian doctors to serve in peaceful areas.
June 2020
In the city of QOM, Iran Country, in the year 1981 a foreign field worker had a STAB INJURY in the Epigastric region. He was almost pulseless in the Casualty dept.  Myself and an Iranian Surgeon rushed him to major O.T. for IMMEDIATE SURGERY with an Anaesthetist. Immediate blood transfusion arranged. In Iran near Major O.T. blood bottles are stored for immediate usage. Under sedation and G.A. Epigastric Stab injury area abdomen opened. There was Diaphragmatic injury also and the stab had gone to the Pericardium  and Right Ventricle of the Heart. Chest was also opened by Intercostal incision. Injured Pericardium and Right Ventricle of the Heart were identified with heavy bleeding. The wounds were closed with a drain kept in the Pericardium. He progressed well and was discharged.
In QOM, Iran in the year 1981 a case of strangulated Inguinal Hernia in critical condition was found in the ward in the evening hours on my evening duty. Because of strangulation I wanted to operate on him as an emergency operation immediately under local anaesthesia. Even painting the part with Povidone Iodine and draping the part the patient was not co-operating. I asked the anaesthetist to give mild sedation. He was given a small dose of sedation IV slowly. Patient suddenly died. We tried all resuscitative measures. But it failed. Patient died on the O.T. Table.
In QOM, Iran in the year 1981 I was called to go to a village to see a dead child about 2 years old of burns. In the village there was no electricity. Only kerosene lamps used at home. That child was a First wife’s child. The First wife had died of natural cause. There was a Second Wife with her mother. The 2nd wife had a small baby of 5 months old. The 2nd wife had pressed on the neck of the First wife’s child and had caused death. But she wanted to prove that the cause of death was due to burns. So she had burnt the lower limbs with Kerosene cloth bed sheet making people to imagine that the cause of death is due to burns. At the place of death myself and another Madras MBBS doctor with 5 years Iran  experience could not find any cause of death apart from burns. In Iran if the cause of death is certified by the attending doctor no Post Mortem is necessary in any Medico Legal case. In the child’s death as we were not sure of cause of death we ordered for Post Mortem. The body was sent to Tehran (Capital of Iran) which was close to QOM for Post Mortem examination. In one week’s time the Post Mortem report came mentioning Throttling – pressing the airway in the neck as the cause of death. In India for all Medico Legal cases Post Mortem must be done. But in Iran if the cause of death is certified by a qualified Doctor no Post Mortem examination is required.
Sushruta
Rare Experiences in Surgeon’s Life
Dr. B.G. Srinivasa Murthy
The 2nd wife who committed murder was taken to the Police Station with her child. She was looked after till the child became about 10 months old and then she was hanged in Public vision in the noon hours near the Prayer hall on a Friday. So all the people attending prayer can see the hanging of a murderer.
In India hanging is done in the jail compound only at about 4 a.m. to avoid public cry. I have witnessed one such hanging in Belgaum jail.
In Mysore Medical College where I was a PG between 1974-76 under Dr. Y.B. HEGDE as unit chief and Dr. R.H.N.SHENOY as HOD of Surgery. My thesis subject was Tumours and other space occupying lesions in Liver.
June 2020
There was one case of Carcinoma of Liver Right lobe admitted to the ward. I read many journals in MMC library. There was one publication mentioning Hepatic Artery Ligation of the branch which supplies the tumour will supress the tumour. Normal Liver is supplied by Hepatic Artery and Splenic vein. But the Primary Carcinoma is supplied by only Hepatic Artery branch. In the Right sided Primary Liver Tumour, if Right Hepatic Artery branch is ligated only the Tumour will not get blood supply. But the normal Liver gets blood from Left branch of Hepatic Artery and by Splenic Vein also. So the normal Liver should survive, but the Tumour will lose blood supply and Tumour size can reduce. With this idea back ground as found in Journals studied by me and unit chief, Surgery was done on the patient. His Right Hepatic Artery branch was ligated. But unfortunately Patient expired on the 3rd day. We could not find out the exact cause of death.
We never tried this surgery again on any other patient.
I am herewith narrating a few of rare experiences of a Serving Surgeon.
Just to share a few interesting facts on how some of our Surgical Fore-fathers moved on…!    1.  HAMILTON BAILEY                         Intestinal Obstruction, d/o Carcinoma Left                                                                          Colon, post operative Faecal Fistula, & Sepsis   2.  CHARLES McBURNEY                      Heart Attack (Ac MI) while on an Hunting Trip!   3.  FRIEDRICH TRENDLENBERG            Carcinoma Mandible   4.  JOHANN FRIEDRICH MECKEL          Pulmonary Tuberculosis   5.  CARL LANGEBUCH                        Peritonitis caused by Ruptured Appendix..!   6.  JOHN HUNTER                            Acute Angina – MI – Syphilitic Heart Disease..!   7.  WILHELM RONTGEN                      Carcinoma Rectum   8.  RUDOLP VIRCHOW                        Fracture Femur, while jumping of a moving train, death due to septic complications of prolonged immobilisation!   9.  HARVEY CUSHING                        Of Acute MI, but Autopsy showed ‘Colloid Cyst’                                                                    of 3rd Ventricle of his brain   10. WILLIAM HALSTEAD                     From bronchopneumonia as a complication of                                                                    surgery for gallstones and cholangitis   11.  PERCEVIAL POTT Of Pneumonia, after riding 20 miles in the rain, to see a patient. His famous last words are “My life is almost extinguished. I hope it has burned well for the benefit of others."   12.  JOHANN GEORG WIRSUNG           Murdered in 1643 by Giacomo Cambier, reportedly the result of an argument, as to who was the discoverer of the pancreatic duct.   13.  ARAMAND TROUSSEAU               Found himself to have the sign of internal                                                                           malignancy that he had described, was diagnosed as Carcinoma Stomach, and died shortly thereafter.   14.  KURT SEMM                               Complications of Parkinson’s Disease   15.  FREDRIC EUGENE BASIL FOLEY     Lung Cancer
Page 24
HOW DID THEY DIE…?……. !!!! Compiled By - Dr C.S.Rajan
Sushruta June 2020
Authors Ahmed W H Barazanchi 1, Weisi Xia 1, Wiremu MacFater 1, Sameer Bhat 1, Hoani MacFater 1, Ashish Taneja 2, Andrew G Hill 1 3 (PMID: 32580245 DOI: 10.1111/ans.16082)
Affiliations 1. Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. 2. Dept of General Surgery, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand. 3. Dept of General Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
Risk Factors for Mortality After Emergency Laparotomy: Scoping Systematic Review
Page 25
Newsletter of Surgical Society of Bangalore
Emergency laparotomy (EL) is a common procedure with high mortality leading to several efforts to record and reduce mortality. Risk scores currently used by quality improvement programmes either require intraoperative data or are not specific to EL. To be of utility to clinicians/patients, estimation of preoperative risk of mortality is important. We aimed to explore individual preoperative risk factors that might be of use in developing a preoperative mortality risk score.
Background
Two independent reviewers identified relevant articles from searches of MEDLINE, EMBASE and Cochrane databases from January 1980 to January 2018. We selected studies that evaluated only preoperative predictive factors for mortality in EL patients.
Method
Result The search yielded 6648 articles screened, with 22 studies included examining 157 728 patients. The combined post-operative 30-day mortality was 13%. All, but one small study, were at low risk of bias. A meta-analysis of results was not possible due to the heterogeneity of populations and outcomes. Age, American Society of Anesthesiologists, preoperative sepsis, dependency status, current cancer and comorbidities were associated with increased mortality. Acute physiological derangements seen in renal, albumin and complete blood count assays were strongly associated with mortality. Delay to surgery and diabetes did not influence mortality. Higher body mass index was protective.
Preoperatively, risk factors identified can be used to develop and update risk scores specific for EL mortality. This scoping review focused on the preoperative setting which helps tailor treatment decisions. It highlights the need for further research to test the relevance of newer risk factors such as frailty and nutrition.
Conclusion
June 2020
Very sad to hear the news . He was senior to me during MB
and MS. Then my colleague in MSR. A dear friend. I will
miss him. RIP -Dr MG Bhat
Obituary
Newsletter of Surgical Society of Bangalore
Dr Belani was my good friend and a colleague at St. John's
heartfelt condolences to the family.......Om Shanthi
- Dr. Ramdev
I pray: May his soul be blessed by the Almighty. We will miss a very vocal member during MCM.
-Dr Shivaram HV
R.I.P om shanthi. Since 1981 first time meet in surgical
society and we were good surgical friends.
- Dr.Gopinath
RIP Dr SBB...! In 1977, he joined SJMC, after his MS from KMC Manipal, and work at SMH. I was one of the 1st medical interns to go thro his instructions then. In Nov 1981, I got the vacancy he left at SMH, when he left SJMC for MSRMC..! Om Shanthi, kind Sir..!
- Dr.C.S.Rajan
Very sad to know about the sad demise of Dr Srichand Belani Prof of Surgery. A brilliant surgeon & teacher. We
were classmates for 4 Years at St Joseph’s college & close friends those days and after.Even as a student he was
good & excellent at Zoology dissctions & Student science circle meetings. Later after graduating from Manipal
he had great carrier & his presence was always felt at SSB meetings. I am going to miss him very much. My
condolences to the family & prayers for his soul to Rest In Peace
- Dr Srinath
Really a very sad news. Sir used to be in the first row always. We are grateful to him for his contribution and active participation in all meetings. My heartfelt condolences to the bereaved family. Ohm Shanti
-Dr Kalaivani
Very sad to learn about Dr Belani. A very vocal live wire of our society. He introduced the concept of video of patients during clinical discussions in large audiences CMEs. We will miss his presence
-Dr Raghuram
So sad to hear the news RIP Dr Balani, We really miss him regularly attending SSB and exchange knowledge with junior surgeons. Om Shanthi,
-Dr Lakanna
I worked alongside Dr. Belani at MSRMC for several years. A simple and good human being. He was always supportive. It's indeed very sad that he is no more. Our prayers are with him and his family. May his soul rest in peace.
-Dr Ravi
I was the secretary when he was the president
of SSB ASIC. It was the 1st time in the history
of surgical society all monthly clinical
meetings were held centrally at St.Josephs
Auditorium. Great Person. Rest in Peace. Pray
God to give courage to his family members.
-Dr Prakash B R
Sushruta
Very sad to note the same. He was my teacher in UG and
very good person at heart. May his soul rest in peace
-Dr Satyakrishna
Newsletter of Surgical Society of Bangalore
Kind hearted person .Your absence will be felt in the SSB
meets. Om Shanthi
- Dr. Seshagiri Rao
His constant presence in all SSB meetings will be missed. He always had questions for the students.
-Dr Venkatachala
Heartfelt condolences and fond remembrance expressed by
Dr Vasudev Rao and Dr Ashok Nayak prior to the online
MCM.
Sad to know the demise of our beloved Surgeon Prof. Belani. I remember most one thing - I used to pick him up along with Ashok Nayak and Srikant, and come to attend our monthly meet. While going back we all used to have Pan near Shivananda Circle and always it was Belani's treat for that day. He will only pay for that. He will never allow us to pay. Then the routine of dropping him to his house and then Srikant and Nayak.
It will be in my memory always. Very much saddened by his absence. Om Shanti...
- Dr. Murali
Fond memories of him right from my post graduate days (when I used to present cases during CSEP and he was a chair). To Me being the President of SSBAICC when there was no monthly clinical meeting without his presence and questions. Always a charm to see him occupy the front seat. Rest in peace Sir.
You will forever be remebered. Om Shanthi
- Dr Arvind Gubbi

Very sorry to hear about Dr.Belani. Knew him well all through our college days and as an active member of our KMC alumni association.
-Dr Giridhar & Nalini Shenoy
Page 28
Sushruta
mandatory.
Roads are empty but it is impossible to go on long drive.
People have clean hands but there is a
ban on shaking hands.
Friends have time to sit together but they cannot get together.
The cook inside you is crazy, but you cannot
call anyone to lunch or dinner.
On every Monday..the heart longs for the office but the weekend does not seem to end.
Those who have money have no way to spend it. Those who don't have
money have no way to earn it.
There is enough time on hand but you can't
fulfill your dreams.
The culprit is all around but cannot be seen. A world full of irony!
So be positive and Stay negative...
Courtesy - Dr Venkatesh Kesarla
An Humble Appeal !!
Whenever u find a Person Infected with Covid 19 in your neighbourhood and going for Quarantine or Hospital or isolation Pls do not take Video or Photography and make him feel shameful or guilty, Instead stand in your Balcony or Window or Terrace and Wish him good luck and a Speedy Recovery.
1. Respect Him. 2. Pray for Him 3. Make him feel you are a good friend / Neighbour / Relative. 4. Wish him to get well Soon.
This Disease can be cured by each others help and not by humiliation. Feel the Pain he and his Family may go thru, Lets Pray for Each other in these Hard times.
Feeling Others Pain is also a Sign of Humanity
Trivia

Humble Appeal Courtesy - Dr Murali L
June 2020
Courtesy - Dr Dr Rajshekar Halkud
June 2020

June 2020
Dear Doctor,
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Generates Leads & Wins Patients?
Advertise your events, workshop or courses in this space at a nominal charge.
Contact: editorssb@gmail.com
Call Now # 9845848572 www.DrHappitude.com
Sushruta June 2020
June 2020
Page 34

Sushruta - Editorial Team 2020
Advisors
Dr C S Rajan Dr K Lakshman Dr Ramesh S Dr H V Shivaram
Members
Dr Sai Shruthi Rai Dr Monika Pansari Dr Nagbhushan J S Dr Wassim Darr Dr Nayar Sajeet G Dr Santosh K
Chief Editors
Editorial Board
Dr Venkatesh KL Dr Sreekar Pai Dr Niranjan P Dr Mallikarjun M N Dr Sunil Kumar V Dr Venkatesh S Dr K S Hanumnthaiah Dr Manohar T M Dr Rajashekhar C Jaka Dr Hosni Mubarak Khan Dr Manjunath B D
Thank-You