New techniques in General Surgery

I have described a new clinical diagnostic test for hernia[1], a method to record diastolic blood pressure without a stethoscope[2], and a new surgical knot[3].

While investigating the reasons for vomiting after surgery, we found that omitting nitrous oxide reduces its incidence[4] [5]

I have written about my concerns about training of doctors and surgeons[6][7] and of overspecialisation that could have had fatal consequences[8]

Here is an interesting case of gall stone ileus [9] diagnosed from a plain abdominal film and a new disease described by my son Hrisheekesh Vaidya at age 9[10].

When we used the delay from symptom onset rather than clinical presentation, we found that it increases conversion rate from laparoscopic to open cholecystectomy [11][12] which prompted a commentary.

I reviewed the popular must-read for surgical residents [13] and wrote in the BMJ about alleged ‘safety-valve’ effect of spanking and people’s reaction to bad press about doctors

[1] [pdf] J. Vaidya, “A new test for distinguishing direct and indirect inguinal hernia,” Contemporary Surgery, vol. 48, p. 225, 1996.
[Bibtex]
@article{vaidya1996ahernia,
author = "Vaidya, JS",
journal = "Contemporary Surgery",
month = "Apr",
organization = "USA",
pages = "225",
title = "A new test for distinguishing direct and indirect inguinal hernia",
volume = "48",
year = "1996",
issue = "4",
}
[2] [pdf] J. Vaidya and S. Vaidya, “Diastolic blood pressure can be reliably recorded by palpation,” Arch Int Med., vol. 156, p. 1586, 1996.
[Bibtex]
@article{vaidya1996diastolicpalpation,
author = "Vaidya, JS and Vaidya, SJ",
journal = "Arch Int Med.",
pages = "1586",
title = "Diastolic blood pressure can be reliably recorded by palpation",
volume = "156",
year = "1996",
}
[3] [pdf] J. Vaidya, “A new noose type non-slip surgical knot that can be tied by one hand,” Contemporary Surgery, vol. 49, p. 294, 1996.
[Bibtex]
@article{vaidya1996ahand,
author = "Vaidya, JS",
journal = "Contemporary Surgery",
month = "Nov",
organization = "USA",
pages = "294",
title = "A new noose type non-slip surgical knot that can be tied by one hand",
volume = "49",
year = "1996",
issue = "5",
}
[4] [pdf] J. Divatia, J. Vaidya, R. Badwe, and R. Hawaldar, “Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting: a meta-analysis,” Anesthesiology, vol. 85, pp. 1055-1062, 1996.
[Bibtex]
@article{divatia1996omissionmeta-analysis,
author = "Divatia, JV and Vaidya, JS and Badwe, RA and Hawaldar, RW",
journal = "Anesthesiology",
month = "Nov",
note = "Imported via OAI, 7:29:01 8th Sep 2005",
pages = "1055--1062",
title = "Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting: a meta-analysis",
volume = "85",
year = "1996",
abstract = "Background: Postoperative nausea and vomiting are important causes of morbidity after general anesthesia. Nitrous oxide has been implicated as an emetogenic agent in many studies. However, several other trials have failed to sustain this claim. The authors tried to resolve this issue through a meta-analysis of randomized controlled trials comparing the incidence of postoperative nausea and vomiting after anesthesia with or without nitrous oxide.Methods: Of 37 published studies retrieved by a search of articles indexed on the MEDLINE database from 1966 to 1994, 24 studies (26 trials) with distinct nitrous-oxide and non-nitrous oxide groups were eligible for the meta-analysis. The pooled odds ratio and relative risk were calculated. Post hoc subgroup analysis was also performed to qualify the result.Results: The pooled odds ratio was 0.63 (0.53 to 0.75). Omission of nitrous oxide reduced the risk for postoperative nausea and vomiting by 28% (18% to 37%). In the subgroup analysis, the maximal effect of omission of nitrous oxide was seen in female patients. In patients undergoing abdominal surgery and general surgical procedures, the effect of omission of nitrous oxide, although in the same direction, was not significant.Conclusion: Omission of nitrous oxide reduced the odds of postoperative nausea and vomiting by 37%, a reduction in risk of 28%.",
issn = "0003-3022",
issue = "5",
}
[5] [pdf] J. Vaidya, “Comment on Ä comparison of the effects of droperidol and the combination of droperidol and ondansetron on postoperative nausea and vomiting for patients undergoing laparoscopic cholecystectomy\".,” J Clin Anesth, vol. 15, p. 570, 2003.
[Bibtex]
@article{vaidya2003commentcholecystectomy.,
author = "Vaidya, JS",
journal = "J Clin Anesth",
month = "Nov",
organization = "United States",
pages = "570",
title = "Comment on \"A comparison of the effects of droperidol and the combination of droperidol and ondansetron on postoperative nausea and vomiting for patients undergoing laparoscopic cholecystectomy\".",
url = "http://www.ncbi.nlm.nih.gov/pubmed/14698374",
volume = "15",
year = "2003",
issn = "0952-8180",
issue = "7",
keyword = "Antiemetics",
keyword = "Cholecystectomy, Laparoscopic",
keyword = "Droperidol",
keyword = "Drug Therapy, Combination",
keyword = "Humans",
keyword = "Ondansetron",
keyword = "Postoperative Nausea and Vomiting",
keyword = "Randomized Controlled Trials as Topic",
language = "eng",
pii = "S0952818003001363",
}
[6] [pdf] J. Vaidya, “Minor-injury care by nurse practitioners or junior doctors (Letter),” The Lancet, vol. 355, p. 229, 2000.
[Bibtex]
@article{vaidya2000minor-injuryletter,
author = "Vaidya, JS",
editor = "Vaidya, JS",
journal = "The Lancet",
pages = "229",
title = "Minor-injury care by nurse practitioners or junior doctors (Letter)",
volume = "355",
year = "2000",
issn = "0140-6736",
issue = "9199",
keyword = "Care",
keyword = "letter",
keyword = "Minor Injury",
}
[7] [pdf] [doi] J. Vaidya, “Junior Doctors should have a parallel postgraduate student contract,” International Journal of Surgery, 2007.
[Bibtex]
@article{vaidya2007juniorcontract,
author = "Vaidya, JS",
journal = "International Journal of Surgery",
title = "Junior Doctors should have a parallel postgraduate student contract",
url = "http://www.ncbi.nlm.nih.gov/pubmed/17660138",
year = "2007",
abstract = "All of us are acutely aware of the low level of training
opportunity that is now available to Junior Doctors.
The big mistake is in accepting that everything the
trainees do is ‘‘work’’ and hence European Working Time
Directive (EWTD) applies to it all.
But Junior Doctor training is an apprenticeship which is
a combination of service (work) and training/learning.
Hence these should be formally distinguished, and EWTD
should apply only to the work part.
For example, an SpR should have the stipulated 48 (or
30!) hours per week of WORK and another 30 of 40 (or as
many as we þ they decide are required) hours per week of
LEARNING which is formally timetabled and NOT counted as
work. Or better e we formally stipulate that 40% of the
time a Junior Doctor is in the hospital he/she is purely
learning and 60% is purely working. This may sound
artificial, but is necessary for protecting the very existence of surgical and medical training. If that is accepted e then they can be around to learn for 66% longer. So out of the 80 hours a trainee is in the hospital, 48 hours is work and 32 hours is learning. OR, of the 90 hours a trainee is in the hospital, 54 hours is work and 36 hours is learning or postgraduate studentship. Of course, no salary need be paid for these learning/postgraduate studentship hours, and they are not included in the EWTD hours count. Such work þ postgraduate studentship will then match the training most of us have undergone; and if implemented the eager trainees will be ‘‘allowed’’ to be in their alma mater e the place of learning e the hospital e long enough for adequate training/education. This is a simple concept, but if this model works, it could be applied to the rest of the World.",
doi = "10.1016/j.ijsu.2006.05.015",
issn = "1743-9191",
}
[8] [pdf] [doi] J. Vaidya, F. Alem, and F. Mansor, “A stitch in time did not save nine–because ït was not my field\".,” Int J Surg, vol. 5, p. 371, 2007.
[Bibtex]
@article{vaidya2007afield.,
author = "Vaidya, JS and Alem, F and Mansor, F",
journal = "Int J Surg",
month = "Oct",
organization = "England",
pages = "371",
title = "A stitch in time did not save nine--because \"it was not my field\".",
url = "http://www.ncbi.nlm.nih.gov/pubmed/17933697",
volume = "5",
year = "2007",
doi = "10.1016/j.ijsu.2006.06.016",
eissn = "1743-9159",
issue = "5",
keyword = "Aged",
keyword = "Female",
keyword = "Gastrointestinal Hemorrhage",
keyword = "Humans",
keyword = "Ileostomy",
keyword = "Medicine",
keyword = "Specialization",
keyword = "Suture Techniques",
language = "eng",
pii = "S1743-9191(06)00143-9",
}
[9] [pdf] [doi] J. Vaidya, O. Lalude, D. Grant, and H. Mukhtar, “Gallstone ileus.,” Lancet, vol. 362, p. 1105, 2003.
[Bibtex]
@article{vaidya2003gallstoneileus.,
author = "Vaidya, JS and Lalude, O and Grant, D and Mukhtar, H",
journal = "Lancet",
month = "Oct",
organization = "England",
pages = "1105",
title = "Gallstone ileus.",
url = "http://www.ncbi.nlm.nih.gov/pubmed/14550697",
volume = "362",
year = "2003",
doi = "10.1016/S0140-6736(03)14465-0",
eissn = "1474-547X",
issue = "9390",
keyword = "Aged",
keyword = "Female",
keyword = "Gallstones",
keyword = "Humans",
keyword = "Ileus",
keyword = "Treatment Outcome",
language = "eng",
pii = "S0140-6736(03)14465-0",
day = "4",
}
[10] [pdf] J. Vaidya HJ c/o Vaidya, “Playstation Thumb,” The Lancet, vol. 363, p. 1080, 2004.
[Bibtex]
@article{vaidya2004playstationthumb,
author = "Vaidya, HJ c/o Vaidya, JS",
journal = "The Lancet",
pages = "1080",
title = "Playstation Thumb",
url = "http://www.ncbi.nlm.nih.gov/pubmed/15051306",
volume = "363",
year = "2004",
issn = "0140-6736",
issue = "9414",
keyword = "Friction",
keyword = "Injury",
keyword = "Child",
keyword = "Games Console",
keyword = "Playstation",
}
[11] [pdf] [doi] S. Hadad, J. Vaidya, L. Baker, H. Koh, T. Heron, and A. Thompson, “Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis,” World Journal of Surgery, vol. 31, pp. 1300-1303, 2007.
[Bibtex]
@article{hadad2007delaycholecystitis,
author = "Hadad, SM and Vaidya, JS and Baker, L and Koh, HC and Heron, TP and Thompson, AM",
journal = "World Journal of Surgery",
month = "Jun",
pages = "1300--1303",
title = "Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis",
url = "http://www.ncbi.nlm.nih.gov/pubmed/17483986",
volume = "31",
year = "2007",
abstract = "BACKGROUND: Randomized trials suggest that laparoscopic cholecystectomy should be performed on first admission for acute cholecystitis. However, this is not widely practiced, possibly because of a perceived high conversion rate. We hypothesized that delay from onset of symptoms may increase the conversion rate. METHODS: We performed a retrospective case note review of patients undergoing emergency cholecystectomy in a single institution between January 2002 and December 2005. We analyzed whether delay from onset of symptoms was related to the conversion rate in patients with a histopathological diagnosis of acute cholecystitis. RESULTS: Of patients who underwent emergency laparoscopic cholecystectomy in our institution, 32.4% (197/608) had acute cholecystitis on histopathology. The conversion rate of those with acute cholecystitis was considerably higher (24.4%) than for those with other pathologies (6.3%). For patients with acute cholecystitis, the conversion rates increased with duration of symptoms: 9.5%, 16.1%, 38.9%, and 38.6% for delays of 0-2 days, 3-4 days, 5-6 days, and > 6 days from symptom onset, respectively (chi-square for trend = 14.27, DF = 1, p = 0.00016). Most conversions were due to the presence of acute inflammatory adhesions. CONCLUSIONS: Early intervention for acute cholecystitis (preferably within 2 days of onset of symptoms) is most likely to result in successful laparoscopic cholecystectomy; increasing delay is associated with conversion to open surgery.",
doi = "10.1007/s00268-007-9050-2",
issn = "0364-2313",
issue = "6",
keyword = "laparoscopic cholecystectomy",
keyword = "optimum time",
keyword = "delay",
keyword = "open",
keyword = "conversion rates",
}
[12] [doi] S. Hadad, J. Vaidya, L. Baker, H. Koh, T. Heron, K. Hussain, and A. Thompson, “Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis (World Journal of Surgery 31, 6, DOI: 10.1007/s00268-007-9050-2),” World Journal of Surgery, vol. 32, pp. 2747-2747, 2008.
[Bibtex]
@article{hadad2008delay10.1007/s00268-007-9050-2,
author = "Hadad, SM and Vaidya, JS and Baker, L and Koh, HC and Heron, TP and Hussain, K and Thompson, AM",
journal = "World Journal of Surgery",
month = "Dec",
pages = "2747--2747",
title = "Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis (World Journal of Surgery 31, 6, DOI: 10.1007/s00268-007-9050-2)",
volume = "32",
year = "2008",
doi = "10.1007/s00268-008-9750-2",
issn = "0364-2313",
eissn = "1432-2323",
issue = "12",
}
[13] [pdf] J. Vaidya and S. Massarut, “Recent advances in Surgery -28,” The Surgeon, vol. 4, p. 119, 2006.
[Bibtex]
@article{vaidya2006recent-28,
author = "Vaidya, JS and Massarut, S",
journal = "The Surgeon",
pages = "119",
title = "Recent advances in Surgery -28",
volume = "4",
year = "2006",
issue = "2",
}