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Saha S, Hiremath R, Sanjay P. Barriers to adoption of green buildings – a review. CM 2022. [DOI: 10.18137/cardiometry.2022.22.377385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The global construction sector accounts for 13.2% of the world GDP. It contributes to the world’s economic growth engine and climate changes due to its high energy footprint. Sustainable buildings can reduce the adverse impacts of the construction industry, but their adoption is slow due to hindrances. The purpose of this paper is to extensively review the literature on barriers to green building adoption to date. Also, to highlight the overlapping and unique barriers specific to India compared to few prominent countries, provide solutions and recommendations for future research. The barriers were classified under Economic, Governmental, Organizational, and Social perception, Information, Technology, and material categories. Barriers unique to India and few others developing countries are an extension of project schedules, lack of research and developmental works, lack of public motivation, poor building code enforcement, high payback period, uncertain supply of green materials, improper implementation of policy framework, and performance of GBTs. The green building construction sector is fragmented around the world. Even green building definition is not the same globally, although the environmental aspect is the same. Similarly, there are unique and overlapping challenges in green building adoption globally. Buildings in usage perspectives can be classified into Residential and Non-residential. This study looks only at non-residential buildings due to their homogenous nature. There is a dearth of specific studies related to the adoption of green buildings in India. This study aims to fulfill India’s standing in the barriers to green building adoption concerning the developed and developing countries.
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Salik M, Mir M, Arafa M, Sanjay P. 305 Effect of COVID 19 on Ward Notes Documentation Standards. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To assess the effect of COVID 19 on ward notes documentation standards
Method
100 ward notes entries (before COVID, during COVID Peak, and after COVID Peak, 100 each) were evaluated against set ward notes documentation standards derived from the GMC Good Medical Practice document. The results were analysed, and the three data sets were compared to assess any effect of the COVID 19 pandemic on ward notes documentation standards.
Results
Individually, clear handwriting and documenting signatures showed a slight decline, and a slight increase was seen in the use of unknown abbreviations during the COVID-19 Peak. However, documentations standards were maintained across other categories and even showed improvement in some standards. Overall compliance showed a small improvement rather than a decline during the COVID 19 Peak.
Conclusions
COVID 19 Pandemic has certainly had an effect on every aspect of life globally. The health sector came under significant pressure and saw unprecedented stressful working conditions during the peak of the pandemic. However, even under the unprecedented pressures of COVID 19, we were able to maintain remarkable documentation standards and even showed improvements across various standards.
It should be kept in mind that there are limitations to this Audit and further studies are needed to confirm these findings.
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Affiliation(s)
- M. Salik
- Luton and Dunstable University Hospital, Luton, United Kingdom
| | - M.H. Mir
- Luton and Dunstable University Hospital, Luton, United Kingdom
| | - M. Arafa
- Luton and Dunstable University Hospital, Luton, United Kingdom
| | - P. Sanjay
- Luton and Dunstable University Hospital, Luton, United Kingdom
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Sanjay P, Fulke JL, Shaikh IA, Woodward A. Anatomical differentiation of direct and indirect inguinal hernias: Is it worthwhile in the modern era? Clin Anat 2015; 23:848-50. [PMID: 20641068 DOI: 10.1002/ca.21022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 05/09/2010] [Accepted: 06/08/2010] [Indexed: 11/10/2022]
Abstract
The study aimed to assess the clinical accuracy of differentiating direct and indirect inguinal hernias preoperatively by different grades of surgeons. A retrospective audit was conducted over a 9-year period and comprised all adult inguinal hernia patients operated by one consultant surgeon. The hernias were differentiated into direct and indirect hernias based on the direction of cough impulse and the deep ring occlusion test. The preoperative diagnosis was compared with intraoperative findings. During the study period, 503 patients were examined. Of these, 272 patients were diagnosed as having indirect hernias and 56 patients as having direct hernias. In 175 patients, no attempt was made to differentiate indirect and direct hernias. When compared with intraoperative findings, the diagnosis was correct in 77% of the indirect hernias and 55% of direct hernias. Of the patients in whom no differentiation was attempted, 115 patients had indirect hernias, 56 had direct hernias, and four had both. For indirect hernias, the diagnostic accuracy was 82, 63, and 30% for consultant, registrars, and senior house officers. For direct hernias, the diagnostic accuracy was 66, 50, and 44%, respectively. This study demonstrates relatively poor accuracy in diagnosing direct inguinal hernias regardless of seniority.
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Affiliation(s)
- P Sanjay
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Wales, United Kingdom.
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Ragupathy K, Priyadharsini I, Sanjay P, Yuvaraj V, Balaji TS. Peripheral Osteoma of the Body of Mandible: A Case Report. J Maxillofac Oral Surg 2014; 14:1004-8. [PMID: 26604477 DOI: 10.1007/s12663-014-0710-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/19/2014] [Indexed: 11/24/2022] Open
Abstract
Osteoma is a slow growing benign tumor consisting of well differentiated compact or cancellous bone that increases in size by continuous growth. It can be of a central, peripheral, or extraskeletal type. The peripheral type arises from the periosteum and is rarely seen in mandible. Although completely curable with adequate surgical treatment, osteomas precede the clinical radiographic evidence of colonic polyposis/Gardner's syndrome. Therefore they may be sensitive markers for the disease. Recurrence of peripheral osteoma after surgical excision is extremely rare. However it is appropriate to provide both clinical and radiographic follow up after surgical excision of peripheral osteoma. This article describes the case of a 45 year old male who presented with painless swelling of the right body of mandible and resultant cosmetic facial disfigurement and functional impairment.
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Affiliation(s)
- Karthik Ragupathy
- Department of Dentistry, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Pondicherry, India
| | - Indira Priyadharsini
- Department of Dentistry, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Pondicherry, India
| | - P Sanjay
- Department of Dentistry, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Pondicherry, India
| | - V Yuvaraj
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Cudallore Main Road, Pillaiyarkuppam, Pondicherry, 607402 India
| | - T S Balaji
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Cudallore Main Road, Pillaiyarkuppam, Pondicherry, 607402 India
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Abstract
INTRODUCTION Groove pancreatitis is a form of chronic pancreatitis affecting the space surrounded by the pancreatic head, duodenum and common bile duct. The clinical findings can conflict with pancreatic cancer causing diagnostic dilemma preoperatively. CASE SERIES We describe two patients with a history of alcohol excess, who presented with a few months history of upper abdominal pain associated with weight loss and vomiting. Endoscopic and radiological investigations related duodenal narrowing, biliary dilatation and multiple pseudocysts around the head of the pancreas and duodenum. A Whipple's pancreaticoduodenectomy was carried out in both patients. Histopathology report demonstrated cystic areas in both medial and lateral walls of the duodenum microscopically consistent with groove pancreatitis. CONCLUSION The diagnosis of groove pancreatitis should be considered in patients with duodenal stenosis and cystic lesions around the head of the pancreas associated with history of alcohol excess. Differentiation from pancreatic cancer is difficult preoperatively.
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Affiliation(s)
- J Latham
- Department of General Surgery, Ninewells Hospital & Medical School, UK
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Sanjay P, Marioud A, Woodward A. Anaesthetic preference and outcomes for elective inguinal hernia repair: a comparative analysis of public and private hospitals. Hernia 2012; 17:745-8. [DOI: 10.1007/s10029-012-1011-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 10/29/2012] [Indexed: 11/28/2022]
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Abstract
A lipoma of the small bowel mesentery is a rare pathological entity. It has been shown to rarely cause obstruction and volvulus of the small bowel. We report a case of a 72-year-old man who presented with lower abdominal pain and slightly raised inflammatory markers. Computerized tomography of the abdomen showed small bowel perforation and oedematous terminal ileum. At laparotomy the cause was found to be a mesenteric lipoma causing small bowel perforation. As far as the authors are aware, this presentation is not described in the English language literature.
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Affiliation(s)
- D G Watt
- Department of General Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
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Abstract
BACKGROUND The technique of pancreatoduodenectomy (PD) has evolved. Previously, non-resectability was determined by involvement of the portal vein-superior mesenteric vein. Because venous resection can be achieved safely and with greater awareness of the prognostic significance of the status of the posteromedial resection margin, non-resectability is now determined by involvement of the superior mesenteric artery (SMA). This change, with a need for early determination of resectability before an irreversible step, has promoted the development of an 'artery-first' approach. The aim of this study was to review, and illustrate, this approach. METHODS An electronic search was performed on MEDLINE, Embase and PubMed databases from 1960 to 2011 using both medical subject headings and truncated word searches to identify all published articles that related to this topic. RESULTS The search revealed six different surgical approaches that can be considered as 'artery first'. These involved approaching the SMA from the retroperitoneum (posterior approach), the uncinate process (medial uncinate approach), the infracolic region medial to the duodenojejunal flexure (inferior infracolic or mesenteric approach), the infracolic retroperitoneum lateral to the duodenojenunal flexure (left posterior approach), the supracolic region (inferior supracolic approach) and through the lesser sac (superior approach). CONCLUSION The six approaches described provide a range of options for the early determination of arterial involvement, depending on the location and size of the tumour, and before the 'point of no return'. Whether these approaches will achieve an increase in the proportion of patients with negative margins, improve locoregional control and increase long-term survival has yet to be determined.
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Affiliation(s)
- P Sanjay
- Hepatopancreatobiliary/Upper Gastrointestinal Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
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Sanjay P, Weerakoon R, Shaikh IA, Bird T, Paily A, Yalamarthi S. A 5-year analysis of readmissions following elective laparoscopic cholecystectomy - cohort study. Int J Surg 2010; 9:52-4. [PMID: 20804872 DOI: 10.1016/j.ijsu.2010.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/01/2010] [Accepted: 08/14/2010] [Indexed: 12/12/2022]
Abstract
AIMS This study aimed to determine readmission rates, causes for readmission and outcomes for patients undergoing elective Laparoscopic Cholecystectomy (LC) without intraoperative cholangiogram (IOC). METHODS Timing related to readmissions was grouped as <6 weeks, 6 weeks-1 year, 1-2 years and >2 years. Outcomes and variables related to readmission were evaluated. RESULTS 101 readmissions (6.6) were noted amongst 1523 consecutive LC. The median follow up was 4 years (range 1.6-6.4 years). There was no difference in the median age (48 vs. 53 years, P = 0.2) and sex of the patients between the readmitted and no readmission groups. The incidence of readmissions (n = 101) within the first 6 weeks, 6 weeks-1 year, 1-2 years and >2 years were 2.8%, 1.5%, 1.4% and 0.7% respectively. The most common reasons for readmissions were non-specific abdominal pain (NSAP) (36%), obstructive jaundice (14%), peptic ulcer disease (10%), intra-abdominal collection (4%) and bile leak (3%), pancreatitis (3%), and other reasons (30%). Overall, 24 (22%) of readmissions were related to biliary problems, the majority of these occurred (15/24, 63%) within 6 weeks of LC. The incidence of retained stones within the first 6 weeks, 6 weeks-1 year, 1-2 years and >2 years were 0.4%, 0.3%, 0.1% and 0% respectively. Overall 14 (14%) patients were readmitted with retained stones and all were managed by ERCP & ductal clearance. CONCLUSIONS Readmission rate following elective LC is low with the majority occurring within the first 6 weeks and only a quarter of these related are directly to biliary pathology. In the absence of routine IOC, around 1% of patients present with retained stones within 2 years of LC. A small fraction of patients continue to suffer from NSAP and should be warned prior to the surgery.
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Affiliation(s)
- P Sanjay
- Ninewells Hospital and Medical School, Dundee, UK.
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Sanjay P, Kulli C, Polignano FM, Tait IS. Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland. Ann R Coll Surg Engl 2010; 92:302-6. [PMID: 20501016 DOI: 10.1308/003588410x12628812458617] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION There is debate on optimal techniques that reduce bile duct injury during laparoscopic cholecystectomy (LC). A national survey of Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) members was carried out to determine current surgical practice for gallstones, including the use of intra-operative cholangiography (IOC) or critical view of safety to reduce the risk of bile duct injury. SUBJECTS AND METHODS An anonymous postal survey was sent to all 417 AUGIS members. Data on grade of surgeon, place of work (district general hospital, teaching), subspecialty, number LC per year, use of IOC, critical view of safety, and management of stones detected during surgery were collated. RESULTS There was a 36% (152/417) response - 134 (88%) from consultant surgeons (36, HPB; 106,OG; 64, DGH; 88, teaching hospital). Of these, 38% performed > 100 LC per year, 36% 50-100 LC per year, and 22% 25-50 LC per year. IOC was routine for 24%; and selective for 72%. Critical view of Calot's triangle was advocated by 82%. Overall, 55% first clip and divide the cystic artery, whereas 41% first clip and divide the cystic duct. Some 39% recommend IOC and 23% pre-operative MRCP if dilated common bile duct (CBD) is noted on pre-operative ultrasound. When bile duct stones are identified on IOC, 61% perform laparoscopic CBD exploration (LCBDE), 25% advise postoperative ERCP, and 13% perform either LCBDE or ERCP. Overall, 88% (n = 134) recommend index cholecystectomy for acute pathology, and this is more likely in a teaching hospital setting (P = 0.003). Laparoscopic CBD exploration was more likely to be performed in university hospitals (P < 0.05). CONCLUSIONS A wide dissection of Calot's triangle to provide a critical view of safety is the technique most commonly recommended by AUGIS surgeons (83%) to minimise risk of bile duct injury, in contrast to 24% that recommend routine IOC. The majority (88%) of AUGIS surgeons advise index admission cholecystectomy for acute gallbladder disease.
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Affiliation(s)
- P Sanjay
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK
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Appleton ND, Bosanquet D, Morris-Stiff G, Ahmed H, Sanjay P, Lewis MH. Extra-anatomical bypass grafting--a single surgeon's experience. Ann R Coll Surg Engl 2010; 92:499-502. [PMID: 20522294 DOI: 10.1308/003588410x12664192076890] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Extra-anatomical bypass grafting is a recognised method of lower limb re-vascularisation in high-risk patients who cannot tolerate aortic cross clamping, or in those with a hostile abdomen. We present a single surgeon series of such procedures and determine relevant outcomes. PATIENTS AND METHODS A retrospective review was performed on a prospectively maintained database of patients undergoing femoro-femoral or axillo-femoral bypass surgery between 1986 and 2004. RESULTS Patency rates for femoral (n = 28; 32%) versus axillary (n = 59; 68%) bypass procedures at 1 month, 1, 3 and 5 years were (92% vs 93%), (69% vs 85%), (60% vs 72%) and (55% vs 67%), respectively. Patient survival rates for the corresponding procedures and time intervals were (96% vs 90%), (96% vs 67%), (85% vs 45%) and (73% vs 38%) and revealed a significantly lower survival rate in those undergoing axillary procedures (P = 0.002). Limb salvage rates were calculated at (100% vs 91%), (96% vs 84%), (96% vs 81%) and (92% vs 81%) with no statistically significant difference found between the two groups (P = 0.124). Two-thirds of the patients who required major amputation died within 12 months of surgery. CONCLUSIONS Acceptable 30-day morbidity, long-term primary patency and survival rates are obtainable in patients suitable for extra-anatomical bypass surgery despite having significant co-morbidities. We have shown 5-year patency rates in those that survive axillary procedures to be as good as those undergoing femoral procedures. Furthermore, surviving patients who evade amputation within a year have an excellent chance of long-term limb salvage.
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Affiliation(s)
- N D Appleton
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK
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Lalitha N, Sanjay P, Vyshak M, Kadri U. Stability-Indicating Reverse Phase HPLC Method for the Determination of Cefazolin. TROP J PHARM RES 2010. [DOI: 10.4314/tjpr.v9i1.52034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sanjay P, Moore J, Saffouri E, Ogston SA, Kulli C, Polignano FM, Tait IS. Index laparoscopic cholecystectomy for acute admissions with cholelithiasis provides excellent training opportunities in emergency general surgery. Surgeon 2010; 8:127-31. [PMID: 20400020 DOI: 10.1016/j.surge.2009.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 10/22/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is minimal data on the outcome of early laparoscopic cholecystectomy (LC) for acute gallbladder disease when performed by trainees. This study assesses the outcomes of a policy of same admission LC incorporated into a surgical training programme in a major teaching hospital. METHODS 447 index LCs performed over a 3-year period were reviewed retrospectively. The indications, operating surgeon, operating time, use of IOC, conversion rates, reasons for conversion and post-operative stay were analysed. Multivariate analysis of reasons for conversion was performed. RESULTS 150 LCs were performed by consultants and 297 by registrars; 67 were performed by year 1-3 specialist registrars (SpR) and 230 by year 4-6 SpRs. The indications were biliary colic (n=7), acute cholecystitis (n=180), chronic cholecystitis (n=260), carcinoma (n=1). No difference was found in demographics, operating time (105 min Vs 115 min), use of IOC (34% Vs 29%; P=0.2) and post-operative stay (2 days Vs 1 day) between consultants and registrars. The conversion rates were higher for consultants compared to registrars (29 (19%) Vs 28 (9%), P=0.004). The overall conversion rate was 11%. There were no bile duct injuries. Predictors for conversion were CRP>50 at admission and acute cholecystitis. CONCLUSION In a teaching hospital setting most acute admission LCs (66%) were performed by trainees. A step wise training programme with active consultant supervision of all index LCs results in low morbidity, low conversion rates, and a short post-operative stay for acute gallbladder disease. This model of same admission cholecystectomy provides a good training opportunity in emergency general surgery.
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Affiliation(s)
- P Sanjay
- Directorate of General Surgery, Ninewells Hospital & Medical School, Ninewells Avenue, Dundee, Scotland DD1 9SY
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Sanjay P, Shaikh I, Rivron R, Woodward A. A new structured work observation programme for prospective medical students. Med Teach 2009; 31:957. [PMID: 19877872 DOI: 10.3109/01421590903359338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
INTRODUCTION Local anaesthetic inguinal hernia repair may be technically demanding. There are minimal data regarding the outcomes of local anaesthetic hernia repair by trainees in comparison with consultants. PATIENTS AND METHODS All consecutive local anaesthetic repairs performed by trainees and one consultant over a 9-year period were reviewed. Operation time, volume of local anaesthetic used, early and long-term complications were assessed. A postal survey was conducted to assess chronic groin pain and satisfaction rates. RESULTS A total of 369 repairs were reviewed of which 265 repairs were performed by the consultant and 104 by trainees. The male-to-female ratio was 25:1 and the median age of the study group was 61 years (range, 18-93 years). The volume of local anaesthetic used was significantly higher for trainees than the consultant (42 ml versus 69 ml; P = 0.03). The operative time for the consultant and the trainees was 35 min and 40 min (P = 0.8). The day-case rate was higher for the consultant than the trainees (84% versus 69%; P = 0.02). Three patients operated by trainees required conversion to a general anaesthetic repair. No difference was noted in chronic groin pain (consultant 28% versus trainees 32%; P = 0.52) on the postal survey. The median follow-up was 5 years (range, 2-7 years). CONCLUSIONS Local anaesthetic inguinal hernia repair can be performed safely by surgical trainees under consultant supervision with minimal short- and long-term morbidity. A large volume dilute solution of Lignocaine and Marcaine is recommended when hernia repair is undertaken by trainees.
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Affiliation(s)
- P Sanjay
- Department of Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Sanjay P, Woodward A. Local versus general anaesthesia with Prolene Hernia System mesh for inguinal hernia repair: early and long-term outcomes. Dig Surg 2008; 25:347-50. [PMID: 18832843 DOI: 10.1159/000159623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 07/30/2008] [Indexed: 12/10/2022]
Abstract
BACKGROUND There are minimal data regarding the feasibility of Prolene Hernia System repair under local anaesthesia and patient acceptability. This study analyses the outcomes of Prolene Hernia System repair under different anaesthetic techniques. METHODS A retrospective review of all Prolene Hernia System repairs over a 5-year period was performed. The outcome measures were type of anaesthesia used, early and late complications, recurrence and patient satisfaction. RESULTS 100 repairs were analysed. Seventy repairs were performed under local anaesthesia and 30 under general anaesthesia. The number of patients with a body mass index >30 were 17 (24%) and 8 (27%), respectively, in the local- and general-anaesthesia groups (p = 0.7). Day cases were higher in the local-anaesthesia group (69 days vs. 16 days, p = 0.001). Early complications were similar in the two groups. 18 (26%) patients in the local-anaesthesia group and 6 (19%) in the general-anaesthesia group developed chronic groin pain (p = 0.6). One recurrence was noted in the local-anaesthesia group. Patient satisfaction was high with both anaesthetic techniques. CONCLUSIONS Prolene Hernia System repair under local anaesthesia results in increased day cases with similar complication rates compared to general anaesthesia. Both anaesthetic techniques are associated with good outcomes and excellent patient satisfaction.
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Affiliation(s)
- P Sanjay
- Ninewells Hospital and Medical School, Dundee, UK.
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Prakash A, Mishra R, Sanjay P, Alexander M, Sankar K. Antibiotic prophylaxis in minor oral surgery: a randomised triple-blind placebo-controlled trial. Int J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.ijom.2007.08.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
INTRODUCTION Specialist hernia centres and public hospitals with a dedicated hernia service (Plymouth Hernia Service) have achieved remarkable results for inguinal hernia repair with the use of local anaesthesia and set the standards for groin hernia surgery. There is minimal data in the literature as to whether such results are reproducible in the National Health Service in the UK. PATIENTS AND METHODS A retrospective analysis of all inguinal hernia repairs performed in one district general hospital over a 9-year period was performed. The outcome measures were type of anaesthesia used, early and late postoperative complications and recurrence. A postal questionnaire survey was conducted to obtain satisfaction rates. In addition, a postal questionnaire survey of consultant surgeons in Wales was performed to determine the use of local anaesthesia and day-case rates for inguinal hernia repair. RESULTS A total of 577 hernia repairs were performed during the study period. Of these, 369 (64%) repairs were performed under local anaesthesia (LA) and 208 (36%) under general anaesthesia (GA). Day-case repair was achieved in 70% (400) of cases. The day-case rates were significantly higher under LA compared to GA (82.6% versus 42.6%; P < 0.05). Patients operated under LA had lower postoperative analgesic requirements and lower incidence of urinary retention compared with the GA group (P < 0.05). There were 7 (1.2%) recurrences at a median follow-up of 5.1 years (range, 10.3-2.5 years). Postal questionnaire revealed higher satisfaction rates with LA compared to GA repair. Only 15% of surgeons in Wales offer the majority of their patients local anaesthetic repair. CONCLUSIONS The use of LA results in increased day-case rates, lesser postoperative analgesic requirements and fewer micturition problems. The excellent results obtained by specialist hernia centres can be reproduced by district general hospitals by increasing the use of LA to repair inguinal hernias.
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Affiliation(s)
- P Sanjay
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK
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Abstract
PURPOSE Cancelled operations are a major drain on health resources: 8 per cent of scheduled elective operations are cancelled nationally, within 24 hours of surgery. The aim of this study is to define the extent of this problem in one Trust, and suggest strategies to reduce the cancellation rate. DESIGN/METHODOLOGY/APPROACH A prospective survey was conducted over a 12-month period to identify cancelled day case and in-patient elective operations. A dedicated nurse practitioner was employed for this purpose, ensuring that the reasons for cancellation and the timing in relation to surgery were identified. The reasons for cancellation were grouped into patient-related reasons, hospital clinical reasons and hospital non-clinical reasons. FINDINGS In total, 13,455 operations were undertaken during the research period and 1,916 (14 per cent) cancellations were recorded, of which 615 were day cases and 1,301 in-patients: 45 per cent (n = 867) of cancellations were within 24 hours of surgery; 51 per cent of cancellations were due to patient-related reasons; 34 per cent were cancelled for non-clinical reasons; and 15 per cent for clinical reasons. The common reasons for cancellation were inconvenient appointment (18.5 per cent), list over-running (16 per cent), the patients thought that they were unfit for surgery (12.2 per cent) and emergencies and trauma (9.4 per cent). PRACTICAL IMPLICATIONS This study demonstrates that 14 per cent of elective operations are cancelled, nearly half of which are within 24 hours of surgery. The cancellation rates could be significantly improved by directing resources to address patient-related causes and hospital non-clinical causes. ORIGINALITY/VALUE This paper is of value in that it is demonstrated that most cancellations of elective operations are due to patient-related causes and several changes are suggested to try and limit the impact of these cancellations on elective operating lists.
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Affiliation(s)
- P Sanjay
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
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Abstract
BACKGROUND There is a general belief that inguinal hernias are often caused by a single strenuous event, however there are no data to support this association. This study aims to assess the frequency with which inguinal hernia is attributed to a single muscular strain and to identify predisposing factors. METHODS All patients who underwent inguinal hernia repair under the care of one surgeon over a nine-year period were studied. Five hundred and twenty patients were sent a structured postal questionnaire. RESULTS There was a 62% response rate (320). The median age of the study group was 61.5 (range 19-88) years. Out of a total 320 hernias, 51% (163) of the hernias were gradual in onset and in 42.5% (137) of hernias there was a history suggesting an association between a particular strenuous event and the sudden onset of hernia. In the sudden-onset group 101 (74%) patients had indirect hernias while in the gradual-onset group, 93 patients (57%) had indirect hernias (P < 0.05). Thirty-four patients (25%) had direct hernias in the sudden-onset group and 63 (39%) in the gradual-onset group (P < 0.05). The various predisposing factors were lifting (67.8%, 93), coughing (14.5%, 20), exercise (10.2%, 14), and gardening (7.3%, 10). Heavy work was associated with sudden inguinal herniation. CONCLUSIONS This study supports the hypothesis that the appearance of inguinal herniation may be attributed to a single strenuous event. Indirect hernias are more likely to present following such an event.
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Affiliation(s)
- P Sanjay
- Ninewells Hospital and Medical School, Dundee, Scotland
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21
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Sanjay P, Woodward A. A survey of inguinal hernia repair in Wales with special emphasis on laparoscopic repair. Hernia 2007; 11:403-7. [PMID: 17541493 DOI: 10.1007/s10029-007-0241-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The National Institute of Clinical Excellence (NICE) recently published its guidance on the use of laparoscopic repair for inguinal hernias. This study aimed to assess the likely uptake of laparoscopic surgery for inguinal hernias in Wales. In addition the current practice with regards to day case surgery, use of local anaesthesia, antibiotic prophylaxis, thromboembolic prophylaxis and advice regarding convalescence was assessed. METHODS A postal questionnaire survey of all consultant surgeons (n = 91) in Wales was performed. RESULTS There was a 70% (n = 67) response to the questionnaire. Fifteen percent of surgeons (n = 9) perform laparoscopic inguinal hernia repair in Wales; 10% of surgeons in Wales agreed with the NICE guidance. Lichtenstein hernia repair was the most commonly used the technique to repair primary inguinal hernias in Wales (82%). No surgeon currently is using a laparoscopic repair as the technique of choice for repair of primary inguinal hernias. Eighteen percent of surgeons perform all the procedures as day cases; 15% of surgeons perform more than 90% of the procedures under local anaesthesia; 44% of surgeons do not use any form of thromboprophylaxis for elective inguinal hernia repair, while 78% of the surgeons used routine antibiotic prophylaxis. Post-operative advice regarding return to sedentary work and driving was highly variable (1-4 weeks), as was advice regarding heavy work and sport (2-12 weeks). CONCLUSIONS The uptake of laparoscopic surgery for inguinal hernia repair in Wales is low. Only a minority of surgeons agree with the NICE guidance. Similarly the uptake of day case repair and the use of local anaesthesia are minimal. The use of antibiotic and thromboembolic prophylaxis is empirical and inconsistent. There is a need for evidence-based guidelines to standardise the antibiotic prophylaxis, TE prophylaxis and advice regarding post-operative advice.
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Affiliation(s)
- P Sanjay
- Ninewells Hospital and Medical School, Dundee, Scotland
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22
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Sanjay P, Reid TD, Bowrey DJ, Woodward A. Defining the position of deep inguinal ring in patients with indirect inguinal hernias. Surg Radiol Anat 2006; 28:121-4. [PMID: 16636774 DOI: 10.1007/s00276-006-0105-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 11/28/2005] [Indexed: 10/24/2022]
Abstract
A preliminary survey of surgeons of all grades in our hospital revealed confusion about the position of the deep inguinal ring. Standard teaching is that the deep inguinal ring is lateral to the femoral artery. The aim of this study was to define the position of the deep ring in patients undergoing elective inguinal hernia repair. Thirty consecutive male patients undergoing indirect inguinal hernia repair under local anaesthesia were studied. The following landmarks were marked on the patient with a felt pen: anterior superior iliac spine (ASIS), femoral artery (FA), deep inguinal ring (DR), pubic tubercle (PT) and pubic symphysis (PS). The distance of each point from the ASIS was measured in centimetres. The relation of the femoral artery to the deep inguinal ring was confirmed by palpation through the deep ring during surgery. The femoral artery was consistently identified midway between the anterior superior iliac spine and pubic symphysis (mid-inguinal point). The deep inguinal ring was located medial (22/30) or above (8/30) the femoral artery, but never lateral. The mean distances from the anterior superior iliac spine to the deep ring and femoral artery were 8.8 and 7.7 cm, respectively. Contrary to standard teaching, this study demonstrates that the deep inguinal ring lies medial, not lateral, to the femoral artery. This may clarify some of the variations in textbook anatomy, and explain the difficulty in distinguishing direct and indirect inguinal hernias pre-operatively.
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Affiliation(s)
- P Sanjay
- Royal Glamorgan Hospital, Llantrisant, CF72 8XR, S Wales, UK
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Sanjay P, Jones P, Woodward A. Inguinal hernia repair: are ASA grades 3 and 4 patients suitable for day case hernia repair? Hernia 2006; 10:299-302. [PMID: 16583150 DOI: 10.1007/s10029-005-0048-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Accepted: 09/21/2005] [Indexed: 11/30/2022]
Abstract
The American Society of Anaesthesiologists (ASA) 3 and 4 patients are generally considered unsuitable for day case hernia repair. There are minimal data regarding the acceptability of day case repair in these patients. This study analysed day case hernia rates with special emphasis on ASA grades. A retrospective review of all adult inguinal hernia repairs, under the care of one surgeon over a 9-year period, was performed. The data collected included demographics, ASA grades, the mode of anaesthesia and early complications. 577 patients underwent inguinal hernia repair during the study period. 204 (35%) patients were ASA grade 1, 214 (37%) ASA grade 2, 132 (23%) ASA grade 3 and 29 (5%) ASA grade 4. Day case rates for ASA grades 1-4 under LA were 86, 83, 77 and 76% and under GA, 59, 36, 32 and 0%, respectively (P<0.05). There was no significant difference in the wound complication rates for different ASA grades under GA and LA. ASA grades 3 and 4 patients can undergo day case inguinal hernia repair, with similar complication rates to ASA grades 1 and 2 patients, when surgery is performed under local anaesthesia. ASA grades 3 and 4 patients need not be excluded from day case hernia repair.
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Affiliation(s)
- P Sanjay
- Royal Glamorgan Hospital, Llantrisant, Wales CF72 8XR, UK
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24
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Ball EL, Sanjay P, Woodward A. Comparison of buffered and unbuffered local anaesthesia for inguinal hernia repair: a prospective study. Hernia 2006; 10:175-8. [PMID: 16424994 DOI: 10.1007/s10029-005-0058-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 11/30/2005] [Indexed: 11/29/2022]
Abstract
Bicarbonate buffered local anaesthetic solutions are known to reduce the pain of infiltration. However, its efficacy in reducing the pain of infiltration in patients undergoing inguinal hernia repair has never been tested. This study aims to test the efficacy of bicarbonate buffered solution in reducing the pain of infiltration and pain for the total surgical procedure in a series of patients undergoing elective inguinal hernia repair. Forty consecutive male patients with unilateral, reducible inguinal hernias were studied prospectively. All patients underwent surgery under local anaesthesia, the first 20 with unbuffered solution and the next 20 using buffered solution. Pain scores were obtained for the infiltration in the anaesthetic room and for the total surgical procedure. In addition, satisfaction scores were obtained at the end of the procedure. The mean pain score for the initial infiltration of unbuffered anaesthetic was 3.00 (range 0-5), and for the buffered anaesthetic it was 1.45 (range 0-4), P=0.02. The mean pain score for the entire procedure for the unbuffered group was 3.05 (range 0-6), and for the buffered group it was 1.45 (range 0-5), P=0.02. The patient satisfaction rate was higher with the buffered solution compared to unbuffered solution (P<0.05). There were no complications reported with either solution. Buffered local anaesthetic solution significantly reduces the perceived pain of inguinal hernia repair, both during the infiltration and during the procedure itself. It is safe to administer and it results in a high rate of patient satisfaction.
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Affiliation(s)
- E L Ball
- Royal Glamorgan Hospital, Llantrisant, Wales, UK
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25
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Abstract
Vascular tumours of the stomach are rare, representing 0.9%-3.3% of all gastric neoplasms. A 58 year old man was admitted as an emergency with a one day history of haematemesis and melaena. He underwent an emergency laparotomy for a tumour in the lesser curve of the stomach. The tumour showed the characteristic histological and immunohistochemical features of epithelioid haemangioendothelioma. Surgery in the form of wide excision seems to be the treatment of choice for this rare neoplasm. This case highlights the difficulty in diagnosing this rare tumour preoperatively and emphasises the need for long term follow up in view of its uncertain metastatic potential.
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Affiliation(s)
- P Sanjay
- Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, South Wales CF72 8XR, UK.
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Sanjay P, Reid TD, Davies EL, Arumugam PJ, Woodward A. Retrospective comparison of mesh and sutured repair for adult umbilical hernias. Hernia 2005; 9:248-51. [PMID: 15891810 DOI: 10.1007/s10029-005-0342-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Accepted: 03/28/2005] [Indexed: 12/14/2022]
Abstract
Adult umbilical and paraumbilical hernia repair is associated with a high recurrence rate of 10-30%. Mesh repair has been reported to be associated with low recurrence rates. This study aims to compare sutured repair with prosthetic mesh repair to evaluate recurrence and infection rates. A retrospective study was conducted over an 8-year period including all the umbilical and paraumbilical hernia repairs performed by one consultant surgeon. The hernias were repaired using interrupted suture, Mayo overlap, flat mesh and mesh plug techniques. The study was based on case-note review, telephone and postal questionnaire survey. A total of 100 patients were studied, of which 70 had paraumbilical hernias, 28 had umbilical hernias and 2 had both types of hernia. Median age was 56 years (range 19-90 years). A total of 61 patients had suture repair (50 interrupted suture repair, 11 Mayo) and 39 had prosthetic mesh repair (33 mesh plug, 6 flat mesh). The median body mass index (BMI) was 31.2 (range 23.4-44.5) in the suture repair group and 33.3 (range 24.1-59.1) in the mesh group, with no significant statistical difference in BMI between the two groups (P>0.05). Median follow-up was 4.5 years (range 1-8 years). Recurrence rates for the suture and mesh repair groups were 11.5 and 0%, respectively (P=0.007). Infection rates for the suture and mesh repair groups were 11.5 and 0%, respectively (P=0.007). Our data suggest that prosthetic mesh repair is ideal for managing primary and recurrent umbilical hernias in both obese and non-obese patients.
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Affiliation(s)
- P Sanjay
- Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, Wales CF72 8XR, UK
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Rao GM, Janaki M, Reddy KL, Sanjay P. Primary hypertrophic enteropathy. Indian J Gastroenterol 2002; 21:122. [PMID: 12118931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28
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Rao GM, Janaki M, Reddy KL, Sanjay P. Primary choriocarcinoma of jejunum. Indian J Gastroenterol 2002; 21:78. [PMID: 11990334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 60-year-old man was admitted with pain in the abdomen and vomiting for one day; radiography revealed pneumoperitoneum. Laparotomy with excision of ulcer-bearing portion of the jejunum was done. Histology revealed choriocarcinoma with syncytiotrophoblastic and cytotrophoblastic cell differentiation. Postoperatively, urine and serum showed high levels of beta-human chorionic gonadotrophins. The patient expired after an unsatisfactory postoperative course.
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Affiliation(s)
- G Mallikarjuna Rao
- Department of Surgery, Kurnool Medical College and Govt General Hospital, AP
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