Papers by Santosh Balakrishnan
ABSTRACTAIMTo investigate whether pre-operative counselling about non-procedural elements of peri... more ABSTRACTAIMTo investigate whether pre-operative counselling about non-procedural elements of perioperative care improves patient’s overall surgical experience, through their first surgical journeyOBJECTIVETo study the effect pre-operative counselling about non-procedural elements of perioperative care in a tertiary care centre, on the care experience of such patients.METHODS62 Patients charted for their first-ever surgical procedure, were enrolled for the trial giving an Interventional group (A: n= 32) and control group (B: n = 30). Surgical experience was recorded 48 hours after surgery on regional-language questionnaire, developed & validated by an expert group. Data was compiled in Ms Excel and Statistical analysis was done using R software.RESULTSMean scores were compared with paired T-test. Groups A and B had a mean experience score of 71.78 and 62.93 respectively (Mean difference (MD) 8.85; P <0.001). Mean scores in preoperative, intraoperative & post-operative domains were...
Introduction: Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countri... more Introduction: Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications at the earliest stage for effective management to minimise
Asian Journal of Medical Sciences, 2022
Background: Conventional teaching-learning methods often fail to assure competency in male bladde... more Background: Conventional teaching-learning methods often fail to assure competency in male bladder catheterization (MBC) in the Indian Medical Graduate. Introduction of structured training methods could offer a solution. Aims and Objectives: The objective of the study was to compare efficiency of demonstrate, observe, assist, and perform (DOAP) method of training in a skill lab against structured educational video (SEV)-based learning in training final MBBS students in the psychomotor skill to safely perform MBC. Materials and Methods: Following IRB and IEC clearance, final MBBS students fulfilling selection criteria were randomly allocated into two comparable groups. One group underwent skill lab training using DOAP method while the other group underwent training using a SEV by the same instructor. CRRI interns, regularly performing MBC at work by virtue of conventional training, with 6–8 months experience formed a control group. All participants underwent assessment of skill in MB...
Asian Journal of Medical Sciences
Background: Symposium as a large group teachinglearning method ensures active participation from ... more Background: Symposium as a large group teachinglearning method ensures active participation from students compared to conventional lectures. Competency-based curriculum lays emphasis on student-centered learning. The number of students who join medical colleges to pursue MBBS increase each year. At the same time, infrastructure and faculty strength do not change much. Though small group teaching is preferred student-centered method, other teachinglearning methods can be modified accordingly. Aims and Objectives: To assess the effectiveness of symposium-based learning (SBL) in enhancing active learning compared to conventional lecture in Phase 1 MBBS students with a secondary assessment of student’s comparative perception of both teachinglearning methods in a teaching institution. Materials and Methods: We selected six-core gross anatomy topics which were discussed in the dissection table prior to the sessions. Students were grouped into two by odd and even roll numbers. One group un...
Journal of the Society of Laparoendoscopic Surgeons
The prevalence of gallstone disease in the community makes it an important area of service in dis... more The prevalence of gallstone disease in the community makes it an important area of service in district general hospitals. Laparoscopic surgical techniques in synergy with modern imaging and endoscopic and interventional techniques have revolutionized the treatment of gallstone disease, making it possible to provide prompt and definitive care to patients. Patients with gallstone disease were treated based on a predetermined protocol by a special-interest team depending on the patient's mode of presentation. Data were collected and analyzed prospectively. Our team treated 1332 patients with gallstone disease between September 1999 and December 2007. Patients (249) with acute symptoms presented through Accident and Emergency (A&E). Despite varied presentations, laparoscopic treatment was possible in all but 8 patients. The study comprised 696 patients who underwent laparoscopic cholecystectomy (LC) as in-hospital (23 hour) cases in a stand-alone center, and 257 outpatients and 379 ...
Abstract: Introduction: Conventional teaching and learning methods have been seen to fail to assu... more Abstract: Introduction: Conventional teaching and learning methods have been seen to fail to assure achievement of competencies in male bladder catherization in the Indian Medical Graduate (IMG) with wide variation noted in competencies. This could be remedied by introduction of Structured training methods. Aims and Objective: The study aimed to investigate DOAP method of training in a Skill Lab against training through a Structured Educational Video (SEV) with the objective of comparing their efficacy in training Final MBBS Students in the psychomotor skill of performing male bladder catheterisation. Material & Methods: Final MBBS students fulfilling selection criteria were randomly allocated into two comparable groups. One group underwent Skill lab training using DOAP method while the other group underwent training using a SEV by the same instructor. CRRI interns, regularly performing MBC at work by virtue of conventional training, with 6-8 months experience formed a control group...
Singapore medical journal
Journal of the Society of Laparoendoscopic Surgeons, 2006
Acute episodes of gallstone-related diseases have traditionally been managed conservatively. In t... more Acute episodes of gallstone-related diseases have traditionally been managed conservatively. In the event of gallstones obstructing the common bile duct, patients had endoscopic extraction of calculi with interval cholecystectomy after 4 weeks to 6 weeks when acute inflammatory changes have subsided. This placed the patient at risk of recurrent cholecystitis, pancreatitis, or other complications of cholelithiasis. Patients presenting with acute gallstone-related diseases were investigated and underwent laparoscopic cholecystectomy during the same admission according to a predetermined treatment protocol. All patients (119) treated according to the study protocol had good results, with no 30-day mortality and no biliary tract injuries. One patient had bleeding from the cystic artery, and 6 patients required conversion to open cholecystectomy. Growing expertise in laparoscopic cholecystectomy has made it possible for surgeons to perform safe cholecystectomy in the presence of acute ga...
Annals of Surgical Innovation and Research, 2009
INTRODUCTION: Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countri... more INTRODUCTION: Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications
Journal of Biomedical Graphics and Computing, 2012
Introduction: Oesophageal motility disorders (OMDs) are a recognized cause of pain in 25-33% of p... more Introduction: Oesophageal motility disorders (OMDs) are a recognized cause of pain in 25-33% of patients with non-cardiac chest pain. The understanding of these disorders based on standard multichannel oesophageal manometry has improved with high resolution oesophageal manometry (HROM). This could facilitate selection of treatment modality including identifying those suitable for surgical myotomy while preserving oesophageal function. Material and methods: This discussion is based on a 65 year old lady with a 17 year history of oesophageal pain due to Nutcracker oesophagus. Persistence of symptoms despite medical management using proton pump inhibitors, calcium channel blockers, nitrates, endoscopic pneumatic dilatation & Botulinum toxin injection prompted re-referral to our specialist unit and analysis of residual oesophageal function using HROM. This revealed a segment of nutcracker oesophagus in the mid oesophagus with significant supine reflux. Result: Surgical treatment with trans-hiatal open focused oesophageal myotomy with preservation of lower oesophageal sphincter and floppy Nissen fundoplication led to satisfactory and complete resolution of symptoms. Discussion: HROM provides a clearer classification of the functional abnormalities and their co-relation to symptoms. This allows application of the best available treatment modality including surgery to achieve symptomatic relief with preservation of residual oesophageal function. Conclusion: Limited evidence is currently available on the comparative benefits of available treatment modalities for OMDs. HROM provides greater insight into OMDs and the benefits of available treatment modalities allowing selection of optimal treatment modality and preserving oesophageal function while achieving relief of the patients distressing symptoms.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
The prevalence of gallstone disease in the community makes it an important area of service in dis... more The prevalence of gallstone disease in the community makes it an important area of service in district general hospitals. Laparoscopic surgical techniques in synergy with modern imaging and endoscopic and interventional techniques have revolutionized the treatment of gallstone disease, making it possible to provide prompt and definitive care to patients. Patients with gallstone disease were treated based on a predetermined protocol by a special-interest team depending on the patient's mode of presentation. Data were collected and analyzed prospectively. Our team treated 1332 patients with gallstone disease between September 1999 and December 2007. Patients (249) with acute symptoms presented through Accident and Emergency (A&E). Despite varied presentations, laparoscopic treatment was possible in all but 8 patients. The study comprised 696 patients who underwent laparoscopic cholecystectomy (LC) as in-hospital (23 hour) cases in a stand-alone center, and 257 outpatients and 379 ...
Singapore medical journal
The correlation between clinical and histopathology findings in appendicitis has been highlighted... more The correlation between clinical and histopathology findings in appendicitis has been highlighted by many studies. However, the impact of this correlation on the surgical decision to remove a normal-looking appendix is still vague, with no clear definition of positive appendicitis. The aim of this study was to correlate the histological, operative and clinical diagnoses of acute appendicitis (AA). 200 patients with a preoperative diagnosis of AA underwent laparoscopic appendectomy. A single consultant surgeon performed all the procedures. The clinical, macroscopical and microscopical outcomes were reported and analysed. Follow-up assessment was performed as an outpatient appointment. 112 women and 88 men were included in this study. The mean age was 18.8 (range 8-83) years. Macroscopical appendicitis was confirmed in 139 (69.5 percent) patients, while microscopical appendicitis was reported in 147 (73.5 percent) specimens of the appendix. Ten (7.2 percent) out of 139 patients who we...
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 2007
After the introduction of laparoscopic hernia repair to the National Health Service (NHS), we stu... more After the introduction of laparoscopic hernia repair to the National Health Service (NHS), we studied the benefits and practicality of carrying out this specialised hernia repair technique in a District General NHS hospital. Patients with groin hernia were stratified into groups for day-surgery or inpatient care based on Trust guidelines. Patients underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair by a single consultant surgeon. Patients were followed-up in the clinic. All data were collected prospectively on a structured proforma. Postal questionnaire was sent to 100 randomly selected patients who had surgery more than two years ago and responses were evaluated. A total of 830 hernias were operated upon in 572 patients, aged between 16 and 89 years. Three hundred and twelve patients had the operation as a day-case procedure, and the remaining 260 were treated as inpatients. Incidental hernias were discovered in 19.1% of patients, and were treated si...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Congenital absence of the gallbladder is a rare, usually asymptomatic, anatomical variation. Some... more Congenital absence of the gallbladder is a rare, usually asymptomatic, anatomical variation. Some affected individuals may present with a clinical picture suggestive of gallbladder disease. This presentation, coupled with the inability of standard abdominal ultrasonography to convincingly diagnose agenesis of the gallbladder, can put the surgeon in a diagnostic and intraoperative dilemma. A 30-year-old lady presenting with clinical features of cholecystitis and diagnosed with shrunken gallbladder on ultrasonography was scheduled for laparoscopic cholecystectomy. Intraoperatively, the gallbladder could not be seen even after thorough dissection in the region of the porta hepatis. The procedure was terminated at this stage, and further imaging of the extrahepatic biliary system by magnetic resonance cholangiopancreatography and endoscopic ultrasound confirmed the diagnosis of congenital absence of the gallbladder. Nonvisualization of the gallbladder at laparoscopy, in the absence of a...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
The prevalence of gallstone disease in the community makes it an important area of service in dis... more The prevalence of gallstone disease in the community makes it an important area of service in district general hospitals. Laparoscopic surgical techniques in synergy with modern imaging and endoscopic and interventional techniques have revolutionized the treatment of gallstone disease, making it possible to provide prompt and definitive care to patients. Patients with gallstone disease were treated based on a predetermined protocol by a special-interest team depending on the patient's mode of presentation. Data were collected and analyzed prospectively. Our team treated 1332 patients with gallstone disease between September 1999 and December 2007. Patients (249) with acute symptoms presented through Accident and Emergency (A&E). Despite varied presentations, laparoscopic treatment was possible in all but 8 patients. The study comprised 696 patients who underwent laparoscopic cholecystectomy (LC) as in-hospital (23 hour) cases in a stand-alone center, and 257 outpatients and 379 ...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Laparoscopic surgery is widely practiced and offers realistic benefits over conventional surgery.... more Laparoscopic surgery is widely practiced and offers realistic benefits over conventional surgery. There is considerable variation in results between surgeons, concerning port-site complications. The aim of this study was to evaluate the laparoscopic port closure technique and to explore the factors associated with port-site incisional hernia. Between January 2000 and January 2007, 5541 laparoscopic operations were performed by a single consultant surgeon for different indications. The ports were closed by the classical method using a J-shaped needle after release of pneumoperitoneum. The incidence of port-site incisional hernias was calculated. All patients were followed up by outpatient clinic visits and by their general practitioners. During a 6-year period, 5541 laparoscopic operations were performed. Eight patients (0.14%) developed port-site hernia during a mean follow-up period of 43 months (range, 25 to 96) and required elective surgery to repair their hernias. No major compl...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Acute episodes of gallstone-related diseases have traditionally been managed conservatively. In t... more Acute episodes of gallstone-related diseases have traditionally been managed conservatively. In the event of gallstones obstructing the common bile duct, patients had endoscopic extraction of calculi with interval cholecystectomy after 4 weeks to 6 weeks when acute inflammatory changes have subsided. This placed the patient at risk of recurrent cholecystitis, pancreatitis, or other complications of cholelithiasis. Patients presenting with acute gallstone-related diseases were investigated and underwent laparoscopic cholecystectomy during the same admission according to a predetermined treatment protocol. All patients (119) treated according to the study protocol had good results, with no 30-day mortality and no biliary tract injuries. One patient had bleeding from the cystic artery, and 6 patients required conversion to open cholecystectomy. Growing expertise in laparoscopic cholecystectomy has made it possible for surgeons to perform safe cholecystectomy in the presence of acute ga...
Case Reports in Medicine, 2010
The peril of incorrect diagnostic labelling is highlighted by this case of acute respiratory dist... more The peril of incorrect diagnostic labelling is highlighted by this case of acute respiratory distress caused by a retrosternal recurrent goitre. An initial clinical diagnosis which cannot be fully validated on investigation with unexpected or poor response to treatment should prompt consideration and investigation for an alternative explanation.
Surgeon, 2009
Aim: Laparoscopic cholecystectomy (LC) is now accepted as the 'gold standard' procedure for chole... more Aim: Laparoscopic cholecystectomy (LC) is now accepted as the 'gold standard' procedure for cholecystectomy. However, a signiÝ cant proportion of patients with complicated cholecystitis are still converted to 'open' to complete the procedure. Laparoscopic subtotal cholecystectomy (LSC) is an option, which is still too infrequently used. Methods: A single surgeon in our NHS trust has performed 1150 LCs since September 1999. The procedure was converted to LSC in 52 cases (4.52%) due to complicated cholecystitis. The data were collected and prospectively analysed for any morbidity or complications in the peri-operative period. Results: At the initial presentation, 21 patients (40.38%) were diagnosed with recurrent biliary colic, 24 patients (46.15%) had acute cholecystitis, 6 patients (11.53%) had jaundice, and 1 patient (1.92%) had peritonitis due to gallbladder (GB) perforation. Twenty-six cases (50%) were performed as emergencies, i.e. within one week of symptoms, and 26 (50%) were planned for surgery within four weeks after symptoms started. The cystic duct or Hartmann's pouch stump was closed using endo-loop application in 34 (65.38%), intracorporeal suturing of stump of Hartmann's pouch in 13 (25%), and closure of cystic duct opening in the Hartmann's pouch by purse-string suturing in 5 cases (9.62%). Conclusion: LSC is a safe option in treating gallstone disease when inÞ ammation or Ý brosis precludes conventional dissection of Calot's triangle. LSC can clearly help reduce morbidity associated with open laparotomy.
Annals of Surgical Innovation and Research, 2009
Introduction: Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countri... more Introduction: Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications at the earliest stage for effective management to minimise the morbidity and mortality. Methods: 301 patients underwent laparoscopic treatment for GORD by a single consultant surgeon in our NHS Trust from September 1999. The data was prospectively collected and entered into a database. The data was retrospectively analysed for presentations for complications and their management. Results: Surgery was completed laparoscopically in all patients, except in five, where the operation was technically difficult due to pre-existing conditions. The complications we encountered during surgery and follow-up period were major intra-operative bleeding (n = 1, 0.33%), severe postoperative nausea and vomiting (n = 1, 0.33%), wound infection (n = 3, 1%), port-site herniation (n = 1, 0.33%), wrap-migration (n = 2, 0.66%), wrap-ischaemia (n = 1, 0.33%), recurrent regurgitation (n = 4, 1.32%), recurrent heartburn (n = 29, 9.63%), tension pneumothorax (n = 2, 0.66%), surgical emphysema (n = 8, 2.66%), and port-site pain (n = 4, 1.33%). Conclusion: Minimal access approach to treat GORD has presented with some specific and unique complications. It is important to recognise these complications at the earliest possible stage as some of these patients may present in an acute setting requiring emergency surgery. All members of the department, and not just the members of the specialised team, should be aware about these complications to minimise the morbidity and mortality.
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Papers by Santosh Balakrishnan