Best hernia surgeon in navi mumbai

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KETAN VAGHOLKAR

DR KETAN VAGHOLKAR IS A HIGHLY SKILLED HERNIA SURGEON WITH A EXTENSIVE EXPERIENCE SPANNING OVER 26 YEARS.

Health & Medicine

BEST HERNIA SURGEON IN
NAVI MUMBAI
DR. Ketan Vagholkar
MS, DNB, MRCS, FRCS FACS
Appointment: 9821341290

More from KETAN VAGHOLKAR

Carbuncle is a confluent folliculitis that is infection affecting multiple hair follicles leading to multiple sinuses discharging pus. It is commonly seen on the back of immuno-compromised patients. Admission to hospital with aggressive treatment, both systemic and locally is necessary. Optimisation of co-morbidities such as diabetes, adequate hydration, and antibiotics and are mainstay of initial treatment. Surgical intervention in the form of debridement and desloughing followed by wound care is the next line of management. Patient education at the time of discharge is necessary for prevention of recurrence.

Carbuncle: A challenging infective lesion

KETAN VAGHOLKAR

Cases of self-inserted foreign bodies into the lower urinary tract are uncommon. They are associated with a mental illness called polyembolokoilomania. The site, size and nature of the foreign body determines both the symptomatology and complications. A case of self-inserted needle into the penile urethra by a 15-year-old boy is presented. A plain X-ray of the pelvis revealed the needle. The needle was successfully removed by cystoscopy. Plane X-ray imaging and CT scan are essential to locate the site, size, and nature of the foreign body. Endoscopic approach is preferred in majority cases. Psychiatric counselling in the post-operative period is required to prevent further episodes of reinsertion of such foreign bodies.

Foreign body in the male urethra: case report

KETAN VAGHOLKAR

Introduction: Morel-Lavalleé lesion is an uncommon closed degloving injury usually affecting the lower extremity. Although these lesions have been documented in literature, yet there is no standard treatment algorithm for the same. A case of Morel-Lavallée lesion following blunt injury to the thigh is therefore presented to highlight the diagnostic and therapeutic challenges in managing such lesions. The aim of presenting the case is to create awareness of clinical presentation, diagnosis, and management of Morel-Lavallée lesions, especially in the setting of polytrauma patients. Case Report: A case of Morel-Lavallée lesion in a 32-year-old male with history of a blunt injury to the right thigh caused by a partial run over accident is presented. A magnetic resonance imaging (MRI) was done to confirm the diagnosis. A limited open approach for evacuating the fluid in the lesion was performed followed by irrigation of the cavity with a combination of 3% hypertonic saline and hydrogen peroxide in order to induce fibrosis to obliterate the dead space. This was followed by continuous negative suction accompanied with a pressure bandage. Conclusion: A high index of suspicion is necessary especially in cases of severe blunt injuries to the extremities. MRI is essential for early diagnosis of Morel-Lavallée lesions. A limited open approach is a safe and effective option for treatment. The use of 3% hypertonic saline along with hydrogen peroxide irrigation of the cavity to induce sclerosis is a novel method for treating the condition.

Morel-Lavallée Lesion: Uncommon Injury often Missed

KETAN VAGHOLKAR

Background: The development of a pseudocyst after mesh repair of an incisional hernia is a rare complication. Both diagnosis and management pose a great challenge to the attending surgeon. Therefore, the need to report such an uncommon complication and its management in order to create awareness of this distinct though rare entity. Case report: A pseudocyst formation following an onlay mesh repair of an incisional hernia is reported. Contrast-enhanced CT scan was diagnostic. It revealed a well-formed cyst with no communication with the peritoneal cavity. Complete excision of the cyst was curative. Conclusion: Pseudocyst formation is a rare complication following mesh repair. Contrast-enhanced CT scan is essential for confirming the diagnosis. Complete surgical resection of the cyst is the mainstay of surgical treatment.

ABDOMINAL WALL PSEUDOCYST COMPLICATING INCISIONAL HERNIA REPAIR

KETAN VAGHOLKAR

Background: Traumatic lumbar hernia is due to shearing of bony insertions of the muscle in the lumbar region. In recurrent cases, there is more attenuation of muscles. This makes fixation of the mesh extremely difficult. Hence, the need to develop a new technique. Case report: A 27-year-old male presented with a recurrent post-traumatic right- sided lumbar hernia. He had a severe two wheeler accident. Following the accident he had undergone various surgical interventions for a fractured pelvis with a deglowing injury involving the right gluteal region and upper thigh. He had also developed a post-traumatic lumbar hernia for which he had undergone open mesh repair. Subsequently he developed recurrence of the post traumatic right-sided lumbar hernia. After complete investigation he underwent open mesh repair for the recurrent post traumatic lumbar hernia. The defect was wide and was devoid of healthy surrounding muscles. The mesh was fixed to the ileal bone with bone anchors and to the twelfth rib with trans-osseous fiber sutures passed through holes drilled in the twelfth rib. Flaps were created from the remnant surrounding attenuated muscles. They were double-breasted to cover the mesh. Postoperative outcome was excellent with no recurrence for the last six months. Discussion: The various anatomical and technical considerations of bone fixation of the mesh for hernia repair are discussed. Conclusion: Bone fixation of the mesh with bone anchors is a viable option especially in cases where there is severe attenuation of adjacent muscles for mesh fixation.

Novel Technique for Mesh Fixation to the Bone in Recurrent Post Traumatic Lum...

KETAN VAGHOLKAR

Background: Acute calculous cholecystitis is one of the commonest biliary tract emergencies. The advent of laparoscopic cholecystectomy has changed the treatment approach from conservative to emergency surgical intervention. As a result, emergency laparoscopic cholecystectomy is emerging as the standard of care. Therefore, the needs to evaluate the various factors that determine the procedure’s safety. Aims: The study aims to evaluate the efficacy and safety of laparoscopic cholecystectomy in acute calculous cholecystitis. Materials and methods: Consecutive patients who underwent laparoscopic cholecystectomy for acute calculous cholecystitis over a 2-year-old period were studied prospectively. Results: 75 patients were evaluated. The mean age was 49.48 years. Majority presented with right hypochondriac pain. 22 patients had hypertension. 26 had diabetes and 6 patients had both hypertension and diabetes. In 61 patients the mean duration of surgery was less than 60 minutes. 5 patients needed conversion to an open procedure. 10 patients developed complications. Mean hospital stay was 4.34 days. Conclusion: Early emergency laparoscopic cholecystectomy is a safe and viable option for treating acute calculous cholecystitis

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS (STUDY OF 75 CA...

KETAN VAGHOLKAR

Lipoma is one of the most common soft tissue tumor arising from the mesenchyme. It is slow growing, encapsulated, and usually benign in nature. Tumors over the back, shoulder, and neck region have a high propensity to assume large size thereby getting redefined as a giant lipoma when they exceed 10 cm in width or weigh more than 1000 grams. MRI is the investigation of choice for evaluating giant lipomas. Fine needle aspiration cytology (FNAC) or frozen section may be pertinent in suspected cases of liposarcoma. Complete surgical incision is the treatment of choice. A case of a giant lipoma on the back of a 64-year-old lady is presented with a view to revisit conceptual understanding of the clinical evaluation, investigation, and management of giant lipomas.

Giant lipoma over the back

KETAN VAGHOLKAR

Background: Appendicectomy is one of the common procedures performed by a general surgeon. However, the advent of laparoscopic appendicectomy has reduced the number of open appendicectomies performed. Therefore there is a need to study the advantages of the laparoscopic approach over the traditional open approach. Aims: The study aimed to compare laparoscopic appendicectomy with open appendicectomy based on various intraoperative and postoperative parameters Materials and methods: 50 patients undergoing interval appendicectomy were randomised into two groups. Group A comprised 25 patients who underwent laparoscopic appendicectomy and group B comprised 25 patients who underwent open appendicectomy. Results: Confirmation of diagnosis and evaluation of intraoperative findings was easier in group A patients. In addition, early commencement of feeds with early bowel movements, reduced need for postoperative analgesia due to less pain, lesser complications and shorter duration of hospital stay was observed in group A patients. Conclusion: Laparoscopic appendicectomy has better outcomes rendering it a preferable procedure for appendicectomy.

LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)

KETAN VAGHOLKAR

Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical intervention for complications is the mainstay of treatment.

ABDOMINAL TUBERCULOSIS (STUDY OF 50 CASES)

KETAN VAGHOLKAR

Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed by clinical and radiological investigations were included in the study and studied prospectively. On admission to the hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented in an advanced stage developed complications. The majority of patients were males. The interval between the onset of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process, were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication. Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.

PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...

KETAN VAGHOLKAR

Background: Skin approximation is a very important step in a surgical operation. The quality of skin approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications. Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation). The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation) had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction. Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.

COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...

KETAN VAGHOLKAR

Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively. Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60 years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B. The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic requirement, early commencement of oral feeds, and shorter duration of hospitalization

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...

KETAN VAGHOLKAR

Background: Sigmoid Volvulus is the third most common cause of colonic obstruction and accounts for 2-4% of intestinal obstructions. A variety of abdominal and functional factors contribute to the development of sigmoid volvulus. The progression of pathology is extremely rapid. Hence, understanding these factors enables early diagnosis and prompt surgical intervention. Aims: 20 cases of surgically treated sigmoid volvulus were studied retrospectively to identify and evaluate various factors causing morbidity and mortality in these patients. Results: The condition was commonly seen in males, especially those who were institutionalized and were using laxatives for over 5 years. The mean age was 65.2 years. Co-morbidities were a common accompaniment. 13 patients had diabetes, 12 patients had hypertension, 2 patients had ischemic heart disease and 9 patients had the neurological disease (Parkinson’s disease). 6 patients had single co-morbidity, 13 patients had 2 co-morbidities and 1 patient had 3 co-morbidities. A plain X-ray of the abdomen was diagnostic in all cases. The mean time interval from the onset of symptoms to hospital admission was 8.1 hours, the time interval from hospital admission to confirmation of diagnosis was 2.1 hours. The mean time interval from diagnosis to surgical intervention was 3.2 hours. The surgical options exercised were resection anastomosis with a proximal diversion in 13 patients, Hartmann’s procedure in 6 patients, and primary resection anastomosis in 1 patient. Post-operative complications included ileus in 16 patients, stomal dysfunction in 4 patients, and surgical infections in 10 patients. The mean duration of stay in hospital ranged from 7-13 days. Only 1 patient who had 2 co-morbidities developed complications and succumbed. Conclusion: Prompt diagnosis, optimization of haemodynamic status including co-morbidities is essential before contemplating surgical intervention. Resection anastomosis with a proximal diverting stoma is best suited for patients who have not developed a colonic perforation whereas Hartmann’s procedure is indicated in patients presented with perforative peritonitis.

SIGMOID VOLVULUS (STUDY OF 20 CASES)

KETAN VAGHOLKAR

Background: Burns injury continues to be the greatest challenge to the trauma surgeon. A multitude of factors determine the mortality in burns patients. The present study aims at identifying those factors which have a significant impact on mortality in burns patients. Methods: A total 80 patients presenting with burns injury were studied prospectively. Various factors which included age, sex, aetiology, mode of injury, total body surface area which is burnt (BSA), duration of stay, time interval up to admission, pregnant state, inhalation injury, systemic complications, wound complications, and psychological impact were studied. Results: The mean age was 24.07 years. 59 were females, 21 were males. 19 (23.75%) cases were suicidal in aetiology whereas the remaining 61(76.25%) were accidental. Flame injury was the most common mode of injury in 65 patients (81.25%). The mean BSA in the study was 53.5% whereas the mean BSA in those patients who expired was 71.4%. Mean duration of stay in hospital was 6.55 days whereas mean time interval between burns injury and admission to hospital was 101.33 minutes. All 12 pregnant women had spontaneous miscarriages with a mortality in 11 patients. Inhalation injury was seen in 49 patients (61%) with mortality of 42 (83.7%) patients. Systemic complications seen in 60 patients mortality and BSA was high in patients who had infection. 31 patients in the study had severe depression with a mortality of 91.32%. 50 out of the 80 patients studied expired. Conclusions: Increased age, BSA, mode of injury, presence of inhalation injury, systemic complication, pregnant state, wound infection and depression had a significant impact on the mortality of burns patients.

Factors affecting mortality in burns: a single center study

KETAN VAGHOLKAR

Cholesterolosis of the gall bladder or cholesterol polyps of the gall bladder have always been a contentious issue with respect to the role of prophylactic surgery in view of its asymptomatic state. Symptomatic cholesterol polyps behave similar to gall stones. There is therefore a need for a surgical algorithm to manage these lesions. A case of symptomatic cholesterol polyps of the gall bladder is reported to highlight the clinical presentation, imaging modalities and management strategies. Symptomatic cholesterol polyps of the gall bladder necessitate cholecystectomy. However, surgical intervention for asymptomatic polyps is guided by their size. Increased diameter is highly suspicious of a malignant potential requiring pre-operative staging and radical surgery.

Cholesterolosis of the gall bladder: a surgical dilemma

KETAN VAGHOLKAR

Introduction: Colocolic intussusception in adults is uncommon and poses both a diagnostic and therapeutic dilemma. The association of an underlying malignancy necessitates a preoperative confirmation of diagnosis. The presenting features are variable. Hence contrast enhanced computed tomography of the abdomen is pivotal for diagnosis. An en bloc resection of the specimen in accordance with standard oncological principles is the mainstay of treatment. Case report: A case of colocolic intussusception in an adult is presented to highlight the difficulties in preoperative diagnosis and in selecting the best surgical option for treatment. Conclusion: Adult bowel intussusception is a diagnostic dilemma with preoperative diagnosis being the biggest challenge. CT scan of the abdomen is an excellent diagnostic modality with high diagnostic accuracy. Explorative laparotomy with en bloc resection is mainstay of treatment in adults.

Pedunculated Lipoma of the Caecum Causing Colocolic Intussusception in an Adult

KETAN VAGHOLKAR

Gallstone pancreatitis is a serious complication of gallstone disease. Early diagnosis is pivotal. History,laboratory tests and CECT are diagnostic. The severity assessment is necessary for planning optimum aggressivemanagement. ERCP is indicated in patients of biliary pancreatitis with obstructed CBD stones complicated by cholangitis.Cholecystectomy is indicated after inflammatory markers have normalised suggesting the resolution of pancreatitis.Cholecystectomy should be done preferably during the index admission

Gallstone pancreatitis

KETAN VAGHOLKAR

Herpes zoster usually affects middle-aged individuals who are immunocompromised by virtue of comor-bidity. Sensory complications are common aftermath. However, motor complications are rare. Postherpetic paresisleading to pseudo hernia is a rare complication. History of herpes zoster followed by the development of a bulge isdiagnostic of a pseudo hernia. Computed tomography is essential to confirm the normalcy of the body wall and rule outany defect or mass. Treatment is conservative aimed at treating the viral infection and its sensory sequelae. Awareness ofthis rare condition is essential to avoid futile investigations and unindicated surgical intervention

Postherpetic pseudohernia: Acase report.

KETAN VAGHOLKAR

Acute appendicitis is one of the commonest abdominal emergency encountered by a general surgeon. Understanding the surgical pathology is pivotal in identifying the stage of disease at which the patient presents for better correlation of clinical features, laboratory and imaging reports. Various scoring systems enhance and aid this process. Imaging confirms the diagnosis. Early diagnosis is essential to prevent complications. Surgery is the mainstay of treatment. Appendicitis may present in various forms in different clinical settings. A uniform approach to presentations may not always yield good results. Though appendectomy is the mainstay of treatment yet a tailor made surgical plan needs to be developed after holistic evaluation of the patient. The article discusses the differential surgical approach based on the etiopathogenesis, diagnosis and variable clinical presentations.

Acute appendicitis in adults

KETAN VAGHOLKAR

Acute colonic pseudo obstruction is an abdominal emergency seen in elderly hospitalised patients being treated for major orthopaedic or medical ailments. It has to be differentiated from mechanical obstruction. Identifying and treating medical and metabolic derangements is the first line of treatment. If the patient does not respond then prokinetic medications such as neostigmine should be administered. Colonoscopic decompression and finally surgical intervention are indicated in cases resistant to treatment. The morbidity and mortality associated with these modalities is quite high.

Acute colonic pseudo obstruction

KETAN VAGHOLKAR

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Carbuncle: A challenging infective lesion

Foreign body in the male urethra: case report

Morel-Lavallée Lesion: Uncommon Injury often Missed

ABDOMINAL WALL PSEUDOCYST COMPLICATING INCISIONAL HERNIA REPAIR

Novel Technique for Mesh Fixation to the Bone in Recurrent Post Traumatic Lum...

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS (STUDY OF 75 CA...

Giant lipoma over the back

LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)

ABDOMINAL TUBERCULOSIS (STUDY OF 50 CASES)

PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...

COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...

SIGMOID VOLVULUS (STUDY OF 20 CASES)

Factors affecting mortality in burns: a single center study

Cholesterolosis of the gall bladder: a surgical dilemma

Pedunculated Lipoma of the Caecum Causing Colocolic Intussusception in an Adult

Gallstone pancreatitis

Postherpetic pseudohernia: Acase report.

Acute appendicitis in adults

Acute colonic pseudo obstruction

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