RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / Name of the Candidate and Address(in block letters) / Dr. NIRANJAN HIREMATH
NO 381, “I” ROAD, IDEAL HOMES TOWNSHIP,
2ND PHASE, R.R. NAGAR
BANGALORE 560 098. KARNATAKA.
2. / Name of the Institution / J.J.M. MEDICAL COLLEGE,
DAVANGERE-577004.
3. / Course of Study and Subject / POST GRADUATE - MEDICAL
M.S. IN GENERAL SURGERY
4. / Date of admission to Course / 30.05.2008
5. /
Title of the Topic
/ “COMPARATIVE STUDY OF LORD’S PLICATION WITH SHARMA JHAWER’S OPERATION IN THE TREATMENT OF PRIMARY VAGINAL HYDROCELE”6. /
Brief resume of the intended work
6.1 Need for the study:Hydrocele is an abnormal collection of serous fluid in some part of the processus vaginalis, usually in the tunica.1 Being a common disease occurring world wide, many operations have been described for the treatment of hydrocele.
Surgical treatment for hydrocele has been done successfully since the beginning of the common era but it is traumatic, painful and in the past has caused risk, high morbidity and prolonged convalescence.2 But modern surgical procedures have been adopted to minimize the severity of such complications.
One of the most commonly applied surgical procedure for hydrocele is Lord’s plication. The complications during the operation are bleeding, injury to the cord structures and torsion of the testis.3
One of the other surgical techniques implemented is the Sharma-Jhawer’s operation. In this procedure, complications like haematoma, scrotal oedema, etc are minimal compared to Lord’s plication.4
In our setup, hydrocele is one of the most common surgical conditions we come across. We, in this study, intend to compare two common operative procedures done for primary vaginal hydrocele, namely Lord’s plication and Sharma-Jhawer’s operation.
6.2 Review of Literature :Ø Hydrocele has been described in the ancient Indian surgery SUSHRUTA (6th century B.C.) which states that any swelling of the body is due to “TRIDOSHA” i.e. “VATTA”, “PITTA”, “KAFA”.
Ø Celsus in 53 B.C. – 17 A.D. distinguished hydrocele from hernia by translucency. Arvelius Cornelius Celsus, a roman of the first century A.D. who dealt very extensively with hernia, was the most important single figure in the long history of this subject for more than a millennium. He described hydrocele, varicocele and tumor.
Ø Edward Gibbon, 1737 -93, the English historian, who is best known for history of the decline and fall of the Roman empire, was greatly embarrassed by a large hydrocele. The second time this was tapped, the hydrocele became infected and Gibbon died a few days after the operation. The hydrocele was associated with a large scrotal hernia, probably was punctured.
Ø Dupeutyran, 1834 and later Loster did some work on hydrocele especially on abdomino scrotal hydrocele. It was MATHEW JABOULAY (1860-1913) who contributed the operation of partial excision with eversion of the sac in the treatment of hydrocele.
Ø Ozdilek 1957 and Rinker and Allen, 1951 gave some theoretical evidence that an imbalance in the secretion and absorption in responsible for the collection of the fluid.
Ø In 1960 Wallace found that, the hydrocele is due to the result of lymphatic obstruction, either due to the low grade inflammation of epididymis or due to trauma to the scrotum.
Ø In 1964 Lord described his technique, in which the hydrocele sac is everted and then plicated.5
Ø In 1979 SHARMA – JHAWER described a technique which involved lesser complications as compared to other procedures.
Ø Sauncuoglu, an ancient surgeon (1385-1470) defined hydrocele as “a fluid collection between the white fascia beneath the skin (tunica vaginalis parietalis) and fascia surrounding the testis (tunica vaginalis visceralis), resembling a natural capsule” .He cautions that if the sac was not excised appropriately, hydrocele might recur. He also listed the complications.6
The other operations for hydrocele are :
1. Eversion of sac
2. Sub total excision and eversion of sac
3. Partial excision and eversion of sac ( JABOULAY ‘S PROCEDURE)
4. Gangal’s technique
5. Window operation
6. Willkinson’s technique7
6.3 Objectives of the study:
To compare Lord’s plication and Sharma-Jhawer’s operation in terms of :
1. Duration of the procedure
2. Complications - haematoma and infection
3. Time taken for the scrotal size to revert back to normal
7. / Materials and methods:
7.1 Source of data:
The patients admitted to Chigateri General Hospital and Bapuji hospital attached to J.J.M Medical College with a clinical diagnosis of Primary Vaginal Hydrocele who will undergo either Lords plication or Sharma-Jhawer’s procedure, will be taken for this study from September 2008 to September 2010.
7.2 Method of collection of data :( including sampling procedure if any)
This study will be a comparative study. A minimum of 15 cases each for the Lords plication and Sharma-Jhawer’s operation would be studied. A pre-structured proforma will be used to collect all the relevant data from the patients.
After obtaining a detailed history and thorough clinical examination, investigations will be performed for all the patients in both the study groups. After ensuring fitness for surgery, either Lord’s plication or Sharma-Jhawer’s procedure will be performed under spinal anaesthesia.
All cases will be followed up to discharge and subsequently for a follow up after 4 weeks, 6 weeks and 8 weeks. Each case will be analysed with respect to duration of surgery, complications and time taken for the scrotal size to revert back to normal
Inclusion criteria :
Ø All cases of primary vaginal hydrocele undergoing surgery.
Exclusion criteria :
Ø Other clinical varieties of hydrocele
Ø Cystic swellings of scrotum other than hydrocele
Ø All solid swellings of the scrotum
Statistical analysis:
Comparisons between the two procedures will be done by ‘Z’ test / Fisher’s exact test.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly:
Yes
Ø All patients will undergo the following investigations
1. Complete haemogram
2. Blood group
3. Random blood glucose , B. urea, S. creatinine
4. HIV, HBsAg
5. Ultra sonography of the scrotum.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. / List Of References:
1) Russel RCG, Norman WS, Christopher BJK. The testis and the scrotum. Chapter-68. Bailey and Love’s short practice of surgery, 24th edn., London: Arnold Publishers; p.1407-1409.
2) Shan, Chenjen, Lucon, Marmo A, Arap, Sami. Comparative study of selerotherapy with phenol and surgical treatment of hydrocle. J Urol 2003;169(3):1056-1059.
3) Albrecht W. The lord’s procedure the best operation for hydrocele. Br J Urol 1992;68:187-89.
4) Sharma LS, Jhawer PK. Surgery of hydrocele. Indian J Surg 1974;41:700-04.
5) Lords PH. A bloodless operation for radical cure of idiopathic hydrocele. BJS 1964;51:914-16.
6) Kendirci M, Ates, Boylu U, Cengiz. Urogenital surgery of the 15th century in Anatolia. J Urol 2005;173:1880-1882.
7) Wilkinson JL. Surgery for vaginal hydrocele. BJS 1973;60:450-52.
9. / Signature of the Candidate
10. / Remarks of the Guide / Primary vaginal hydrocele is a common problem in our setup. Varieties of surgical procedures have been adopted for treatment purpose. After draining the fluid, Lord’s plication lodges the testes back in to the scrotal sac, while Sharma-Jhawer’s, in the fascial layers of the scrotum. This study is an attempt to compare these two procedures.
11. / Name & Designation of
(in block letters)
11.1 Guide / Dr. DEEPAK .G. UDAPUDI M.S.
READER,
Department of GENERAL Surgery,
J.J.M. Medical College,
Davangere – 577 004.
11.2 Signature
11.3 Head of the Department / Dr. B. PRADEEP M.S.,
Professor and H.O.D.,
Department of GENERAL Surgery,
J.J.M. Medical College,
Davangere – 577 004.
11.6 Signature
12. /
12.1 Remarks of the Chairman
& The Principal12. 2 Signature
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