Surgery

The department of surgery at CMC Vellore is a busy academic and clinical unit catering to about 24000 outpatients a year and numerous undergraduates, postgraduates and visiting medical and paramedical students. In spite of this, research, mainly clinical, is given priority in the department.

All postgraduate trainees are required to submit a thesis for qualification. Trainees are encouraged to pursue clinical research, preferably prospective studies. Laboratory services are available in the institution for collaborative work in basic sciences, and some trainees have pursued lab based projects. Experimental work is also possible in the animal lab.

Recently, with the establishment of the Stem Cell Centre, numerous projects involving the use of Stem Cells or Bone Marrow in wounds and ischaemic legs have been approved.

Two of our faculty have registered for PhD s, one in Australia at the Royal Northshore Hospital, Sydney.

The department publishes about 20 papers in peer reviewed journals a year.

Clinical trials are also conducted in the department, some of the notable international ones being the PROSPER trial in rectal prolapse, the POISE and ASPIRE trials in vascular surgery.

Visiting students and doctors from the United States and United Kingdom have pursued projects in the department, leading to publication in international journals (Ostomy Wound Manage. 2008 Dec;54(12):36-46., Colorectal Dis. 2009 Jun;11(5):475-9.)

Some of the recently completed and ongoing studies are mentioned below:

Surgery Unit 1:

• Modified Alvarado score in acute appendicitis using ultrasound.
• Facial node involvement in oral cancer.
• Function of the residual deep lobe of parotid gland following superficial parotidectomy.
• Role of MRND III in early tongue cancer.
• Quality of life assessment after preservation of GAN in benign tumours of parotid gland treated with superficial parotidectomy.
• Role of preoperative enteral nutrition in the oral cancers.
• Comparative study of various strategies of treatment of neck in early tongue cancer.
• Sensitivity, specificity and accuracy of FNA in diagnosis of parotid neoplasms.
• Cancer stem cells in oral cancers
• Role of HPV in oral cancers
• SNB in early tongue carcinoma
• The effect of carcinoma in induced oral cancer in an animal model
• The reversal of neuropraxia after superficial/conservative parotidectomy as assessed by House-Brackman score.
• Functional impairment after modified neck dissection that presume SAN.

Surgery Unit 2:

• Urinary haemosiderin as a biochemical marker of chronic venous insufficiency
• Autologous monouclear stem cell transplantation for limb salvage in critical limb ischaemia
• Prevalence of malnutrition in patients with peripheral arterial disease
• Prevalence of erectile dysfunction in patients with TAO
• Lipoprotein A as a marker for disease severity in PAOD
• Lipoprotein A as a marker for disease severity in TAO
• Modified DEI TAK scoring index as a prognostic tool in TAO
• Use of perioperative tranexamic acid in aortic surgery to prevent perioperative complications
• Qualitative assessment of factors affecting patient compliance in treatment of CVI
• Pattern of secondary venous changes after DVT
• Role of temporal artery biopsy in TAO: a pilot study
• Peripheral nerve involvement in TAO: a histomorphological study
• Role of homocysteine in atherosclerotic peripheral arterial disease.
• Radiation induced changes in the carotid artery
• Use of supine and dependent TCPO2 as a prognosticator for benefit of sympathectomy for relief of rest pain.
• Role of temporal artery biopsy in temporal arteritis: a pilot study
• Outcome of chemical sympathectomy: subjective and objective assessment at 6 months.
• Foam sclerotherapy for treatment of venous malformations.
• Study of diameter of left common iliac vein in an Indian population
• Study of diameter of aorta in an Indian population
• Incidental findings in CT angiograms and their significance
• COCHRANE review: Lumbar sympathectomy versus prostanoid infusion for the relief of rest pain in patients with nonreconstructable arterial disease.
• COCHRANE review: Perioperative embolisation in carotid body tumours.

Surgery Unit 3:

• Role of routine nasogastric intubation in cases undergoing subtotal gastrectomy for gastric malignancy.
• Correlation of serum tumour markers with stage of the disease in carcinoma stomach.
• Prevelance of Epstein Barr virus in gastric adeno carcinoma by detecting mRNA for EBNA1.
• Role of stem cells in post op adhesions in an animal model.
• To assess gastric emptying time in uncut Roux Vs conventional Roux enY gastrojejunostomy.
• Impact of elective tracheostomy on morbidity and mortality due to aspiration pneumonia in patients undergoing surgery with a cervical oesophageal anastomosis.
• Role of serum pepsinogen 1/2 ratio in patient with gastric cancer and its association with pepsinogen gene C polymorphism in Indian population.

Surgery Unit 4:

• The effect of doxycycline on the healing and patency of femoral artery microvascular anastomosis in the rat model
• Bactibilia and early predictors of post operative sepsis in patient undergoing surgery on the biliary tract
• Preoperative and Intraoperative Predictors Of Laparoscopic Converted Open Cholecystectomy
• Pancreatic fat as a prognostic factor for pancreaticojejunostomy fistula

Surgery Unit 5:

• Pilot study to determine the gene expression of 5-Fluorouracil metabolic enzymes in patients with colorectal cancers.
• The role of Bone Marrow derived Stem Cells in healing of irradiated APE wounds.
• Effect of Radiation on the Anal Sphincter (ERTAS): A study on the effect of pre operative radiotherapy on anal sphincter function in patients undergoing Anterior Resection for rectal cancer.
• What is the prevalence of tuberculous fistula in ano in a tertiary care centre? How useful is PCR as a diagnostic tool for tuberculosis in fistula in ano? Concluded
• The effect of pre operative carbohydrate loading in major colorectal resections: a randomized controlled trial: Concluded.
• Recruiting centre for PROSPER Trial 2006-2007.

Surgery Unit 6:

• CA 163 – 100 BMS sponsored multi centre randomised trial on breast cancer comparing 1 x abepilone verses paclitaxel
• A multi centre, open label, randomised, phase II, III study to evaluate the safety and efficacy of combretastatin A-4 phosphate in comibation with paclitaxel and carboplatin in comparison. Paclitaxel and carboplatin against Anaplastic carcinoma Thyroid.
• Randomised controlled study of bilateral superficial block versus no block in the prevention of post operative nausea and vomiting in thyroidectomy patients.
• Role of vitamin D deficiency in post thyroidectomy hypocalcemia – a prospective observational study.
• The role of haematopoietic stem cells in the healing of colonic anastomoses in an animal model.
• The effect butyrate in the healing of colonic anastomoses in rats
• Abdominal wall defect closure : A cheaper alternative
• A Comparison of chitosan coated polypropylene mesh with polypropylene–polydioxanone composite with oxidized cellulose coating (Proceed mesh ) in a Rabbit Hernia Model.