Census 2008

(1st Jan – 31st Dec)

Surgery Unit I,
Department of Surgical Disciplines,
AIIMS
No. of Admissions 1085

No. of Surgeries 867

Elective Cases 762

Emergency Cases 105

 Total -867
• Elective 615
• Emergency 105
• Day care 147
Distribution of cases- Type of
Anaesthesia
Anaesthesia No. of cases

GA / SA 720

Local 147

Total 867
ELECTIVE
 System Wise Distribution
Head and Neck 113
Hepatobiliary 152
Breast 117
Hernia 33
Adrenal 8
Vascular 43
Soft tissue tumour 18
Thoracic Surgery 4
GI Surgery 62
Dermatological malignancies 12
Splenectomy 19
Genito-urinary Surgery 15
Miscellenous 19
TOTAL 615
 Breast operations-117
Breast Cancer - 99
Modified Radical Mastectomy 58
MRM + LD flap 2
MRM + DIEAP fasciocutaneous free flap 2
MRM + TRAM flap 2
WLE + SLNB +/- ALND 25
WLE + SLNB +/- ALND + Brachytherapy ports insertion 2
Wire guided WLE 1
Radical mastectomy 2
Simple mastectomy –Paget’s disease 2
Axillary Lymph Node Dissection 2
Simple mastectomy + Axillary sampling 1
 Cont….
Male Breast cancer- Radical mastectomy 2
Reduction Mammoplasty 2

Gynaecomastia 4
•Subcutaneous mastectomy 3
•Inferior dermoglandular flap mastectomy 1

Simple mastectomy- Phylloides tumor 2

Giant fibroadenoma 5
? Malignancy – TB abscess 1
Radical duct excision 2
 Thyroid-81
Hemithyroidectomy 35
Sub-total thyroidectomy 11
Total thyroidectomy 13
Near total thyroidectomy 4
Completion thyroidectomy 7
Total thyroidectomy + MRND 4
Total thyroidectomy + Central compartment excision 1
Total thyroidectomy+ Tracheostomy 2
Reexploration for high drain output 2
Total thyroidectomy+ Adrenalectomy 1
Total thyroidectomy +Neck paraganlioma excision 1
 Neck
Parathyroid
Miniparathyroidectomy 15
Neck exploration 2
Video assisted parathyroidectomy 1

Salivary gland operations

Parotid Surgeries 9
•Superficial parotidectomy 5

•Total parotidectomy 1
•Total parotidectomy + P.major flap 1
•Superficial parotidectomy+ Enucleation (B/L) 1

•Incision and Drainage for abscess 1

 Neck Contd...
Others

Neck dissections-MRND 5
(Already mentioned)
Cystic hygroma 1

Torticollis 1

Paraganglioma 1
 Biliary-145
Laparoscopic cholecystectomy 110
Lap to Open Cholecystectomy 9
Open Cholecystectomy 6
•On anticoagulants (post valve replacement) 3
•? CAGB 2
•GB polyp 1

Lap cholecystectomy+ Other procedures 7

(Vaginal Hysterectomy, Tubal ligation,
Ovarian cyst excision, Umbilical hernia)

CBD Exploration+ T-tube 1

CBD Exploration + Choledochoduodenostomy 8

Excision of choledochal cyst + Hepaticojejunostomy 2

Hepaticojejunostomy for Biliary stricture 1

Explorative laparotomy + Biopsy -?CaGB 1
 Liver-6
Hydatid Cyst of liver – Deroofing 5
•Laparoscopic
2
•Open 3

Simple Liver Cyst – laparoscopic drainage 1

Pancreas-1
Whipple’s procedure 1
 Splenectomy-19
Idiopathic Thrombocytopenic purpura 9

Haemolytic anaemia + Gall stone disease 5

(Splenectomy + Cholecystectomy)
Hereditary Spherocytosis 3

Diagnostic ( Isolated NHL of Spleen) 1

Sarcoidosis ( Hypersplenism) 1
 Colorectal -22
Hemicolectomy 7
•Ileocaecal tuberculosis 2
•Carcinoma 3
•? Malignancy 2

Segmental resection and anastomosis for Colonic 1

polyp
Carcinoma rectum 8
•Abdomino perineal resection 4
•Low anterior resection 2
•Lap assisted sigmoid colostomy 1
•Explorative laparotomy + abandoned 1

Colostomy closure 4
Rectal Prolapse 2
•Delorme’s procedure
 Minor Anorectal procedures-3
Haemorrhoids 1
•Stappler haemorrhoidectomy 1

Fistula in Ano 2
•Kharsutra insertion 1
• Lay open 1
 Oesophagus-1
Transhital Oesophagectomy for Carcinoma 1
Oesophagus

Stomach-4
Gastrojejunostomy for Gastric outlet obstruction 2
•Liposarcoma 1
•Carcinoma stomach 1

Gastrojejunostomy + Truncal vagotomy for 1

Gastric outlet obstruction

Trichobezoar 1
•Gastrotomy and removal
 Small bowel-22
Ileostomy closure 6
Stricture – Tuberculosis 5
• Stricturoplasty 2
• Resection and anastamosis 3
Delayed fecal fistula post mesh hernioplasty 2
• Mesh removal + resection and anastamosis 2
Subacute intestinal obstruction 2
• Mesh removal + adhesiolysis 1
• Adhesiolysis 1
Malrotation -Ladd’s procedure 2
Heterotopic pancreas 1
• Resection and anastamosis 1
Explorative laparotomy + Biopsy 2
• TB abdomen 2
Meckel’s diverticulum 1
Duodenal Leak – Tube duodenostomy + Feeding jejunostomy 1
( Operated case of Paraganglioma)
 Appendix-10
Interval Appendicectomy 10
•Laparoscopic 5
•Open 5
 Abdomen- 14
Adrenalectomies 8
•Phaeochromocytoma 3
•Cushing’s syndrome 2
•Incidentaloma 2
•Adrenal carcinoma 2
•Adrenalectomy + Parathyroidectomy 1

Pack removal post adrenalectomy 1

Paraganglioma 3
•Explorative laparotomy+ Biopsy of paraganglioma 1
•Excision of paraganglioma + Rt.Nephrectomy +IVC excision+
reconstruction+ Lt.renal vein reimplantation 1

•Excision 1

Retroperitoneal tumor 2
• Unresectable 1
•? Neurofibroma 1
 Genito-Urinary-15
Radical Nephrectomy 5
Penile disorders 3
•Partial penectomy 1
•Total Penectomy 1
•Circumcision 1

Testicular disorders 6
•Orchidopexy 5
•Thigh pouch Implantation of testes for
Fournier’s gangrene 1

Ilioinginal block dissection for Osteosarcoma of 1

Thigh
 Herniae -33
Incisional 20
Umbilical 4
Epigastric 1
Inguinal 7
•Mesh hernioplasty + Orchidectomy 1
•Recurrent Hernia 2

Port site Hernia following Lap Adrenalectomy 1

Mesh removal (already mentioned) 4
•Fecal Fistula 2
•Sub acute intestinal Obstruction 1
•Recurrent inguinal hernia 1
 Arterial - 24
Arterial Pseudoaneurysm 2
Arterio Venous Malformation 8
Arterio Venous Fistula 4
Aorto-Femoral Bypass 1
Aorto-Bifemoral Bypass 1
Stem Cell Therapy for PAD 2
Endovascular Interventions ( Coils and grafts) 5
Abandoned Femoropopliteal Bypass 1
 Venous - 19

SFJ/SPJ Ligation + Perforator Ligation 14

+/- Stab avulsion
Subfascial Endoscopic Ligation of Perforators 4
(SEPS)
Venous Pseudoaneurysm 1
 Soft Tissue Tumors-18
Wide local Excision + Split Skin Thickness grafting 1
Wide Local Excision + Flap 3
Wide Local Excision + Primary Closure 2
Reconstruction for Raw area post excision - Flap 2
Excision of lipoma forearm post radical 1
mastectomy for carcinoma breast
Above Knee Amputation 2
•Malignant Fibrous Histiocytoma 1
•Neurofibroma with deformed foot 1
Split Skin Thickness grafting 5
Lipomatosis of Abdominal wall 1
Neurofibroma excision 1
 Thorax - 4
Hydatid Cyst Lung 2
•Wedge Resection 1
•Excision of sac 1
Hydatid cyst of Erector Spinae- Excision 1

Bullectomy 1
 Dermatological Malignancies-12

BCC – WLE + Rotation flap 6

SCC- WLE + Reconstruction 5
Malignant melanoma- Digit amputation+ALND 1
 Surgeries in other Units/Departments-13

Resection and Anastamosis ( Gyn) 5

Ileostomy (Gyn) 1
Adhesiolysis (Gyn) 3
Choledochoduodenostomy ( SUR-3) 1
Total Thyroidectomy (SUR-3) 1
Mesh Hernioplasty (Gyn) 1
Sigmoid Volvulus (Gyn) 1
 Reexplorations
( Already mentioned)
Thyroid 4
•High Drain Output 2
•Stridor- Tracheostomy 2
Post MRM + DIEAP flap necrosis 1

Post WLE + Bleeding for Breast Cancer 1

Post Lap Cholecystectomy + Bleeding 1

Post Bullectomy Pneumonectomy 1

EMERGENCIES
 Emergencies-105
Perforation peritonitis – 40
Oesophageal Perforation 1
Gastric Perforation 2
Duodenal Perforation 17
Jejunal Perforation 3
•Resection and anastamosis 1
•Exteriorization + feeding Jejunostomy 2
Ileal Perforation 15
•Repair 2
•Ileostomy 13

Rectal Perforation- Repair + Loop Ileostomy 1

SMA Infarction – Laparostomy 1
 Cont…..
Open Appendicectomy 13
Intestinal Obstruction 11
•Obstructed Herniae 5
- Inguinal Herniae 2
- Umbilical Herniae 2
- Femoral Hernia 1
•Adhesions 2
•Rectal cancer 2
•Stricture (Resection and Anastamosis) 2

Post lap cholecystectomy bleeding 1

Rt. Hemicolectomy 2
•Lower GI bleed 1
•Fecal fistula post Appendicectomy(operated PVT) 1
Rectus sheath haematoma 1
Feeding jejunostomy 2
 Cont……
Neck exploration post Thyroidectomy + 2
Tracheostomy
Total thyroidectomy + Tracheostomy(Emergency) 1
Tracheostomy –(Prolonged intubation) 4

Debridement 7
Necrotizing fascitis 4
Fournier’s gangrene 1
Flap necrosis 2

Incision and drainage 4

Pyomyositis 2
Gluteal abscess 2

Post Wide local excision Breast carcinoma -bleeding 1

Post bullectomy-Pneumonectomy 1
 Cont….

Above knee amputation 3

Below Knee amputation 7

Fore foot amputation 1

Day care
 Day care-147
Radical Duct Excision 24
Microdochectomy 1
Fibroadenoma 5
Inguinal Herniae 46
Hydrocele 1
Pilonidal Sinus 3
Varicocele- High ligation of testicular veins 3
SFJ Ligation+/- stab avulsion 19
Ray/ digit/ toe Amputations 10
Sinus tract exploration 5
Ksharsutra Insertion 4
Debridement 10
Chemoport Insertion 4
Miscellaeneous 12
Mortality
 Mortality-Data
• No. of Operated Elective cases -6
No. of Operated Emergency cases - 14
• No. of Non-operated Elective cases -2
No. of Non-operated Emergency cases -12
• Average age group of patients- 51.58 years
• Average duration of stay of operated cases- 12.6 days
• Average duration of stay of non operated cases- 8 days
 Cause of Death
Sl. Cause No. of Operated (20) Non-operated(14)
No. Cases
1 Septicemia 25 •Perforation peritonitis – 7 •Perforation Peritonitis – 2
•Pyogenic liver abscess - 1 •Diabetic foot-1
•Diabetic Foot – 2 •Necrotizing fascitis - 3
•Necrotizing Fascitis – 2 •Pneumonia – 2
•Gastric carcinoma-1 •Faecal fistula -1
•Faecal fistula -1
•Strangulated hernia-1
•SMA infarct-1

2 Advanced 7 •Retroperitoneal tumor -2 Breast - 2

Malignancies •Osteosarcoma-1 HCC-1
•Adrenal carcinoma-1

3 Aspiration 2 Carcinoma Stomach- 1

pneumonia Carcinoma Rectum- 1
 Perforation Peritonitis – Operated
S.No. Age/ Hospital Surgery Cause of Predisposing factors
Sex stay performed death

1. 17/M 5 Perforation Septicaemia Perforation jejunal, On

peritonitis Steroids for Minimal change
disease and anticoagulants for
EHPVO
2. 81/M 12 Modifid Septicaemia Duodenal perforation,
grahams Bronchial asthma on steroid,
patch CAD
3. 68/M 4 Explorative Septicaemia Sigmoid perforation
Laporotomy+ COPD
sigmoid loop
colostomy

4. 14/F 11 Explorative Septicaemia Perforation peritonitis, TB

laparotomy +
peritoneal
lavage +
ileostomy
 Perforation Peritonitis – Operated
S.No. Age/ Sex Hospital Surgery Cause of Predisposin
Stay performed death g factors

5. 54/F 35 Resection Septicaemia Perforation

and shock peritonitis,
anastomosis Rheumatoid
arthritis +
Steroid+post
THR

6. 62/F 22 Graham’s Septicaemia Duodenal

patch repair perforation,
Post CABG

7. 65/F 2 Explorative Septicaemia Carcinoma

laparotomy+ GB with
Ileostomy infiltration
of hepatic
flexure
 Septicaemia – Operated
S.No Age/ Hospital Surgery performed Cause of Predisposing
. Sex Stay death factors

8. 48/M 9 Explorative laparotomy Septicaemia SMA embolus

9. 65/M 20 Explorative laporotomy + Septicaemia ECF post mesh

resection anastamosis (Fungal) hernioplasty for
ileostomytracheosto Incisional hernia
my COPD
10. 67/M 9 Subtotal gastrectomy+ Septicaemia Duodenal blow
Gastrojejunostomy out, COPD

11. 42/M 15 Explorative Septicaemia Ruptured Pyogenic

laparotomy+peritoneal liver abscess,
lavage COPD
12. 50/F 36 Strangulated umbilical Septicaemia Strangulated
hernia+Resection umbilical hernia,
anastamosis;decompressi CAD post
on craniectomy angioplasty, ARF,
MI,CVA
 Septicaemia – Nonoperated
S.No. Age/ Hospit Surgery performed Cause of death Predisposing factors
Sex al Stay

13. 26/F 15 - Septicaemia Faecal fistula

( Operated PVT)
14. 65/M 17 - Septicaemia Caecal perforation with
status ileostomy ,
COPD
15. 48/M 1 B/L drains Septicaemia Perforation peritonitis
COPD
 Necrotizing fascitis – Operated and Nonoperated
S.No. Age/ Sex Hospita Surgery Cause of Predisposing factors
l Stay performed death

16. 50/M 1 Debridement Septicaemia Necrotizing fascitis

17. 50/M 1 Debridement Septicaemia Necrotizing fascitis

18. 52/M 2 - Septicaemia Gangrene , Rt. CIA occlusion

CAD
19. 65/M 1 - Septicaemia Necrotizing fascitis, COPD

20. 70/F 2 - Septicaemia Necrotizing fascitis+DM+

ARF
CAD post angioplasty
 Ventilator Assosciated Pneumonia – Nonoperated
S.No. Age/ Sex Hospital Surgery Cause of Predisposing
Stay performed death factors

21. 72/F 8 - Pneumonia Idiopathic

noncardiogenic
pulmonary oedema
, DM,GSD

22. 35/F 24 - PUO Carcinoma breast 3

cycles of NAC
 Diabetic foot – Operated and Nonoperated
S.No. Age/ Sex Hospital Surgery Cause of Predisposin
Stay performed death g factors

23. 56/M 18 B/K Septicaemia Diabetic

amputation foot,
CHF,CRF,
CVA, CAD

24. 60/M 21 A/K Septicaemia Diabetic

amputation foot,
DM,Hyperte
nsion, PAD

25. 73/M 26 Dressing Septicaemia Diabetic

foot , CRF,
pace maker
insitu, CAD
 Disseminated Malignancies – Nonoperated
S.No. Age/ Sex Hospital Surgery Cause of death Predisposing
Stay performed factors

26. 36/F 1 - Disseminated Metastatic

malignancy Carcinoma
breast

27. 35/F 1 - Disseminated Septicaemia ,

malignancy Metastatic
disease

28. 56/M 1 - Disseminated HCC rupture

malignancy HCV
 Disseminated Malignancies – Operated
S.No. Age/ Hospital Surgery performed Cause of Predisposing
Sex Stay death cause

29. 35/F 17 Resection of Disseminat 0steosarcoma

ilioinguinal lymph ed Metastatic
nodal mass metastases disease

30. 52/M 8 Explorative DVT + Retroperitone

laparotomy+incisiona pulm. al tumor
l Bx emboliosm

31. 35/M 10 Palliative Advanced Metastatic

Gastrojejunostomy carcinoma liposarcoma

32. 28/M 7 Adrenalectomy Recurrence Adrenal

with carcinoma
metastases Metastatic
disease
 Aspiration – Nonoperated
S.No. Age/ Sex Hospital Surgery Cause of Predisposi
Stay performed death ng cause

33. 75/M 8 - Aspiration Metastatic

pneumonia carcinoma
stomach
COPD
34. 70/M 4 - Aspiration Ca. Rectum
pneumonia COPD
Thank You
 Complications
• Wound infections
– Thyroid 6
– CBD exploration 1
– Breast cancer 8
– Umbilical mesh hernioplasty 1
– Others 6
• Flap necrosis
– Breast 10
• Thoraco epigastric flap 2
• LD flap 1
– Others 6