New Indian Journal of Surgery

Introduction: A parotid fistula is a rare, extremely unpleasant disease. Various treatment modalities including surgical and conservative management are present to treat this disease. Case Presentation: A 45 year old male presented to us with a 2 years history of a swelling and clear watery discharge from a region above and behind the angle of his left jaw. A diagnosis of a parotid gland fistula was made based on clinical examination and investigations. The parotid fistula was successfully managed by fistulectomy, compression bandage and anticholinergic post operatively. Conclusion: Chronic parotid fistula is difficult to manage successfully. There are various treatment options available; however it is necessary to standardize the treatment according to the duration of history and the patient’s general condition.

There are conditions where the nail may be lost. The cosmetic importance of nail is very clear in this case of finger reconstruction. There are may methods to camouflage the defect with synthetic nails and materials. But once own nail can be harvested and used as free graft in reconstructed fingers. With one example the possibility is described.

Blastomas are tumors that are unique to childhood. They are thought to arise from immature, primitive tissues that present persistent embryonal elements on histology, affect a younger paediatric population and are usually malignant. A blastoma is thought to be a genetic error of normal development rather than the result of any external, environmental factor [1, 2].

Introduction: Tuberculous mastitis is a rare clinical entity. It often mimics breast carcinoma and pyogenic breast abscess clinically. Case Presentation: We present 2 cases of Tubercular mastitis who presented as lump in the breast, with radiology showing features of abscess. FNAC and Tissue biopsy showing granulomatous mastitis and Acid Fast Bacilli was demonstrated on ZeihlNeelson Stain in both cases. Patients were treated with Anti tubercular treatment for 6 months under extra pulmonary category. Both patients improved and were asymptomatic at the end of the treatment. Conclusion: A high index of suspicion is required for diagnosis of breast tuberculosis. Antitubercular drugs in combination with aspiration or surgical drainage are usually associated with an excellent outcome.

Low level lasers are low power lasers which have biostimulatory effects on wounds when exposed for short duration and energy. The bio-stimulatory effects of low level laser therapy (LLLT) have been found to be effective as adjuvant therapy to accelerate wound healing. It augments tissue repair and regeneration along with its anti inflammatory and analgesic effects. This property of low level lasers can be used effectively for burn wound bed preparation as an adjuvant therapy. A 30 year female with old and infected thermal burns, measuring 15% of total body surface area was treated with Low level gallium arsenite Laser. Wound was debrided and LLLT was given for 10 minutes along entire raw area at weekly intervals for 3 sittings following which split skin grafting was done. It was notice that wound healing was enhanced, graft was taken successfully and no complications were noted. Through this article we would like to highlight the use of LLLT as an adjuvant therapy in burn wound healing.

The quality of skin wound healing can be improved by the application of collagen scaffolds as biological dermal substitutes. Dermal extract helps to improves wound healing and quality of the scars. They serve as a scaffold into which cells can migrate and repair the injury. In the current scenario where in many biological and cellular engineering skin substitutes are available, wound management is a multimodality treatment with use of multiple available methods to augment wound healing at various levels. In this article we have described the role of dermal extract with collagen scaffolding in management of post burn raw area.

Background: Necrotizing enterocolitis (NEC) is the most common life threatening emergency of the gastrointestinal tract in newborn period. Despite aggressive medical management many patients develop complications which require surgical intervention. There is controversy regarding the optimal timing and type of surgical intervention in these high risk patients. This paper presents our experience of peritoneal drainage as the primary treatment in all patients of NEC with bowel perforation and its effect on the overall survival of these patients.

Method: Total 142 patients of NEC with perforation were admitted in the study period of 5 years. These patients were prospectively analysed. Patients were divided in two groups according to their body weight to judge the clinical improvement by the peritoneal drainage (Group 1- birth weight< 1500 grams, and group 2- birth weight > 1500 grams). All these patients of NEC (irrespective of their weight and gestational age) with perforation were subjected to primary peritoneal drainage.

Results: Primary peritoneal drainage (PPD) provided a cure in more than half of these high risk babies. Out of 142, 80 patients required no other operative procedure and they were considered cured by PPD only. The survival was 61.7% in group 1 while group 2 had a survival rate of 68.9%.

Conclusion: The study shows that, though the primary peritoneal drainage is not a definitive cure in patients of NEC with perforation, but it definitively reduces the number of laparotomies and also helps in improving the general condition of the patients who need surgery later on. Primary peritoneal drainage (PPD) reduces the mortality in these high risk neonates.

Acute appendicitis is the commonest cause of “Acute abdomen”. Appendicectomy is the most frequently performed emergency operation. The aim of this study is to determine the diagnostic accuracy of the above markers individually in acute and perforated appendicitis as well as their value in excluding the condition. The study is a prospective study. This study was performed on 100 patients who have been clinically diagnosed of having acute appendicitis and who were posted for emergency appendicectomy have been clinically and radiologically diagnosed of acute appendicitis. Out of 100 patients, 52 were males and 48 are females, so male predominance is seen in the present study. Appendicitis is common in the age group of 21-30 years and <20 years in this study. Appendicitis reaches its peak incidence in the teens and early 20’s. Clinical diagnosis was found to be correct in 88% of cases and hence the rate of negative laprotomies for acute appendicitis in our study is 12%. Patients presenting with elevated levels of serum bilirubin in the context of right iliac fossa pain warrant early surgical intervention. The diagnosis of acute appendicitis, however remains multifactorial and such test simply help to guide the surgeon in the decision making process.

To evaluate all patients with calculus disease of the urinary tract with special reference to the clinical epidemiology including: Age and Sex, Heredity / metabolic diseasesl Environment. Urinary infection Dietary factors, Distribution of calculi within the urinary tract. To clinically evaluate all patients with thorough clinical examination, their common modes of presentation, associated urological problems and by investigating them to arrive a decision making process. To study various modalities of treatment offered at different levels of calculus impaction and finally the stone analysis.

Introduction: Perforation is the second most common complication of peptic ulcer. Over 20% of the patients over the age of 60 years old presenting with perforated peptic ulcer are taking NSAID at the time of perforation. Perforated gastric ulcer results in a higher mortality rate than the perforated duodenal ulcer. Up to 80% of perforated duodenal ulcers are Helicobacter pylori positive. Treatment for perforated ulcer ranges from conservative treatment (Taylor’s approach) to radical surgery (vagotomy, gastrectomy). The surgical technique most often used is closure of the perforation combined with extensive peritoneal lavage. Repair of duodenal perforation by Graham patch placation represents an excellent alternative approach. Laparoscopic repair of duodenal perforation is a useful method for reducing hospital stay, complications and return to normal activity. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late incisional hernia.

Aim and Objectives: Comparison between open closure of PPU and laparoscopic closure of PPU on the basis of day of the oral start of the feed, day of drain removal and pain score (VAS) on the 5th day.

Material and Methods: The present prospective study was carried out in Dept. of surgery in Govt. Medical College and hospital, Aurangabad from December 2012 to November 2014. In this study, total 30 patients of perforated peptic (duodenal) ulcer with perforation peritonitis admitted was included after considering intra-operative confirmation of peptic (duodenal) perforation with exclusion and inclusion criteria. All 30 patients had first part duodenal ulcer perforation. Of total 30 patients, 15 patients were included in the laparoscopic (test) group and other 15 patients in open (control) group.

Results: In the laparoscopic surgery group, the mean oral start of feed was on 2.64 days, while that in open surgery group was on 5.53 day. In the laparoscopic surgery group, the mean VAS score on day 5 was 1. 80, while that in open surgery group was 3.40. In the laparoscopic surgery group, the mean duration of hospital stay in days was 6.73, while that in open surgery group was 12.06.

Conclusion: We concluded that, laparoscopic suture with omental patch repair is an attractive and superior alternative to conventional open surgery with extraordinary benefits of minimally invasive surgery.

Abdominal injuries are not as common as that of orthopedic injuries or head injuries following trauma (Road traffic accidents fall or hit).When it occurs it need a quick investigation and surgical intervention to reduce the Mortality and Morbidity. For that we need to to know the probabilities of hallow viscus injury following trauma.

Introduction: Surgical site infection is one of the most common postoperative complications that causes significant postoperative morbidity and mortality leading to prolonged hospital stay and increases cost. About 25-30 percent infections are preventable to the adherence to strict guidelines by health care workers. There are many factors that affect susceptibility of any wound to infection.

Aim and Objectives: To study the frequency, common risk factors, different organisms and complications of surgical site wound infections.

Materials and Methods: This prospective study was conducted in the General surgery department amongst 527 patients for surgery, both emergency as well as elective.

Results and Analysis: The infection rate in clean cases was 9.04%, contaminated 16.20%, clean contaminated 20% and in dirty 32.87%. Overall infection rate was 16.12%. In dirty cases out of 73 cases 6(25%) were mild, 7(29.16%) moderate, 11(45.83%) severe infections including two burst abdomen. The SSI rate in elective surgeries was 12.08% and in emergency surgeries it was 21.39%. The infection rate in patients with hospital stay 0-4 days was 13.06%. The infection rate in preoperative hospital stay of 5-8 days is 24.32%. The wound infection rate in anaemic patient was 25.71%. The postoperative wound infection was 21.34% when drains were used. Coagulase positive Staphylococcus aureus was a single major organism obtained.

Conclusion: The overall infection rate was 16.12% which was mainly due to the higher infection rate in the contaminated (20%) and dirty procedures (32.87%).

Aim: To analyse wild boar bite injuries presenting at tertiary healthcare center, assess their impact & to suggest appropriate measures to counteract the problem.

Background: Human injury resulting from encounters with non-domesticated animals is increasingly common throughout the world, particularly as ecosystems change and humans encroach on previously wild land. Wild pigs not only damage the crops but also contribute significantly to an increasing morbidity and mortality, especially in the Beed district in Maharashtra.

Materials and Methods: The case records of the patients admitted and treated for wild pig bite injuries during 2014 to 2016 in Swami Ramanand Teerth Rural Medical College was studied retrospectively. The data was analysed using the software SPSS 16.

Results: A total of 52 patients were admitted which comprised the study population. The mean age of the study group was 33.1 ± 20.91 years with median age of 30 years. The male to female ratio was 2.4:1. Injury to the extremities was the most common site of injury affecting 80.76% of the patients. 14 patients (26.92%) were managed conservatively after initial treatment and 37 patients (71.15%) surgical management in the form of delayed primary suturing was done.1 patient had sustained severe injuries and required local debridement (1.92%). Mortality rate in this study was 1.92%. There was no case of rabies or tetanus in any of the above victims.

Conclusion: Proper prevention and treatment measures should be developed by decision makers to reduce morbidity and mortality related to such cases. Similar study in prospective manner should be carried out to assess the magnitude of the problem.

Phantom limb pain is defined as abnormal sensation from an amputated limb. There is overwhelming evidence regarding central nervous system changes in phantom limb pain, however the role of peripheral mechanisms and psychological factors are as important in the pathogenesis of phantom limb pain. Phantom limb pain is a very common condition in patients with amputation. The phantom limb pain should be differentiated from nonpainful phantom sensation, residual limb pain and stump pain secondary to bony overgrowths. The treatment of phantom limb pain is difficult. The evidence for the use of pharmacological approaches for phantom limb pain is weak and non-pharmacological approaches do not work for most of the patients. Prolonged phantom limb pain interferes with the ongoing rehabilitation and prosthetic fitting leading to poor functional outcome. Multi treatment approach, tailored to the individual needs of the patients, has the best chance of improving the symptoms of phantom limb pain and functional outcome.

Purpose of this study is to know incidence of Mucocele of appendix amongst cases of acute apppendicits operated at an Institution. Mucocele of Appendix occurs when there is abnormal accumulation of mucus within the appendix leading to dilation of appendiceal lumen by mucus. The disease is considered as a rare lesion of the appendix, which is found in 0.2 to 0.3 % of the appendectomies. The course and prognosis of mucocele related to the histological subtypes. Preoperative diagnosis is difficult due to non-specific clinical manifestation and 50% are discovered incidentally at surgery. Patient may present with pain in lower right quadrant of abdomen and surgeon may mistake it for acute appendicitis. Treatment is always surgery and depends on the integrity and size of the appendix base and on the histological type of the disease.

 Aim: To assess the post-operative pain in patients presenting with haemorrhoids and undergo haemorrhoidectomy with or without lateral sphincterotomy.

Background: Haemorrhoids, a common and painful condition, are the most prevalent ano-rectal disorder among adults. Haemorrhoids, and their treatment, have been a subject of consideration and discussion in the medical literature, from the beginning of documentation of human diseases. Pain after hemorrhoidectomy is universal [1].Postoperative pain following haemorrhoidectomy is a major concern now a days and its management has taken centre stage.

Material and Methods: The present study was carried In the Department of Surgery at Swami Ramanand Teerth Medical College, Maharashtra from Nov 2013 to Nov 2015. The postoperative pain in patients with hemorrhoids &undergo either haemorrhoidectomy with lateral  sphincterotomy (GROUP A) or haemorrhoidectomy without lateral sphincterotomy (GROUP B) was recorded using Visual analogue scoring (VAS).Data was compared using appropriate tests.

Results: Total 60 patients were included in the study. (30 in each group). Maximum were above 30 years of age. Almost half were male and female in both groups. Maximum patients were belonging to type III degree of haemorrhoids. The main objective was to assess the postoperative pain among patient using Visual Analogue Scale after 48hours, 1 week, 4 weeks, and after 3 months of surgery in both groups. There was no significant difference among study participants regarding frequency of pain in both groups. At the end of study 16 patients in group A and 17 patients in group B were completely pain free (p value> 0 .05).

Conclusion: The addition of lateral sphincterotomy to open haemorrhoidectomy seems to have a positive effect on reducing the postoperative pain in a few patients though not statistical significant.

Purpose of this study is to relive postoperative pain as effective pain management is now integral part of surgical management. Effective postoperative pain management has a humanitarian role with additional medical and economic benefits of rapid recovery.

Methods: The study included 200 patients who are to undergo appendectomy, hernia, and TURP surgery at Punjab Institute of Medical Sciences (PIMS) Jalandhar from April, 2012 to March, 2013. Procedures include Cases (Group A) n= 100 Lower abdominal surgery patients with TAP Block and Controls (Group B) = 100 Lower abdominal surgery patients without TAP block.P atient was made to lie in supine position. Just posterior midaxillary line, cephalad to iliac crest, an epidural needle of 18 gauges was introduced. “Two pops” technique was used

Results: Pain assessment was done using Visual analogue scale ( VAS) and number of pain killer ijections at 2, 4, 6, 12 & 24 hours. The block has number of advantages which include technical simplicity, high analgesic effectiveness, long duration of effect and minimal side effects 9 e.g., hypotension, motor blockade) in comparison to that associated neuroaxial analgesia. Overall, TAP block is relatively safe procedure with minimal complications.

Conclusions: TAP is a new infiltration technique aimed at reducing post-operative pain. It may be a good alternative strategy for patients who are highly sensitive to popiods. We concluded that TAP is a good analgesic regimen after lower abdominal surgeries like appendectomy, hernia and TURP.

Background: Inguinal hernia is one of the common surgical conditions, surgery being the absolute choice of treatment for cure. It is being done on inpatient basis since decades, because of the requirement of spinal or general anaesthesia.

Aims & Objectives: 1. to compare the efficacy of Lichtenstein tension free hernioplasty under local versus spinal anaesthesia for inguinal hernia. 2. To assess the overall outcome of hernia surgeries including intraoperative and postoperative complications, duration of hospital stay & cost effectiveness.

Materials and Methods: A prospective & comparative study was conducted on 60 patients presenting to Victoria Hospital, Bangalore with inguinal hernia during the period October 2013 to May 2015. Patients who fulfilled all criteria of inclusion were planned for surgery under 2 different groups.

Results: Total of 60 patients were included in the study with all 60 being male patients. The commonest group of presentation was between 31- 40 years (33.33%). Most of the patients presented with swelling in the groin alone about 60% and swelling with dragging type of pain of 40%. Indirect variety were common (76.66%) followed by direct (18.33%), recurrent (5%). Right sided hernia were common (63.33%) followed by left sided (36.33%). Risk factors associated with 43.33 % of increase intra abdominal pressure due to straining factors such as BPH, strenuous exercises, chronic constipation etc followed by smokers accounting for 40%. A comparative study of 30 cases each in group, SA group had more intra op and post op complications than LA group. Mean time taken for surgery under LA group was 36 +/- 9 minutes when compared to 51 +/-9 minutes, which is significant. LA group patients were ambulated early and there was a short hospital stay of 2-3 days in LA group when compared to SA group of 6-7 days. LA group was cost effective when compared to SA group.

Conclusion: Commonest age group affected being third decade of which most were right sided indirect type of hernia presenting mainly with the swelling in the groin. Both spinal and local anaesthesia can be used for LTF hernioplasty but spinal anaesthesia had high complication rates compared to local anaesthesia, considering short stay in hospital causing less economic burden to the patients.

Background: A Ileostomy/Colostomy is a lifesaving surgery that enables a person to enjoy a full range of activities, including traveling, sports, family life and work, even though they have a stoma and may wear a pouching system.

Material and Method: Prospective & retrospective hospital based study. 50 patients reporting to the General Surgery dept. within study duration and eligible as per inclusion criteria will be included in the study.

Results: Overall, 19 (38%) patients developed complications post closure of ileostomy or colostomy (SeeTable 12). Medical complications accounted for a large proportion of complications (n=8), while major (n=6) and minor complications (n=5) were present.

Conclusion: ileostomy is effective and feasible as a diversion procedure and has reduced morbidity and complication rates.

Background: Open biliary surgery followed by Ttube drainage is still a treatment of choice in patients of choledocholithiasis in many hospitals of developing world. The use of T-tube is not without complications. There are limited studies comparing efficacy of internal biliary stents versus T-tube in open CBD exploration to prevent T-tube complications. The present study assesses clinical short term results in patients who underwent open CBD exploration using a biliary stent versus a T-tube decompression method.

Objectives: To compare the clinical outcomes in patients who underwent open CBD exploration using a biliary stent versus as a T-tube decompression method.

Material and Methods: This prospective randomized controlled study was conducted on 50 consecutive patients undergoing open CBD exploration in the Department of Surgery, Government Medical College and Hospital, Chandigarh from June 2012 to October 2014. Patients were randomly allocated into two groups of 25 each to use of a biliary stent (Group A) (Indovasive, India) or a Kehr’s T-tube (Group B), following open CBD exploration.

Results and Analysis: Baseline characteristics of both the groups were comparable. Surgical site wound infection was observed in 64% of group B patients as compared to 4% in group A (p=0.003). There was statistical significant difference in postoperative stay in hospital for patients in Group A (6±3.1days) as compared to Group B (9.6±5.3days). Postoperative VAS was significantly low in group A as compared to group B on 7th postoperative day (p=0.018). 3 patients in group B had retained CBD stone as compared to none in group A. 4 patients underwent readmission and 1 patient required reoperation in group B as compared to 1 readmission and no reoperation in group A.

Conclusion: primary closure of CBD over biliary stent appeared safe and effective with lesser rate of surgical site wound infections, shorter postoperative hospital stay, few readmission rate and less postoperative discomfort in hospital settings where either laparoscopic CBD exploration facility or expertise are not available.

Background and Objectives: With the advances that are being made in many areas of medicine, the surgeon must be familiar with infectious diseases of the peritoneal cavity which has increased in severity and complexity. Objective of my study was to study the validity of a scoring system, presently being studied worldwide along the following lines: 1. Analysis of various causes of acute peritonitis with respect to morbidity and mortality. 2. Mannheim peritonitis index scoring system as a predictor of prognosis in acute peritonitis. 3. To assess the role of laparoscopy in acute peritonitis.

Methods: All patients above the age of 18 year diagnosed with acute peritonitis and admitted to MVJMC & RH, Surgical Ward or who develop features of peritonitis due to various causes excluding obstetric and gynecological causes and those secondary to dialysis, admitted between the period November 2014 to July 2016.

Results: In our study duodenal perforation formed 65.4% of cases and mortality attributed to it was only 0.9%. Overall mortality was 4.5%. MPI score predicted both morbidity and mortality accurately, patients with MPI score < 26 had no mortality but who above 26, mortality was around 20% which is statistically significant (p < 0.001).

Interpretation and Conclusion: MPI score predicted mortality & morbidity well. It helped in 1. Determining morbidity pre operatively. 2. Duration of hospital stay. 3. Surgery can be safely done irrespective of scores. 4. Duration of peritonitis < 24 hour and its outcome on post operative complications. 5. Score above 20, managed well in ICU where adequate monitoring and facilities available and its impact on prognosis.

Objectives and Background: P-POSSUM (Physiological and operative severity score for the enumeration of mortality and morbidity) predicts mortality and morbidity in general surgical patients providing an adjunct to surgical audit. The Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and its modification the Portsmouth POSSUM; have been proposed as a method for standardising patient data so that direct comparisons can be made in spite of differing pattern of referral and population. In this prospective study, P-POSSUM is applied in predicting the mortality and morbidity patients undergoing abdominal surgery.

Methods: A total of 130 abdominal surgery were performed. The mortality and morbidity was calculated using P-POSSUM equations. The estimatedrates were compared with observed rates using P-POSSUM equations. The estimated rates were compared with observed rates using both linear and exponential methods of analysis.

Results: A total of 21 deaths observed. P-POSSUM with linear method of analysis predicted deaths of 22 with O:E ratio of 0.95, whereas with exponential method it under predicted the death( 16 patients) with O:E ratio of 1.5, which was both clinically and statistically insignificant. With the linear analysis though it was clinically significant, statistically it was insignificant. On analysis of morbidity 81 patients had developed complications, with the predicted value of 86, with O:E ratio0.94, which was clinically significant but statistically insignificant.

Interpretation and Conclusion: with linear method for P-POSSUM equation, the scoring systems are valid in predicting details and complications which were comparable to observed mortality and morbidity. However, P-POSSUM scoring system with exponential method over predicted the mortality

Introduction: Diabetic foot ulcers are the most common cause for prolonged hospitalizations. Though preventable by effective identification, education and preventive foot care practice, we come across plenty cases of diabetic foot ulcers. Health education is imparted through various modes, however the practice of preventable measures remains important.

Objective: To know the practices of foot care among patients with diabetic foot ulcer with predominant rural background.

Methodology: Individuals having diagnosed diabetic foot ulcers (n=150) were selected from MVJMC & RH, Hoskote a rural medical college hospital. They were given an interviewer administered, pre tested questionnaire following informed consent. Patient perceptions of foot care were inquired. A scoring system ranging from 0-10 was employed to analyze the responses given for practice of diabetic foot care.

Results: Mean age was 58.4 years (SD ±8.6) and 74% were males. Non healing ulcers were present among 82.7% and amputations amounted to 38.2%. The control of diabetes was poor in 60%. Regarding foot care knowledge, the mean score was 8.37, 75.5% had scored above mean and 52.7% were aware of all principles of foot care. Regarding foot care practices, the mean score was 4.55, 47.3% participants had scored below mean and 22.7% did not practice any foot care principle and hence scored 0. A Statistically significant difference exists between the foot care knowledge and practice scores (p<0.001, z= -8.151). In the study sample 51% were not educated prior to occurrence of complications.

Conclusion: Results demonstrate a satisfactory knowledge on diabetic foot disease; however their practices of preventive techniques were unsatisfactory. Implementation of a national policy on diabetic foot management and good patient follow-up to increase compliance would help to improve this situation.

Laparoscopic cholecystectomy (LC) is considered the treatment of choice for symptomatic cholelithiasis /cholecystitis. However, of all Laparoscopic cholecystectomy attempted, 1-13% requires conversion to open cholecystectomy.

Aims: The present study was conducted to ascertain various patient related pre- operative risk factors for difficult laparoscopic cholecystectomy.

Methodology: A prospective study was carried out at Karnataka Institute of Medical sciences, Hubballi, Karnataka. Forty-five cases diagnosed between 1st October 2013 to 31stJuly 2015 with gall stone diseases following exclusion criteria and undergoing laparoscopic cholecystectomy were considered for the study. They were evaluated with risk factors like age, sex, clinical findings, ultrasound imaging and hematological reports.

Results: LC was successfully accomplished in 43 patients (95.5%). Moderate bleeding occurred in 12 patients (26.67%) from the liver bed during gall bladder bed dissection. Gall bladder bed dissection was difficult in 19 patients (42.2%). Gall bladder perforation occurred in 10 patients (22.2%) while stone spillage occurred in 7 patients (15.5%) and were all retrieved. Extraction of the excised gall bladder was difficult in 10 patients (22.2%). Conversion to open cholecystectomy occurred in 2 patients (4%). The preoperative parameters that significantly predicted difficult LC were based on the presence of local signs of cholecystitis in addition to the ultrasound criteria of liver cirrhosis, impacted stone at the neck of the gall bladder and thick walled gall bladder exceeding 4mm.

Conclusions: Clinical and ultrasonographic findings may help predict a difficult LC. This information may be useful to both the patient and the treating surgeon.

Scrotal swellings are one of the commonest surgical problems. Different scrotal swellings may be present, but many a times patients hesitate to come early and may come with late complications. Objectives of the Study: 1. To study the etiology for different scrotal swellings. 2. To study different types and modes of clinical presentation of scrotal swellings. 3. To study the different investigations & treatment modalities for scrotal swellings & results of operations. Materials & Methods: Total of 50 cases clinically presenting as scrotal swelling were picked up randomly during the study. This is prospective study conducted on patients admitted with scrotal swellings of K.R Hospital attached to MMC & RI. The study was done for a period of 1 year 6 months. Results: Scrotal swellings formed less than 1.7% of surgical admissions. Primary vaginal hydrocele was present in 42% of patients studied, the other causes were Varicocele, epididimo orchitis, etc., and Most of the patients were in age group of 21-30 years. Most of them presented with painless scrotal swelling. Conclusion: Primary vaginal hydrocele constituted a major portion. Ultrasound of scrotum was helpful in confirmation of diagnosis. Jaboulay’s procedure was the commonest operation done, followed by lord’s plication. Amongst the various operations for hydrocele, Jaboulay’s procedure was associated with the least number of complications. Testicular tumors can be curable if they come early. Testis can be saved in torsion testis if they come within 6 hours of onset.

Introduction: The definition of recurrent appendicitis requires a history of similar, recurrent right iliac fossa pain leading to appendectomy, with the histological confirmation of inflammation of the appendix. Subsequently, there should be complete resolution of symptoms after removal of the appendix.

Materials & Methods: Data were collected from the patient’s admission records. Recurrent appendicitis is defined as patients who had previous history of similar, recurrent right iliac fossa pain leading to appendectomy and histological confirmation of appendicular inflammation was done. Further information including number of previous episodes, number of previous admissions and subsequent treatment was collected.

Results: There were 450 patients who underwent appendix surgery during the review period. Seventy patients had normal appendices and so were excluded. Of the 360 patients with appendicitis, there were 275 males and 95 females between six to 90 years old. Fifty five patients had a history and clinical course that fit the definition of recurrent appendicitis. Twenty five of the fifty five patients had one previous episode of pain while fifteen had two prior episodes and rest had multiple episodes.

Discussion & Conclusions: Recurrent appendicitis accounts for about 17% of acute appendicitis in our institution. History of recurrent episodes of right iliac fossa pain typical of appendicitis should be sought in patient with suspected appendicitis and should alert the clinician to the possibility of recurrent appendicitis. It is important to consider recurrent appendicitis as a differential diagnosis in patient with recurring right iliac fossa pain.

Introduction: Reliable clinical and/or microbiological parameters from easy to obtain specimens that may be used to diagnose bacterial infections and rule out other infections not in need of antibiotic therapy have been largely lacking. In this perspective this prospective study was done prospectively with the intention of finding out the diagnostic power of PCT as a reliable marker to differentiate infectious from non-infectious wound discharge.

Material & Methods: A total of 300 patients who had undergone surgical procedure with no other evidence of any infection. Patients who either had immunocompromised states or didn’t give consent for inclusion were excluded from the study. Those patients who suffered from some other source of infection (respiratory or urinary infection) or any other septic foci, deviated from our study protocol, suffering from pre-op infection were excluded from the study.

Results: On comparing the serum levels of prolactine there is significant rise in procalcitonin level in patients with confirmed surgical site infection on the day of discharge from the surgical site with a p value of <0.001.

Conclusion: Using PCT, which mirrors the likelihood of bacterial infection and the severity of infection, to guide antibiotic therapy, is a persuasive, evidence-based approach to a more rational use of antibiotics.

Background: Obesity is abnormal or excessive accumulation of fat in the body which may impair health. Body mass index (BMI) is a simple index that is used to classify obesity in adult population. BMI is calculated by following method BMI=weight in kg/ height in meters [2]. Obesity is defined as BMI>30 kg/m2. Morbid obesity is defined as a BMI>35 kg/m2 with associated co morbid conditions or a BMI>40 kg/m2. A BMI>25 kg/m2 is defined as overweight. The present study has been designed to evaluate the surgical outcomes in terms of weight loss and resolution of co-morbidities in two different bariatric surgical procedures, namely laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG).

Method: The prospective, interventional comparative study was conducted in the at Maulana Azad Medical College and Associated hospitals, New Delhi. Study includes 50 Motivated patients knowledgeable about the sequel of the procedure, age between 18 and 65 years, attending the surgical out-patients department with BMI > 33 kg/m2 with significant obesity-related co morbidities. Patients divided into Group A and Group B, each group comprising of 25 patients each. Group A comprising of 25 patients treated with LAGB. Group B comprising of 25 patients treated with LSG. All the patients were followed up at 6 month, 9 month and 12 months period for evaluation of excess weight loss, resolution of co-morbid conditions and for any late complications.

Results: Mean duration of surgery was more in group B (148 min) as compared to group A (108 min). Mean value of percentage of excess body weight loss (EWL) was more in LSG (53.761 %) than in LAGB group (40.842) with the significant difference of p value of 0.05. Mean value of change in BMI was also seen to be more in LSG group with p value 0.001 ( <0.05). Resolution of hypertension was more in LSG group (98%) as compared to LAGB Group (87.5%). Resolution of DM type 2 was also more in LSG group (92%) as compared to LAGB group (80%).

Conclusion: With our experience, we are of the opinion that sleeve gastrectomy (LSG) seems to be the preferred procedure in Indian population due to better post operative excess weight loss (EWL) and resolution of comorbidities.

Background: Perforation peritonitis is quite common surgical emergency in India as well as worldwide. There are various prognostic indexes available for evaluation of prognosis in patients with peritonitis but none of them is ideal and universally accepted. Our study is to evaluate prognosis in patient with perforation peritonitis using Mannheim’s peritonitis index.

Material and Methods: A prospective observational study of 100 patients with secondary peritonitis due to hollow viscous perforation was conducted at J.L.N. Medical College, Ajmer, Rajasthan (India). Evaluation of prognosis was done using Mannheim’s Peritonitis Index, after dividing the patients into three categories according to the total score.

Results: In our study of 100 patients, 19% patients were having MPI Scores > 29 and mortality rate among these patients was 68.4%, 29% patients were having MPI 21-29 with mortality of 10.3% and 52% patients were having MPI Score < 21 and mortality rate was ZERO% , which is statistically significant with Chi-square value 51.656 and p-value 0.001 (< 0.05). In our study, total 18% patients developed wound infection, out of these 16.7% patients were having MPI Score < 21, 55.6% patients were having MPI Scores between 21-29, while 27.7% patients were having MPI Score > 29.

Conclusion: We concluded that MPI is accurate, reliable and simple scoring index for evaluation of the patients with peritonitis and for estimating their mortality and morbidity risk. Our study differs in two adverse outcome variables, female sex & non-colonic origin of sepsis and we advocate need for further studies on Mannheim Peritonitis Index to include colonic origin of sepsis and to remove female sex as variables of adverse outcome in Mannheim Peritonitis Index.