New Indian Journal of Surgery

 Tuberculosis of various parts of the body has been well studied and reported, but tuberculosis of the penis is still a rare entity, the cause of which can be primary or secondary. Here, we present a case of a 74yr old male who came with complaints of difficulty in passing urine. On examination, the patient had phimosis and nodular growth over the prepuce and glans penis. Biopsy revealed TB of the penis. With circumcision under the cover of antitubercular therapy, patient’s symptoms dramatically improved. 

Keywords: Tuberculosis; Antitubercular Therapy; Carcinoma Penis; Penile Tuberculosis.

  Foreign bodies, malignancy, trauma, tuberculosis, actinomycosis, leukemia, postoperative infection, inflammatory bowel disease, and simple skin infections have longbeen associated with anal sepsis. Fish bone ingested causing perianal abscess is a rare cause. We report here a case of ischiorectal abscess caused by fish bone. 

Keywords: Foreign Body Ingested; Fishbone; Ischiorectal Abscess.

  Hidradenitis suppurativa (HS) is a chronic, inflammatory follicular cutaneous disease characterized by recurrent skin nodules, sinus tracts and scarring affecting mainly the axilla, groin, and other parts of the body that contain apocrine glands. We report a rare case of HS in a 29 years lady, who presented with a large swelling, insidious in onset, progressive in nature and measuring approximately 25 x 25 cm in the pubic region along with multiple small lesions, scarring and sinuses in axillae and groins for 6 months duration. The lesions were also associated with offensive discharge. The swelling was excised under general anesthesia. The diagnosis was confirmed by histopathologic examination. The postoperative period was uneventful and she is doing well on follow-up. 

Keywords: Hidradenitis Suppurativa; Pilosebaceous Unit; Sinuses; Abscesses; Excision 

  Introduction: Ventral Hernia repair has been one of the most commonly performed surgeries. The  most significant advances to impact Ventral Hernia repair have was addition of the prosthetic materials to conventional repair and the introduction of Laparoscopy to general surgical procedures. This clinical study was undertaken to compare the results of Open Ventral Hernia Repair (OVHR) with Laparoscopic Ventral Hernia Repair based on - Mean duration of surgery, Post operative hospital stay, Post operative pain, Mean duration of hospitalization, Complications of the surgery, incidence of recurrence after 6 months follow up. Material and Methods: The prospective study was conducted on 64 patients presenting with a ventral abdominal hernia to Great Eastern Medical School, Srikakulam, Andhra Pradesh, India between July 2016 and July 2017. Results: In the study, Laparoscopic hernia repair experienced less postoperative pain, reduced mean duration of hospital stay and postoperative hospital stay, early resume of work and normal activities, less complications and less incidence of recurrence after 6 months of follow up. However, the cost of surgery and mean duration of surgery was high in laparoscopic group compared to open group patients. Conclusion: Even though the initial expenses of the laparoscopic surgery is more, the overall cost benefit ratio is better in the laparoscopic technique than the open one for ventral hernias since there is less   postoperative stay, faster post op recovery and earlier return to work. 

Keywords: Ventral Hernia; Open Ventral Hernia Repair; Laparoscopic Ventral Hernia Repair; Visual Analog Scale (VAS).   

  Objective: Venous thromboembolism (VTE)/ Deep venous thrombosis (DVT) is one of the major  causes of morbidity in burn patients. There are various prophylactic measures been described for preventing VTE/DVT. We report our experience over one year period. Methods: Patients admitted to our Burn Unit over the period 2015–2016 and was put on thrombolytic prophylaxis were identified. Their records were retrospectively analysed for demographic factors, extent and severity of burn injury and outcome. Results: A total of 14 patient’s records were analysed. None of them were diagnosed as developed DVT. There were no complications associated with DVT prophylaxis. Conclusion: The sample size in our study is much less. However we have not encountered any DVT or the complications associated with the DVT prophylaxis based on Caprini risk assessment tool. 

Keywords: DVT Prophylaxis; Caprini Score.

  In Paediatric Surgery practice in our region Urinary bladder calculi is common health problem. Material and Methods: It’s a retrospective study of all cases of bladder stone admitted and operated in two tertiary care centers in Bhopal between June 2012 to June 2018.The data was collected regarding age, sex, socioeconomic status ,surgery and its complications. Routine blood investigations, Kidney function test X ray KUB and USG KUB was done in all patients. All patients underwent Suprapubic cystolithotomy and were followed. Results: Most of the patients were of age group 3-5 years and most of the patients were males. Burning in micturition 22 (62.85%) was the most common complain followed by dribbling of urine 15 (42.81%). Most of the patients 23 (65.71%) presented with complain of less than one month duration. Wound infection 4 (11.42%) was the most common complication followed by catheter block (5.71%) in this series. Conclusion: In developing nation Bladder stones are public health problem amongst children. Low protein diet, dehydration, deficiency of vitamin A, and poor socio-economic conditions are major risk factors identified for development of bladder stones. Surgical management is the preferred treatment modality. Keywords: Bladder Stone; Health Problem; Suprapubic Cystolithotomy.

  Background: Varicocele is still an enigma. Its effects on semen analysis, fertility are not yet fully understood. Studies showed that surgical correction of varicocele could improve the semen parameters. However, there is scarcity of study to demonstrate post-operative outcome of varicocelectomy. Objectives: The objectives of the present study were 1) To study clinical profile of varicocele patients 2) To study the effect of varicocelectomy on spermatogenesis. Material and Methods: The present descriptive type of retrospective record base study was carried out at tertiary care teaching hospital of Maharashtra. Archives were screened, to retrieve out previous three years (2014 to 2017) medical records of varicocelectomy patients. Total 50 medical records of patients who had undergone varicocelectomy were analyzed. Results: Statistical significant difference was observed in between pre and post operative sperm parameters like count, motility and morphology. Conclusion: This study showed that surgical treatment could lead to the betterment of semen parameters in patients. However, to recommend varicocelectomy as a most useful procedure further comprehensive multi centric trials are required to confirm the findings of present study. 

Keywords: Varicocelectomy; Spermatogenesis; semen.

  Introduction: Giant cell tumor of the tendon sheath (GCTTS) is a solitary benign soft- tissue tumor. It is the second most common tumor of the hand. GCTTS is most commonly found in the distal interphalangeal (DIP) joint of hand and very common in 4th decade of life. Our diligent search through available literature could not find any consensus on the etiology,  prognostic factors and treatment modalities of GCTTS. We did prospective study of twenty patients with GCTTS of hand who underwent complete excision of the tumour, which was first of such kind of study. Methods: A prospective non-randomized study of twenty patients with GCTTS of hand, who underwent excision of the tumor was done. ompilation of the parameters were done which included, age and gender of patient, presentation of tumor, tumor size and location. Pre-operative X-ray of hand and wrist, ultrasonography and/or MRI whenever required was done. FNAC findings and post operative histopathological reports were recorded carefully. All the patients were followed up at months 3 and 6 and year 1 post-operatively, and recurrence rate was carefully noted. Results: In our study of 20 patients, 13 were female and 7 were female. The mean age of patients was 44 years. Patients presented, an average 14 months after initial onset of symptoms. Size of tumor on clinical  examination was mean diameter of 3.4 cm in its greatest dimension. Most common location of the tumor was the palmar aspect of the hand on the thumb followed   by little finger. Four patients had neurovascular bundle involvement who presented with predominant pain and swelling. All patients underwent surgical excision without adjuvant radiotherapy. No surgical complications were noted in any of the cases.In follow up study up to the 1 year, 2 patients had recurrence. 

Keywords: Wrist Thumb Radiotherapy; Adjuvant Giant Cell Tumors Fingers Tendons.   

  Maintaining the logbook by surgeons was not properly done in India. In this paper we analyzed the logbook of a surgeon during the first year of surgical practice immediately after the postgraduation. Periodical self logbook analysis will improve the efficacy of surgeon and morbidity to the patients. 

Keywords: Logbook; Surgeon; Morbidity.

  Colonoscopy has the advantage of not only picking up a primary cancer but also having the ability to detect synchronous polyps or even multiple carcinomas, which occur in 5% of cases. Colonoscopy enables a more detailed study of the mucosa, visualising lesions of less than 0.5cm. The principle advantage over radiology is that lesions can be biopsed, or removed by snare, cautery if they proved to be adenomatous polyps or a small polypoid carcinoma. A minimum of 30 cases with the following inclusion and exclusion criteria will be selected for the study. A presented proforma will be used to collect relevant information (Patient data, Clinical findings, Lab investigations, operative findings, procedure performed and postoperative complications) from all the selected patients. In present study, 29 patients were managed surgically and one patient managed conservatively. All patients of Appendicular abscess and mass were managed surgically.Out of 7 cases of Ileocaecal tuberculosis 6 cases were managed surgically followed Anti-tubercular treatment. One patient managed conservatively with ATT. All cases of Carcinoma caecum managed surgically followed by  chemotherapy. Non-Hodgkin’s lymphoma managed surgically but patient expired. Retroperitoneal sarcoma managed surgically followed radiotherapy. 

Keywords: Colonoscopy; Mass in Right Iliac Fossa; Non-Hodgkin Slymphoma

  Aim: To evaluate the presentation and clinical outcome of inguinal hernias in patients in their fifth decade or later. Objective: To analyze inguinal hernia in the subset of elderly adults with respect to the type of inguinal hernia, type of surgery, postoperative complications and recurrence. Material & Methods: The present study is a two year prospective descriptive study conducted from July 2015 to Jun 2017. 112 elderly adults in the age group of > 50 years of either sex, diagnosed with ‘Inguinal Hernia’ were included in the study. The patients were initially evaluated in the general surgery outpatient department of a tertiary care hospital & then admitted for surgery. Patients who were <50 years or those who were unwilling for surgery were excluded from the  study. Elective surgical treatment was offered in the form of Lichteinstein’s tension free mesh hernioplasty  or Plug & Patch mesh hernioplasty or laparoscopic TEP (Total Extra-Peritoneal) repair; whereas the patients presenting with direct hernias or both direct & indirect hernia underwent herniorrhaphy also along with mesh hernioplasty. Herniorrhaphy was performed on all complicated inguinal hernias. Polypropylene mesh measuring 15 x 7.5 cm was employed in tension-free mesh hernioplasty and approximation of conjoint tendon & the inguinal ligament was done with 2-0 polypropylene sutures in herniorrhaphy in order to strengthen the weak posterior wall. The follow-up visits were scheduled at three weeks, six weeks, three months and six months postoperatively. Results: Maximum number   of patients selected in the study belonged to the age group of 61-70 years with a representation of 42 individuals & a share of 37.5% of the included subjects. The oldest patient in the study population was 84 years old. Males constituted 98.2% of subject population with 1.8% female subjects. The most common presenting complaints of the study population were groin swelling (100%) & associated pain over the swelling (54.46%). 48 (42.8%) patients out of the study population had direct inguinal hernia, 53 (47.3%) had indirect inguinal hernia & 11 (9.82%) patients harbored both direct & indirect inguinal hernias. 101 (90.18%) patients had unilateral inguinal hernia whereas 11 (9.82%) patients had bilateral hernia. 64 (57.14%) patients with unilateral hernias were on the right side & the rest 37 (33.03%) were on the left side. 8 (7.14%) patients in various age groups had complicated inguinal hernia; whereas 6 (5.35%) patients had evidence of recurrent inguinal hernia. 91 (81.25%) patients suffered from associated comorbid conditions. 85.71% patients with the diagnosis of uncomplicated inguinal hernia could be operated comfortably under spinal anesthesia. Elective Lichteinstein’s tension free mesh hernioplasty was performed on 25 (22.32%) patients, 1 (0.89%) patient with only indirect inguinal hernia underwent Laparoscopic TEP, Plug & patch mesh hernioplasty was performed on 4 (3.57%) patients on elective basis. 74 (66.07%) patients with direct inguinal hernia & both direct + indirect inguinal hernia underwent Herniorrhaphy + Lichteinstein’s tension free mesh hernioplasty. 7 (6.25%) patients with irreducible inguinal hernia underwent Herniorrhaphy + Lichteinstein’s tension free mesh hernioplasty after reduction of the hernia sac & herniotomy. whereas 1 (0.89%) patient with strangulated inguinal hernia underwent resection of the strangulated bowel segment followed by bowel anastomosis &    herniorrhaphy. All recurrent inguinal hernias underwent Herniorrhaphy & tension free mesh hernioplasty. The mean hospital stay was 5.57±0.96 days. In the post operative phase, a total of 23 (20.53%) patients were detected with surgical site infection (SSI), 1 (0.89%) patient with strangulated inguinal hernia & with co-existing COPD had ARDS (Acute Respiratory Distress Syndrome) & SSI. 3 (2.67%) patients in the age group of 61-80 years developed scrotal edema. 3 (2.67%) recurrences were observed and there was no peri/postoperative mortality. Conclusion: Inguinal hernia is a relatively common surgical ailment in the elderly adults. The challenge of managing this entity becomes complex in the background of multiple associated co-morbid medical conditions. However, an elderly human shall not be denied surgical treatment of his/her inguinal hernia despite presence of a plethora of associated illnesses. The tension free mesh hernioplasty is a feasible, comfortably safe & cost-effective surgical technique for elderly adult population once a comprehensive pre-operative assessment & optimization of co-morbid conditions is done. 

Keywords: Inguinal Hernia; Elderly Adults; Herniorrhaphy; Mesh Hernioplasty.  

Breast pain, also known as mastalgia or mastodynia, is a commonly encountered symptom in clinical practice. It causes significant patient anxiety and was the primary indication for breast-related visits in the hospital. Women often seek medical attention for breast pain due to concerns of breast cancer. Given that breast pain as a sole complaint has low risk of breast cancer. It is not unusual for women to have 2–3 days of mild breast pain premenstrually but 8–30% of women report moderate to severe breast pain with a duration of 5 or more days each month. Mastalgia can
be severe enough to interfere with the quality of life. It may be cyclical or non cyclical mastalgia. The etiology of mastalgia is not well understood. Hormonal assays of Estrogen, Progesterone, and Prolactin have shown no abnormalities despite the relationship to the menstrual cycle. Even so, Pregnancy, Lactation,  Menopause, Oral contraceptives, and hormone replacement therapy variously affect the course of breast pain. Evening primrose oil, Vitamin E, Danazol, Bromocriptine can be effective in treatment of mastalgia.  However the studies are inconclusive about the effective treatment modalities for mastalgia. Nevertheless, reaching definitive diagnosis in patients with breast pain represents a dilemma, as the causes and treatments
of breast pain are inadequately defined. 

Keywords: Mastalgia; Breast Cancer; Estrogen; Evening Primrose Oil; Vitamin E   

  Context: Evaluation of sentinel lymph node is essential in deciding on need for axillary clearance in patients with breast cancer. We evaluate the role of methylene blue dye in identifying sentinel lymph node in our institution. Aims: To evaluate the use of methylene blue dye to detect axillary lymph node involvement in breast carcinoma. Settings and Design: Prospective interventional study. Methods and Material: Women with node negative, biopsy proven breast carcinoma scheduled for modified radical mastectomy or breast conservative surgery were selected. Consent was taken. Five ml of 2% methylene blue dye was injected to the lateral aspect of tumor and massaged for five minutes. Axillary dissection was done. Lymph nodes stained blue and unstained were collected and examined separately for tumor involvement. Patient was examined postoperatively to evaluate for any adverse reactions. Statistical analysis used: Using Chi-square test- Fisher’s Exact Test. Results: Our study showed that the probability of sentinel node representing axillary status was significant (p value - 0.022). Sentinel and nonsentinel histology were in agreement in 80% cases. Conclusions: Methylene blue dye is an effective and safe blue dye for sentinel lymph node biopsy. 

Keywords: Methylene Blue Dye; Breast Cancer; Sentinel Lymph Node.

  Background: Incisional hernia is a common surgical condition with a reported incidence of 2-11% of patients subjected to abdominal operations. Aim: This is a prospective study to compare the differences in the post-operative events of the onlay mesh repair and the sublay mesh repair in our setup. Methods: This is a prospective study of 60 cases of incisional hernia that were operated in the department of general surgery, Govt. medical college, Omandurar govt. estate, Chennai, India from Dec 2017 to June 2018. Patient’s history, clinical findings, investigations, operative findings, operative procedures and  postoperative complications were all recorded in a proforma specially prepared. All patients underwent open mesh repair. Randomsation was done, as every other case was alternately proceeded with onlay and sublay mesh placement. Patients were followed up for immediate post-operative complications. The two groups were compared using appropriate statistical tests. Results: Most of the patients presented with incisional hernia in the infraumbilical region. Both the groups had 30 patients each. Operative time and pain score was significantly higher in the sublay group; whereas the drainage volume and duration and the incidences of seroma, superficial surgical site infection and flap necrosis were higher in the onlay
group. Conclusion: Even though, the operative time and the pain score were significantly higher in the   sublay group, theoretically, it is considered as a superior technique of mesh placement. The study showed that the post-operative complications were higher in the onlay group. 

Keywords: Incisional Hernia; Onlay Mesh Repair; Sublay Mesh Repair; Post-Operative Complications.  

  Proper management of bowel obstruction requires a methodology to prevent nontherapeutic laparotomy while minimizing the chance of overlooking strangulation obstruction causing intestinal ischemia. Our aim was to identify preoperative risk factors associated with strangulating SBO and to develop a model to predict the need for operative intervention Context: We chose to re-evaluate preoperative diagnostic capability for the recognition of strangulation in a retrospective study. Aims: To identify preoperative risk factors, associated with strangulated intestinal obstruction and to develop a model to predict the need for operative intervention in such cases. Retrospectively study the symptomatology, clinical signs, biochemical markers and findings on imaging. Settings and Design: Retrospective study of sixty two patients conducted in Victoria Hospital, Bangalore Medical College and Research Institute (BMCRI) for a period of six months. Methods: Sixty two patients who underwent exploratory laparotomy for intestinal obstruction were divided into two groups and their pre operative factors were compared and tested for significance. Stastical Analysis Used: Chi Square test for value of significance (p value <0.05). Results: Out of sixty two patients, strangulation was seen in twenty four cases. Vomiting, fever, guarding etc. were co relating. Laboratory parameters were leukocytosis (>12.3 +/- 3.3), serum lactate and acidosis on arterial blood gas analysis, free fluid and dilated, aperistaltic loops on   ultrasound were significant. Conclusions: We conclude that no single factor is predictive, combination has high sensitivity, specificity and predictive value. 

Keywords: Strangulation; Intestinal Obstruction.  

  Introduction: Breast lump is one of the most common surgical problems in female. Fine needle aspiration cytology (FNAC) and histopathology are two investigational tools often used to differentiate malignant breast lump from benign one. The aim of present study was to find out the sensitivity, specificity and predictive values of fine needle aspiration cytology (FNAC) and compare it to histopathology in breast lump. Material and Method: Fifty patients who presented with clinically palpable breast lump at the department of surgery, Bombay Hospital India during the year 2005- 2007 were included. All patients underwent FNAC by disposable fine needle, 21-25 gauges, outside diameter 1.2 to 1.6mm and 30-50mm in length , the detailed clinical examination and mammography were done before FNAC and 49 patients underwent different operative procedures like excision biopsy, frozen section and MRM. Histopathological examination was done on the specimen. The diagnosis was made by the pathology department of Bombay Hospital. Results: Out of fifty cases in which FNAC were done, 20 were diagnosed with benign lesions, 27 as malignant lesions and 3 as suspicious. Out of 49 patients in which histopathology were done 28 patients had infiltrating ductal carcinoma, and 12 patients had fibroadenoma. Sensitivity, specificity, positive and negative predictive values of FNAC were 81%, 100%, 100%, 72% respectively. Conclusion: FNAC and histopathology are 100% specific in diagnosing malignant breast lesion. Although histopathology   appears more sensitive than FNAC the later procedure is safe, quick and economical. 

Keywords: Breast Lump; FNAC; Histopathology; Breast Lump  

  Abdominal pain is one of the most common symptoms patients present in surgical outpatient department. It may be associated with other symptoms which sometime point towards a working diagnosis. But many a time because of the numerous intraabdominal structures it is not possible to arrive at a diagnosis. And particularly chronic abdominal pain is further difficult to diagnose. In such circumstances we need to investigate further and upper GI endoscopy has played a pivotal role in arriving at or excluding some diagnosis since its invention. Recent advances like chromo-endoscopy and narrow band imaging have expanded the applicability of UGI endoscopy both as therapeutic and diagnostic procedure. In our study we have attempted to evaluate the role of upper GI endoscopy in the diagnosis and treatment of chronic abdominal pain. Materials and Methods: after informed consent hundred patients were randomly selected from opd
and ipd basis and subjected for UGI endoscopy in MVJ medical college and research hospital for a period of one year from August 2016 to August 2018. The observations and results were analzed under different headings such as gender distribution, association with habits like nicotine consumption, role of helicobacter pylori. Results: detailed analysis of the results revealed that males are more affected than females and gastric and duodenal benign conditions constitute the majority of the causes for upper abdominal pain   Smoking and alcohol consumption are the key risk factors and helicobacter p[ylori infection was uniformly found in all patients with duodenal ulcers and most of the patients with gastric ulcers. Conclusion: Even though associated symptoms along with pain abdomen point towards a provisional diagnosis upper gastrointestinal endoscopy plays a very important role in diagnosing Upper Gastrointestinal pathology with precision and is cost effective in most of the patients. Investigation and eradication of H pylori should be considered in all  patients found to have gastric and duodenal lesions on endoscopic studies. 

Keywords: Upper abdomen, Pain, Endoscopy   

  Background: The Lichtenstein mesh repair is the present gold standard for open repair of the inguinal hernia. As a result the recurrence of hernia has come down from 40% to less than 1%. However, the problem of chronic inguinodynia remains. The aim of the present study was to assess whether chronic inguinodynia could be influenced by using partially absorbable monofilament light weight mesh as compared to heavy weight prolene mesh. Methods: The study randomised 200 patients undergoing elective inguinal hernia repair into two groups of 100 each according to the type of mesh used. Group I underwent HW (prolene ) mesh repair and group II underwent LW (vypro) mesh repair. Follow up for chronic groin pain was done using VAS ( 1-10 ), for a period varying between 06 months and 02 yrs with an average period of 15 months. The patient and the assessor of pain during the follow up, were blinded to the type of mesh used. Results :. The chronic pain was observed to be of mild severity (VAS 1-3 ) in both groups. The pain difference between the two groups at 03 months was not statistically significant ( p=0.197), whereas at 06 months , 01yr and at 02 yrs pain was although mild (vas1-3) but was statistically significant, p=<0.001, p=0.001 and p=<0.001 respectively, more in prolene group. The foreign body sensation was 16% in group I and 0% in group II. Conclusions : The chronic pain seen in both groups has been of mild variety ( VAS 1-3 ), though slightly more among the prolene group.  

Keywords: Chronic Pain; Lichtenstein Hernioplasty; Light Weght (Vypro) Mesh; Heavy Weight (Prolene) Mesh.  

  Background: Inguino-scrotal swellings are one of the commonest anomalies in infancy and childhood throughout the world. Delay indiagnosis and treatment leads to loss of testis, ovaries or portion of bowel to incarceration or strangulation. This study was under taken to evaluate the age, sex and sidewise distribution and the complications like incarceration, strangulation and gonadal infarction. Methodology: Atotalof 50 children were selected ranging in age from 5 months to12 years presenting to the hospital with inguino-scrotal swelling which will be examined, followed up and managed. The data will be used to interpret results. Results: Of the 50 cases, 30 were on
the right side, 16 on the left side, 4 were bilateral. Prematurity was associated in 2 cases. Parents noticed the swelling in 64%, 30% by grandmother, 6% by doctor. Undescended testis, encysted hydrocele of the cord and congenital hydrocele were simultaneously presenting in 2, 6 and 16 cases respectively. There were 2 cases of incarceration. Post-operative complications were noticed 3 cases of wound hematoma, 1 case of wound infection and 1 of stitch granuloma. Conclusion: Childhood inguinalhernias are more common on right side due to delay in descent of right testis and males are more commonly affected. Congenital hydrocele may involutes spontaneously, so we should observe at least up to 2 years of age before considering repair but not inthe case   of congenital inguinal hernia. Parents are usually thefirstpersontonoticetheswelling. 

Keywords: Incarceration; Strangulation; Inguinal Hernia; Hydrocele; Hematoma; Herniotomy; Stitch Granuloma  

  Lower limb amputation is one of the most feared complications of diabetes preceded by foot ulcers. Amputations among people with diabetes are more common than in non-diabetic patients. This retrospective study included 50 random cases of lower extremity amputation done in diabetic patients admitted and treated in department of surgery, M.P. Shah medical college, Jamnagar during period of November 2015 to October 2017.Their age ranged  between 24-87 years with a mean age of 58.86 years. There were 34 males and 16 females. All 50 patients were admitted previously, out of them 27 patients had history of previous any amputation and 23 patients treated conservatively. The majority of patients presented with alone or combination with infected/ non healing ulcer, cellulitis and gangrene. The primary healing occur in 18 patients, healing occur after
refashioning in 10 patients, after split skin grafting in 4 patients, required proximal amputation in 12 patients and 6 patients expired. The mean duration of hospital stay was 42.18 days±27.48 with no significant difference in the hospital stay in relation to the level of the amputation. Transmetatarsal, Transtibial and Transfemoral amputations are the main types of lower extremity amputations in diabetic patients. Transtibial amputations are associated with higher rates of complications, reoperation, delayed healing and mortality. 

Keywords: Diabetes; Lower Extremity Amputation.

  Background: Fournier gangrene often results in defects involving lower abdominal wall, perineum, scrotum with exposed testes. The coverage of these defects often is a challenge for the reconstructive surgeon. Reconstruction with coverage of exposed testes with skin grafts or flaps have been described with specific protocol. Methods: The study was done on consequent 17 male patients who presented with fourniers gangrene from jan 2015 to jan 2017. Minimum follow up was 1year. 4 patients were treated with scrotal advancement and closure, 3 patients were treated with testes deposition in medial thighs and closure and 8 patients were treated with skin grafts. 2 of our patients required pudendal flaps. Results: All patients healed well with no recurrence at 1 year follow up period. 2 patients with skin graft had partial graft loss which healed conservatively. Conclusion: Our results show that proper selection of method of treatment for fourniers gangrene can give very good results in this debilitating condition with minimal recurrence. We have elaborated on the choice of surgical method while treating fourniers gangrene and tried to simplify the treatment of fourniers gangrene for the help of surgeons. Flap coverage over skin grafts has not proven to have much proven benefit. We recommend reconstruction with skin grafts or flap reconstruction for defects involving greater than 50 percent of scrotum where as simpler   techniques such as secondary intention healing or scrotal advancement is recommended for defects involving less than 50 percent of scrotum. 

Keywords: Fourniers Gangrene; Skin Graft; Scrotal Advancement.  

  Introduction: Inguinal hernia repairs are one of most commonly performed surgeries. Lichtenstein repair is popular technique and has decreased the hernia recurrence rate to less than 3%. The prosthetic mesh repair causes chronic groin pain in 15-40% of the population. Transinguinal Pre Peritoneal Repair (TIPP) by its nascent posterior approach is theoretically and practically sound alternative.It is a populartechnique in the developing countries. It can also be used in lieu of Lichtenstein repair or when laparoscopic facilities are not available or not affordable by patients. Aims and Objectives: To evaluate Transinguinalpreperitoneal mesh placement for inguinal hernia as an alternative to Lichtenstein repair. The Study compares the two procedures in terms of operative duration; Intraoperative and post-operativecomplications; postoperative pain at day 1, 7, 14, 30; chronic groin pain at 6months and reccurence within 6month. Design of the Study: A prospective randomized comparative study. Materials and Methods: A prospective randomized study was carried out in Mahatma Gandhi Medical College and Research Institute, Pondicherry, India from January 2015 to January 2016 involving 60 patients. Out of them, 30 patients each were randomly classified under two groups, who underwent Lichtenstein repair and Open Pre-peritoneal repair, and a comparative study was made between the two groups. Patients were evaluated intra-operatively and post-operatively and multiple variables assessed. Post-op pain scores were calculated using Visual Analogue Pain scores (VAS).   Mean duration of procedure, Paired t test and Independent t test were used for statistical analysis. Results: In our study of 60 patients; 50% of the patients were above 30 years , 59 (98.3%) patients are males and 42 (70%) had direct hernia. In the open pre-peritoneal group; 5 (16.7%) patients had injury to peritoneum and 2 (6.7%) patients had injury to vessels during surgery. The post-operative pain score on days 1, 7 30 and 180 (<0.0001 on day 1, 0.0001 on day 7, 0.004 on day 30 and 0.0014 on day 180) were better in patients who underwent open pre-peritoneal repair than in patients who underwent Lichtenstein repair. Conclusion: Compared to the patients who had Lichtenstein repair, Patients having Pre-peritoneal repair had no post-operative complications, returned to work earlier and enjoyed good quality of life. The study shows that TIPP repair do hold a considerable promise which needs to be investigated futher in a larger population. TIPP by its nascent posterior approach is theoretically and practically sound  alternative. 

Keywords: Inguinal Hernia; Preperitoneal Repair; Lichtenstein’s Repair; Visual Analogue Pain Scores; Blindedmanuscript.  

  Background and Objective: Occurrence of incisional hernia in subcostal incisions (used mainly for open cholecystectomy and liver surgery) and lumbar incisions (used mainly for nephrectomy and pyelolithotomy) is relatively less travelled journey than midline incisional hernias. During my tenure here as an assistant professor, in 2 years, I saw many cases of weakness (flank bulge) due to damage to subcostal nerve, to pure hernias. All of us were using layered closure using vicryl 1 no. for these incisions as a standard method. post-operative infection was rare in these clean cases. I thought that layered closure must be the cause and mass closure could prevent this complication. Methodology: We decided to do a prospective study to know the fact. During next 5 years 50 patients were operated for different indications through these incisions, 20 through lumbar and 30 through subcostal incisions. All the incisions were closed by nylon 1 no. mass closure as described below. Patients were followed up in O.P.D. and by telephone. The results were noted. Results: No patient with mass closure technique developed weakness with mass closure during follow up. Conclusion: Mass closure, with non-absorbable suture, of subcostal and lumbar  incisions as described below is a better method of closure than layered closure using delayed absorbable suture for prevention of post-operative hernias. 

Keywords: Subcostal Incision; Lumbar Incision; Incisional Hernia; Layered Closure; Mass Closure; Absorbable and Non-Absorbable Suture  

  A partial or complete disruption of an abdominal wound closure is noted in wound dehiscence. It can be with or without protrusion and evisceration of abdominal contents. Cutaneous wound healing is hampered because of wound dehiscence. Weakness in musculoaponeurotic layer causes abnormal protrusion of viscus which is referred to as incisional hernia. High index of morbidity and moratlity occurs when there is disruption of surgical wound following laparotomy. This also indirectly increases the financial burden of the patient. Objectives and

Aim: To identify the clinical presentations in post laparotomy sequlae and wound dehiscence and risks associated with the same. To identify the associated diseases. This study to be carried out in elective and emergency operation. Materials and Methods/Source of Data: A study of clinical presentations in post laparotomy sequale was conducted at Department of General Surgery, MVJ Medical College and Research Hospital, situated in rural area, on patients admitted in Department of General Surgery between August 2016 and August 2018, undergoing routine and emergency laparotomies. Conclusion: Significant Risk Factors for the Development of Post-Operative Abdominal Wound Dehiscence: Patient factors like elderly age, gender predominance among males, anaemia, nutritional factors, obesity, patients who have underwent emergency procedure. Wound infection and wound dehiscence were noted in midline incisions, improper suture technique and improper aseptic precautions. These can be prevented by   maintaining proper nutritional status and strict asepsis and strict aseptic surgical techniques.

Keywords: Post Laparotomy; Wound Dehiscence