New Indian Journal of Surgery

Objective: To study the epidemiology of burn patients attending Jipmer Tertiary Burn Care centre, Management and Outcomes using 'Jipmer Burn Proforma'. Methods: Retrospective analysis of all the burn patients proformas admitted to our Burn Unit over the period one year (January – December 2016). Results: 306 patients were admitted for burns. Male to female ratio was 1:1.2. Majority of the burns due to scald and flame burns, 21-40 years age group is the commonest age group involved. Poor educational and socioeconomic status was consistently associated. Child group (0-10 years) associated with poor housing standards. Fluid lag noted was around 40-50%. Conclusion: This study suggests the importance of public education on burns and improving the quality of first aid for burn patients and following the comprehensive burn injury documentation method.

Keywords: Burn proforma; Burn epidemiology

 Paragangliomas (extra-adrenal pheochromocytomas) are rare tumours that arise from extra adrenal chromaffin cells. Paragangliomas originate from para-ganglia at number of anatomical sites, including the head, neck, thorax and abdomen. Paragangliomas are characterized by secretions of excessive catecholamines. However, between 40 and 50% of paragangliomas are non-functional and/or potentially functional. Functional and potentially functional (difficult to diagnose preoperatively) paragangliomas during intraoperative handling of the tumour may cause a sudden release of catecholamines, leading to disastrous consequences [1]. We present a case of a middle aged male presenting with abdominal mass and pain was found to be a potentially functional paraganglioma intraoperatively. With this report we aim to raise awareness that a paraganglioma should be considered in differential diagnosis for intraabdominal tumours.

Keywords: Hypertensive crisis; Pheochromocytoma; Paraganglioma.

 Objective: The purpose of this review article is to provide an insight to the recent recommendations in the field of colorectal surgery to yield a better outcome following colorectal anastomosis. Background: Anastomotic leak following colorectal resection surgery is associated with high rates of morbidity, mortality, and escalated healthcare expenditures. Knowledge about the factors predisposing patients to anastomotic leak is vital to its early detection and decision making for surgery. Early detection of the complications and its methodical management is vital for patient survival. Methodology: A literature search on colorectal surgery was carried out using PubMed, COCHRANE library and MEDLINE. Results: Current practice however should comprise pre-operative risk assessment and its optimization, subsequent adaptation of appropriate operative technique when necessary, intraoperative testing of the integrity of the anastomosis, use of diverting stoma in specific situations, avoid unnecessary use of pelvic drains and avoid preoperative bowel preparation. Absolute vigilance is a must for early detection of an anastomotic leak. Appropriate investigations and post-operative clinical scoring systems acts as a guide to help us salvage the situation. Conclusion: Anastomotic leaks still occur despite advancements made in preoperative optimization of the patient, surgical techniques, equipments, and post-operative management. Many attempts are being made to enhance the healthcare systems in regards to dealing with the anastomotic leaks and other colorectal surgery complications. Additionally future studies should aim at identification of other factors that may lead to anastomotic leak.

Keywords: Colorectal anastomosis technique; colorectal anastomotic leak; defunctioning stoma; Charlson Comorbidity Index; Colon Leakage Score (CLS); leak test; bowel preparation; drains in colorectal surgery; Dutch Leakage (DULK) Score.

 Objective: Malnutrition is a common problem encountered by burns patients who were prone for prolonged hospitalisation. ’Malnutrition Universal Screening Tool’ (Must) has been used as a screening method for early detection, categorisation and institute the intervention of malnutrition in burns patients. We report our experience over one year period. Methods: Patients admitted to our Burn Unit over the period 2015–2016 who were all screened and intervened by Must score were identified. Their records were retrospectively analysed for demographic factors, Body Mass Index, severity of burn injury, nutritional status, interventions and outcomes. Results: A total of 12 patient's records were analysed. All of them were discharged without any evidence of malnutrition. Conclusion: The sample size in our study is much less. However we have not encountered any nutritional imbalance in these patients at the time of discharge using ’Malnutrition universal Screening Tool’ (Must).

Keywords: Malnutrition; Burns; MUST.

 Diabetes is no longer a disease of the affluent west. Global prevalence of diabetes in 2003 was estimated to be 194 million. By 2030, this figure is predicted to rise to 366 million due to longer life expectancy and changing dietary habits. In fact the prevalence is soaring in southern India it may reach an astronomical figure 13% to 18%. In such a scenario knowing about the disease is important [1]. The purpose of the study is to access the percentage of lower limb ischemia in patients with diabetic foot, to study the Efficacy of the lower limb revascularization procedures (open and endovascular) and conventional medical management in ischemic diabetic foot. We also study the role of antiplatelet and anticoagulant agents in ischemic diabetic foot and to study the percentage of patients with diabetic foot prevented from Amputations. The main reasons to diagnose Peripheral artery disease in diabetic individuals are to initiate therapies that decrease the risk of atherothrombotic events, improve quality of life, and decrease disability. A diagnosis of Peripheral artery disease indicates the presence of systemic atherosclerosis that confers additional cardiovascular risk to the patient with diabetes, and gives further impetus to aggressively manage vascular risk factors in this high-risk group. The clinical material for this study consisted of 150 cases of Diabetic foot patients admitted in the surgical wards of Thanjavur Medical College Hospital, Thanjavur during the period September 2016 to September 2017. Various diagnostic and therapeutic criteria were followed, protocols was framed and progress recorded.

Keywords: Diabetes; ulcers; peripheral artery disease; Doppler; Angiography; stents; grafts.

 Context: Postoperative ileus limits early hospital discharge for patients who had undergone abdominal surgery. Literature indicates that chewing gum is evaluated as a convenient method to enhance recovery from postoperative ileus after abdominal surgery. Aims: To evaluate the efficacy of chewing gum on post-operative ileus among the patients of abdominal surgery. Settings and Design: Prospective randomized interventional study. Methods and Material: Patients were assigned randomly to one of two groups of each procedure depending on condition of the patient. Interview schedule and checklist were used to assess the bowel sounds, passage of first flatus, passage of stool and return of appetite. The patients in the study group as per planned protocol were administered chewing gum three times a day for 30 min starting from the time patient become conscious till the onset of one of the primary endpoints. The patients are allowed to chew the gum even with Ryle’s tube. Statistical analysis used: Data was analysed using IBM SPSS version 22 software with Chi-square test used for test of significance. Results: The mean duration of return of first bowel sounds, the passage of first flatus and return of appetite was significantly shorter in the study group as compared to the control group as per tests of statistical significance. Conclusions: It is concluded that use of chewing gum in the postoperative period is a safe and cheap method to stimulate bowel motility and reduce the postoperative ileus after abdominal surgery.

Keywords: chewing gum; bowel motility; postoperative ileus.

 Background: Diabetic foot ulcers (DFUs) are considered one of the most common and devastating chronic complications of diabetes. As a consequence of DFUs, a lower limb is lost every 30 seconds some where in the world, and the probability of losing the other leg is 50% after 3 years. DFUs contribute to 85% of non traumatic lower Lind amputations and lead to 13 to 17% of mortality rate in patients with diabetics mellitus. Negative pressure wound therapy (NPWT) is a newer non-invasive adjunctive therapy system that uses controlled negative. pressure, using vacuum assisted closure (VAC) device, to. help promote faster wound healing by removing fluid. from open wounds, preparing the wound bed for closure, reducing oedema, and promoting formation of granulation tissue. Methodology: We have conducted a study in Bangalore Medical College and Research Institute Bangalore for a period of one year comparing the conventional dressing versus VAC dressing in faster healing of the wound. Induced about 40 patients in the study. Conclusion: Patients treated with VAC therapy has faster appearance of granulation tissue than that with Conventional dressings. From our study VAC therapy has proved to be more effective than conventional dressing in healing of Diabetic Foot Ulcers.

Keywords: Diabetic foot ulcers (DFUs); Negative pressure wound therapy (NPWT). Diabetes mellitus (DM).

Context: Acute appendicitis is one the very common acute abdomen presenting to the emergency department. Many scoring systems and radiological modalities have been developed over the years for the diagnosis of acute appendicitis. Aims: Our objective is to study acute appendicitis, the various clinical patterns that help to make a clinical diagnosis and effectiveness of radiological investigation in diagnosing acute appendicitis and its influence on clinical decision making. Method: The study group included all the patients presenting to KIMS Hubli with suspected acute appendicitis and operated for the same during December 2016 to May 2018. Results: The current study included 172 cases. Out of which 61.8% were male and 38.2% were female. Majority of the study population belonged to the age group f 10-30 years. The most common symptom was pain abdomen followed by nausea and vomiting, fever and anorexia. Most common sign elicited was right iliac fossa tenderness and followed by rebound tenderness. On blood investigations 66.5% of the patients had leukocytosis of >10,000. 64.1% of the patients had Alvarado score of 7 and more. As per USG, 94.1% of them had signs of acute appendicitis. The most common position in our study is retrocecal. Appendicitis was reported in all the cases on histopathological examination. Conclusion: Clinically diagnosing a case of appendicitis based on symptoms and signs combined with affordable radiological investigations can reduce unnecessary delay in the operative management of acute appendicitis. It is evident in our study that clinical and radiological investigations have no specificity in clinical diagnosis of acute appendicitis.

Keywords: RIF- right iliac fossa, USGultrasonography

Background: Acute bacterial non-necrotizing cellulitis, or erysipelas, is an acute infection of the dermis and subcutaneous tissue, characterized by erythema, swelling, warmth and pain. Cellulitis has an incidence of 16.4 to 24.6 per 1000 persons-years [1]. Cellulitis is an acute, painful and potentially serious infection associated with significant morbidity and healthcare costs [2]. In the present study, cellulitis denotes acute, nonsuppurative, superficial skin infection of presumed bacterial origin. Prompt diagnosis and treatment leads to faster recovery and reduces the risk of serious complications and longterm health problems. Supportive nursing measures can ease symptoms and provide comfort during the acute phase. Cellulitis is a widely prevalent condition, especially in a country like India, with the highest population of diabetics. Cellulitis most typically occurs in the leg, and less often in the upper extremity, in the face, or other parts of the body. Around 50% of people who develop cellulitis suffer from longstanding oedema following the infection. Thus reducing oedema is important, as it improves venous return, maintains skin health and reduces the risk of recurrent infection [3]. Objectives: The purpose of this study is to study, establish and compare two treatment modalities namely, Magnesium Sulphate & Glycerin paste dressing versus plain Glycerin dressing for cellulitis in diabetic patients. Methods: The present prospective study was done in the Department of General Surgery, Basaveshwar Teaching and General Hospital, attached to Mahadevappa Rampure Medical College, Kalaburagi, Karnataka. A total of 60 diabetic patients with cellulitis of limbs were divided into 2 groups (Group A- MgSO4+ Glycerin paste dressing, Group B - Plain Glycerin dressing) and were subjected to the above mentioned treatment modalities respectively and followed up, to assess the outcome with respect to improvement in oedema, erythema and pain associated with cellulitis. Results: The average (Mean) number of days required for erythema to resolve in Group A patients – 5.33±1.32 days, while for patients in Group B it was – 19.5±4.12 days, which is statistically significant (p<0.0001). These findings suggest towards anti-inflammatory action/ property of MgSO4+ Glycerin paste dressing. The average(Mean) number of days required for oedema to resolve among Group A patients was – 12.56±2.55 days, while among Group B patients it was – 38.56±9.67 days, which was statistically significant (p<0.0001). These findings re-establish the hygroscopic nature of MgSO4+ Glycerin paste and hence its role in resolving oedema from cellulitis areas. There is very limited evidence showing action of MgSO4 in relieving pain associated with wounds. In our study we found that, the mean duration required for total relief from pain among cellulitis patients, treated with MgSO4+ Glycerin paste dressing was 3.9±1.06 days, as against 15.06±3.15 days needed for patients in plain Glycerin dressing group(p<0.0001). This suggests that MgSO4+ Glycerin paste indeed helps in alleviating pain as against plain Glycerin dressing, in cellulitis. The overall beneficiary effects of MgSO4+ Glycerin paste can be emphasized clearly by comparing the average length of hospital stay for patients- which was 13.76±2.84 days for Group A versus 41.03±10.96 days for Group B. Interpretation & Conclusion: Based on the findings of this study, it can be concluded that MgSO4+ Glycerin paste dressing is better than plain Glycerin dressing, for reducing oedema in patients with cellulitis. In this study the overall length of hospital stay (LOS) was significantly less for patients treated with MgSO4+ Glycerin paste dressing. The findings of this study are also suggestive of the possible anti-inflammatory action of MgSO4+ Glycerin paste dressing, as evidenced by lesser duration required for resolution of erythema and pain among cellulitis patients treated with this modality.

Keywords: Cellulitis; Diabetes Mellitus; Magnesium Sulphate and Glycerin paste; Oedema; Erythema.

 Background: Frequently commonly happened abdominal surgery is appendicectomy. Open appendicectomy (OA) first introduced by Mac Burney in 1884, as on now operation of choice in acute appendicitis. Laparoscopic Appendicectomy (LA) now a days is widely practiced but could not gain universal approval. LA was first done in 1983. All recent studies shows in favour of LA. Our study is to view the therapeutic benefits of LA by comparing with open appendicectomy. Methods: It is a prospective study in 101 cases underwent in district hospital Gulbarga which was attached to esic medical college. Our study series is taken from july 2017 to aug 2018 in LA and OA from jan 2018 to july 2018, and compared mean operating time, time of oral feeding, post operative stay, analgesics administered. Results: we observed that mean operating time for LA is 48±8 and OA is 35±10, LA requires 1.1 shots less analgesics than OA, Oral feeding was resumed in 20 hours earlier following LA when compared to OA, Post operative stay 2.1 days shorter in LA than OA, In female patients we noticed other pathologies like ovarian cysts and peritoneal pathology, diagnosis done and managed laparoscopically in same sitting. Conclusion: In our study it is found that LA is more effective and safe procedure in both male and female sexes. LA has tremendous advantage having less post operative infection, hospital stay and less analgesia administered and early return of bowel movements.

Keywords: (LA) Laparoscopic Appendicectomy; (OA) Open Appendicectomy; Appendicitis.

 Background and Objectives: The management of thyroid nodules is multi-disciplinary and involves surgeons, pathologists, endocrinologists and radiologists. Here, we conducted a prospective correlational study of 50 patients who presented with solitary thyroid nodule to Basaveshwara Teaching and General Hospital during Nov 2016 to June 2018. The objectives were: 1. To study the clinical presentation, USG and FNAC findings of thyroid nodules. 2. To study the concordance and discordant results in the triple assessment. 3. To compare the results with the histopathological findings when available. Methods: All the patients who fit the inclusion criteria (n=50), underwent triple assessment i.e clinical examination, Ultrasound Examination and US guided FNAC of the thyroid nodule along with complete thyroid profile and routine investigations. The findings of the triple assessment were then compared with Histopathological Report, post-surgery. The concordance of the preliminary investigations was then assessed. Results: In this study, the peak incidence was noted in the age group of 31-40 with 34% of the patients (n=17). The youngest patient was 18 yrs old and the eldest, 70 yrs old. 88% (n=44) of the patients were females, whereas 12% patients were male. The most commonly accompanied symptom to the thyroid swelling was pain/discomfort (in 14 patients). Most patients (44%) were categorised into Bethesda Category II indicating benign swellings. The diagnostic accuracy of USG and FNAC were 92% and 98% respectively. Conclusion: • The incidence of thyroid cancer is 22% among the patients with thyroid nodules. • There is a higher incidence of benign lesions (88%) most of which belonged to Bethesda Category II. • Sex profile of both benign and malignant lesions showed high female preponderance. • Ultrasound guided Fine Needle Aspiration Cytology showed high sensitivity and 98% diagnostic accuracy.

Keywords: Triple assessment; thyroid nodule; US guided FNAC.

 Background: The choice of wound closure after surgery, whether major or minor procedure, has always raised many concerns. One of those concerns is how fast and comfortable will be the recovery. Usage of surgical adhesives, 2-Octyl Cyanoacrylate provides a flexible, water resistant, sealed skin closure. It provides a needle-free method of wound closure, an important consideration because of bloodborne viruses (e.g., HIV). Objectives: To discover the advantages and disadvantages of using 2-Octyl Cyanoacrylate glue for skin closure in comparison with that of suturing. Methodology: A comparative study was done in two groups of patients (with 35 patients each). In both the groups, detailed history was taken preoperatively and routine investigations like haemoglobin, total count, ESR, RBS were done to rule out any acute or chronic infection. Shaving of the parts was done at the same time on previous evening. Injection Cefazolin 1 gm single dose was given intravenously at the time of anaesthesia. In one group, 2-Octyl Cyanoacrylate was used as a method of skin closure. In the 2nd group, skin incision was closed using sutures. Results: The present study proves that the Time taken for skin closure, the Post-operative pain and Cosmetic appearance are significantly better with adhesive glue 2-Octyl Cyanoacrylate than the traditional skin closure by suturing. Conclusion: Skin closure with adhesive glue Octyl Cyanoacrylate is better than the traditional skin suturing. As it forms a flexible, water resistant sealed skin closure and allows patient to shower any time after surgery. It is faster, comfortable and cosmetically better technique for skin closure. It significantly reduces post-operative pain. To conclude, adhesive glue Octyl Cyanoacrylate skin closure is a significantly better technique than traditional skin closure by suturing in clean elective surgeries.

Keywords: Adhesive glue; 2 Octyl Cyanoacrylate; Skin suturing; clean elective surgeries.

 Background: Hyperbaric Oxygen Therapy (HBO) is an established treatment modality, internationally practiced since a long time ago. International protocols for the practice of hyperbaric oxygen therapy have been established in the United States by the Undersea and Hyperbaric Medical Society and in Europe by the European Committee for Hyperbaric Medicine. In India, HBO seems to be a well-accepted adjunctive treatment for diabetic foot, gas gangrene and post radiation complications. Objective: The main aim of this study is to describe the referral patterns, the different indications and patient population treated at the Prana HBO center, and to describe the protocols followed at the center and determine whether these conform to the standards established by the UHMS. Study Design: A Descriptive cross sectional study (retrospective record review) was performed to realize the aim and objectives of this study. Place of Study: The study was carried out at the Prana HBO Centre, which is owned by the Investigator and located in the Northern parts of Mumbai, in India. Methods: The data was collected from all the patient files, which are stored at the center. TCOM data was also collected from the Centre register which is maintained separately. Observation & Discussion: A total number of 276 patients were treated at the hyperbaric facility during the study period. These individuals received a total of 2,740 individual treatment sessions. An average of 9.928 (SD=F.2) treatment sessions were thus provided to each patient. One patient received 80 treatment sessions, skewing the data. The median number of treatment sessions was 10, with an inter-quartile range of 5 - 10. TCOM was carried out on diabetic foot patients (67.8%) and in non-healing wound (22.2%). Chronic venous ulcers and compromised skin graft cases TCOM was not advised either by the treating doctor or the wound was so big that, TCOM was not possible. Conclusions: Indian perspective requires Standard HBOT facility and registry reporting as a part of healthcare reform to facilitate the acquisition of real-world data for HBOT comparative effectiveness studies, with matched cohorts. Keywords: Hyperbaric oxygen therapy; India; Clinical and basic research.

 Context: Primary vaginal hydrocele is commonest disease worldwide. In tropics lymphatic filariasis is main cause. Surgery is treatment of choice. A number of methods are described. “Sac eversion with minimal separation” is described to have many advantages. This study is done to know the efficacy of the method over others. Aims: To study the efficacy of “Sac eversion with minimal separation technique”. Settings and Design: Prospective experimental study, General Surgery department of Narayana Medical College from 15th October 2014 to September 2016. Methods and Material: Detailed history, clinical examination, investigations from patients with primary vaginal hydrocele is noted in proforma. All are operated by this technique. Post operative complications are documented. Statistical analysis used: Percentages and mean. Results: Among 64 cases maximum incidence was found in 3rd decade, agriculturist and coolies. Many cases presented with symptoms for 2 - 4 years. Right sided scrotal swelling was common. Scrotal odema was the common complication. Average hospital stay was 2 days. Conclusions: This technique is good compared to conventional procedures because it is much easier and simpler, consumes less time, can be done with small incision under local anesthesia. As the sac is not stripped from the surrounding scrotal tissues, bleeding is minimal, post operative haematoma does not occur and other complications like pain, fever, infection, disruption of wound are prevented.

Keywords: Hydrocele; Sac eversion technique; scrotal oedema; hematoma.

 Background: Figure of 8 techniques has been described in the literature for peptic ulcer perforation repair especially when the patient comes late, when the edges of the ulcer and the wall of duodenum are very friable. Methods: Sixty patients included in the study at AIMS, B G Nagar, Bellur Cross were divided into two groups after randomization. Study group, patients underwent figure of eight suturing technique and Control group, patients underwent Grahm’s technique of omentopexy for peptic ulcer perforation. Results: The mean age of the study group was 48.7+ 7.56 Years and 49.6+8.69 years among the control group. In the Study group nearly 29 (96.6%) male and 1 (3.3%) female. Among the Control group 27(90%) males and 3 (10%) Females were included in the study. The Mean APACHE II score in the study group was 3.8+ 1.8 and in the control group it was 3.6+ 1.3 with p value found to be statistically not significant between the groups. The mean operative time in the control group was 76.65 min in study group and 73.58 min in control group. Bile Leak was in 2 (6.6%) in study group and 1 (3.3%) in control group. Septicemia was seen in 6.6% in study group and 10% in Control group. The commencement of oral Feed was started after 5.5 days in study group and 5.13 days in control group. The Mean hospital stay was 12.6 days in both the study and control group. Conclusions: The present study is non-inferior than omentopexy in terms of post-operative complications. It can be used as a safe alternative to omentopexy especially when the patient comes late.

Keywords: Peptic ulcer perforation; Figure of eight suturing technique; Omentopexy; APACHE.

 Developed in the early 1990s, the BIRADS classification has been used extensively as a surrogate to histopathological reporting of breast cancer. Prior to implementation of BIRADS there was a lack of uniformity in reporting of mammography findings and this often resulted in varied reporting and management strategies. This ambiguity had also led to increased difficulties in establishing performance standards across settings. This had been the main impetus in developing the BIRADS system and several research studies have shown the scoring system to be useful in predicting the likelihood of cancer. These results are also seen in this study and hence further show the value of BIRADS in effective management of breast cancer. In this study, a total of 50 patients aged between 15 and 73 years with mean age being 44 years were included. They underwent preoperative imaging with either ultrasound or mammogram after which they underwent surgery. And their Mammogram/ultrasound findings are compared with their final Histopathology report. The BIRADS categories 1, 2 and 3 are clubbed together and considered as “Benign”, while categories 4, 5 and 6 were clubbed together as “Malignant”. This was compared with the final histopathology report which was either benign or malignant and the correlation was established. Out of the 50 cases, 40 of them were correctly classified. Breast lesions evaluated for malignancy using BIRADS scoring had Sensitivity of 75%, Specificity of 83.3%, Positive predictive value of 75% and Negative predictive value of 83.3%. The standardized terminology of the BI-RADS lexicon allows quantification of the likelihood of carcinoma in a breast lesion. In experienced hands, the BIRADS system can be a very useful predictor of malignancy. However, Imaging should not be used in isolation due to chance of missing malignancy. Imaging should always be done in conjunction with clinically examination and FNAC/Biopsy (Triple Test) to get a comprehensive perspective prior to surgery [25].

Keywords: BIRADS; Prediction; Breast cancer; Mammogram; Histopathology; Correlation.

Background: Open hernioplasty is one of the most common surgical treatments [1]. The aim of the mesh used in hernia repair should be to reinforce the abdominal wall without reducing the mobility by excessive scarring [2]. Worldwide over a million meshes are implanted every year [3]. Complications such as foreign body sensation and reduced life quality are described in the follow-up and depends on the size and structure of the incorporated material [12] Polyester mesh is hydrophilic as opposed to hydrophobic prosthesis such as polypropylene mesh or polytetrafluoroethylene mesh and thus encourages early biologic fixation and collagen ingrowth into surrounding tissue[5]. Objective: Evaluate the effect of type of mesh (polypropylene mesh versus polyester mesh) used during hernia repair on mean-time outcomes mainly focusing on post-operative wound infection, development of seromas, post-operative return to work, post-operative foreign body awareness and recurrence. Methods: A total of 50 cases of anterior abdominal wall hernias are selected and divided into Group A that consists of 25 cases of hernioplasty done using polypropylene mesh and Group B that consists of 25 cases of hernioplasty done using polyester mesh. They are studied and followed up using standard questionnaire at Sir T. Hospital and Government Medical College, Bhavnagar, Gujarat (364001). Results: Among 50 cases studied, percentage of male patients was higher than that of female patients. The use of synthetic polyester mesh in the hernioplasty results in no or decreased incidences of wound infection, seroma formation and foreign body sensation. It can also be concluded that Polyester mesh is cost effective in terms of hospital stay duration and early resumption of work. Conclusion: In this study use of polyester mesh for hernioplasty have more satisfactory outcomes as compared to polypropylene mesh when various parameters are compared.

Keywords: Hernioplasty; mesh; polypropylene; polyester.

 Background: Multiple risk factors and perioperative characteristics can increase the likelihood of superficial surgical site infections. Research has shown that patient factors, surgical techniques, skin preparation, timing and method of wound closure are significant factors that can influence the incidence of subsequent infection. Keeping the facts in the mind, the present study was undertaken to determine the various risk factors to SSI. Material and methods: The present study is hospital based observational study conducted over period of two year. Patients admitted in surgical ward requiring Emergency non traumatic exploratory laparotomy were included in the study. After admission, short history and physical examination was conducted on each patient admitted in General surgery with acute abdomen. Patients requiring emergency laparotomy and fulfilling the inclusion criteria were offered to participate in the study. All the traumatic cases were excluded from the study. Result: Surgical Site Infections, though can be found at any age, high incidence was seen in the 4th, 5th, 6th decades of life. Most of the infections were noticed between 4th – 8th postoperative days. SSI was high in patients with co-morbidities. Conclusion: It can be concluded from the findings of the study that microorganisms that are normal inhabitants of our body are mainly responsible for surgical site infection (SSI). Proper care of the patients as a whole throughout the peri – operative period is very vital to reduce the rate of surgical site infection. Strict adherence to aseptic wound dressing techniques should be enforced during each procedure to reduce the SSIs.

Keywords: Risk factor; surgical site infection; Type of operation; Co-morbidity.

 Upper gastrointestinal cancers i.e. Esophageal and gastric cancers are common cancers worldwide and prognosis remains poor. In recent years, hematological parameters are being studied as prognostic indicators for various cancers. There are not many studies on these hematological parameters as screening markers in different cancers. So we conducted a retrospective single center study to evaluate if these blood parameters can be utilized as screening markers for upper GI malignancies. Aims & objectives is to determine if blood parameters are significantly different in patients with upper gastrointestinal malignancies as compared to control cases. Hundred (100) cases of upper GI malignancy and equal number of control – age, gender matched to cases without malignancy or infection was included. Both groups evaluated with routine complete blood count and upper GI endoscopy are included. Hematological parameters like hemoglobin, neutrophils and lymphocyte count, Platelet count (PC), mean platelet volume, MPV/PC ratio, red blood cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were calculated and compared to look for statistical difference. Results proved that blood parameters are statistically different in cases (upper gastrointestinal malignancy) versus controls. We conclude that hematological parameters can be utilized as a screening markers in upper GI malignancies.

Keywords: upper gastrointestinal malignancy, hematological parameters, neutrophil / lymphocyte ratio, platelets / lymphocyte ratio, screening markers.