New Indian Journal of Surgery

Neonatal mastitis is an uncommon condition which can be complicated with local abscess formation. Here is a case reporting of unilateral breast abscess in a 16-day old term female neonate caused by methicillin -resistant Staphylococcus aureus [MRSA], treated with antibiotics and surgical drainage. This report was to emphasis the health education to readers regarding the prevention of breast abscess formation. 

Keywords: Neonatal breast enlargement; Neonatal mastitis; MRSA.

Impacted foreign body in esophagus is a clinical emergency as such most often seen in children, but sometimes in adults foreign bodies are usually accidentally ingested admixed with food. Food foreign body require emergent treatment within 2 hours and definitive treatment within 6 hours. In adults, fish bone is the most common food associated foreign body in Asia, while meat bone is the most common cause in Europe. Male gender is more commonly involved gender than female.1 In 80% of cases, the ingested material pass uneventfully through the gastro/intestinal tract (GIT).2 Endoscopy is performed in 20% cases3 and surgical intervention is required in less than 1% cases.4 Emergency esophagogastroduodenoscopy is indicated when occlusion is complete, impacted object is sharp and if impacted foreign body is a battery. Poor prognosis is associated with time lapse after impaction, type of foreign body and size of foreign body (>3 cm). We are reporting a case of chronic dysphagia of more than one year duration in a male caused by impacted meat bone of size more than 3 cm in esophagus. 

Keywords: Eesophagus; Endoscopy; Chronic dysphagia; Gastro intestinal tract (GIT).

Fournier’s gangrene or idiopathic gangrene of the scrotum has a fulminant course if not identified and managed at the earliest possible. The main stay of treatment is intensive care along with thorough surgical debridement and culture sensitive antibiotics. Multimodality treatment is advised as it hastens the wound healing, thereby shortening the patient stay in the hospital and thereby decreasing the patient mortality and morbidity. We hereby share our experience in managing a case of Fournier's gangrene using topical phenytoin as an adjunct for wound-bed preparation. 

Keywords: Phenytoin; Fournier’s gangrene; Wound-bed

Aims and objectives: Color Doppler Ultrasound Scan is a non-invasive and cheap tool than other Radiological Investigations for Screening, Diagnosis and follow-up of Vascular Diseases. In this study performed at Basaveshwara Teaching and General Hospital, Kalaburagi, Karnataka, we correlated the Clinical data with the findings of Color Doppler Ultrasound of the Lower Limb Arteries in Chronic Lower Limb Ischemic cases with Claudication. Patients and methods: Fifty Patients admitted under Department of General Surgery at Basaveshwara Teaching and General Hospital, Kalaburagi, between November 2017 and May 2019, with Claudication Pain of Lower Limb and associated symptom were studied. All examinations were done clinically and then compared with the Color Doppler Ultrasound using 7.5 MHz linear transducer connected to Digital Ultrasound Imaging System. Results: Fifty Patients were studied out of which 43 were male and 7 were female with a ratio of 6.14:1. The minimum age was 48 years and maximum age was 92 years. Number of patients were highest in the group of 51–65 years, i.e. 58%, with a mean age of 59.3 years. Thirty-nine patients were Smokers, which were statistically significant. Most common clinical presentation of the patients was gangrene with claudication pain (42%), Gangrene alone in 76% of the patients. The most common cause of lower limb ischaemia in our study was Atherosclerosis constituting 84% of all the etiology for the provided above age groups, followed by Thromboangiitis Obliterans. Femoro-Popliteal and below the knee arteries were commonly involved by these abnormalities while diabetes and hypertension were frequently associated clinical problems of these Patients. Conclusion: Doppler ultrasound has a high diagnostic yield in depicting abnormalities in Patients with clinical features of peripheral arterial disease. 

Keywords: Doppler ultrasound; Peripheral arteries; Diabetes.

Introduction: Liver abscess is the accumulation of pus in the liver parenchyma. It is the most common cause of intraabdominal abscess. It is of two types: pyogenic liver abscess and amoebic liver abscess. Treatment of larger abscesses involves drainage, either by percutaneous aspiration or percutaneous drainage. This study was an attempt to compare the efficacy between the two methods. Methods: The study included 50 patients with liver abscess of size more than 5 cm. Two compared modalities of percutaneous treatment of liver abscess were needle aspiration and pigtail catheter aspiration, performed under ultrasonographic guidance. Results were compared on the basis of clinical improvement, duration of hospital stay and time for reduction of abscess. Results: Amoebic liver abscess (72%) was more common than pyogenic liver abscess (28%). Clinical recovery was faster in catheter group (average 2.56 days) than in aspiration group (average 5.2 days) (p-value <0.05). The mean reduction in total counts in the catheter group was 8193 while that in the aspiration group was 6208. The mean duration for the abscess size to reduce to 50% was 4.3 days in the aspiration group while that was 2.76 in the catheter group (p = 0.018). Patients who underwent aspiration needed repeated interventions as compared to the other group. The mean duration of hospital stay was 10.32 among the aspiration group while that was 5.72 among the catheter group (p < 0.05). Conclusions: Our study concluded that catheter drainage of liver abscess had earlier improvement of symptoms, better control of infection, faster duration of resolution of the abscess and shorter hospital stay as compared to percutaneous aspiration. 

Keywords: Liver abscess; Pigtail catheter; Aspiration; Faster recovery.

Craniectomy following head injury is a common surgery with a high rate of complications. Postoperative infection following cranioplasty leads to shortening of the scalp flap and leads to problems in closure. Various techniques have been described like local flaps, wide tissue mobilization and tissue expansion. Another technique, not so well described in literature, is Intraoperative expansion. We present a case of similar calvarial defect managed by intraoperative expansion to enable tension-free closure of the scalp. 

Keyword: Cranioplasty; Calvarial defect.

Trauma is the leading cause of death and disability in developing countries and also the most common cause of death under 45 years of age. Injury is the 7th cause of mortality worldwide and abdomen is the third most common injured organ. The spleen and liver are the most commonly injured abdominal organs as a result of blunt trauma. In the civilian population, blunt injury to the abdomen is commonly caused due to road traffic accidents. Material and Methods: A retrospective study of 157 cases of blunt abdominal trauma patients presenting to department of emergency surgery in medical college of Central India from January to June 2019 was done. Results: Amongst the studied cases most common age group involved was 21–30 years (46 cases) and 31-40 years (32 cases) followed by 41–50 years (28 cases). Liver was found to be the most commonly injured organ 60 cases followed by spleen 39 cases and bowel and kidney (21 and 17 cases respectively). Conclusion: Blunt Abdominal Trauma is one of the important causes of morbidity and mortality in relatively young individuals. Most common mode of injury was road traffic accidents and men were affected predominantly. Hospitals and trauma care centers must adopt a multi-pronged approach to diagnose and promptly treat patients with blunt injury abdomen so that the prognosis can be better in these patients. 

Keywords: Abdominal trauma; Road traffic accident.

Background: Esophageal cancer is relatively common gastrointestinal tract malignancy with poor prognosis. The aim of the study is to conduct retrospective review of esophageal cancer patients managed by Transhiatal esophagectomy (THE). Methodology: The study was retrospective analysis of prospective collected data of esophageal cancer patients from June 2010 to June 2019. Inclusion criteria: Histologically proven carcinoma, medically fit lower third esophageal cancer. Exclusion criteria: Middle third esophageal carcinoma requiring transthoracic route, metastatic cancer, medically unfit patient, patient refusing consent for surgery. Results: 575 cases of esophageal cancer were managed in a single unit of surgery. Of these 575 cases, Transhiatal esophagectomy was done in 69 patients. Mean age of the patients was 58 years. Male to female ratio was 15:54. THE alone was done in 18 (25.7%), THE + adjuvant chemotherapy in 24 (34.3%), THE + adjuvant radiotherapy in 12 (17.1%), THE + neoadjuvant chemotherapy 6 (8.6%), THE + neoadjuvant chemoradiotherapy 9 (12.9%). The overall morbidity was 40.5% (14/69). Perioperative mortality was in 5 patients (7.24%). Follow up was done for mean 26.4 months. The mean survival was 19.3 months. Conclusion: Esophagectomy is complex operation with high morbidity and potential mortality. Multimodality approach appears to be reasonable safe in managing esophageal carcinoma patients. 

Keywords: Esophageal cancer; Transhiatal esophagectomy; Morbidity; Multimodality therapy.

Burns due to contact with hot coal tar are challenging as it is very difficult to remove and there is no specified appropriate agent for the removal of tar. Hot tar burns usually occur as occupational hazard. This is a case series of our experience in treating 6 patients who sustained hot tar burns. Patients were treated with diesel, butter and Vaseline. Keywords: Tar; Diesel; Butter; Vaseline.

Introduction: Acute pancreatitis is one of the commonest conditions that presents as a surgical emergency worldwide. Aim: The aim of the study was to compare BISAP scorings and serum levels of C-reactive protein in predicting severity of acute pancreatitis. Materials and methods: Thirty patients got admitted from November 2012 to April 2014 in our hospital with acute pancreatitis were included in the study. C-reactive protein evaluated along with BISAP score at the time of admission. Patients assessed for severity by comparing both. Statistical analysis done by using Fischer's exact test, chi-square test and student t-test. Results: 23.3% of patients had a BISAP score of 3, rest had a score of 1 or 2. 66.7% of patients had an elevated CRP. An elevated CRP level and an increased BISAP score was found to have a statistically significant relation (p = 0.009 and p = 0.0002 respectively) to length of patient’s stay in hospital and hence the severity. BISAP and CRP levels had a positive correlation with a p-value of 0.064. Here, we found that BISAP scores had a statistically significant relationship with ICU stay (p-value: 0.014) Conclusion: In conclusion, we found that BISAP is a better predictor of severity of acute pancreatitis compared to CRP levels. It is a useful means of predicting severity in acute pancreatitis. Larger studies will be needed to further consolidate our findings, but it is safe to say that BISAP has the advantage of simplicity and speed over more traditional scoring systems. Keywords: Acute pancreatitis; Bisap scoring; C-reactive protein; Hospital stay.

Context: Laparoscopic incisional ventral hernia repair (LIVHR) has been associated with a high incidence acute and chronic pain due to use of nonabsorbable tackers. Several absorbable tackers have been introduced to overcome these complications. Aims: To compare postoperative effectiveness, comfort, complications of mesh fixation using absorbable and non-absorbable tacks in laparoscopic ventral hernia repair. Settings and design: A Prospective randomized clinical trial. Randomization was done by computer generated randomization number method for a period of 2-year study duration. Material and methods: A total of 60 patients were randomized in two groups. Patients of Group A were subjected to mesh fixation with absorbable tacks and group B were subjected to mesh fixation with no-absorbable tacks. All were evaluated for visual analogue scale (VAS) postoperative, length of hospital stay, time to resume normal activity. Statistical analysis used: Results were compared by student t test or Mann Whitney U test for continuous variables, and chi-square or Fisher's exact tests were used for categorical variables. Results: Patients in both the groups were comparable in terms of demographic profile and hernia characteristics. No significant difference found in VAS score at day 0, 1 week, 3 months and 6 months. No significant difference found in hospital stay, time to return to normal activity, postoperative complications. Conclusions: As per our opinion, the choice of either of these fixation methods during surgery should not be based on the concerns of pain or recurrence. AT may be the preferable option in LIVHR due to the lower cost. 

Keywords: Laparoscopic incisional ventral hernia repair; Non-absorbable tackers; Mesh fixation; Pain; Visual analogue scale.

The most common benign neoplasm of the salivary glands is pleomorphic adenoma originating from the parotid gland. Surgical excision is usually all that is required to provide both definitive diagnosis and adequate treatment. Despite this relatively simple algorithm, management of salivary neoplasms is challenging because of their relative infrequency, inconsistent classification, and variable biologic behavior. Although many studies regarding the incidence of salivary gland tumors have been reported, the epidemiology of these neoplasms is not well established because these studies are frequently restricted to a specific population, anatomical location, or a specific tumor type. There are numerous studies on the incidence and histological types of salivary gland tumors from countries in the western world and African countries. However, there is little available information about the pattern of their presentation from Asian countries. The aim of this study was to analyze the incidence and distribution of all types of salivary gland tumors in an Indian series, and to provide data for comparison with other epidemiological studies from different geographical sites and races. Demographic data from these studies should help us to a better understanding of the biological and clinical characteristics of the disease. 

Keywords: Salivary gland; Parotid gland; Pleomorphic adenoma; Warthin’s tumor; Submandibular sublingual salivary gland; Minor salivary gland.

Neonatal mastitis is an uncommon condition which can be complicated with local abscess formation. Here is a case reporting of unilateral breast abscess in a 16-day old term female neonate caused by methicillin -resistant Staphylococcus aureus [MRSA], treated with antibiotics and surgical drainage. This report was to emphasis the health education to readers regarding the prevention of breast abscess formation.

Keywords: Neonatal breast enlargement; Neonatal mastitis; MRSA.

Impacted foreign body in esophagus is a clinical emergency as such most often seen in children, but sometimes in adults foreign bodies are usually accidentally ingested admixed with food. Food foreign body require emergent treatment within 2 hours and definitive treatment within 6 hours. In adults, fish bone is the most common food associated foreign body in Asia, while meat bone is the most common cause in Europe. Male gender is more commonly involved gender than female.1 In 80% of cases, the ingested material pass uneventfully through the gastro/intestinal tract (GIT).2 Endoscopy is performed in 20% cases3 and surgical intervention is required in less than 1% cases.4 Emergency esophagogastroduodenoscopy is indicated when occlusion is complete, impacted object is sharp and if impacted foreign body is a battery. Poor prognosis is associated with time lapse after impaction, type of foreign body and size of foreign body (>3 cm). We are reporting a case of chronic dysphagia of more than one year duration in a male caused by impacted meat bone of size more than 3 cm in esophagus.

Keywords: Eesophagus; Endoscopy; Chronic dysphagia; Gastro intestinal tract (GIT).

Fournier’s gangrene or idiopathic gangrene of the scrotum has a fulminant course if not identified and managed at the earliest possible. The main stay of treatment is intensive care along with thorough surgical debridement and culture sensitive antibiotics. Multimodality treatment is advised as it hastens the wound healing, thereby shortening the patient stay in the hospital and thereby decreasing the patient mortality and morbidity. We hereby share our experience in managing a case of Fournier's gangrene using topical phenytoin as an adjunct for wound-bed preparation.

Keywords: Phenytoin; Fournier’s gangrene; Wound-bed

Aims and objectives: Color Doppler Ultrasound Scan is a non-invasive and cheap tool than other Radiological Investigations for Screening, Diagnosis and follow-up of Vascular Diseases. In this study performed at Basaveshwara Teaching and General Hospital, Kalaburagi, Karnataka, we correlated the Clinical data with the findings of Color Doppler Ultrasound of the Lower Limb Arteries in Chronic Lower Limb Ischemic cases with Claudication. Patients and methods: Fifty Patients admitted under Department of General Surgery at Basaveshwara Teaching and General Hospital, Kalaburagi, between November 2017 and May 2019, with Claudication Pain of Lower Limb and associated symptom were studied. All examinations were done clinically and then compared with the Color Doppler Ultrasound using 7.5 MHz linear transducer connected to Digital Ultrasound Imaging System. Results: Fifty Patients were studied out of which 43 were male and 7 were female with a ratio of 6.14:1. The minimum age was 48 years and maximum age was 92 years. Number of patients were highest in the group of 51–65 years, i.e. 58%, with a mean age of 59.3 years. Thirty-nine patients were Smokers, which were statistically significant. Most common clinical presentation of the patients was gangrene with claudication pain (42%), Gangrene alone in 76% of the patients. The most common cause of lower limb ischaemia in our study was Atherosclerosis constituting 84% of all the etiology for the provided above age groups, followed by Thromboangiitis Obliterans. Femoro-Popliteal and below the knee arteries were commonly involved by these abnormalities while diabetes and hypertension were frequently associated clinical problems of these Patients. Conclusion: Doppler ultrasound has a high diagnostic yield in depicting abnormalities in Patients with clinical features of peripheral arterial disease.

Keywords: Doppler ultrasound; Peripheral arteries; Diabetes.

Introduction: Liver abscess is the accumulation of pus in the liver parenchyma. It is the most common cause of intraabdominal abscess. It is of two types: pyogenic liver abscess and amoebic liver abscess. Treatment of larger abscesses involves drainage, either by percutaneous aspiration or percutaneous drainage. This study was an attempt to compare the efficacy between the two methods. Methods: The study included 50 patients with liver abscess of size more than 5 cm. Two compared modalities of percutaneous treatment of liver abscess were needle aspiration and pigtail catheter aspiration, performed under ultrasonographic guidance. Results were compared on the basis of clinical improvement, duration of hospital stay and time for reduction of abscess. Results: Amoebic liver abscess (72%) was more common than pyogenic liver abscess (28%). Clinical recovery was faster in catheter group (average 2.56 days) than in aspiration group (average 5.2 days) (p-value <0.05). The mean reduction in total counts in the catheter group was 8193 while that in the aspiration group was 6208. The mean duration for the abscess size to reduce to 50% was 4.3 days in the aspiration group while that was 2.76 in the catheter group (p = 0.018). Patients who underwent aspiration needed repeated interventions as compared to the other group. The mean duration of hospital stay was 10.32 among the aspiration group while that was 5.72 among the catheter group (p < 0.05). Conclusions: Our study concluded that catheter drainage of liver abscess had earlier improvement of symptoms, better control of infection, faster duration of resolution of the abscess and shorter hospital stay as compared to percutaneous aspiration.

Keywords: Liver abscess; Pigtail catheter; Aspiration; Faster recovery.

Craniectomy following head injury is a common surgery with a high rate of complications. Postoperative infection following cranioplasty leads to shortening of the scalp flap and leads to problems in closure. Various techniques have been described like local flaps, wide tissue mobilization and tissue expansion. Another technique, not so well described in literature, is Intraoperative expansion. We present a case of similar calvarial defect managed by intraoperative expansion to enable tension-free closure of the scalp.

Keyword: Cranioplasty; Calvarial defect.

Trauma is the leading cause of death and disability in developing countries and also the most common cause of death under 45 years of age. Injury is the 7th cause of mortality worldwide and abdomen is the third most common injured organ. The spleen and liver are the most commonly injured abdominal organs as a result of blunt trauma. In the civilian population, blunt injury to the abdomen is commonly caused due to road traffic accidents. Material and Methods: A retrospective study of 157 cases of blunt abdominal trauma patients presenting to department of emergency surgery in medical college of Central India from January to June 2019 was done. Results: Amongst the studied cases most common age group involved was 21–30 years (46 cases) and 31-40 years (32 cases) followed by 41–50 years (28 cases). Liver was found to be the most commonly injured organ 60 cases followed by spleen 39 cases and bowel and kidney (21 and 17 cases respectively). Conclusion: Blunt Abdominal Trauma is one of the important causes of morbidity and mortality in relatively young individuals. Most common mode of injury was road traffic accidents and men were affected predominantly. Hospitals and trauma care centers must adopt a multi-pronged approach to diagnose and promptly treat patients with blunt injury abdomen so that the prognosis can be better in these patients.

Keywords: Abdominal trauma; Road traffic accident.

Introduction: Liver abscess is the collection of pus within the liver parenchyma. It is the most common cause of intra-abdominal visceral abscess. Though ultrasonography has been used for diagnosing liver abscesses, other hematological investigations, such as total counts, and liver function tests have often been useful aids in diagnosis and planning the management. These may also provide a basis for early detection of the condition and serve as a tool for prediction of the prognosis of the condition. This study aims at identifying the correlation between the size of the liver abscess and liver function tests. Methodology: This was a prospective observational study conducted at Victoria hospital between April and June 2019. Fifty patients between the ages of 18–60 presenting to emergency and diagnosed as having liver abscess were included in the study and were subjected to ultrasonography and routine investigations. Details such as etiology, leukocyte counts, liver function tests including albumin levels, levels of enzymes such as ALT, AST and ALP were noted and tabulated and analyzed. The correlation between the variables was calculated by using the Pearson’s coefficient. A p-value of <0.01 was considered statistically significant. Results: 34 (68%) of the 50 patients were male while 16 (32%) of the 50 patients were females. 36 (72%) of the patients had amoebic liver abscess while 14 (28%) had pyogenic liver abscess. The greatest dimension of the liver abscess was in the range of 4–10 cm with a mean of 6.9 ± 1.38 cm. The total leukocyte counts of the 50 patients included in the study ranged from 10,300–32,100 cells/mm3 (mean 21627 ± 4994). Serum albumin levels ranged between 1.8–3.2 mg/dL, with a mean of 2.57 ± 0.3 mg/dL. AST ranged from 33–99 (mean of 70.4 ± 15.76), ALT from 29–110 (mean 70.96 ± 16.15) and ALP between 45–190 (mean 110.1 ± 41.68). Conclusion: Total leukocyte counts, AST, ALT and ALP showed a positive correlation with the size of liver abscess whereas serum albumin showed a negative correlation with the size of liver abscess.

Keywords: Liver abscess; Correlation with LFT; Hypoalbuminemia; Leukocytosis.

Background: Esophageal cancer is relatively common gastrointestinal tract malignancy with poor prognosis. The aim of the study is to conduct retrospective review of esophageal cancer patients managed by Transhiatal esophagectomy (THE). Methodology: The study was retrospective analysis of prospective collected data of esophageal cancer patients from June 2010 to June 2019. Inclusion criteria: Histologically proven carcinoma, medically fit lower third esophageal cancer. Exclusion criteria: Middle third esophageal carcinoma requiring transthoracic route, metastatic cancer, medically unfit patient, patient refusing consent for surgery. Results: 575 cases of esophageal cancer were managed in a single unit of surgery. Of these 575 cases, Transhiatal esophagectomy was done in 69 patients. Mean age of the patients was 58 years. Male to female ratio was 15:54. THE alone was done in 18 (25.7%), THE + adjuvant chemotherapy in 24 (34.3%), THE + adjuvant radiotherapy in 12 (17.1%), THE + neoadjuvant chemotherapy 6 (8.6%), THE + neoadjuvant chemoradiotherapy 9 (12.9%). The overall morbidity was 40.5% (14/69). Perioperative mortality was in 5 patients (7.24%). Follow up was done for mean 26.4 months. The mean survival was 19.3 months. Conclusion: Esophagectomy is complex operation with high morbidity and potential mortality. Multimodality approach appears to be reasonable safe in managing esophageal carcinoma patients.

Keywords: Esophageal cancer; Transhiatal esophagectomy; Morbidity; Multimodality therapy.

Burns due to contact with hot coal tar are challenging as it is very difficult to remove and there is no specified appropriate agent for the removal of tar. Hot tar burns usually occur as occupational hazard. This is a case series of our experience in treating 6 patients who sustained hot tar burns. Patients were treated with diesel, butter and Vaseline.

Keywords: Tar; Diesel; Butter; Vaseline.

Introduction: Acute pancreatitis is one of the commonest conditions that presents as a surgical emergency worldwide. Aim: The aim of the study was to compare BISAP scorings and serum levels of C-reactive protein in predicting severity of acute pancreatitis. Materials and methods: Thirty patients got admitted from November 2012 to April 2014 in our hospital with acute pancreatitis were included in the study. C-reactive protein evaluated along with BISAP score at the time of admission. Patients assessed for severity by comparing both. Statistical analysis done by using Fischer's exact test, chi-square test and student t-test. Results: 23.3% of patients had a BISAP score of 3, rest had a score of 1 or 2. 66.7% of patients had an elevated CRP. An elevated CRP level and an increased BISAP score was found to have a statistically significant relation (p = 0.009 and p = 0.0002 respectively) to length of patient’s stay in hospital and hence the severity. BISAP and CRP levels had a positive correlation with a p-value of 0.064. Here, we found that BISAP scores had a statistically significant relationship with ICU stay (p-value: 0.014) Conclusion: In conclusion, we found that BISAP is a better predictor of severity of acute pancreatitis compared to CRP levels. It is a useful means of predicting severity in acute pancreatitis. Larger studies will be needed to further consolidate our findings, but it is safe to say that BISAP has the advantage of simplicity and speed over more traditional scoring systems.

Keywords: Acute pancreatitis; Bisap scoring; C-reactive protein; Hospital stay.

Context: Laparoscopic incisional ventral hernia repair (LIVHR) has been associated with a high incidence acute and chronic pain due to use of nonabsorbable tackers. Several absorbable tackers have been introduced to overcome these complications. Aims: To compare postoperative effectiveness, comfort, complications of mesh fixation using absorbable and non-absorbable tacks in laparoscopic ventral hernia repair. Settings and design: A Prospective randomized clinical trial. Randomization was done by computer generated randomization number method for a period of 2-year study duration. Material and methods: A total of 60 patients were randomized in two groups. Patients of Group A were subjected to mesh fixation with absorbable tacks and group B were subjected to mesh fixation with no-absorbable tacks. All were evaluated for visual analogue scale (VAS) postoperative, length of hospital stay, time to resume normal activity. Statistical analysis used: Results were compared by student t test or Mann Whitney U test for continuous variables, and chi-square or Fisher's exact tests were used for categorical variables. Results: Patients in both the groups were comparable in terms of demographic profile and hernia characteristics. No significant difference found in VAS score at day 0, 1 week, 3 months and 6 months. No significant difference found in hospital stay, time to return to normal activity, postoperative complications. Conclusions: As per our opinion, the choice of either of these fixation methods during surgery should not be based on the concerns of pain or recurrence. AT may be the preferable option in LIVHR due to the lower cost.

Keywords: Laparoscopic incisional ventral hernia repair; Non-absorbable tackers; Mesh fixation; Pain; Visual analogue scale.

The most common benign neoplasm of the salivary glands is pleomorphic adenoma originating from the parotid gland. Surgical excision is usually all that is required to provide both definitive diagnosis and adequate treatment. Despite this relatively simple algorithm, management of salivary neoplasms is challenging because of their relative infrequency, inconsistent classification, and variable biologic behavior. Although many studies regarding the incidence of salivary gland tumors have been reported, the epidemiology of these neoplasms is not well established because these studies are frequently restricted to a specific population, anatomical location, or a specific tumor type. There are numerous studies on the incidence and histological types of salivary gland tumors from countries in the western world and African countries. However, there is little available information about the pattern of their presentation from Asian countries. The aim of this study was to analyze the incidence and distribution of all types of salivary gland tumors in an Indian series, and to provide data for comparison with other epidemiological studies from different geographical sites and races. Demographic data from these studies should help us to a better understanding of the biological and clinical characteristics of the disease.

Keywords: Salivary gland; Parotid gland; Pleomorphic adenoma; Warthin’s tumor; Submandibular sublingual salivary gland; Minor salivary gland.