New Indian Journal of Surgery

A 28 years female presented with discharge in the perineal area from 1 month. No history of previous surgeries and comorbidities. On examination of the perianal region, 2 external openings were noted
at 11° and 1° clock positions and on per rectal examination internal opening was noted in the 12° clock position 1cm from the anocutaneous junction. MRI fistulogram showed bilateral intersphincteric perianal fistula communicating with each other and a common internal opening at midline anteriorly at 12° clock position. Patient was posted for surgery and fistulotomy was done. Patient was discharged on 2nd day and is being followed on outpatient basis. Wound healing was noted at the 2nd week. Since anterior horse shoe shaped fistulas are rare we present this case report.
Keywords: Horse Shoe Fistula; Goosalls Rule; Fistulotomy.

Syncope is a clinical presentation which is a transient loss of consciousness for a short period of time. Micturition (or post-micturition) syncope is fainting during or immediately after micturition due to a severe drop in blood pressure. Micturition syncope is most common in elderly men and usually occurs at night after a deep sleep. Paraganglioma of the urinary bladder are tumors of chromaffin tissue originating from the sympathetic innervations of the urinary bladder wall and are extremely rare. Paraganglioma of the urinary bladder
is one of the causes of micturition syncope in early postmenopausal women who usually present with severe dysuria, hypertension and post-micturition syncope with elevated Plasma and Urinary metanephrine levels. In our case it is a silent paraganglioma of the urinary bladder that presented only with severe dysuria, hypertension and post-micturition syncope with normal Plasma and urinary catecholamine levels.
In this report we analyse the clinical presentation, investigations and management of bladder pheochromocytoma.
Keywords: Micturition syncope; Bladder pheochromocytoma.

Hydatid cyst disease is a common worldwide zoonosis. Most of the cysts are located in the liver. Abscess formation due to infection of the hydatid cyst is an important complication. Pyogenic hydatid cyst of liver are extremely rare. We report a case of solitary, hydatid cyst in the liver with secondary infection. A 14-year-old female was admitted to our
hospital with chief complaints of abdominal pain in the right upper quadrant and loss of appetite. Physical examination revealed a mass filling the rightupper quadrant. Diagnosis was made of hydatid cyst
was on the basis of ultrasonography and computed tomography. Course of 21 days of albendazole was given preoperatively and patient was taken for surgery. During operative procedure on opening the cyst cavity, about 1 litre of pus came out along with daughter cysts, biliary communication was not found and pericystectomy was done. Patients condition improved and was discharged on 8th post-operative
day.
Keyword: Hepatic Hydatid Cyst; Pericystectomy; Abdominal pain.

Context: More and more silver based products are becoming available and therefore it is necessary to prove beyond doubt the effectiveness of these products by research Aims: To study effects of use of Silver Nitratein healing of chronic wound Settings and design: Longitudinal observational study was carried out in a tertiary care academic
hospital. Methods: 100 Patients were recruited as cases using inclusion and exclusion criteria. Age, Gender, Occupation and Detailed history pertaining to Pain associated with wound, discharge from wound, site of
wound, and duration of wound. Clinical examination was done. Local examination and Investigations were carried out. Statistical Analyzis: Data was coded and analyzed in statistical software, STATA version 10.1, 2011. Descriptive statistics like mean and standard deviation were calculated to summarize continuous variables. Frequency and percentages were used to summarize categorical variables. p-value < 0.05 was considered statistically significant. Results: Most common etiology was trauma (61%) followed by infections. 33 had diabetes out of which 16 were above 60 years. 64 patients healed completely
on Silver Nitrate dressing only with varied time of duration and 36 patients have required Split Thickness Skin grafting. 9 patients had wound of size 1–3 cm, 27 patients had 4–5 cm, 28 patients had 6–7 cm, 30 patients had 8–10 cm and 06 patients had 11–12 cm. 8–10 cm was most common wound size. Patients with wound size ≤ 7 cm has successfully healed with Silver Nitrate dressings only but patients with wound size >7cm required STSG. Wound with size >7 cm when
managed with Silver Nitrate dressings it is found to have increased duration of hospital stay. Conclusion: It is concluded that Silver Nitrate is
found to be very effective in early healing of chronic wound.
Keywords: Clinical study; Silver nitrate; Chronic; Wound, Management.
 

Introduction: Abdominal surgery that has to be redone in association with initial surgery is referred to as re laparotomy. Re-laparotomy is associated with 22 to 513% morbidity and mortality, therefore it’s the final choice of surgery. The main aim of this study was to find out the incidence of re- laparotomy and to identify the risk factors i.e. predictors of relaparotomy in patients undergoing general surgery operations.
Materials and Methodology: This was a retrospective study involving 100 patients, done from 1st Jan 2016 till 1st June 2017 Patients with age more than 18 years, those requiring laparotomy for both general and trauma surgery were included. Those with initial laparostomy, with only flank drain placement, any Laparotomies during colostomy or ileostomy closure, those with Initial laparoscopic procedure, minimal
invasive procedure like ultrasound guided drainage etc. Were excluded. Data was analyzed using SPSS Software. The Results were expressed in percentage. Associations were analyzed using chi-square or ‘t’
test depending on outcome variables. Results: The incidence of revision laparotomy in this study was 7% and the incidence of second revision laparotomy was 1%. The indications for relaparotomy were anastamotic leak 2/7 (20%), burst abdomen 2/7 (20%), pancreatic injury 1/7 (10%),
bladder injury 1/7 (10%), negative laparotomy 1/7 (10%). The variables with significant p-value are systemic hypertension, COPD, CAD, intra-op and post-op inotoropic support, wound infection, wound dehiscence and intra-abdominal abscess. These data can thus be used in future to formulate a prediction scoring system.
Keywords: Laparotomy; Re-lapaprotomy; Post-op peritonitis; Burst abdomen.
 

Context: FNAC is cost effective, cheap, more patient compliant compared to histopathology. It is not only screening tool but has been considered as gold standard also. But it is not without limitations.
Hence studies are required to prove its feasibility and accuracy compared to histopathology in different settings. Aims: To correlate FNAC results before surgery with histopathology reports after surgery.
Settings and design: Present hospital based diagnostic evaluation prospective study was carried out at Government Medical College, Latur. Methods: Detailed history was recorded in the pre designed, pre tested, semi structured study questionnaire prepared for the present study. Thorough clinical examination including general, local and systemic examination for each and every patient included in the present study was carried out. All patients were subjects to routine   investigations. FNAC and USG of the thyroid gland was carried
out for all the included patients. FNAC report was obtained from the pathology department. Statistical Analyzis: Sensitivity, specificity, positive predictive value and negative predictive value was calculated for FNAC Results: All cases had swelling of thyroid gland and majority on right side. Majority (73.4%) swelling was non neoplastic and 95.7% were females and 38.3% were in 41–60 years group. Out of 94 FNAC
studies majority i.e. 33 cases as colloid goitre with cystic degeneration. Among the 69 non neoplastic lesions, 28 cases were colloid goitre with cystic degeneration. Among 25 neoplastic lesions 12 cases were benign neoplastic lesions. FNAC and HPE correlated well in majority of the cases i.e. 92.6% of the cases. Conclusion: High rate of diagnostic accuracy can be achieved by use of ultrasound guidance with strict adherence to adequacy criteria and meticulous examination of all the smears.
Keywords: Histopathology; Smears; Cases; surgery; Goitre.

Context: Umbilical hernia is treated by conventional anatomical suture method, mesh and suture repair. Ultra Pro-hernia System is recently introduced for umbilical hernia treatment. Present study was
aimed to compare all three methods in treatment of umbilical hernia.
Aims: In this study we aimed to investigate whether use of a UHS was better in reducing recurrence, postoperative pain compared with suture repair and on-lay mesh repair for umbilical hernias. Settings and Design: Prospective randomized clinical trial Methods and Material: Sixty consecutive patients diagnosed with a primary umbilical hernia were enrolled for the study. They were randomized and underwent elective repair of umbilical hernia using the UHS, anatomical repair, or on-lay repair with mesh. Data for the time required for the surgical
repair methods, length of hospital stay, postoperative pain, analgesic necessity, and return to work, and early and late complications were recorded, and compared with respect to the repair procedure. Statistical Analyzis used: All data are compared by ANOVA followed by post hoc Analyzis either tukey method for parametric or kruskal –Wallis. Results: The mean operating time, VAS score, were higher in the anatomical repair and on-lay mesh method as compare to UHS. Patient in UHS
have significant less requirement of analgesics, less hospital stay and less recurrence as compared to anatomical repair and on-lay mesh repair. Conclusions: UHS have better advantage in terms of less post-operative pain, low rate of recurrence, less hospital stay and early return to normal activity over the traditional anatomical method and on-lay
repair with mesh.
Keywords: Ultrapro Hernia System; Umbilical hernia; Anatomical repair; On-lay mesh rpair.

Background: Present study was conducted to evaluate and compare the safety outcome and advantages of three-port and four-port LC.
Methods: This prospective study included 100 patients presenting with symptomatic gall stone disease or gall bladder polyp more than 1 cm at base. Patients with jaundice and choledocholithiasis were excluded. Patients were divided into two groups: A and B, who underwent three-port and four-port LC respectively. Results: The mean age of Group A patients was 46.4±8.53 Yrs and Group B was 45.24 ± 10.34. 63% of
the operated patients were females and 37% males. Adhesion was seen in 24.00% patients in Group A and 22.00% patients in Group B. In the three-port group, 45 cases were completed successfully without
any need for conversion. 4 patients were converted to four-port procedure and 1 patient was converted to open cholecystectomy. In the four-port group, 3 cases were converted to open cholecystectomy for
completion. The average operative time was slightly more in the three- port LC group as compared to the four-port group. It was 46.3 +11.2 minutes for threeport cholecystectomy, ranging from 25 to 75 minutes.
In the four-port cholecystectomy group, it was 42.4 ± 15.4 minutes, ranging from 20 to 100 minutes. Pain at 6 hours and 24 hours post-operatively was found to be less in the three-port group than the four-port group. The mean Visual Analog Score was 5.71 ± 0.84 and 6.60 ± 0.83 at 6 hours; and 2.80 ± 0.81 and 3.60 ± 0.80 at 24 hours in the three-port and four-port groups respectively. The average number of hours of hospital stay was slightly less in the three-port group (37.8 ± 10.8 hours) as compared to the four-port cholecystectomy group (39.2 ± 5.6 hours). Conclusions: Three-port procedure is safe and appears to be more cost effective than four-port LC.
Keywords: Three-port; Four port; LC.

One hundred and forty patients were studied in prospective, randomized trial in order to determine whether a vertical, transverse or oblique abdominal incision is the more satisfactory in producing sound
wounds. Thirty-five patients were randomized between vertical midline and para-median, transverse and oblique incisions respectively, and followed up for 6 months post-operative. All these patients are
compared among all four groups based on age, sex, BMI, length of incision, direction of incision, type of closure, suture material used and chronic illness. All the values are statistically insignificant indicating
there is no significant difference in the predisposing factors among the groups. In our study Para median incision is found to be the most difficult of all the four types of incisions. Time taken for closure is found to be significantly more in Para median incision. Immediate post-operative pain is significantly less in patients with transverse incisions. Wound infection is found to be more in patients with midline incisions but the results are not statistically significant. No significant difference in
wound dehiscence in all the groups. Wound sinus formation is found to be more in patients with midline incisions but the results are not statistically significant. No significant difference in wound dehiscence in all the groups. Healing time is found to be significantly prolonged in patients with transverse incisions. No significant difference in scar
hypertrophy among the groups. Incisional hernias are seen to be more in midline group but the result is not statistically significant.
Keywords: Incision; Laparotomy; Hernia;
Infection.

Background: Port site infection though rare, shall be evaluated and studied so as to improve the quality of healthcare. Materials and Methods: This prospective study was conducted in the Department of General Surgery, Sardar Patel Medical College & P.B.M. Hospital,
Bikaner, Rajasthan. 300 patients of all age group and both sexes with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy.
Result: Out of 300 patients studied only 12 patients presented with port site infection. Most common organism was enterobacter specius (25.00%), Staphylococcus auras spp (16.67%), Enterobacter spp.
(16.67%) and E. coli (8.33%). Conclusion: It is concluded that port site infection are rare in elective laparoscopic cholecystectomy and
can be further reduced by proper selection of patients, and strictly following basic principles of laparoscopic cholecystectomy.
Keywords: Laparoscopic cholecystectomy (LC); Port site infection; Micro-orgnism.

Rectal prolapse is a condition in which protrusion of full thickness of rectum of 4 cm or more occurs through the anal canal. Though worldwide literature shows that it is more common in females with a weak pelvic floor, incidence of this condition is seen more in males in India. This report is a retrospective study of cases who underwent perineal proctosigmoidectomy (Altemeier’s procedure) for the rectal prolapse presented as an emergency irreducible rectal prolpse
as well as recurrent reducible rectal prolapse during the period of two and half yrs. (January 2016 to June 2018). The study was done on 12 operated patients. The procedure was done in 4 patients as an emergency. The patients were followed up for immediate complications like bleeding, suture dehiscence, infections or abscess. They were also periodically assessed for delayed complications like constipation
and recurrence. None of the complications were reported during the Follow-up period, except in one patient. He was having recurrent prolapse.
Keywords: Rectal prolapse; Perineal proctosigmoidectomy; Altemeier’s procedure; Perineal procedures; Defaecation pressure; Obstructive defaecation.

Laparoscopic appendicectomy is normally performed under general Anesthesia which is said to be necessary for tolerance of pneumoperitoneum and muscle relaxation. The efficacy of laparoscopic
appendicectomy under spinal Anesthesia has been documented in few selected studies so far. In view of the above consideration, this clinical study was performed to evaluate the feasibility of laparoscopic
appendicectomy under spinal Anesthesia. Fifty patients underwent laparoscopic appendicectomy under spinal Anesthesia which
were selected randomly. Intra operatively, out of the 50 patients, 4% experienced anxiety and 6% complained of shoulder/neck pain. None of the patients developed intraoperative nausea/vomiting and hypotension. 10% of the patients who underwent under spinal Anesthesia required sedation either due to shoulder/neck pain or anxiety. Out of these,
2 (4%) of the patients required conversion to general Anesthesia. Patients who underwent laparoscopic appendicectomy under spinal anesthesia experienced lesser post-operative pain as compared to those who underwent laparoscopic appendicectomy under
general anesthesia. Our data in this prospective study has confirmed
the efficacy of laparoscopic appendicectomy under spinal Anesthesia. Moreover, it appears that spinal Anesthesia is more effective than the standard general Anesthesia on post-operative pain control during the patient’s hospital stay. From these data, it appears that spinal Anesthesia is a promising method of Anesthesia for laparoscopic procedures, and with proper refinements, it could potentially evolve as
the new gold standard Anesthetic approach for laparoscopic appendicectomy in healthy patients.

Background: Haemorrhoids are tormenting human race since ancient times. It affects all people irrespective of gender, age, race, socioeconomic status and cultural differences. The exact prevalence
can’t be estimated accurately. Many patients don’t seek medical guidance. This causes severe discomfort for patients and cause complications. There are many treatment modalities available for this condition. This study is aimed at evaluating those various modalities
available. Objectives: 1. To study the various modalities of treatment options available for the treatment of haemorrhoids at our hospital (Open Haemorrhoidectomy, Closed Haemorrhoidectomy, Rubber Band Ligation and conservative management). 2. To evaluate advantages and disadvantages of one modality over the other. Methods: Clinically diagnosed case of haemorrhoids in a Tertiary care hospital, Kalaburagi. 50 patients clinically diagnosed case of haemorrhoid presenting
between December 2017 to June 2019 (18 months) at our hospital. The presenting complaints were noted, detailed examination, diagnosis was made and treated accordingly. The relevant data was collected.
Post-operative complications were noted and postoperative Follow-up was done on day 7, 1 month and 3 month. Results: The mean age of presentation was in the fourth decade (41.36 ± 13.26 years). The disease was more in males. The major presenting complaint was Bleeding per rectum + Mass per rectum (28%) followed by Bleeding per rectum (26%). On detailed examination 11 (22%) cases were diagnosed as External Haemorrhoids, 39 (78%) cases as internal haemorrhoids, further internal haemorrhoids were graded as 9 (18%) Grade-1 cases, 10 (20%) Grade-2 cases, 10 (20%) Grade-3 cases and 10 (20%)
Grade-4 cases. As treatment modality, 9 (18%) cases were managed conservatively, in 15 (30%) cases Closed Haemorrhoidectomy, in 16 (32%) Open haemorrhoidectomy and in 10 (20%) cases Rubber
Band ligation was done. Post-operative pain was more in Open haemorrhoidectomy 10 (62.5%) cases, Closed haemorrhoidectomy 6 (40.0%) cases and 2 (20.0%) of cases had post-operative pain in
whom RBL was done. Post-operatively bleeding was seen in 7 (43.75%) cases who underwent Open haemorrhoidectomy, 4 (26.6%) cases under Closed haemorrhoidectomy, 2 (20%). One case each under
Open haemorrhoidectomy and RBL had postoperatively discharge per rectum and developed recurrence. Comparison was done between
different treatment modalities; statistical Analyzis was done. Surgery was beneficial compared to conservative approach. RBL was better than other modalities with lesser rate of complication, early resumption of work and short hospital stay. Closed haemorrhoidectomy had lesser post-operative pain, bleeding and complications, when compared to
Open haemorrhoidectomy. Conclusion: Surgical intervention is better than conservative approach. In the surgical techniques RBL was better followed by Closed haemorrhoidectomy and Open haemorrhoidectomy in respect of postoperative complications, hospital stay and better
wound healing.

Keywords: Rubber Band Ligation (RBL) Open Haemorrhoidectomy, Closed Haemorrhoidectomy, Bleeding per rectum, Mass per rectum.

This is a review of 197 patients of inguinal hernia operated at the Indian Institute of Medical Science and Research, Warudi over a period of 6 years. Ketamine is a rapid acting potent analgesic agent, that is safe, effective and with no respiratory depression. Herniotomy is a simple procedure recommended for children with inguinal hernia. It can be safely done under sedation with local Anesthesia using ketamine.
In this study intravenous (i.v.) ketamine was given at dose of 2 mg/kg and local infiltration was done with 1% lignocaine solution. Patients were kept on spontaneous respiration with oxygen by face mask.
Keywords: Herniotomy, ketamine, local Anesthesia

Background: Amoebic liver abscess is an important cause of inflammatory space occupying lesion of liver. 0It is a common condition in India; a serious problem and associated with higher morbidity and mortality; if not managed properly. This study is conducted to know the clinical presentation, management and efficacy of conservative management and percutaneous aspiration in amoebic liver abscess.
Materials and Methods: A total of 30 patients of amoebic liver abscess were selected for the study in Vydehi Institute of Medical Sciences and research centre, Bangalore. Their clinical presentation, lab findings and treatment in the form of conservative (in abscess less than 5 cms diameter and volume of 125 cm3) and ultrasound guided percutaneous aspiration (in abscess more than 5 cms diameter and volume of
125 cm3 or more) were studied. Results: This study showed that the amoebic liver abscess was more common in low socioeconomic
middle aged male patients. Male to female ratio was 6:1. Mean duration of symptoms 7.5 days in conservative management and 7 days in percutaneous aspiration patients. Pain and fever were the most
common symptoms. USG abdomen was very useful in early diagnosis and assessing prognosis. Most of the abscess was solitary and more common in right lobe of liver. Liver function tests helps in knowing
effectiveness of the treatment and the prognosis. None of the patients were positive for cysts in the stool. All 30 (100%) patients were positive for anti amoebic antibody. Conservative management was more effective in patients with cavities less than 5 cms (125 cm3 volume). Two patients were converted to percutaneous aspiration. Percutaneous aspiration was more effective in patients with cavities more than
5 cms. In none of the cases of amoebic abscess surgical drainage was employed. There was mortality due to complications. Conclusion: The study conclusion includes Amoebic liver abscess is more commonly seen in young to middle aged males. Ultrasonography helps in early
diagnosis and reducing morbidity and mortality. It also confirms the site, size and number of amoebic liver abscess and knowing the prognosis. Liver function tests helps in knowing the effectiveness of the treatment and prognosis. Amoebic liver abscess less than 5 cms are effectively treated by conservative management and abscess more than 5 cms by percutaneous aspiration. Resolution of abscess cavity is faster in patients treated by percutaneous aspiration as compared to conservative treatment, but duration of hospital stay is more in patients treated by percutaneous aspiration due to retained pigtail catheter for drainage for long duration. Metronidazole effective in most of the
amoebic liver abscess.
Keywords: Amoebic; Liver abscess; Metronidazole.

Introduction: Breast cancer is a major concern in modern India. The growing population of the patients and the increased death toll require immediate attention from the scientific and medical community.
Material and Methods: In this study, we have conducted a rigorous survey between 2012 and 2014 and investigated all possible contexts in relevance to the disease. Detail Analyzis was done for 112 patients.
The focus was made on vital information n such as parity, age during first live birth, complaint details, location and exact clinical features of the problem, association of axillary lymph node, hormone receptor
Analyzis, histopathological grading, and TNM staging. Results: Our study showed that the age of menarche, the presence of lump in a specific quadrant was quite specific and supported the recently reported data. We have found that the mean age of the patient has declined as discussed in some of the recent studies. Only 8% of the participant patients were found to be nulliparous. Very less number of patients (11.60%) were found to link with the disease hereditarily. We observed that presence of positive nodes were almost triple than the patients with negative lymph nodes, thus, chances of survival in those patients
were comparatively lower. Statistical co-relation was found between ER status, PR status, lymph nodes and age of the patients. Conclusion: We expect this study will increase the present understanding of breast cancer in India. Detail Analyzis with larger population may yield
confirmation to our Analyzis.
Keywords: Hormone receptor; ER status; PR status.

Context: Microbiological culture and sensitivity though gold standard, takes time to convey report which can delay rational treatment for the infection of the wound that take place after surgery. Aims: To assess the efficacy of clinical assessment of infected wounds in terms of bacteriology in comparison to culture and sensitivity Settings and design: Hospital based observational diagnostic evaluation study was carried out at department of General Surgery, Government Medical
College, Latur. Methods: Detailed history, thorough clinical
examination including systemic examination of all the patients and local examination of the wound of all the patients was carried out and the data was recorded. Swabs taken on sterile swab sticks and sent
for culture within 1 hr. Where swabs cannot be taken pus, samples are taken and sent for culture. Antibiotic regimen started as per the clinical judgement from history and examination. Comparison between the
swab reports and the suspected organism done and observations noted. Statistical Analyzis: The data was analyzed using sensitivity, specificity, positive predictive value and negative predictive value
Results: The sensitivity of the clinical assessment of the infected wound for positivity was found to be 87% with same rate for Positive predictive value. But it has been observed that the clinical assessment lacked the
specificity. The sensitivity of the clinical assessment of the resistant infected wound was found to be 100% with same rate for negative predictive value. Specificity was 98.9% and a Positive predictive value
was found to be 83.3%. The sensitivity of the clinical assessment of the type of organism was found to be 100% with same rate for negative predictive value. Specificity was 78.3% and a Positive predictive value
was found to be 84.4%. Conclusion: Commensal flora of organisms is
responsible for infections in almost 80 percent of wounds as the wounds are due to trauma causing break in the epithelial barrier. This can be identified clinically and can be treated accordingly before the
microbiological report appears

Keywords: Infection; Clinical assessment; Wounds; Correlation; Therapy.

Context: Acute Appendicitis is a commonest surgical emergency. Manytimes, the diagnosis is made by clinical examination only. There is no definitive diagnosis preoperatively. The definitive diagnosis of acute appendicitis confirmed at time of surgery and after histopathologic examination of the appendix specimen. However, Investigations like
USG, CT scan are used in diagnosis. Despite this, negative appendectomy rates are high. Hence better diagnostic tool, a scoring system was explored to diagnose appendicitis. Present study was conducted for evaluation of Modified Alvarado Scoring System
for diagnosis of acute appendicitis. Alvarado scoring systemis based on history, clinical examination of patient and certain laboratory findings.
Aims: To evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis. Settings and Design: Prospective study Methods and Material: A prospective study
was conducted on 100 patients with sign and symptom suggestive of acute appendicitis and were subsequently underwent operative management from November 2018 to November 2019 over a
period of one years at Sir T. Hospital Bhavnagar. All patients underwent surgery and grouped according to the variables of Alvarado scoring system and then divided into two groups. Group I patients (score 7
or more), group II patients (score ≤6). Diagnosis was confirmed by histopathological examination. Results: Pre-operatively Modified Alvarado Score was assigned to all patients and the results were
compared with operative and histopathological diagnosis reports. The sensitivity and specificity of MASS in this study counted accordingly.
Conclusions: This scoring system is Reliable and more accurate diagnostic modality in the diagnosis of acute appendicitis, thus avoiding unnecessary surgery.
Keywords: Acute Appendicitis; Alvarado score.

Context: Diabetic ulcer severity score (DUSS) was by Beckert considering palpable pedal pulses, probing to bone, ulcer location and presence of ulcerations assess outcome. Aims: To calculate DUSS in the patients with diabetic foot andassess the outcome. Settings and Design: A single center Prospective Analytical study in Tertiary care center among 150 Diabetic patients of 20–80 years with foot ulcers
Methods and Material: Medical history, physical examination, investigation results are entered into data collection forms. Patients were followed for 6 months. Statistical Analyzis used: Median and inter quartile range, Kaplan-Meier Analyzis, Cox regression. Results: Mean age was 53 ± 14 years. Males were 58%. DUSS 3 score was common, 50.66% had amputations. The probability of healing with Score 0 was 93.75%, 92.86% with Score 1, 75% with Score 2, 15% with Score 3 and 0% with Score 4. Conclusions: DUSS scoring system provides an easy diagnostic tool for anticipating probability of healing/ amputation and need for surgery by combining four clinically assessable wound based parameters.
Keywords: DUSS score; Amputation; Skin grafting; Secondary healing.

Background: Both Conservative and aggressive surgical strategies have been advocated for the treatment of corrosive injuries of the upper
gastrointestinal tract but the optimal management is still a dilemma. The aim of this study was to report our experience with caustic upper gastrointestinal tract injuries in adult patients treated with a endoscopybased therapeutic protocol. This prospective clinical study 50 cases was carried out on patient of a Oesophageal stricture due to
corrosive ingestion admitted in Surgery Department, Govt. Medical College & Sir T. Hospital, Bhavanagar from Aug 2018 to Aug 2020 who had given inform written consent, after fulfillment of exclusion and
inclusion criteria Result: In this series, out of 50 cases, 20 cases
were male, 30 female. 40 (80%) cases were age group of 31–45 year, 05 (10%) were age group of 15–30 & 46–60 year with mean age of 36 year. Most common mode of ingestion was suicidal 39 (78%) compare to accidental 11 (22%) with the most common substance was House hold bleaches (5% Na Hydrochloride). Most common symptoms was Dysphagia, Vomiting, Weight loss Conclusion: Esophageal dilatation for post corrosive injury esophageal stricture relatively safe, acceptable
and easy in uncomplicated post acid ingestion esophageal stricture. Patient can start taking liquid diet on same day and can resume his or her routine activites quickly with little or no discomfort or pain.However Patient with uncomplicated post acid ingestion esophageal stricture require repeated upper G.I. scopy guided esophageal dilatation at regular interval.
Keywords: Esophageal dilatation; Non surgical management; Post acid ingestion esophageal stricture; Repeated dilatation.

Context: Based on the cause and type of wound, numerous products are available in the market, making the selection a very difficult task.
Aims: To study the Effectiveness of various modalities of and protocol for optimal management of chronic leg ulcers Settings and design: The present study was a hospital based observational descriptive study
carried out in Government Medical College, Latur Methods: The study population was all patients with leg ulcers with complaint duration of more than 6 weeks. The patients were subjected to appropriate
investigations like complete blood counts (Hb gm%, total leucocyte count and platelets), blood sugar (random blood sugar). Colour Doppler study of lower limb vessels was done in patients with suspected vascular disease of lower extremity, X ray of affected leg to rule out any bone involvement in clinically suspicious cases. Statistical Analyzis: Chi-square for proportions and ANOVA for continuous variables was applied. Results: Healthy granulation formation and mean follow-up period was significantly less in VAC method. Healthy granulation formation and mean follow-up period was significantly lesser when
silver nitrate was used. Mechanical debridement was required in only one case when silver nitrate was used. Conclusion: Out of all the available dressing methods for conservative management of ulcer
in this setup, vacuum assisted closure/negative pressure wound therapy is superior followed by conventional dressing method. Placental extract
is better for ulcers with no or minimal slough for accelerated formation of granulation tissue. Any ulcer with any etiology of size more than 5 cm2
mostly requires surgical intervention.
Keywords: Management; Therapy; Dressing; Placental extract; Tissue.

Context: A hernia is the bulging of part of the contents of the abdominal cavity through a weakness in the abdominal wall. Synthetic mesh
implants are one of the commonly used materials in many surgical interventions, especially during hernia repair. Mesh repair is now standard procedure which is widely accepted and superior to primary suture repair. Nowadays we use mainly three groups of material regarding to nonabsorbable meshes: polypropylene, polyester and
polytetrafluroethylene. They are non-absorbable mesh and provoke less tissue reaction. Aims: To compare use of light weight 3d polyester
mesh vs. light weight polypropylene mesh in laparoscopic e-tep inguinal hernia repair. Settings and Design: Prospective study Methods and Material: This study was conducted on patient of inguinal hernia admitted from May 2018 to September 2019 in Sir T. Hospital Bhavnagar. This study involving 60 patients with inguinal hernia, who were classified into two groups. Group I: 30 patients with inguinal hernia who were operated by e-TEP hernia repair using light weight
polypropylene mesh. Group II: 30 patients with inguinal hernia who were operated by e-TEP hernia repair using light weight 3D-polyester mesh. All patients provided informed consent to participate in the trial and for the surgical procedure. Both groups are compared with certain parameter and result obtained. Results: In our study, Group II has lesser mesh fixation time, less incidence of post-op pain and discomfort, less use of additional analgesic with less incidence of seroma as compared to Group I. Conclusions: The use of 3D-polyester mesh for laparoscopic e-TEP inguinal hernia repair offers many advantages as compared to lightweight polypropylene mesh.
Keywords: e-TEP hernia repair, light weight polypropylene mesh, light weight 3D-polyester mesh

Background: Acute pancreatitis is a sudden inflammation of the pancreas. Acute pancreatitis (acute hemorrhagic pancreatic necrosis) is
characterized by acute inflammation and necrosis of pancreas parenchyma, focal enzymic necrosis of pancreatic fat and vessel necrosis (hemorrhage). The early diagnosis and precise scoring of disease severity are important goals in the initial evaluation and the management of pancreatitis. Pancreatitis not only must be differentiated from a myriad of other potential diagnoses, but patients also must be
stratified to identify those with severe disease and to guide appropriate therapy. Methods: This prospective observational study was conducted by the Department of General Surgery at Dhanalakshmi srinivasan
medical college and hospital from July 2012 to July 2013. A total of 32 patients were included in the study on the basis of the non probability
(purposive) sampling method. Multiple clinical and laboratory variables of both Ranson’s and APACHE II scoring system and the final score of
the patient from both the scoring systems were assessed. Results: The mean age group of the subjects was 37.72 years ranging from 20 to 70 yrs. As sensitivity, specificity, positive predictive value and negative
predictive value and accuracy are found to be the same for Ranson’s and APACHE II score, Ranson’s score is equally efficacious as APACHE II scoring system in the prognostication of acute pancreatitis.

Introduction: Though laparoscopic cholecystectomy provides for a faster recovery, there have been reports of intra operative difficulties in the laparoscopic technique, often necessitating the conversion to
open procedure. A number of factors influencing this has been studied but the role of gender on the intra operative difficulties and post-operative complications is unclear. This study was an attempt to understand the role of gender in the intra and post-operative complications following laparoscopic cholecystectomy. Methodology: This was a prospective observational study conducted among 100 patients undergoing laparoscopic cholecystectomy in Victoria Hospital.
Patient details such as age, sex, BMI, intra operative details such as duration of surgery, CBD injury, biliary leak and conversion to open surgery, post-operative complications such as jaundice and pancreatitis, and duration oh hospital stay were noted down. This data was analyzed using student t-test and chi-square test. Results: Of the 100 patients, 68% were females and 32% were males. The mean operative time for male patients 75.31 ± 37.95 minutes while that for female patients was 56.76 ± 29.36 minutes. Of the 32 males patients, 1 (3.125%) patient had CBD injury while 4 (12.5%) patients had conversion to open procedure.
4 (5.8%) of the surgeries were converted to open procedures among female patients, with no CBD injury noted. The mean post-operative hospital stay in male patients was 5.0 ± 2.52 days while that in
female patients was 3.64 ± 1.40 days (p < 0.05). Postoperative jaundice was observed among one male patient while it was not observed among female patients. Post-operative biliary leak was observed among 2 male patients and 1 female patient. Conclusion: The intra operative and post-operative morbidity was comprable among males and females
undergoing laparoscopic cholecystectomy, with the male gender having a longer duration of surgery and a higher duration of hospital stay.
Keywords: Male gender; Laparoscopic cholecystectomy; Post-operative complications; Difficult laparoscopic cholecystectomy.

Aim: To compare the efficacy of autologous platelet-rich fibrin (PRF) over moist sterile saline/ povidone-iodine dressing in diabetic foot ulcers. Objective: To compare the mean reduction in ulcer area at the end of 4 weeks of dressings. Methodology: 60 diabetic patients with foot ulcers from the department of general surgery, general medicine, endocrinology, and cardiology were prospectively studied. Detailed clinical history was obtained, the ulcer was evaluated and the presence
of wound infection was assessed for all the patients. Patients were randomised into two groups of 30 patients each. While one group received PRF dressings, the other received saline/povidone-iodine
dressings. The wound healing was then compared in the two groups. The efficacy of platelet-rich fibrin dressing over moist saline/povidone-iodine dressings was assessed by comparing the percentage reduction of the ulcer area, at the end of four weeks, using chi-square test and A NOVA test. Results: It was found that there was a better reduction in the area of the ulcer at the end of four weeks in patients who received platelet-rich fibrin dressings than in moist saline/povidone-iodine
dressings. Conclusion: PRF dressing was superior to moist saline/povidone-iodine dressings.
Keywords: Diabetes; Foot ulcer; PRF.

Background: Peritonitis is an inflammatory response of peritoneum to different stimuli caused by bacteria. It can also be fungal or chemical. Secondary peritonitis is due to spillage of gastrointestinal or genitourinary organisms in to peritoneal cavity due to breech in the
mucosal barrier. Mannheim peritonitis index (MPI) was developed by Wacha and Linder in 1983. The Mannheim Peritonitis Index (MPI) is a specific score which has a very good accuracy and serves as an easy way to assess clinical parameters allowing the determination of the individual prognosis of patients with peritonitis. Methods: This  rospective observational study was conducted by the Department of General Surgery at Dhanalakshmisrinivasan medical college and hospital from July 2012 to July 2013. A total of 60 patients were included in the study where in diagnosis of peritonitis due to hollow viscous perforation was made by history and clinical examination and
relevant investigations. Results: The mean age group of the subjects was 45.72 years ranging from 15 to 75 yrs. In our study group, 33.3% of the patients had morbidity where in MPI score more than 29 had the highest morbidity (72%) where in the overall mortality rate in our study
was 12%.
Keywords: Peritonitis; Mannheim Peritonitis Index; Hollow viscous perforation.

Scrotal complaints are common surgical problems encountered in men for whom patients report in surgical out patients department as well as in emergency department. Scrotum is present at a place which is easily accessible, yet patients suffer for long time before presenting.Objectives: A prospective study was done in department of General Surgery, FH Medical College, Etmadpur, Agra from July’ 2016 to December’ 2019 to know the correct incidence of pathologies affecting the scrotum, their mode of presentation, diagnosis
and the management done for these conditions. Material & Methods: We identified a total of 184 patients who came to us with some scrotal complaints and followed up all patients in pre, peri and postoperative phases. Results: Most of the scrotal diseases were seen in individuals below 30–40 years, which is the most productive earning age for the men. Hydrocele was the commonest condition. The most common
presenting symptom was swelling in the scrotum (n = 153). Other complaints were pain (n = 76), heaviness, fever or absence of testes. Ultrasound of the scrotum was performed on all patients to confirm
the diagnosis. Most common surgical procedure done was eversion of sac. Conclusion: Hydrocele is the most common disease of scrotum for which patients report. They mostly belong to 30–40 years of age group. The presentation is swelling of scrotum. Ultrasound is primary investigation of choice. Eversion of sac was done for all patients with hydrocele. Patients with no significant pathology were reassured and managed conservatively.
Keywords: Scrotal swelling; Scrotal pain; Hydrocele.

Background: The purpose of the study is to know the diagnostic accuracy of fine needle aspiration cytology over histopathological examination in clinically palpable breast masses and its reliability in
planning definitive surgical treatment. Methods: A prospective study conducted in 50 female patients admitted with clinically palpable
breast masses in all surgical units at ESI Medical College, Gulbarga, during the study period of 18 months (from January 2018 to Sepetember 2019). All women underwent FNAC with subsequent
Histopathological correlation. The cytological diagnoses were classified as: malignant, suspicious, benign or unsatisfactory. Histopathological
correlation was based on either, an excisional biopsy, or a mastectomy specimen. Results: A total of 50 fine-needle aspirations performed during the study period, on women being evaluated for a clinically palpable breast mass were included in the study. Out of 50 cases
there were 19 (38%) malignant FNAC diagnoses, 2 (4%) cases diagnosed as suspicious on FNAC and histopathology revealed as malignant. There were no false-positive cases. Of the 27 (54%) cases interpreted as benign, only 1 (2%) was false negative, which later on histopathology diagnosed as infiltrating duct carcinoma. Two cases (4%) had unsatisfactory samples. Conclusions: The study showed a very high
sensitivity (95.45%), specificity (100%), positive predictive value (100%), and negative predictive value (96.29%), with minimal false-negative rates (4.54%) and without any false positive rates. The
overall accuracy was 96 percent. This study, confirms that FNAC is safe, simple, quick, cost-effective, reliable and accurate method in the initial diagnosis of clinically palpable breast masses. When correctly
performed and interpreted by an experienced cytopathologist FNAC can be a valuable tool in the diagnosis of breast masses, hence to plan definite treatment.
Keyword: Fine Needle aspiration; Histopathology;
Breast Mass.

Since the introduction of laparoscopic surgery for gallbladder stones, different types of retrieval devices have been used to extract the gallbladder from the peritoneal cavity. These ranged from simple nonpowdered gloves to several types of commercially produced bags. We compared the advantages and disadvantages of using a retrieval bag (using simple drain cover) with direct extraction of gall bladder
specimen through the epigastric port in 600 patients. We concluded that using a retrieval bag (simple drain cover) for specimen retrieval in laproscopic cholecystectomy is a simple and cheap method with advantages of low rates of spillage andwound infection in comparison to direct retrieval of the specimen.
Keywords: Lap cholecystectomy; Retrieval bag; Wound infection.