New Indian Journal of Surgery

Background: Pressure sores are defined as soft tissue injuries resulting from unrelieved pressure over a bony prominence such as sacrum, trochanter, heel and occiput etc. There are a variety of reconstruction techniques for sacral pressure sore defects , including Rhomboid flap by Limberg which is a geometric local transposition flap. This paper outlines the rationale for using this flap as well as demonstrates its versatility. Method: We present our case report using Limberg flap technique for treating a sacral pressure sore. After obtaining history, thorough clinical examination and necessary investigations, a single patient underwent surgical excision and single flap coverage of the defect. After flap coverage, the defect was closed over a suction drain. Result: Full primary healing occurred in the patient without any complications after a hospital stay of one week. Conclusion: Limberg flap is a rapid, accurate and reliable alternative surgical technique utilising local tissue in treating sacral pressure pressure ulcer and can be easily done by a general surgeon.

Keywords: Limberg flap; rhomboid flap; sacral pressure sores.

Background: Ruptured liver abscess can results in lethal outcome if there is delay in diagnosis and treatment. It is a surgical emergency presents with an acute abdomen. Objective: A study to determine the outcome associated with different treatment strategies of ruptured liver abscess. Material and Methods: This was a retrospective study in which 50 patients with liver abscess who were reported to general surgery department in scl hospital, ahmedabad included in the study. All patients with ruptured liver abscess included in the study and other causes of peritonitis were excluded. A perfpormed protocol for management was followed for all the patients, and various parameters contributing to the illness and its prognosis were evaluated and assessed. Results: Out of 50 patients assessed , male patients were mainly affected (86%). The most affected age group was 31–4 years (64%) followed by 41–50 years (22%). Right hypochondrium pain was the most common presenting complain. Nine patients were presented with signs of toxaemia. Escherichia coli was the most common organism in our study in 19 patients. A total of 20 patients had mortality . Conclusion: Ruptured liver abscess most commonly involved in right lobe of the liver. Males were affected more than the females due to more alcohol consumption . Most common age group falls between 30 to 60 years of age. If prompt treatment were given at time , mortality involved with it is evitable.

Keywords: Liver abscess; USG; Drainage; Rupture; Septicemia.

Double-chambered right ventricle (DCRV) is a rare congenital heart disease in which the right ventricle (RV) is hypertrophied due to anomalous muscle bundles. Anomalous left coronary artery from pulmonary artery (ALCAPA) is also a rare lesion constituting 1 in 3,00,000 live births. Isolated LAD from pulmonary artery (ALADAPA) is further rare. We report a case of DCRV associated with Anomalous left anterior descending Artery from Pulmonary artery (ALADAPA). The patient was initially diagnosed to have DCRV and on further evaluation associated anomalous left anterior descending artery from pulmonary artery was detected. The patient underwent DCRV repair and Takauchi repair and had an uneventful post operative recovery.

Keywords: Congenital Heart Disease; Double Chamber Right Ventricle; DCRV; ALCAPA; ALADAPA.

Introduction: Turell (1960) stated that 70% population suffers from haemorrhoids and 40% needs surgical treatment. The treatment of haemorrhoids is as old as the age of man and many different treatments have been described, none of which is entirely satisfactory. Material and Methods: A total of 50 patients of Haemorrhoids were studied who were admitted to department of surgery, RNT Medical College and attached MB Government Hospital, Udaipur, Rajasthan, India. All patients were managed by one of the treatment modalities. Result: Mean age was 40 years with male preponderance. Common presenting symptoms were bleeding per Rectum, constipation and prolapse of pile mass. Most of the patients presented late to hospital (1–6 months). Most of the cases belonged to II and III degree haemorrhoids. At presentation 62% patients were anaemic (Haemoglobin <12 Gram %). A Total of 16 patients were managed by nonoperative modalities while 32 were managed by various surgical operations. Most of the Grade I or II patients were managed by non-operative measures while all the Grade III and IV patients were operated for their disease. Post-procedural complications were a few and mostly limited to pain or urinary retention. Conclusion: Non-operative techniques like Sclerotherapy and conservative for first and second degree haemorrhoids gives excellent results. Surgical treatment like open and closed haemorrhoidectomy remains the ideal treatment option for third and fourth degree haemorrhoids and recurrent cases.

Keywords: Piles; Haemorrhoids; Sclerotherapy; Plication; MIPH; haemorrhoidectomy

 Background: Gallstone disease is one of the most common problems affecting the digestive tract. The prevalence of gallstone varies widely in different parts of the world, in India it is estimated to be around 4%. Earlier Open cholecystectomy was treatment of choice but with the advent of minimal invasive surgery laparoscopic cholecystectomy evolved and further evolution now single incision laparoscopic surgery for cholecystectomy has become routine approach for better cosmoses. Materials and Methods: It’s a randomized controlled trial .The main source of data for study are patients admitted in Basaveshwara Teaching and General Hospital attached to Mahadevappa Rampurae Medical College, Kalaburagi surgery department undergo Laparoscopic cholecystectomy during period of July 2018 – July 2020. Details of cases are recorded including history, clinical examination, and investigations and following parameters of each patient will be recorded preoperatively and compared with intraoperative findings. And postsurgical outcome will be studied for each SILS and Conventional laparoscopic cholecystectomy. Results: This study included a total of 65 patients who were planned to undergo laparoscopic. Cholecystectomy out of which 45 patients were in convential four port and 20 patients in single port. The time taken for surgery was more in single port i.e 129.0 min with conventinal four port is 64.4 min and complications was more single port is 20.0% than conventional four port is 15.6%.post-operative complication seen in conventional four port were fever (n=2, 4.4%), pain (n=4, 8.9%), pain and fever (n=1, 2.2%) and in single port were fever (n=3, 15.0%), pain (n=2, 10.0%), biliary leak (n=1, 5.0%). In our study mean length of hospital stay in conventinal four port is 4.2 min and in single port is 7.1 .ports is significantly associated with length of hospital stay. Conclusion: From this study we conclude Single Incision Laparoscopic Cholecystectomy is an emerging technique and has better cosmesis and needs expertised hands and lot of learning curve to perform it when compared with Conventional Four port Laparoscopic Cholecystectomy.

Keywords: Single Port; Four Port; Cholecystectomy Laparoscopic

In poorly controlled high Blood Pressure patients developing hypertensive leg ulcers, can be managed effectively by controlling the blood pressure, also with the Cilostazol- Antiplatelet agent withVasodilating properties. The study was done in Mount Zion Medical College, Adoor, Kerala and Palakkad Institute medical Sciences Walayar, Palakkad, Kerala, in the period June 2018 to October 2020, with 20 poorly controlled Hypertensive patients with painful leg Martorells ulcer. By giving Cilostazol along with antihypertensive drugs and antibiotics, analgesics in 10 patients in one group, the ulcer is healing nicely after 15 days, but giving only antihypertensive, antibiotics, analgesics in other 10 patients in another group, healing is not occurring even after one month. Aim: To prove the effect of Tab. Cilostazol in the management of Martorells leg ulcers.

Keywords: Martorells Ulcer; Hyertensive Leg Ulcer; Cilostazol

Transverse testicular ectopia (TTE) or crossed testicular ectopia is an extremely rare anomaly characterized by migration of one testis towards the opposite inguinal canal. Treatment is difficult and includes laparoscopic or surgical exploration.1 The typical presentation of crossed testicular ectopia is ipsilateral inguinal hernia and contralateral undescended testis.2 We present our experience of 7 cases of transverse testicular ectopia (TTE). Keywords: undescended testis; ectopic testis; transverse testicular ectopia; persistent Mullerian duct syndrome; hernia uterine inguinale; laparoscopic management of transverse testicular ectopia.

Background: Acute appendicitis is one of the most common cause of acute abdomen for which a prompt diagnosis and treatment is required to decrease morbidity and mortality. Routine history and clinical examination both remain the most effective and practical diagnostic modalities. Material and Methods: A prospective study conducted during the period of October 2017 up to October 2019 on symptomatic patients presented with complaints of right iliac fossa pain. Clinical history with clinical examination, and radiological record of patient had been taken according to the proforma attached. Diagnosis was confirmed by postoperative histopathological examination reports. We compared combined modified RIPASA score and Ultrasound with Histopathological reports. Result: Sensitivity, specificity and diagnostic accuracy of modified RIPASA score was 89.5%, 60% and 88% respectively. Sensitivity, specificity and diagnostic accuracy of USG was 70.5%, 60% and 70% respectively. On combining modified RIPASA score with USG, Sensitivity, specificity and diagnostic accuracy were 97.8%, 60% and 95% respectively. It is noted that by adding USG with modified RIPASA score sensitivity and diagnostic accuracy is increased and negative appendectomy is reduced to 5%. Conclusion: On adding USG with modified RIPASA score there is increase in sensitivity and diagnostic accuracy. So modified RIPASA score with USG can be used in patient with RIF pain for making diagnosis of acute appendicitis.

Keywords: Right iliac fossa pain; Acute appendicitis; Modified RIPASA score; USG.

Foreign body ingestion in children less than 1 year of age was found to be rare. Here we retrospectively analyzed the foreign body (FB) ingestion in children in less than one year with reporting of two rare cases in the era of COVID-19. Most of the FB ingestion can be managed conservatively, only few required interventions. When intervention required use proper personal protective equipment kit.

Keywords: Children; COVID-19; Foreign Body Ingestion; Infants.

Introduction: Benefits of electricity to mankind are well known because of its easy availability, less pollution, simplicity and no need to store like conventional storage, which makes it more used form of energy in day to day life. Electrical burn injuries represent a special type of lesion; it is one of the most devastating injuries to be seen in emergency departments, leading to functional disability and aesthetic sequelae. Aim and Objectives: The purpose of this study was to review our experience in treating electrical burns in terms of region of body involved, percentage of burnt area, types of surgical procedures performed, complications and hospital stay in a tertiary care centre. Material and Methods: The present prospective observational study was carried out at a tertiary care centre from August 2013 to November 2015 in patients with history of electric burns reporting to casualty or admitted in department of general surgery, 70 patients were included in the study. The following variables were studied age, sex, occupation, site of incidence, voltage, clinical presentation, region of body involved, percentage of burnt area, types of surgical procedures performed, complications and hospital stay Results: Present study showed the incidence of electric burns as 6.18% amongst total burns. Incidence of electric burns was highest in 21–30 years of age and in 31–40 years of age. In present study the incidence of electrical burns is higher in rural population as compared to urban population with percentage of electrical burns as 71.42% in rural population and 28.58% in urban population. The incidence of male was high and measured 87.14% (n= 61).In our study we have found that out of 70 patients, 94.28% injuries were due to direct contact with the electricity In our study we have found that 32.86 % injuries were related to work and 67.14% injuries were not related to work those were accidental and while playing.(Table 1). In present study the incidence of electrical burns was more at workplaces and then at home thus matches with previous studies. In present study we found that 50 (71.43%) patients out of 70 had upper limb involvement, 44 (62.86%) had lower limb involvement. (Table 2) The majority 48.57% of the patients had upto 10% and 25.71% patients had 11–20% burnt surface area. The incidence of myoglobinuria was 8.57%. Amputation (28.4%) was the most common surgery followed debridement by (24.69%). (Table 3) Conclusion: Electrical injury is very serious type of burn causing considerable health hazard, victims end up with major disabilities, most of the injuries are preventable with proper education and knowledge, efforts for rehabilitation and counseling should be part of treatment protocol.

Keywords: Burns; Electrical; wound; myoglobinuria; Amputation; grafting.

Context: Surgical correction of uncomplicated hypospadias involves bringing the meatus closer to ventral tip and correction of any presence of chordee. These genital repairs are performed when patients are young. Increasing the length of penis may have an additional advantage in these repairs. Aims: Study objectives were to explore the functional and cosmetic outcomes of use of parenteral testosterone and its effect on reducing postoperative complications. Settings and Design: A randomized prospective study was conducted amongst patients who were diagnosed with hypospadias between January 2019 and January 2020 in department of Pediatric Surgery at a large institution in India. Methods and Material: Random groups included surgery with and without intramuscular injection of testosterone, respectively. Patients were evaluated pre testosterone therapy for: 1) stretched penile length (SPL), 2) glans circumference at the base. And postoperatively for: 1) reoperation rate, 2) complications. The surgical outcome was compared among the two groups on the basis of cosmesis and postoperative complication rate. Results: A total of 42 patients (21 in each group) matched the eligibility criteria and were recruited in the study. Overall 85% of Group 2 patients showed an increased SPL of approximately 1.15cm. As compared to Group 1, Group 2 performed well in terms of reduced complications, increased SPL and glans circumference at base. Conclusions: Overall, study findings showed better functional outcomes with use of preoperative testosterone treatment and reduced complications. A follow-up study is planned to explore the longterm surgical outcomes of these surgical repairs of preoperative testosterone therapy.

Keywords: Hypospadias; Testosterone; Treatment; Genital Organs; Male.

Introduction: The purpose of our study was to compare Total-Body Computed Tomography (TBCT) with selective scanning in adults with poly-trauma and assess outcomes as a function of scan time, cost, radiation exposure and length of hospital stay. Methodology: A retrospective analysis was performed with data derived from the trauma registry of the Emergency department of a Quaternary care hospital. Admissions from January, 2017 to December, 2017 were considered. Patients were selected based on their Injury Severity Score (ISS). Descriptive and inferential statistical analysis was done using this data. Results: Outcomes were independent of gender and age distribution. Most patients belonged to the Young Adult (18–35 years) age group. The average time for scanning was 43.88m. Radiation Exposure was found to be increased after TBCT imaging compared with selective imaging. Scan-time and cost of investigation were less for the TBCT group. In the case of the selective scanning group, cost increased as re-imaging and further extended imaging was used. LOS was less for the TBCT imaging group. Subsequent re-visits post hospitalization were more in the case of the selective imaging group. Conclusions: The results from this study suggest that application of Total Body CT significantly reduces overall time spent in the emergency department, with higher exposure to radiation, but with an overall benefit in terms of lower cost.

Keywords: Total Body CT; Whole Body CT; Pan scan; Poly-trauma; Time; Cost; Radiation

Introduction: Acute Appendicitis is the most common general surgical emergency and early surgical intervention improves outcomes. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%) and the rate of appendicular perforation. In an age, accustomed to early and accurate preoperative diagnosis, acute appendicitis remains an enigmatic challenge and a reminder of the art of surgical diagnosis. This study was done to conclude whether the Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis. Aims: To evaluate whether elevated Bilirubin level is important in predicting the diagnosis of acute appendicitis (simple and complicated appendicitis). Material and Methods: This retrospective study was conducted in the department of general surgery, Adichunchanagiri institute of medical sciences, B. G. Nagara, Mandya (D), from August 2018 to February 2020. A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation were studied. Results: In this study, males (68%) outnumbered females (32%) and overall mean age was 27±9.58 years. Of the 100 patients, 71% were confirmed as acute appendicitis while 29% were diagnosed with appendicular perforation. Of 71 patients with acute appendicitis, 12.7% had raised bilirubin levels, while 87.3% had normal levels. Conclusion: This scoring system is practical and reliable diagnostic modality for the accuracy in diagnosis of acute appendicitis and to avoid negative appendicectomies.

Keywords: Pain abdomen; Acute Appendicitis; Appendicular perforation; Elevated Serum Bilirubin level; Negative Appendicectomy.

 Gall stone disease is one of the most common cause for hospital admissions, with thyroid disorders being the most common endocrinopathy world wide. Aim: To establish correlation between subclinical hypothyroidism in the formation of gall stones and bile duct stones. Materials and Methods: Hospital based case control study on 400 patients in surgical OPD. S. TSH used for assesment of thyroid function and Cholelithiasis as diagnosed by ultrasound or suspected. Statistical: Categorical variables are expressed as Number and percentage of patients and compared using Pearson’s Chi Square test for Independence of Attributes/ Fisher’s Exact Test. Continuous variables are expressed as Mean, Median and Standard Deviation and compared using Mann-Whitney U test. Statistical software SPSS version 20 has been used. Result: 400 patients evaluated. Out of 400 there were 7 with low (<0.3 mIU/L), 232 with normal, 161 with high TSH (>3 mIU/L). The proportion of cholelithiasis among males and females 38 and 62 % respectively. Significantly larger proportions of patients in Cases (male = 55.26%; female = 54.03%) have High TSH than Control (male = 38.82%;female = 41.13%), p value < 0.001 i.e significant. Conclusion: There is an association between hypothyroidism and formation of gall stones.

Keywords: Cholelithiasis – stones in gallbladder; Endocrinopathy – disease of endocrine glands; TSH – thyroid stimulating hormone

Introduction: Since its introduction in the early 1990s, laparoscopic ventral hernia repair has gained popularity Over 400,000 ventral hernia repairs (VHRs) are performed each year world-wide. Purpose of this study to evaluate open repair versus laparoscopic approach to offer best possible and effective hernia management.4,11,12,15,24 Methods: Between January 2018 and December 2020, 30 patients with primary ventral hernia were randomized to receive either open retro-rectus mesh repair (OHR, Group 1) or laparoscopic mesh repair (LVHR, Group 2). These patients were followed up at 2,4 and 6 months intervals thereafter annually for both groups. Results: Primary ventral hernia are common in age range 41–50 years. In the group 1, majority of patient opting OHR were females (53.3%) while in group 2, males opted for LVHR (66.7%). Swelling was a common presentation in group 2, where as pain was common in group 1. Duration of complaints were similar in both groups. Precipitating factor in group 1 was multiparity (46.7%),whereas in group 2 it was obesity (46.7%). The majority of defect sizes was less than 2x4cm2 in the open (group 1) and 3x1 to 3x3 cm2 in laparoscopic group (group 2). In group 1, 60% infra-umbilical location,whereas in group 273.3% had supra-umbilical location of hernia. 66.7% showed reducibility in group 1, whilst 73.3% showed reducibility in group 2. Cough impulse was positive in both groups. Both groups had a diagnosis of para-umbilical hernia. Hypertension (13.3%) was mostly associated with group 1, where as Diabetes mellitus (13.3%) was mostly associated with group 2. Both groups underwent their respective surgeries as planned. Seroma collection and wound-related infectious complications were common in group 1 and post-operative respiratory distress was common in group 2. Patient compliance and follow-up was more in group 2 when compared to group 1.There were no cases of recurrence until the time frame of follow-up. Conclusions: Laparoscopic repair of Primary ventral hernias is superior to open mesh repair in terms of fewer complications, recurrence, and patient compliance outcome.

Keywords: Incisional hernia; Laparoscopic mesh repair; Open mesh repair; Primary ventral hernia; Seroma; Wound complications.

Background: Appendicular mass, a common surgical clinical entity is noticed in about 2–6% of patients and present with features of acute appendicitis. Treatment of appendicular mass is often cited as being controversial. Earlier, these patients were managed conservatively which was then followed by an interval appendicectomy carried out 4–6 weeks later. The need for interval appendicectomy has also been questioned. Early surgery on the other hand has an advantage of being curative in the index admission and ensures early return to work and higher compliance. A true controversy exists as to which is the best approach towards this problem and the opinion is divided about the management of an appendicular mass. The present study is designed to evaluate feasibility and safety of immediate appendicectomy in appendicular mass in our hospital by comparing the results of an equal number of patients treated conservatively. Title: Management of appendicular mass: comparative study between different modalities. Aim: To study the effective management of appendicular mass. Materials and Methods: This study is prospective interventional study and included patients aged between 15 to 70 years diagnosed with appendicular mass. Data collected included history, clinical presentation, investigation, diagnosis, surgery, complications and length of hospital stay. Results: A total of 30 patients were admitted with diagnosis of appendicular mass, 15 pts were treated with ochsnersherren regimen out of which 6 were treated with interval appendectomy and other 15 patients were treated with open appendectomy. Conculsion: Patients with appendicular mass who were treated with open appendectomy had longer duration of hospital stay associated with wound infection when compared to that of patients treated with ochsnersherren regimen and interval appendectomy. Therefore this study favors ochsnersherren regimen as preferred approach for the treatment of appendicular mass.

Keywords: Appendicular mass; ochsnersherren regimen; Acute appendicitis

Aims: The aim of this study is the axillary lymphadenopathy in breast disorders. This study categorizes the various disorders of the breast which involve axillary lymph nodes and their incidences. Materials and Methods: A three years retrospective study was performed at the General Surgery department at Vydehi Institute of Medical Science and Research Centre, Bengaluru. A total of 225 cases were included in this study. Demography, Preoperative and postoperative data were recorded, including post-operative complication. Results: Breast carcinoma is the leading disorder which constitutes about 34.3% of the cases. Out of 225 cases, 72 cases belonged to carcinoma breast. The next disorders are breast abscess and fibroadenomas which involve axillary lymph nodes, about 25%. The breast abscess cases are 39 and fibroadenosis are 36 cases out of 225 cases. Paget’s disease accounts for 1.3% (3 cases out of 225). The remaining benign disorders constitute 40%. Conclusion: In our study, the carcinoma breast (About 1/3rd of the cases-34.3%) is the major disorder that involves the axillary lymph nodes among other various disorders of the breast. Next are breast abscess and fibroadenosis, which constitutes 1/3rd of the total breast disorders (Breast abscess 17.3% and fibroadenosis 16%).

Keywords: Breast cancer; Axillary lymph nodes; Axillary tail of Spence; Axillary lymphadenopathy

Undescended testis or cryptorchidism is a common genital problem in boys. Non palpable testis represents 25% of all undescended testis. Non palpable testis presents a unique diagnostic and therapeutic problem. Non palpable testis should be treated to enhance future chances of fertility and to place the testis at a site where it can be easily palpated because such a testis has an increased susceptibility to malignant degeneration. Aims: • Toestablishdiagnosticefficacyandaccuracy in identifying clinically non-palpable testis. • To establish therapeutic role of Open and laparoscopic management of non-palpable testis. Methods and Material: Between 2015 and 2019, 25 boys with 28 clinically non-palpable testis, aged 16 months to 65 years, underwent operative intervention in a single surgical unit at our institute. Out of the 25 patients, 22 had unilateral (11 leftsided, 11 right-sided) and three had bilateral non palpable testis. The testis was considered non palpable after thorough clinical examination, ultrasonography and examination under anaesthesia failed to detect it. Keywords: Nonpalpable Testis

Background: Hernia repair concept underwent a sea change with the introduction of monofilament knitted polyethylene plastic mesh in 1958 and later in 1962 of knitted, malleable PPM Prolene mesh. Objective: To find out the difference between lightweight and standard polypropylene mesh for the repair of inguinal hernia by the Lichtenstein technique. Methods: 60 Patients admitted in the surgery Department, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum with inguinal hernia requiring mesh repair were studied. The sample size was taken as 60, with 30 in study group and 30 in control group. Results: During first follow up, all the patients in group SP reported moderate pain compared to 60% patients in group RP. (p<0.001). During second follow up, most of the patients (90%) in SP group reported mild pain compared to 26.67% patients in RP group (p<0.001). At the third follow up, all the patients (100%) in SP group reported mild pain compared to 53.33% patients in group RP. The mean pain scores in group SP during first (4.50±0.57 vs 5.97±1.07), second (2.30±0.88 vs 4.27±1.48) and third (0.63±0.72 vs 2.57±1.79) were significantly less compared to group RP (p<0.001) but mean reduction in pain score from first follow up to third follow up was comparable in group SP (3.90±0.97) and RP (3.40±1.33) (p=0.092). Conclusions: lightweight macro-porous polypropylene mesh significantly minimise the postoperative pain in patients of lichensteins mesh repair for inguinal hernia as compared to heavyweight composite polypropylene mesh

Keywords: Lightweight macro-porous polypropylene mesh; Heavyweight composite polypropylene mesh; Lichensteins mesh repair; Inguinal hernia; Post operative pain

Introduction: Symptomatic gall stone disease is a common ailment and affects about 10 to 15% of general population. Though the vast majority of cholecystectomies are performed laparoscopically, still the rate of conversion to open is 5% to 10%. Although cholecystitis, choledocholithiasis, male sex, and obesity are major predictors for conversion, there is a need to evaluate various other factors responsible for difcult laparoscopic cholecystectomy. Material and Methods: A total of 115 patients undergoing laparoscopic cholecystectomy for symptomatic gall stone disease in M S Ramaiah Hospital were studied from June 2013 to June 2015. The preoperative clinical and sonological data was compared with the intraoperative data and the outcome of surgery. Results: Disease was more common among women of 40–50 years. 10.4% patients had acute cholecystitis and 5.2% had liver cirrhosis. Symptoms and signs of acute cholecystitis, previous surgery, contracted GB, GB wall thickness > 4mm, Liver cirrhosis were predictors of conversion to open cholecystectomy. Conclusion: Certain parameters like symptoms and signs of acute cholecystitis, previous surgery, contracted GB, GB wall thickness > 4mm, liver cirrhosis, DM, and BMI>25 have signicance in predicting a diicult laparoscopic cholecystectomy and its conversion to open technique.

Keywords: Gall stone disease; Laparoscopic cholecystectomy; Open cholecystectomy.

Background: Gastroduodenal ulcer perforation (GDUP) is one of the most common emergencies which requires surgery. Even with the introduction of H2 receptor antagonists and proton pump inhibitors, the incidence of elective surgery for peptic ulcer diseases have been decreased, although complications of peptic ulcer remained fairly constant and perforation of peptic ulcer associated with significant morbidity and mortality. Aims and Objectives: The purpose of this study was to identify the risk factors that predict the mortality in Gastro duodenal ulcer perforation. Methdology: 226 patients underwent surgery for GDUP in S Nijalingappa Medical College (SNMC) and HSK Hospital and Research Centre, Bagalkot were studied retrospectively from January 2015 to December 2019. The following factors were analysed: age; gender; associated medical illness; chronic ingestion of NSAIDs; pre-operative shock; delay in surgery (>24 hours); site and size of ulcer perforation and type of peritoneal contamination were relating to cause of mortality. Results: Out of 226 patients, were 148 males and 78 were females. Gastric perforation was seen in 36 patients and duodenal perforation in 190.Postoperative death occurred in 15 patients, rest recovered well. In these 15 patients, onset of symptoms >24 hours, history of NSAIDS, preoperative shock and treatment delay (>24hours), large perforated ulcer size in all these factors, the p value is significant (p<0.05). Use of corticosteroids and co morbidities seen in these patients were 73.3 and 80% respectively (p<0.001). Conclusion: Elderly, delayed presentation, preoperative shock, high grade peritoneal contamination, large perforated ulcer size, co-morbidities, long term use of steroids and NSAIDS are the main factors which increased the mortality.

Keywords: Gastro duodenal ulcer perforation; Mortality; Shock; Peptic ulcer; Peritoneal contamination; Omental patch.

Background: Despite the high burden of inguinal hernias in India, and the total embrace of the tension-free mesh techniques (Lichtenstein) its use has remained low in rural areas because of its cost and availability. Desarda’s method, acclaimed to be tension free with very few studies done on this technique, there was need to evaluate its effectiveness in a rural setup like MVJ medical college and analyze its efficacy with respect to procedure, complications and outcomes. Study Objectives: To study outcomes of Desarda’s method of hernia repair like postoperative pain, hospital stay, return to work, Operative time, Foreign body sensation, Chronic Groin pain, Recurrence. Methods: This was a prospective observational study of patients with primary inguinal hernias who underwent Desarda’s repair from July 2017 and June 2019. Postoperative acute pain was assessed with the help of VAS 1, 2, 3 days and 1 month postoperative day. Patients were followed up at 1, 3, 6, 12, 18 months to check for complications. Results: There were 50 male participants (mean age 48.2 yrs). Procedure took 52.32 mins and ambulation time was 1.52 SDdays. Mean pain score was 3.24 SD+0.77 (POD1), decreased to 1.58 (POD2), 1.18 (POD3). Mean hospital stay was 4.06 days. 4% had hematoma, 6% had seroma, Surgical site infection rate was 6%. Many patients returned to work with a mean of 8.12 days. No complaints of chronic pain, foreign body sensation after 3 months. No recurrence was seen during the study period.(Table 2) Conclusion: Desarda technique is fast with less complications, Patients return early to work and none had chronic groin pain and foreign body sensation after 3 months. Without any recurrence the efficacy of Desarda’s repair may be considered equal to mesh repair in preventing recurrence and better in late complications, cost benefit and patient compliance.

Keywords: Desarda’s repair; Tissue based repair; Operative time; Ambulatory period; Post operative pain; Return to work; Chronic groin pain; Recurrence.