Background: Medical science is a blend of Art and Science. Technology evolved conceived presumably to improve the medical science. Increasing incidence of bile duct injury during laparoscopic cholecystectomies proved otherwise. Multiple factors e.g. cognitive psychology, laparoscopic environment and no proper algorithms to manage, factor may be responsible for these results. To understand properly the mystique, we under took this study.Methods: This study was conducted on 200 cases which underwent laparoscopic cholecystectomies. 12 cases developed bile duct injury during laparoscopic cholecystectomies and 10 cases of bile duct injury sustained through open cholecystectomies were studied in detail results noted and analyzed.Results: All these cases 12/200 laparoscopic cholecystectomy, 10/200 open cholecystectomies were followed up, sign and symptoms noted, USG studies, ERCP stenting, sphincterotomy studies reviewed and sequence of management underlined.Conclusions: Early realisation of bile duct injuries remains the hall mark of she success. Even in cases detected late, conservative procedure and stenting with or without sphincterotomy given relief in number of cases. Finally, if surgery is contemplated Roux-Y-biliary enteric procedure gives much better results.

Background In low- and middle-income countries (LMICs), provisioning for surgical care is a public health priority. Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India’s largest national insurance scheme providing free surgical and medical care. In this paper, we present the costs of surgical health benefit packages (HBPs) for secondary care in public district hospitals. Methods The costs were estimated using mixed (top-down and bottom-up) micro-costing methods. In phase II of the Costing of Health Services in India (CHSI) study, data were collected from a sample of 27 district hospitals from nine states of India. The district hospitals were selected using stratified random sampling based on the district’s composite development score. We estimated unit costs for individual services—outpatient (OP) visit, per bed-day in inpatient (IP) and intensive care unit (ICU) stays, and surgical procedures. Together, this was used to estimate the cost of 250 AB PM-JAY HBPs. Results At the current level of utilization, the mean cost per OP consultation varied from US$4.10 to US$2.60 among different surgical specialities. The mean unit cost per IP bed-day ranged from US$13.40 to US$35.60. For the ICU, the mean unit cost per bed-day was US$74. Further, the unit cost of HBPs varied from US$564 for bone tumour excision to US$49 for lid tear repair. Conclusions Data on the cost of delivering surgical care at the level of district hospitals is of critical value for evidence-based policymaking, price-setting for surgical care and planning to strengthen the availability of high quality and cost-effective surgical care in district hospitals. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-022-00342-6.

Abstract

Background: At the present time, acute cholecystitis is a common cause of acute abdominal pain and the definitive treatment is laparoscopic cholecystectomy but when to perform surgery still remains controversial. The aim of present study is to find out if laparoscopic cholecystectomy can be carried out for acute cholecystitis irrespective of the time since onset of acute symptoms. Methods: We conducted a short term 6 months retrospective analysis of 24 patients in our hospital who underwent eTEP procedure for umbilical hernia and inguinal hernia, with a minimum of 3 months followup. Their data were analyzed for operative details, intra-operative and post-operative complications. Results: Judging from our short term results, for 24 patients we have not come across any post-operative complications like seroma, SSI, recurrence, with a minimum of 3 months follow-up. Conclusion: Laparoscopic cholecystectomy can be performed anytime of presentation of acute cholecystitis. Although delaying laparoscopic cholecystectomy was associated with more complications, higher mortality, and higher costs.

Background:The surgery for Hirschsprung's disease is changed from multistage surgery to single stage. The present study compared Duhamel and endorectal pull through in hirschsprung disease. Materials & Methods:The present study was conducted on 48 patients with Hirschsprung's disease of both genders. Patients were divided into 2 groups of 24 each. Group I patients underwent Modified Duhamel's procedure and group II patients underwent transanal endorectal pull-through procedure. Parameters such as blood loss, operating time and intra-operative complications etc. were recorded. Results: Group I patients underwent Modified Duhamel's procedure and group II patients underwent transanal endorectal pull-through procedure. Mean operative time in group I was 146.2 minutes and in group II was 143.6 minutes, recovery days were 20.4 and 19.1 in both groups and hospital stay was 13.7 days and 12.8 days respectively. The difference was non-significant (P>0.05). Blood loss was seen in 2 and 3 in group I and II respectively, continence in 2 and 1 in both genders respectively and frequent stool passing in 3 and 2 in group I and II respectively. The difference was non-significant (P>0.05). Conclusion:Authors found both techniques equally affective in management of cases. The choice of treatment depends upon surgeon's choice and conditions.